Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174

Σάββατο 29 Ιουλίου 2017

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment.

http:--linkinghub.elsevier.com-ihub-imag

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment.

Int J Radiat Oncol Biol Phys. 2017 Jul 15;98(4):868-883

Authors: Maggiore R, Zumsteg ZS, BrintzenhofeSzoc K, Trevino KM, Gajra A, Korc-Grodzicki B, Epstein JB, Bond SM, Parker I, Kish JA, Murphy BA, VanderWalde NA, CARG-HNC Study Group

Abstract
Older adults with head and neck squamous cell carcinoma (HNSCC) pose unique treatment and supportive care challenges to oncologists and other cancer care providers. The majority of patients with HNSCC present with locoregionally advanced disease, for which combined-modality treatment integrating chemotherapy and radiation therapy is often necessary to maximize tumor control. However, applying these approaches to an older population with concomitant comorbidities and a higher risk of functional impairments remains challenging and is exacerbated by the paucity of studies involving older adults. The purpose of this article is to identify knowledge gaps in the evaluation and management of older adults with HNSCC-particularly those undergoing concurrent chemoradiation therapy-and their caregivers through a review of the literature conducted by clinicians, researchers, and patient advocates. The findings highlight the importance of a geriatric assessment and the therapeutic paradigms and challenges relevant to this population. Furthermore, we identify the need for additional research and interventions related to key supportive care issues that arise during and after treatment in older adults with locoregionally advanced HNSCC. On the basis of our findings, we prioritize these issues to guide future patient-oriented research endeavors to address these knowledge gaps and thus better serve this growing patient population.

PMID: 28602414 [PubMed - indexed for MEDLINE]

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Understanding pain and coping in women with interstitial cystitis/bladder pain syndrome.

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Understanding pain and coping in women with interstitial cystitis/bladder pain syndrome.

BJU Int. 2017 Aug;120(2):286-292

Authors: Katz L, Tripp DA, Carr LK, Mayer R, Moldwin RM, Nickel JC

Abstract
OBJECTIVES: To examine a self-regulation and coping model for interstitial cystitis/bladder pain syndrome (IC/BPS) that may help us understand the pain experience of patients with chronic IC/BPS.
PATIENTS AND METHODS: The model tested illness perceptions, illness-focused coping, emotional regulation, mental health and disability in a stepwise method using factor analysis and structural equation modelling. Step 1, explored the underlying constructs. Step 2, confirmed the measurement models to determine the structure/composition of the main constructs. Step 3, evaluated the model fit and specified pathways in the proposed IC/BPS self-regulation model. In all, 217 female patients with urologist diagnosed IC/BPS were recruited and diagnosed across tertiary care centres in North America. The data were collected through self-report questionnaires.
RESULTS: An IC/BPS self-regulation model was supported. Physical disability was worsened by patient's negative perception of their illness, attempts to cope using illness-focused coping and poorer emotional regulation. Mental health was supported by perceptions that individuals could do something about their illness, using wellness-focused behavioural strategies and adaptive emotion regulation.
CONCLUSIONS: The results clarify the complex and unique process of self-regulation in women with IC/BPS, implicating cognitive and coping targets, and highlighting emotional regulation. This knowledge should help clinicians understand and manage these patients' distress and disability.

PMID: 28386966 [PubMed - indexed for MEDLINE]

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Information Needs of Older Women With Early-Stage Breast Cancer When Making Radiation Therapy Decisions.

Information Needs of Older Women With Early-Stage Breast Cancer When Making Radiation Therapy Decisions.

Int J Radiat Oncol Biol Phys. 2017 Jul 15;98(4):733-740

Authors: Wang SY, Kelly G, Gross C, Killelea BK, Mougalian S, Presley C, Fraenkel L, Evans SB

Abstract
PURPOSE: To identify the information older women with early-stage breast cancer need when making radiation therapy decisions, and who patients identify as the main decision maker.
METHODS AND MATERIALS: We surveyed (through face-to-face interview, telephone, or mail) women aged ≥65 years who received lumpectomy and were considering or receiving adjuvant radiation therapy for early-stage breast cancer. The survey instrument was constructed with input from patient and professional advisory committees, including breast cancer survivors, advocates of breast cancer care and aging, clinicians, and researchers. Participants rated the importance (on a 4-point scale) of 24 statements describing the benefits, side effects, impact on daily life, and other issues of radiation therapy in relation to radiation therapy decision making. Participants also designated who was considered the key decision maker.
RESULTS: The response rate was 56.4% (93 of 165). Mean age was 72.5 years, ranging from 65 to 93 years. More than 96% of participants indicated they were the main decision maker on receiving radiation therapy. There was wide variation in information needs regarding radiation therapy decision making. Participants rated a mean of 18 (range, 3-24) items as "essential." Participants rated items related to benefits highest, followed by side effects. Participants who were older than 75 years rated 13.9 questions as essential, whereas participants aged ≤74 years rated 18.7 as essential (P=.018).
CONCLUSIONS: Older women desire information and have more agency and input in the decision-making process than prior literature would suggest. The variation in information needs indicates that future decision support tools should provide options to select what information would be of interest to the participants.

PMID: 28366581 [PubMed - indexed for MEDLINE]

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Urinary continence recovery after radical prostatectomy - anatomical/reconstructive and nerve-sparing techniques to improve outcomes.

Urinary continence recovery after radical prostatectomy - anatomical/reconstructive and nerve-sparing techniques to improve outcomes.

BJU Int. 2017 Aug;120(2):185-196

Authors: Pavlovich CP, Rocco B, Druskin SC, Davis JW

Abstract
In an editorial board-moderated debate format, two experts in prostate cancer surgery are challenged with presenting the key strategies in radical prostatectomy that improve urinary functional outcomes. Dr Bernardo Rocco was tasked with arguing the facts that support the anatomical preservation and reconstruction steps that improve urinary continence. Drs Christian Pavlovich and Sasha Druskin were tasked with arguing the facts supporting neurovascular bundle and high anterior release surgical planes that improve urinary continence. Associate Editor John Davis moderates the debate, and outlines the current status of validated patient questionnaires that can be used to evaluate urinary continence, and recent work that allows measuring what constitutes a 'clinically significant' difference that either or both of these surgical techniques could influence. A review of raw data from a publication from Dr Pavlovich's team demonstrates how clinically relevant differences in patient-reported outcomes can be correlated to technique. A visual atlas is presented from both presenting teams, and Dr Davis demonstrates further reproducibility of technique. A linked video on this concept is available as a supplementary file.

PMID: 28319318 [PubMed - indexed for MEDLINE]

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Geriatric Assessment as a Predictor of Tolerance, Quality of Life, and Outcomes in Older Patients With Head and Neck Cancers and Lung Cancers Receiving Radiation Therapy.

Geriatric Assessment as a Predictor of Tolerance, Quality of Life, and Outcomes in Older Patients With Head and Neck Cancers and Lung Cancers Receiving Radiation Therapy.

Int J Radiat Oncol Biol Phys. 2017 Jul 15;98(4):850-857

Authors: VanderWalde NA, Deal AM, Comitz E, Stravers L, Muss H, Reeve BB, Basch E, Tepper J, Chera B

Abstract
PURPOSE: To evaluate the association between functional status based on a geriatric assessment (GA) and outcomes of tolerance to treatment in patients with lung or head and neck cancer receiving radiation therapy (RT) or chemoradiation (CRT).
METHODS AND MATERIALS: A prospective cohort study was conducted in patients aged ≥65 years with head and neck cancer or lung cancer undergoing curative intent RT or CRT. Pretreatment GA, health-related quality of life (HRQoL), and patient-reported outcomes (PRO) were obtained. Questionnaires were repeated biweekly during RT and at 6 weeks after treatment. Dysfunction was defined as scores <14 on the Instrumental Activities of Daily Living scale. Poor tolerance to treatment was defined by hospitalization, >3-day treatment delay, change in RT or CRT regimen, or death. Associations of dysfunction with tolerance to radiation therapy, HRQoL changes, and PRO ratings were evaluated.
RESULTS: Of the 50 patients accrued, 46 had evaluable data. Mean age was 72.5 years (range, 65-92 years). At baseline, 37% had dysfunction. Poor tolerance to RT or CRT occurred in 39%. There was no association between dysfunction and tolerance. Patients with dysfunction had lower baseline HRQoL scores. From baseline to end of RT, those with baseline dysfunction had less of a decline in Role Functioning (P=.01) and Global Health Score (P=.04) domains. However, from end of RT to 6-week follow-up, those with dysfunction were more likely to continue to drop in the Physical, Role Functioning, and Social domains (all P<.01). Dysfunction at baseline was also associated with higher severity of certain PROs.
CONCLUSIONS: Pretreatment dysfunction was associated with continued decline and lack of recovery of HRQoL in this patient population. Larger studies could further elucidate the GA's predictive value.

PMID: 28258889 [PubMed - indexed for MEDLINE]

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Upper Airway Stimulation for Obstructive Sleep Apnea: Patient-Reported Outcomes after 48 Months of Follow-up.

Upper Airway Stimulation for Obstructive Sleep Apnea: Patient-Reported Outcomes after 48 Months of Follow-up.

Otolaryngol Head Neck Surg. 2017 Apr;156(4):765-771

Authors: Gillespie MB, Soose RJ, Woodson BT, Strohl KP, Maurer JT, de Vries N, Steward DL, Baskin JZ, Badr MS, Lin HS, Padhya TA, Mickelson S, Anderson WM, Vanderveken OM, Strollo PJ, STAR Trial Investigators

Abstract
Objective To assess patient-based outcomes of participants in a large cohort study-the STAR trial (Stimulation Therapy for Apnea Reduction)-48 months after implantation with an upper airway stimulation system for moderate to severe obstructive sleep apnea. Study Design A multicenter prospective cohort study. Setting Industry-supported multicenter academic and clinical setting. Subjects Participants (n = 91) at 48 months from a cohort of 126 implanted participants. Methods A total of 126 participants received an implanted upper airway stimulation system in a prospective phase III trial. Patient-reported outcomes at 48 months, including Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), and snoring level, were compared with preimplantation baseline. Results A total of 91 subjects completed the 48-month visit. Daytime sleepiness as measured by ESS was significantly reduced ( P = .01), and sleep-related quality of life as measured by FOSQ significantly improved ( P = .01) when compared with baseline. Soft to no snoring was reported by 85% of bed partners. Two patients required additional surgery without complication for lead malfunction. Conclusion Upper airway stimulation maintained a sustained benefit on patient-reported outcomes (ESS, FOSQ, snoring) at 48 months in select patients with moderate to severe obstructive sleep apnea.

PMID: 28194999 [PubMed - indexed for MEDLINE]

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Health-Related Quality of Life and Associated Factors of Frontline Railway Workers: A Cross-Sectional Survey in the Ankang Area, Shaanxi Province, China.

Health-Related Quality of Life and Associated Factors of Frontline Railway Workers: A Cross-Sectional Survey in the Ankang Area, Shaanxi Province, China.

Int J Environ Res Public Health. 2016 Nov 30;13(12):

Authors: Zhang X, Chen G, Xu F, Zhou K, Zhuang G

Abstract
After validation of the widely used health-related quality of life (HRQOL) generic measure, the Short Form 36 version 2 (SF-36v2), we investigated the HRQOL and associated factors of frontline railway workers in China. Ground workers, conductors, and train drivers were selected from Ankang Precinct by using a stratified cluster sampling technique. A total of 784 frontline railway workers participated in the survey. The reliability and validity of SF-36v2 was satisfactory. The physical component summary (PCS) scores of three subgroups attained the average range for the USA general population, whereas the mental component summary (MCS) scores were well below the range. Most domains scored below the norm, except for the physical functioning (PF) domain. Among three subgroups, train drivers reported significantly lower scores on MCS and six health domains (excluding PF and bodily pain (BP)). After controlled confounders, conductors had significantly higher PCS and MCS scores than ground workers. There is heterogeneity on risk factors among three subgroups, but having long or irregular working schedules was negatively associated with HRQOL in all subgroups. SF-36v2 is a reliable and valid HRQOL measurement in railway workers in China. The frontline railway workers' physical health was comparative to American norms, whilst mental health was relatively worse. Long or irregular working schedules were the most important factors.

PMID: 27916919 [PubMed - indexed for MEDLINE]

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Effectiveness of a multidisciplinary risk assessment and management programme-diabetes mellitus (RAMP-DM) on patient-reported outcomes.

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Effectiveness of a multidisciplinary risk assessment and management programme-diabetes mellitus (RAMP-DM) on patient-reported outcomes.

Endocrine. 2017 Feb;55(2):416-426

Authors: Wan EY, Fung CS, Wong CK, Choi EP, Jiao FF, Chan AK, Chan KH, Lam CL

Abstract
Little is known about how the patient-reported outcomes is influenced by multidisciplinary-risk-assessment-and-management-programme for patients with diabetes mellitus (RAMP-DM). This paper aims to evaluate the effectiveness of RAMP-DM on patient-reported outcomes. This was a prospective longitudinal study on 1039 diabetes mellitus patients (714/325 RAMP-DM/non-RAMP-DM) managed in primary care setting. 536 and 402 RAMP-DM participants, and 237 and 187 non-RAMP-DM participants were followed up at 12 and 24 months with completed survey, respectively. Patient-reported outcomes included health-related quality of life, change in global health condition and patient enablement measured by Short Form-12 Health Survey version-2 (SF-12v2), Global Rating Scale, Patient Enablement Instrument respectively. The effects of RAMP-DM on patient-reported outcomes were evaluated by mixed effect models. Subgroup analysis was performed by stratifying haemoglobin A1c (HbA1c) (optimal HbA1c < 7 % and suboptimal HbA1c ≥ 7 %). RAMP-DM with suboptimal HbA1c was associated with greater improvement in SF-12v2 physical component summary score at 12-month (coefficient:3.80; P-value < 0.05) and 24-month (coefficient:3.82;P-value < 0.05), more likely to feel more enabled at 12-month (odds ratio: 2.57; P-value < 0.05), and have improved in GRS at 24-month (odds ratio:4.05; P-value < 0.05) compared to non-RAMP-DM participants. However, there was no significant difference in patient-reported outcomes between RAMP-DM and non-RAMP-DM participants with optimal HbA1c. Participation in RAMP-DM is effective in improving physical component of HRQOL, Global Rating Scale and patient enablement among diabetes mellitus patients with suboptimal HbA1c, but not in those with optimal HbA1c. Patients with sub-optimal diabetes mellitus control should be the priority target population for RAMP-DM. This observational study design may have potential bias in the characteristics between groups, and randomized clinical trial is needed to confirm the results.

PMID: 27699706 [PubMed - indexed for MEDLINE]

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Mapping EORTC-QLQ-C30 to EQ-5D-3L in patients with colorectal cancer.

Mapping EORTC-QLQ-C30 to EQ-5D-3L in patients with colorectal cancer.

J Med Econ. 2017 Feb;20(2):193-199

Authors: Marriott ER, van Hazel G, Gibbs P, Hatswell AJ

Abstract
AIMS: The primary aim of this study was to perform a mapping of the EORTC-QLQ-C30 scores to EQ-5D-3L for the SIRFLOX study; a large dataset of patients with previously untreated liver-only or liver-dominant metastatic colorectal cancer (mCRC). A secondary aim was to compare the predictive validity of existing mappings from EORTC-QLQ-C30 to EQ-5D-3L conducted in other cancers.
METHODS AND MATERIALS: Questionnaires (completed within 529 patients) were used in a linear mixed regression to model EQ-5D-3L utility values (scored using the UK tariff) as a function of the five function scores, nine symptom scores, and the global score from the EORTC-QLQ-C30 questionnaire. A Tobit regression was also performed. The mean EQ-5D-3L values for the SIRFLOX trial were calculated and compared with predicted EQ-5D-3L values derived using published mapping algorithms.
RESULTS: The linear mixed regression model provided a satisfactory mapping between the EORTC-QLQ-C30 and the EQ-5D-3L, whilst the Tobit model did not perform as well. When utilities from the SIRFLOX data were calculated with previously published mapping studies, three out of five studies performed well (< 10% mean difference).
LIMITATIONS: The main limitation of the study was the lack of meaningful observations post-progression (67 paired observations). For this reason, this study was unable to test whether the mapping holds by disease stage. Additionally, although the study adds to the literature of mappings to the EQ-5D-3L, it is not known how results would differ using the EQ-5D-5L.
CONCLUSION: This study is the first of its kind in liver-only or liver-dominant mCRC, and mCRC in general. The mapping constructed showed a good fit to the data and provides practitioners with an additional mapping between EORTC-QLQ-C30 to EQ-5D-3L using a large dataset (529 patients, 707 paired observations). The study also confirmed the generalizability of mappings published by Proskorovsky, Kontodimopoulos, and Longworth to liver-only or liver-dominant mCRC.

PMID: 27676291 [PubMed - indexed for MEDLINE]

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Nonhuman Animals, Public Health, and Ethics: A First Step, But….

Nonhuman Animals, Public Health, and Ethics: A First Step, But….

J Appl Anim Welf Sci. 2017 Jan-Mar;20(1):106-107

Authors: Akhtar A

Abstract
In December 2015, the Johns Hopkins Bloomberg School of Public Health held the first-ever summit on the intersection between nonhuman animal ethics and human health. The conference covered a variety of issues where animal health intersects with human health, including the wildlife trade, animal agriculture, and animal experimentation. This article provides a brief overview and critique of the summit.

PMID: 27494236 [PubMed - indexed for MEDLINE]

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Effect of estrogen replacement therapy on bone and cardiovascular outcomes in women with turner syndrome: a systematic review and meta-analysis.

Effect of estrogen replacement therapy on bone and cardiovascular outcomes in women with turner syndrome: a systematic review and meta-analysis.

Endocrine. 2017 Feb;55(2):366-375

Authors: Cintron D, Rodriguez-Gutierrez R, Serrano V, Latortue-Albino P, Erwin PJ, Murad MH

Abstract
Patients with Turner syndrome have adverse bone and cardiovascular outcomes from chronic estrogen deficiency. Hence, long-term estrogen replacement therapy is the cornerstone treatment. The estimates of its effect and optimal use, however, remain uncertain. We aimed to summarize the benefits and harms of estrogen replacement therapy on bone, cardiovascular, vasomotor and quality of life outcomes in patients with Turner syndrome. A comprehensive search of four databases was performed from inception through January 2016. Randomized clinical trials and observational cohort studies studying the effect of estrogen replacement therapy in patients with Turner syndrome under the age of 40 were included. Independently and in duplicate reviewers selected studies, extracted data and assessed risk of bias. Subgroup analyses were based on route of administration and type of estrogen formulation. Twenty-five studies at moderate to high risk of bias (12 randomized trials, 13 cohort studies) with 771 patients were included. Using random-effects models, estrogen replacement therapy showed an increase in bone mineral density [weighted mean change from baseline 0.09 g/cm2 (0.04-0.14)] that differed by type of estrogen but not route of administration. Oral estrogen replacement therapy showed a higher increase in high density lipoprotein cholesterol levels when compared to transdermal [weighted mean difference 9.33 mg/dl (4.82-13.85)] with no significant effect on other lipid fractions. The current evidence suggests possible benefit of estrogen replacement therapy on bone mineral density and high density lipoprotein cholesterol. Whether this improvement translates into changes in patient important outcomes (cardiovascular events or fractures) remains uncertain. Larger randomized clinical trials with direct comparisons on patient important outcomes are necessary.

PMID: 27473099 [PubMed - indexed for MEDLINE]

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Comparison of patient-reported outcomes between immediately and conventionally loaded mandibular two-implant overdentures: A preliminary study.

Comparison of patient-reported outcomes between immediately and conventionally loaded mandibular two-implant overdentures: A preliminary study.

J Prosthodont Res. 2016 Jul;60(3):185-92

Authors: Omura Y, Kanazawa M, Sato D, Kasugai S, Minakuchi S

Abstract
PURPOSE: The aim of this preliminary study is to compare patient-reported outcomes between immediately and conventionally loaded mandibular two-implant overdentures retained by magnetic attachments.
METHODS: Nineteen participants with edentulous mandibles were randomly assigned into either an immediate loading group (immediate group) or a conventional loading group (conventional group). Each participant received 2 implants in the inter-foraminal region by means of flapless surgery. Prostheses in the immediate and conventional groups were loaded using magnetic attachments on the same day as implant placement or 3 months after surgery, respectively. All participants completed questionnaires (the Japanese version of the Oral Health Impact Profile for edentulous [OHIP-EDENT-J], the patient's denture assessment [PDA], and general satisfaction) before implant placement (baseline) and 1, 2, 3, 4, 5, 6, and 12 months after surgery. The median differences between baseline and each monthly score were compared using the Mann-Whitney U test. The differences in median and 95% confidence interval between two groups were analyzed.
RESULTS: The immediate group showed slightly lower OHIP-EDENT-J summary score at 1 and 3 months than the conventional group (P=0.09). In the lower denture domain of PDA, the immediate group showed a statistically higher score at 3 months (P=0.04). There was no statistically significant difference in general satisfaction between the two groups.
CONCLUSIONS: Based on this preliminary study, immediate loading of mandibular two-implant overdentures with magnetic attachments tends to improve oral health-related quality of life and patient assessment earlier than observed with a conventional loading protocol.

PMID: 26803560 [PubMed - indexed for MEDLINE]

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JFB, Vol. 8, Pages 31: Effect of a Particulate and a Putty-Like Tricalcium Phosphate-Based Bone-grafting Material on Bone Formation, Volume Stability and Osteogenic Marker Expression after Bilateral Sinus Floor Augmentation in Humans

JFB, Vol. 8, Pages 31: Effect of a Particulate and a Putty-Like Tricalcium Phosphate-Based Bone-grafting Material on Bone Formation, Volume Stability and Osteogenic Marker Expression after Bilateral Sinus Floor Augmentation in Humans

Journal of Functional Biomaterials doi: 10.3390/jfb8030031

Authors: Christine Knabe Doaa Adel Khattab Esther Kluk Rainer Struck Michael Stiller

This study examines the effect of a hyaluronic acid (HyAc) containing tricalcium phosphate putty scaffold material (TCP-P) and of a particulate tricalcium phosphate (TCP-G) graft on bone formation, volume stability and osteogenic marker expression in biopsies sampled 6 months after bilateral sinus floor augmentation (SFA) in 7 patients applying a split-mouth design. 10% autogenous bone chips were added to the grafting material during surgery. The grain size of the TCP granules was 700 to 1400 µm for TCP-G and 125 to 250 µm and 500 to 700 µm (ratio 1:1) for TCP-P. Biopsies were processed for immunohistochemical analysis of resin-embedded sections. Sections were stained for collagen type I (Col I), alkaline phosphatase (ALP), osteocalcin (OC) and bone sialoprotein (BSP). Furthermore, the bone area and biomaterial area fraction were determined histomorphometrically. Cone-beam CT data recorded after SFA and 6 months later were used for calculating the graft volume at these two time points. TCP-P displayed more advantageous surgical handling properties and a significantly greater bone area fraction and smaller biomaterial area fraction. This was accompanied by significantly greater expression of Col I and BSP and in osteoblasts and osteoid and a less pronounced reduction in grafting volume with TCP-P. SFA using both types of materials resulted in formation of sufficient bone volume for facilitating stable dental implant placement with all dental implants having been in function without any complications for 6 years. Since TCP-P displayed superior surgical handling properties and greater bone formation than TCP-G, without the HyAc hydrogel matrix having any adverse effect on bone formation or graft volume stability, TCP-P can be regarded as excellent grafting material for SFA in a clinical setting. The greater bone formation observed with TCP-P may be related to the difference in grain size of the TCP granules and/or the addition of the HyAc.

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Photopolymerized micropatterns with high feature frequencies overcome chemorepulsive borders to direct neurite growth.

Photopolymerized micropatterns with high feature frequencies overcome chemorepulsive borders to direct neurite growth.

J Tissue Eng Regen Med. 2017 Jul 28;:

Authors: Tuft BW, Xu L, Leigh B, Lee D, Allan Guymon C, Hansen MR

Abstract
Developing and regenerating neurites respond to a variety of biophysical and biochemical cues in their microenvironment to reach target cells and establish appropriate synapses. Defining the hierarchal relationship of both types of cues to direct neurite growth carries broad significance for neural development, regeneration, and, in particular, engineering of neural prostheses that improve tissue integration with native neural networks. In this work, chemorepulsive biochemical borders are established on substrates with a range of surface microfeatures to determine the potential of physical cues to overcome conflicting biochemical cues. Physical micropatterns are fabricated using photomasking techniques to spatially control photoinitiation events of the polymerization. Temporal control of the reaction allows for generation of microfeatures with the same amplitude across a range of feature frequencies or periodicities. The micropatterened substrates are then modified with repulsive chemical borders between laminin and either EphA4-Fc or tenascin-C that compete with the surface microfeatures to direct neurite growth. Behavior of neurites from spiral ganglion and trigeminal neurons is characterized at biochemical borders as cross, turn, stop, or repel events. Both the chemical borders and physical patterns significantly influence neurite pathfinding. On unpatterned surfaces, most neurites that originate on laminin are deterred by the border with tenascin-C or EphA4-Fc. Importantly, substrates with frequent micropattern features overcome the influence of the chemorepulsive border to dominate neurite trajectory. Designing prosthesis interfaces with appropriate surface features may allow for spatially organized neurite outgrowth in vivo even in the presence of conflicting biochemical cues in native target tissues.

PMID: 28753740 [PubMed - as supplied by publisher]

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Geometric Modeling of the Nasal Valve.

Geometric Modeling of the Nasal Valve.

Facial Plast Surg. 2017 Aug;33(4):444-450

Authors: Sclafani AP, Victor W, Sclafani MS

PMID: 28753721 [PubMed - in process]

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Platelet-Rich Plasma for the Aesthetic Surgeon.

Platelet-Rich Plasma for the Aesthetic Surgeon.

Facial Plast Surg. 2017 Aug;33(4):437-443

Authors: Sand JP, Nabili V, Kochhar A, Rawnsley J, Keller G

PMID: 28753720 [PubMed - in process]

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Minimally Invasive Aesthetic Procedures: An Update on a Decade-Old Prediction.

Minimally Invasive Aesthetic Procedures: An Update on a Decade-Old Prediction.

Facial Plast Surg. 2017 Aug;33(4):434-436

Authors: Moayer R, Sand JP, Nabili V, Keller GS

PMID: 28753719 [PubMed - in process]

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Do Patients Access Appropriate Information Online?

Do Patients Access Appropriate Information Online?

Facial Plast Surg. 2017 Aug;33(4):428-433

Authors: Gupta A, Nissan ME, Bojrab DI, Folbe A, Carron MA

PMID: 28753718 [PubMed - in process]

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Facial Defect Reconstruction with Scalp Skin Grafts.

Facial Defect Reconstruction with Scalp Skin Grafts.

Facial Plast Surg. 2017 Aug;33(4):419-422

Authors: Voorman M, Obourn CA, Frodel J

PMID: 28753716 [PubMed - in process]

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Estimated Healthcare Costs of Melanoma in Australia Over 3 Years Post-Diagnosis

Abstract

Background

Skin cancer exerts a large and growing burden on health systems. With new pharmacotherapies for metastatic melanoma now available, a contemporary understanding of the cost burden of melanoma control is warranted.

Objective

To comprehensively assess the healthcare costs of malignant melanoma diagnosis and treatment in Australia, over 3 years after diagnosis.

Methods

We developed a decision-analytic model and micro-costing method to estimate the mean cost per patient for melanoma, incorporating all diagnostic and treatment modalities used in Australia (2017 AU$). By using the de-identified 10% sample of Medicare Benefits Scheme, we analysed health service use and supplemented our analyses with published estimates. We took a health system cost perspective, and addressed input uncertainty with sensitivity analyses.

Results

The mean annual cost per patient for melanoma stage 0/I/II was AU$1681 (US$1175) rising to AU$37,729 (US$26,365) for stage III resectable, and AU$115,109 (US$80,440) for stage III unresectable/IV. Three-year costs for stage III unresectable/IV were AU$187,720. Nationally, the annual estimated cost for treatment of all new cases of in situ and invasive melanomas was AU$201 million (95% CI: AU$187 to AU$216 million). When we included treatments for presumptive melanoma later found to be benign lesions, the estimated annual cost burden reached AU$272 million.

Conclusion

With rapidly rising treatment costs, there is a need to consider a comprehensive melanoma control strategy that includes primary prevention of skin cancers and cost-effective sun protection initiatives.

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Dharmashila Narayana Super speciality Hospital observes World Head, Neck Cancer Day - Medical Dialogues

Dharmashila Narayana Super speciality Hospital observes World Head, Neck Cancer Day
Medical Dialogues
New Delhi: To mark the occasion of World Head & Neck Cancer Day on 27^th July this year, Dharmashila Narayana Superspeciality Hospital, which is managed by Narayana Health, organized a series of week-long activities that included oral cancer ...

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Gli danno 6 settimane di vita, dopo 5 anni è ancora vivo - tio.ch

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Gli danno 6 settimane di vita, dopo 5 anni è ancora vivo
tio.ch
Sopravvissuto ad una forma aggressiva di cancro con metastasi allo stomaco, fegato, polmoni e ben 98 lesioni al cervello. «Avevo notato una piccola escrescenza in testa, e così ho scoperto di avere un tumore. Mi sento bene e conduco una vita normale ...

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The 22-item Sino-Nasal Outcome Test accurately reflects patient-reported control of chronic rhinosinusitis symptomatology.

The 22-item Sino-Nasal Outcome Test accurately reflects patient-reported control of chronic rhinosinusitis symptomatology.

Int Forum Allergy Rhinol. 2017 Jul 28;:

Authors: Gray ST, Phillips KM, Hoehle LP, Caradonna DS, Sedaghat AR

Abstract
BACKGROUND: Patient-reported control of chronic rhinosinusitis (CRS) symptoms is associated with the quality of life impact of CRS. We sought to determine if 22-item Sino-Nasal Outcome Test (SNOT-22) score is predictive of patient-perceived CRS symptom control.
METHODS: Prospective cross-sectional study of 202 patients with CRS. Participants were asked to rate their CRS symptom control as "not at all," "a little," "somewhat," "very," and "completely." The severity of patient CRS symptomatology was measured using the SNOT-22. The relationship between SNOT-22 score and patient-reported CRS symptom control was determined using regression, analysis of variance (ANOVA), and receiver operating characteristic (ROC) curve analysis.
RESULTS: SNOT-22 was negatively associated with patient-reported CRS symptom control (adjusted β = -0.03; 95% CI, -0.04 to -0.02; p < 0.001), after controlling for demographic and clinical characteristics. There was a significant difference in SNOT-22 scores of participants reporting each level of symptom control (p < 0.001) with the greatest differences between participants who rated their CRS symptom control as "not at all," "a little," and "somewhat," which we deem poor CRS symptom control, and the group who described their level of CRS symptom control described as "very" and "completely," which we deem well-controlled CRS symptoms. These results were true across all SNOT-22 subdomains scores as well. Using ROC analysis, a SNOT-22 score of 35 identified patients reporting poor vs well-controlled CRS symptom control with 71.4% sensitivity and 85.5% specificity.
CONCLUSION: SNOT-22 score is associated with how well patients feel their CRS symptomatology is controlled. Moreover, SNOT-22 score can be used to accurately distinguish patients with poor vs well-controlled CRS symptoms.

PMID: 28753732 [PubMed - as supplied by publisher]

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[Sleep Apnea and Mechanical Ventilation - Impact on Clinical Course and Perioperative Management].

[Sleep Apnea and Mechanical Ventilation - Impact on Clinical Course and Perioperative Management].

Pneumologie. 2017 Jul 28;:

Authors: Keymel S, Krüger S, Steiner S

Abstract
There is a high prevalence of sleep related breathing disorders in critical ill patients and in perioperative settings. Nevertheless, less is known about their impact on clinical course and therapeutic strategies in this context. Intensive care physicians should be aware of difficult airway, weaning- and post-extubation failure and negative impact of SRBD on hemodynamics. Sedatives and analgetics might worsen SRBD and their use should be restricted as far as possible, furthermore the use of NIV might be beneficial. However, there is a lack of evidence with regard to this strategies.

PMID: 28753704 [PubMed - as supplied by publisher]

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ERRATUM: Unexpected Serious Cardiac Arrhythmias in the Setting of Loperamide Abuse.

ERRATUM: Unexpected Serious Cardiac Arrhythmias in the Setting of Loperamide Abuse.

R I Med J (2013). 2017 Aug 01;100(8):8

Authors: Rasla S, Parikh P, Hoffmeister P, St Amand A, Garas MK, El Meligy A, Minami T, Shah NR

Abstract
Loperamide (Imodium) is a non-prescription opioid receptor agonist available over-the-counter for the treatment of diarrhea. When ingested in excessive doses, loperamide can penetrate the blood-brain barrier and is reported to produce euphoria, central nervous system and respiratory depression, and cardiotoxicity. There is an emerging trend in its use among drug abusers for its euphoric effects or for self-treatment of opioid withdrawal. We report a case of ventricular dysrhythmias associated with loperamide abuse in a 28-year-old man who substituted loperamide for the opioids that he used to abuse. [Full article available at http://ift.tt/2nJcDQI, free with no login].

PMID: 28753684 [PubMed - in process]

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Healthy lifestyle behaviours are positively and independently associated with academic achievement: An analysis of self-reported data from a nationally representative sample of Canadian early adolescents.

Healthy lifestyle behaviours are positively and independently associated with academic achievement: An analysis of self-reported data from a nationally representative sample of Canadian early adolescents.

PLoS One. 2017;12(7):e0181938

Authors: Faught EL, Gleddie D, Storey KE, Davison CM, Veugelers PJ

Abstract
INTRODUCTION: The lifestyle behaviours of early adolescents, including diet, physical activity, sleep, and screen usage, are well established contributors to health. These behaviours have also been shown to be associated with academic achievement. Poor academic achievement can additionally contribute to poorer health over the lifespan. This study aims to characterize the associations between health behaviours and self-reported academic achievement.
METHODS: Data from the 2014 Canadian Health Behaviour in School-Aged Children Study (n = 28,608, ages 11-15) were analyzed. Students provided self-report of academic achievement, diet, physical activity, sleep duration, recreational screen time usage, height, weight, and socioeconomic status. Multi-level logistic regression was used to assess the relationship of lifestyle behaviours and body weight status with academic achievement while considering sex, age, and socioeconomic status as potential confounders.
RESULTS: All health behaviours exhibited independent associations with academic achievement. Frequent consumption of vegetables and fruits, breakfast and dinner with family and regular physical activity were positively associated with higher levels of academic achievement, while frequent consumption of junk food, not meeting sleep recommendations, and overweight and obesity were negatively associated with high academic achievement.
CONCLUSIONS: The present findings demonstrate that lifestyle behaviours are associated with academic achievement, potentially identifying these lifestyle behaviours as effective targets to improve academic achievement in early adolescents. These findings also justify investments in school-based health promotion initiatives.

PMID: 28753617 [PubMed - in process]

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Attentional avoidance of threats in obsessive compulsive disorder: An event related potential study.

Attentional avoidance of threats in obsessive compulsive disorder: An event related potential study.

Behav Res Ther. 2017 Jul 20;97:96-104

Authors: Zhang ZM, Wang MY, Guo X, Miao X, Zhang T, Gao D, Yuan Z

Abstract
The neural mechanism underlying attentional bias in OCD (Obsessive-Compulsive Disorder) remains unclear. The goal of this study was to examine and compare the time course and the event related potential (ERP) components in OCD patients and healthy controls (HC) to reveal the complex brain activation pattern associated with attentional bias in OCD. The behavioural and electroencephalogram (EEG) data were recorded while the participants performed an emotional Stroop task. Compared to HC, the individuals with OCD exhibited slower response time, prolonged N1 latency and larger N1 and P2 amplitudes across different emotional words. In addition, we discovered that the OCD group showed an enlarged N1 component to OCD-related threat words compared to neutral words. Moreover, the OCD group had decreased P3 and later positive potential (LPP) amplitudes towards all types of words compared to the HC group. More importantly, the OCD group manifested smaller LPP amplitude to threat words compared to the HC group. Our findings suggest that OCD individuals may excessively direct their attention away from the threat at the late processing stage, probably due to the intensive processing or overestimation of the stimuli in the early automatic processing stage.

PMID: 28753449 [PubMed - as supplied by publisher]

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Gender and age differences in sleep problems in children: Person-oriented approach with multi-group analysis.

Gender and age differences in sleep problems in children: Person-oriented approach with multi-group analysis.

Behav Sleep Med. 2017 Jul 28;:

Authors: Chen YL, Tseng WL, Yang LK, Gau SS

Abstract
OBJECTIVE/BACKGROUND: This study aimed to identify subtypes of sleep problems in children and to examine whether these patterns differed between gender and age groups.
PARTICIPANTS: There were 3052 children (951 elementary school boys, 943 elementary school girls, 603 junior high school boys, and 555 junior high school girls) aged 7-16 years from two school-based epidemiological samples.
METHODS: Sleep problems were measured by the Sleep Habit Questionnaire based on parent reports.
RESULTS: Using the latent class modeling, a person-oriented approach, with a multi-group analysis, we identified four classes of sleep problems: moderate/high sleep problems (1.1%-3.1%), sleep related-breathing problems and parasomnias dominant (14.9%-21.1%), insomnias dominant and parasomnias (1.0%-3.1%), and no/low sleep problems (74.7%-81.4%), with varied prevalence rates of sleep problems across gender and age groups.
CONCLUSIONS: This study identified four classes of sleep problems across gender and age groups but with different prevalence rates of sleep problems, suggesting the complex interaction of gender and age in the subtypes of sleep problems. The gender- and age-specific interventions for sleep problems are suggested. Future studies are warranted to replicate these classes and to identify associated factors with each class.

PMID: 28753086 [PubMed - as supplied by publisher]

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Impact of Mucolytic Agents on COPD Exacerbations: A Pair-wise and Network Meta-analysis.

Impact of Mucolytic Agents on COPD Exacerbations: A Pair-wise and Network Meta-analysis.

COPD. 2017 Jul 28;:1-12

Authors: Cazzola M, Rogliani P, Calzetta L, Hanania NA, Matera MG

Abstract
Mucolytics are potentially useful for the management of chronic obstructive pulmonary disease (COPD), although there is conflicting advice on their use in different guideline documents. Furthermore, there is paucity of data comparing the efficacy of the different mucolytic agents in reducing the odds of COPD exacerbations. We performed pair-wise and network meta-analyses to evaluate the impact of mucoly-tics in COPD. Randomized clinical trials lasting at least 3 months and investigating the effects of mucolytics on COPD exacerbations were identified from published studies and repository databases. Mucolytics significantly reduced the odds of exacerbation vs. placebo (11 studies analyzed: odds ratio (OR) 0.51, 95% confidence interval (CI) 0.39-0.67; p < 0.001). The most effective drugs were carbocysteine, erdosteine, and N-acetylcysteine 1,200 mg/day (SUCRA 68.0-79.0%), whereas the OR was similar to placebo for ambroxol and N-acetylcysteine 600 mg/day. Only N-acetylcysteine 1,200 mg/day significantly protected against exacerbations vs. placebo (2 studies analyzed: OR 0.56, 95% CI 0.35-0.92; p < 0.05; high quality of evidence). A signal of effectiveness was detected for carbocysteine (2 studies analyzed: OR 0.45, 95% CI 0.20-1.01; p ≥ 0.05; moderate quality of evidence). Specific differences in study designs and patient-related characteristics, such as history of exacerbations and ethnicity, were potential effect modifiers for our statistical models, whereas neither respiratory function nor the use of corticosteroids influenced the analysis. This meta-analysis demonstrates that mucolytics are useful in preventing COPD exacerbations as maintenance add-on therapy to patients with frequent exacerbations. The effectiveness of mucolytics is independent of the severity of airway obstruction and the use of inhaled corticosteroids.

PMID: 28753070 [PubMed - as supplied by publisher]

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Discomfort associated with Invisalign and traditional brackets: A randomized, prospective trial.

Discomfort associated with Invisalign and traditional brackets: A randomized, prospective trial.

Angle Orthod. 2017 Jul 28;:

Authors: White DW, Julien KC, Jacob H, Campbell PM, Buschang PH

Abstract
OBJECTIVE: To evaluate differences in discomfort levels between patients treated with aligners and traditional fixed orthodontic appliances.
MATERIALS AND METHODS: This blinded, prospective, randomized equivalence two-arm parallel trial allocated 41 adult Class I nonextraction patients to either traditional fixed appliance (6 males and 12 females) or aligner (11 males and 12 females) treatment. Patients completed daily discomfort diaries following their initial treatment appointment, after 1 month and after 2 months. They recorded their levels of discomfort at rest, while chewing, and while biting, as well as their analgesic consumption and sleep disturbances.
RESULTS: Both treatment modalities demonstrated similar levels of initial discomfort. There were no significant sex differences. Patients in the traditional fixed appliances group reported significantly (P < .05) greater discomfort than patients in the aligner group during the first week of active treatment. There was significantly more discomfort while chewing than when at rest. Traditional patients also reported significantly more discomfort than aligner patients after the first and second monthly adjustment appointments. Discomfort after the subsequent adjustments was consistently lower than after the initial bonding or aligner delivery appointments. A higher percentage of patients in the fixed-appliance group reported taking analgesics during the first week for dental pain, but only the difference on day 2 was statistically significant.
CONCLUSIONS: Patients treated with traditional fixed appliances reported greater discomfort and consumed more analgesics than patients treated with aligners. This trial was not registered.

PMID: 28753032 [PubMed - as supplied by publisher]

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Role of a behavioural therapy involving psychodrama for the treatment of sleep disorders in paediatric primary care.

Role of a behavioural therapy involving psychodrama for the treatment of sleep disorders in paediatric primary care.

Minerva Pediatr. 2017 Jul 28;:

Authors: Stagnara J, Lemoine P

Abstract
BACKGROUND: Sleep disorders are common in young children. Our objective was to describe a psychodrama using puppets and to assess the interest of this approach for the treatment of sleep disorders in ambulatory paediatric patients.
METHODS: This retrospective, observational, monocentre study was carried between 1st January 2014 and 31st December 2015. Children aged 12 months to 6 years with a sleep disorder confirmed according to the International Classification of Sleep Disorders-2 were recruited. The parents were questioned separately about their child's sleep rhythm and the family's quality of life (QoL). The child sitting on their parent's knee and, using puppets to represent the family members, the paediatrician reproduced the scenario that took place at home and demonstrated what should be changed. The parents were contacted by telephone 1-2 weeks after the therapy to determine whether the child's sleep patterns had improved. The primary endpoint was resolution of the sleep disorder.
RESULTS: Thirty-eight children (mean age 27.2 ± 14.0 months; mean duration of sleep disorder 12.7 ± 9.5 months) were assessed. The most common sleep disorders were difficulties in falling asleep at evening bed-time (76.3%) and night-time wakening (76.3%). The main triggering factors were the birth of a sibling (30.8%) or an illness (30.8%). In the majority (52.2%) of families who were convinced that the psychodrama would work, an immediate and complete resolution of the sleep disorder was obtained within 3 days of the consultation. QoL improved in the majority of families after the consultation (QoL was average in 68.4% of families before the consultation vs. good in 84.2% after the consultation). Psychodrama was effective at bringing about an immediate and complete resolution of sleep disorders in children. This confirms the findings of other reports that show that behavioural therapy is effective in this context.
CONCLUSIONS: This method could be adapted effectively by individual practitioners, enabling children to establish a good sleep pattern without the use of medications. A further large-scale, randomised, controlled trial is required to confirm these results.

PMID: 28752988 [PubMed - as supplied by publisher]

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[Sleep Duration and Abdominal Obesity in Elderly in China].

[Sleep Duration and Abdominal Obesity in Elderly in China].

Sichuan Da Xue Xue Bao Yi Xue Ban. 2017 Jul;48(4):584-588

Authors: Luo HQ, Cao PY, Zuo ZL, Wu K, Qian JH, Ren XH

Abstract
OBJECTIVE: To determine the relationship between sleep duration and abdominal obesity in elderly in china.
METHODS: Data were drawn from the 2013 China Health and Retirement National Investigation (China Health and Retirement Longitudinal Study, CHARLS). The prevalence of abdominal obesity in the elderly who had a normal range of sleep duration was compared with those who had a shorter or longer sleep duration using Chi-square tests and binary logistic regression models.
RESULTS: Higher odds of abdominal obesity were found in the elderly male with a shorter (OR=1.627, 95%CI: 1.286-2.060, P<0.05) or longer (OR=1.499, 95%CI: 1.009-2.228, P<0.001) sleep duration, compared with those with a normal range of sleep duration. Statistical significances were found in the prevalence of abdominal obesity among those with different characteristics in education, smoking, chronic conditions, and social participation.
CONCLUSION: Both long and short sleep durations are associated with increased risk of obesity, which is more evident in older men. Bad living habits and mental state will increase the risk of abdominal obesity.

PMID: 28752979 [PubMed - in process]

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Sleep patterns among patients with chronic fatigue: a polysomnography-based study.

Sleep patterns among patients with chronic fatigue: a polysomnography-based study.

Clin Respir J. 2017 Jul 28;:

Authors: Pajediene E, Bileviciute-Ljungar I, Friberg D

Abstract
OBJECTIVES: To detect treatable sleep disorders among patients complaining of chronic fatigue by using sleep questionnaires and polysomnography.
METHODS: Patients were referred to hospital for investigations and rehabilitation due to a suspected diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The criteria for further referral to full-night polysomnography (PSG) were symptoms of excessive daytime sleepiness and/or tiredness in the questionnaires.
RESULTS: Of a total of 381 patients, 78 (20.5%) underwent PSG: 66 women and 12 men, mean age 48.6, standard deviation ±9.9 years. On the basis of the PSG, 31 (40.3%) patients were diagnosed with obstructive sleep apnoea, 7 (8.9%) patients with periodic limb movement disorder, 32 (41.0%) patients with restless legs syndrome, and 54 (69.3%) patients had one or more other sleep disorder. All patients were grouped into those who fulfilled the diagnostic criteria for ME/CFS (n = 55, 70.5%) and those who did not (n = 23, 29.5%). The latter group had significantly higher respiratory (p = 0.01) and total arousal (p = 0.009) indexes, and a higher oxygen desaturation index (p = 0.009).
CONCLUSIONS: More than half of these chronic fatigue patients, who also have excessive daytime sleepiness and/or tiredness, were diagnosed with sleep disorders such as obstructive sleep apnoea, periodic limb movement disorder and/or restless legs syndrome. Patients with such complaints should undergo polysomnography, fill in questionnaires, and be offered treatment for sleep disorders before the diagnose ME/CFS is set. This article is protected by copyright. All rights reserved.

PMID: 28752613 [PubMed - as supplied by publisher]

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The Association of Apolipoprotein E Allele 4 Polymorphism with the Recovery of Sleep Disturbance after Mild Traumatic Brain Injury.

The Association of Apolipoprotein E Allele 4 Polymorphism with the Recovery of Sleep Disturbance after Mild Traumatic Brain Injury.

Acta Neurol Taiwan. 2017 Mar 15;26(1):13-19

Authors: Lee HH, Yeh CT, Ou JC, Ma HP, Chen KY, Chang CF, Lai JH, Liao KH, Lin CM, Lin SY, Wu D, Huang YH, Hu CJ, Hong CT

Abstract
PURPOSE: Mild traumatic brain injury (mTBI) is a major public health concern. The apolipoprotein E (APOE) gene contains three polymorphisms, and the APOE4 polymorphism may affect several physiological states, such as the recovery from mTBI as well as sleep. This study aims to investigate the association between APOE4 with the recovery of sleep disturbance after mTBI.
METHODS: From May 2012 to Aug 2015, 189 mTBI patients completed baseline (1st week post-mTBI) and follow-up (6th week post-mTBI) sleep assessments that involved using the Pittsburgh Sleep Quality Index (PSQI). APOE genotypes were determined by sequencing the products of polymerase chain reaction from genomic DNA. Statistical analyses were performed using the Wilcox signed-rank or chi-square test.
RESULTS: Thirty-five (18.5%) participants were APOE4 carriers. At baseline, the demographic data and the severity of sleep disturbance were similar in both groups. APOE4 carriers demonstrated significant improvement in the overall PSQI score (8.34±3.9 at baseline and 7.43±3.99 at follow-up, p = 0.05) and scores of several PSQI subscales, including sleep disturbance, sleep latency, daytime dysfunction caused by sleepiness, and overall sleep quality, which was similar to APOE4 noncarriers.
CONCLUSION: APOE4 is not associated with the recovery of sleep disturbance after mTBI.

PMID: 28752509 [PubMed - in process]

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Therapeutics: Alpha-1 Antitrypsin Augmentation Therapy.

Therapeutics: Alpha-1 Antitrypsin Augmentation Therapy.

Methods Mol Biol. 2017;1639:249-262

Authors: Campos M, Lascano J

Abstract
Subjects with alpha-1 antitrypsin deficiency who develop pulmonary disease are managed following general treatment guidelines, including disease management interventions. In addition, administration of intravenous infusions of alpha-1 proteinase inhibitor (augmentation therapy) at regular schedules is a specific therapy for individuals with AATD with pulmonary involvement.This chapter summarizes the manufacturing differences of commercially available formulations and the available evidence of the effects of augmentation therapy. Biologically, there is clear evidence of in vivo local antiprotease effects in the lung and systemic immunomodulatory effects. Clinically, there is cumulative evidence of slowing lung function decline and emphysema progression. The optimal dose of augmentation therapy is being revised as well as more individualized assessment of who needs this therapy.

PMID: 28752465 [PubMed - in process]

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Accuracy of a Laryngopharyngeal Endoscopic Esthesiometer (LPEER) for Evaluating Laryngopharyngeal Mechanosensitivity: A Validation Study in a Prospectively Recruited Cohort of Patients.

Accuracy of a Laryngopharyngeal Endoscopic Esthesiometer (LPEER) for Evaluating Laryngopharyngeal Mechanosensitivity: A Validation Study in a Prospectively Recruited Cohort of Patients.

Dysphagia. 2017 Jul 27;:

Authors: Giraldo-Cadavid LF, Burguete J, Rueda F, Galvis AM, Castaneda N, Arbulu M, Balaguera JI, Paez N, Fernandez S

Abstract
Recent studies have shown an association between alterations in laryngopharyngeal mechanosensitivity (LPMS) and dysphagia, obstructive sleep apnea, and chronic cough hypersensitivity syndrome. A previous reliability study of a new laryngopharyngeal endoscopic esthesiometer and rangefinder (LPEER) showed high intra- and inter-rater reliability; however, its accuracy has not been tested. We performed an accuracy study of the LPEER in a prospectively and consecutively recruited cohort of 118 patients at two tertiary care university hospitals. Most of the patients were suffering from dysphagia, and all of them underwent a standard clinical evaluation and fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) using a new sensory testing protocol. The sensory test included determinations of the laryngeal adductor reflex threshold (LART), the cough reflex threshold (CRT) and the gag reflex threshold (GRT). Abnormalities on these reflex thresholds were evaluated for associations with major alterations in swallowing safety (pharyngeal residues, penetration, and aspiration). We evaluated the discriminative capacity of the LPMS test using ROC curves and the area under the curve (AUC-ROC) and its relationship with the eight-point penetration-aspiration scale (PAS) using the Spearman's ρ correlation coefficient (SCC). We found a positive correlation between the PAS and LART (SCC 0.47; P < 0.001), CRT (SCC 0.46; P < 0.001) and GRT (SCC 0.34; P = 0.002). The AUC-ROC values for detecting a PAS ≥7 were as follows: LART, 0.83 (P < 0.0001); CRT, 0.79 (P < 0.0001); GRT, 0.72 (P < 0.0001). In this study, the LPEER showed good accuracy for evaluating LPMS. These results justify further validation studies in independent populations.

PMID: 28752266 [PubMed - as supplied by publisher]

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Association between serum vitamin B12 level and frailty in older adults.

Association between serum vitamin B12 level and frailty in older adults.

North Clin Istanb. 2017;4(1):22-28

Authors: Dokuzlar O, Soysal P, Isik AT

Abstract
OBJECTIVE: Frailty is associated with recurrent falls, fractures, limitation of daily living activities, cognitive impairment, increase in hospitalization, placement in nursing home, and mortality rate in older adults. Although malnutrition is one of the most important etiological factors, role of micronutrients is unclear. The aim of this study was to investigate association between frailty and vitamin B12, which has been demonstrated to be related to numerous geriatric syndromes.
METHODS: Total of 335 patients who presented at geriatric outpatient clinic and underwent comprehensive geriatric assessment were included in this study. All patients were evaluated with both Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight (FRAIL) scale and Fried criteria for frailty. Vitamin B12 deficiency was defined as serum vitamin B12 level of less than 400 pg/mL.
RESULTS: In total of 335 patients, 88 (26.3%) were assessed as frail, 156 (46.6%) were prefrail, and 91 (27.2%) were robust. When the 3 groups were compared, it was found that patients in frail group had highest average age and lowest education level (p<0.001) and that complaints of urinary incontinence, balance disorders, recurrent falls, sleep disorders, amnesia, chronic pain, and constipation were more frequent in this group (p<0.05). Albumin and 25-hydroxy vitamin D levels decreased as frailty level increased (p<0.05), but no association between vitamin B12 levels and frailty was found. Patients were divided into 2 groups: vitamin B12 level above and below 400 pg/mL. Groups were then compared in terms of subparameters of both the FRAIL and Fried criteria, and no significant difference between groups was found (p>0.05).
CONCLUSION: Results of this study determined no association between vitamin B12 level and frailty in geriatric population; however, longitudinal studies are needed to clarify relationship.

PMID: 28752139 [PubMed]

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Insomnia and Its Temporal Association with Academic Performance among University Students: A Cross-Sectional Study.

Insomnia and Its Temporal Association with Academic Performance among University Students: A Cross-Sectional Study.

Biomed Res Int. 2017;2017:2542367

Authors: Haile YG, Alemu SM, Habtewold TD

Abstract
INTRODUCTION: Studies show that 9.4% to 38.2% of university students are suffering from insomnia. However, research data in developing countries is limited. Thus, the aim of the study was to assess insomnia and its temporal association with academic performance.
METHODS AND MATERIALS: Institution based cross-sectional study was conducted with 388 students at Debre Berhan University. Data were collected at the nine colleges. Logistic and linear regression analysis was performed for modeling insomnia and academic performance with a p value threshold of 0.05, respectively. Data were entered using EPI-data version 3.1 and analyzed using SPSS version 20.
RESULTS: The prevalence of insomnia was 61.6%. Field of study (p value = 0.01), worshiping frequency (p value = 0.048), marital status (p value = 0.03), and common mental disorder (p value < 0.001) were identified associated factors of insomnia. There was no significant association between insomnia and academic performance (p value = 0.53, β = -0.04). Insomnia explained 1.2% (r(2) = 0.012) of the difference in academic performance between students.
CONCLUSIONS: Nearly 3 out of 5 students had insomnia. We recommended that universities would endorse sleep quality and mental health illness screening programs for students.

PMID: 28752093 [PubMed - in process]

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Sleep onset uncovers thalamic abnormalities in patients with idiopathic generalised epilepsy.

Sleep onset uncovers thalamic abnormalities in patients with idiopathic generalised epilepsy.

Neuroimage Clin. 2017;16:52-57

Authors: Bagshaw AP, Hale JR, Campos BM, Rollings DT, Wilson RS, Alvim MKM, Coan AC, Cendes F

Abstract
The thalamus is crucial for sleep regulation and the pathophysiology of idiopathic generalised epilepsy (IGE), and may serve as the underlying basis for the links between the two. We investigated this using EEG-fMRI and a specific emphasis on the role and functional connectivity (FC) of the thalamus. We defined three types of thalamic FC: thalamocortical, inter-hemispheric thalamic, and intra-hemispheric thalamic. Patients and controls differed in all three measures, and during wakefulness and sleep, indicating disorder-dependent and state-dependent modification of thalamic FC. Inter-hemispheric thalamic FC differed between patients and controls in somatosensory regions during wakefulness, and occipital regions during sleep. Intra-hemispheric thalamic FC was significantly higher in patients than controls following sleep onset, and disorder-dependent alterations to FC were seen in several thalamic regions always involving somatomotor and occipital regions. As interactions between thalamic sub-regions are indirect and mediated by the inhibitory thalamic reticular nucleus (TRN), the results suggest abnormal TRN function in patients with IGE, with a regional distribution which could suggest a link with the thalamocortical networks involved in the generation of alpha rhythms. Intra-thalamic FC could be a more widely applicable marker beyond patients with IGE.

PMID: 28752060 [PubMed - in process]

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IJMS, Vol. 18, Pages 1652: Transcriptome Profiling in Human Diseases: New Advances and Perspectives

IJMS, Vol. 18, Pages 1652: Transcriptome Profiling in Human Diseases: New Advances and Perspectives

International Journal of Molecular Sciences doi: 10.3390/ijms18081652

Authors: Amelia Casamassimi Antonio Federico Monica Rienzo Sabrina Esposito Alfredo Ciccodicola

In the last decades, transcriptome profiling has been one of the most utilized approaches to investigate human diseases at the molecular level. Through expression studies, many molecular biomarkers and therapeutic targets have been found for several human pathologies. This number is continuously increasing thanks to total RNA sequencing. Indeed, this new technology has completely revolutionized transcriptome analysis allowing the quantification of gene expression levels and allele-specific expression in a single experiment, as well as to identify novel genes, splice isoforms, fusion transcripts, and to investigate the world of non-coding RNA at an unprecedented level. RNA sequencing has also been employed in important projects, like ENCODE (Encyclopedia of the regulatory elements) and TCGA (The Cancer Genome Atlas), to provide a snapshot of the transcriptome of dozens of cell lines and thousands of primary tumor specimens. Moreover, these studies have also paved the way to the development of data integration approaches in order to facilitate management and analysis of data and to identify novel disease markers and molecular targets to use in the clinics. In this scenario, several ongoing clinical trials utilize transcriptome profiling through RNA sequencing strategies as an important instrument in the diagnosis of numerous human pathologies.

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IJMS, Vol. 18, Pages 1651: Role of Plasminogen Activator Inhibitor Type 1 in Pathologies of Female Reproductive Diseases

IJMS, Vol. 18, Pages 1651: Role of Plasminogen Activator Inhibitor Type 1 in Pathologies of Female Reproductive Diseases

International Journal of Molecular Sciences doi: 10.3390/ijms18081651

Authors: Yao Ye Aurelia Vattai Xi Zhang Junyan Zhu Christian Thaler Sven Mahner Udo Jeschke Viktoria von Schönfeldt

Normal pregnancy is a state of hypercoagulability with diminishing fibrinolytic activity, which is mainly caused by an increase of plasminogen activator inhibitor type 1 (PAI-1). PAI-1 is the main inhibitor of plasminogen activators, including tissue-type plasminogen activator (tPA) and urokinase-type plasminogen activator (uPA). In human placentas, PAI-1 is expressed in extravillous interstitial trophoblasts and vascular trophoblasts. During implantation and placentation, PAI-1 is responsible for inhibiting extra cellular matrix (ECM) degradation, thereby causing an inhibition of trophoblasts invasion. In the present study, we have reviewed the literature of various reproductive diseases where PAI-1 plays a role. PAI-1 levels are increased in patients with recurrent pregnancy losses (RPL), preeclampsia, intrauterine growth restriction (IUGR), gestational diabetes mellitus (GDM) in the previous pregnancy, endometriosis and polycystic ovary syndrome (PCOS). In general, an increased expression of PAI-1 in the blood is associated with an increased risk for infertility and a worse pregnancy outcome. GDM and PCOS are related to the genetic role of the 4G/5G polymorphism of PAI-1. This review provides an overview of the current knowledge of the role of PAI-1 in reproductive diseases. PAI-1 represents a promising monitoring biomarker for reproductive diseases and may be a treatment target in the near future.

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IJMS, Vol. 18, Pages 1649: Adipokines and Non-Alcoholic Fatty Liver Disease: Multiple Interactions

IJMS, Vol. 18, Pages 1649: Adipokines and Non-Alcoholic Fatty Liver Disease: Multiple Interactions

International Journal of Molecular Sciences doi: 10.3390/ijms18081649

Authors: Timon Adolph Christoph Grander Felix Grabherr Herbert Tilg

Accumulating evidence links obesity with low-grade inflammation which may originate from adipose tissue that secretes a plethora of pro- and anti-inflammatory cytokines termed adipokines. Adiponectin and leptin have evolved as crucial signals in many obesity-related pathologies including non-alcoholic fatty liver disease (NAFLD). Whereas adiponectin deficiency might be critically involved in the pro-inflammatory state associated with obesity and related disorders, overproduction of leptin, a rather pro-inflammatory mediator, is considered of equal relevance. An imbalanced adipokine profile in obesity consecutively contributes to metabolic inflammation in NAFLD, which is associated with a substantial risk for developing hepatocellular carcinoma (HCC) also in the non-cirrhotic stage of disease. Both adiponectin and leptin have been related to liver tumorigenesis especially in preclinical models. This review covers recent advances in our understanding of some adipokines in NAFLD and associated HCC.

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Anxiety-like behavioural effects of extremely low-frequency electromagnetic field in rats

Abstract

In recent years, extremely low-frequency electromagnetic field (ELF-EMF) has received considerable attention for its potential biological effects. Numerous studies have shown the role of ELF-EMF in behaviour modulation. The aim of this study was to investigate the effect of short-term ELF-EMF (50 Hz) in the development of anxiety-like behaviour in rats through change hypothalamic oxidative stress and NO. Ten adult male rats (Wistar albino) were divided in two groups: control group—without exposure to ELF-EMF and experimental group—exposed to ELF-EMF during 7 days. After the exposure, time open field test and elevated plus maze were used to evaluate the anxiety-like behaviour of rats. Upon completion of the behavioural tests, concentrations of superoxide anion (O₂·⁻), nitrite (NO₂⁻, as an indicator of NO) and peroxynitrite (ONOO⁻) were determined in the hypothalamus of the animals. Obtained results show that ELF-EMF both induces anxiety-like behaviour and increases concentrations of O₂·⁻ and NO, whereas it did not effect on ONOO⁻ concentration in hypothalamus of rats. In conclusion, the development of anxiety-like behaviour is mediated by oxidative stress and increased NO concentration in hypothalamus of rats exposed to ELF-EMF during 7 days.

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@Prime2 https://t.co/enmBAlYEZX Let us know if you have any issues.

@Prime2 https://t.co/enmBAlYEZX Let us know if you have any issues.

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IJERPH, Vol. 14, Pages 852: Exogenous GR24 Alleviates Cadmium Toxicity by Reducing Cadmium Uptake in Switchgrass (Panicum virgatum) Seedlings

IJERPH, Vol. 14, Pages 852: Exogenous GR24 Alleviates Cadmium Toxicity by Reducing Cadmium Uptake in Switchgrass (Panicum virgatum) Seedlings

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080852

Authors: Zhenglan Tai Xinqiang Yin Zhigang Fang Gaoling Shi Laiqing Lou Qingsheng Cai

Strigolactones (SLs) are classified into plant hormones, playing a key role as a mediator of plant growth in response to several abiotic stresses, including drought and salinity. However, the role of SLs in cadmium (Cd)-induced stress to plants is still unknown. The physiological responses of switchgrass (Panicum virgatum) stressed in 10 μmol L-1 Cd to exogenous synthetic SLs analog, GR24 were studied in hydroponics. The Cd stress significantly caused the adverse effects on plant growth and root morphology, inhibited photosynthesis, but boosted lipid peroxidation of Switchgrass seedlings. After treatment of 1 μmol L-1 GR24, the above adverse effects caused by Cd stress were significantly alleviated, mainly reflects in improvement of shoot biomass, relative water content, root development, chlorophyll contents, activities of typical antioxidant enzymes, nutrient uptake. The reason for exogenous GR24 alleviating cadmium toxicity might be owing to that exogenous GR24 promoted the content of endogenous SLs, increased some essential element Fe (iron), Zn (zinc), Mn (manganese) and Cu (copper) uptake and reduced cadmium uptake, accumulation and partition in shoot of switchgrass seedlings.

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Antigen-loaded polymeric hybrid micelles elicit strong mucosal and systemic immune responses after intranasal administration

Publication date: 28 September 2017
Source:Journal of Controlled Release, Volume 262
Author(s): You Li, Man Li, Tao Gong, Zhirong Zhang, Xun Sun
Increasing attention has been paid to nasal delivery. Subunit vaccines based on antigenic proteins or polypeptides offer good safety. However, lack of delivery efficiency, particularly for nasal immunization, is a big issue. Here we designed a highly tunable polymeric hybrid micelle (PHM) system offering good vaccine efficacy after nasal administration. PHMs are formulated from two amphiphilic diblock copolymers, polycaprolactone-polyethylenimine (PCL-PEI) and polycaprolactone-polyethyleneglycol (PCL-PEG), the ratio of which determines PHM physicochemical properties. Citraconic anhydride-modified ovalbumin (Cit-OVA), as model antigen, was incorporated into PHMs via electrostatic interaction, giving antigen-loaded micelles of around 150nm in size. Their surface characteristics which are found closely related to their in vivo kinetics can be modulated by adjusting the mass ratio of PCL-PEG and PCL-PEI. PHM/Cit-OVA complexes containing PCL-PEI and PCL-PEG in a 1:1 mass ratio induced strong immune responses in nasal mucosa and serum in vivo without causing obvious toxicity, and Cit-OVA was efficiently internalized by dendritic cells. These results demonstrate the promise of this multifunctional polymeric delivery system for nasal vaccination.

Graphical abstract

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False Ring Formation in Bald Cypress ( Taxodium distichum )

Abstract

False rings are intra-annual bands of high density xylem cells that form in response to an environmental condition that a causes a tree to form two bands of latewood cells during a single growing season. We examined whether precipitation and/or stream flow measurements coincided with false ring formation in adult bald cypress trees (Taxodium distichum (L.) Rich.). We collected increment cores from bald cypress growing along the Blackwater and Nottoway Rivers in Virginia, U.S.A. The frequency and timing of false rings was quantified for each core. Annual synchronicity of false ring formation occurred, indicating a common environmental trigger. At both sites, false ring formation in bald cypress appeared to be more common during years with late summer precipitation and associated high late summer stream flow. In years when moisture is available late in the growing season, dormant bald cypress trees resume earlywood formation and a false ring is formed. Therefore, false rings in bald cypress wood can serve as a proxy record of seasonal historical stream flow and precipitation.

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National emission ceilings in Portugal—trends, compliance and projections

Abstract

The national emission ceilings (NEC) Directive was implemented to contribute to the reduction of transboundary air pollutions impacts, limiting emissions of acidifying and eutrophication pollutants as well as ozone precursors. It was first adopted by the European Commission (EC) in 2001 (Directive 2001/81/EC) covering four pollutants (NO_x, SO₂, NH₃ and NMVOC). Under the scope of the clean air programme for Europe, which established the air policy objectives for 2020 and 2030, a new NEC was adopted (Directive 2016/2284/EU) establishing more strict ceilings for those pollutants and adding as well PM_2.5. The objective of this paper is to analyse the evolution of the Portuguese national emissions and the compliance of NEC Directive in 2010 and to foresee if the new ceilings for 2030 will be fulfilled. The emission inventories reported to the EC show that emissions in Portugal presented a consistent decreasing trend for all pollutants from 2000 to 2014, and a slight increase in 2015. The 2010 targets were achieved with measures implemented at the time (particularly on the energy, industrial combustion and transport sectors) which allowed Portugal to even surpass the defined goals. The emission projections for 2030, however, reveal that necessary emission reductions for all pollutants could be attained only if measures of the most demanding scenarios are implemented. Therefore, an integrated strategy should be designed and implemented aiming to not only fulfil the NEC in 2030 but also guarantee a better air quality with the highest cost-benefit for the environment and health.

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Jill Zarin's husband Bobby Zarin hospitalized with cancer complications 'He's not doing well' - Starcasm.net

Screen-Shot-2017-07-28-at-5.28.21-PM-490

Starcasm.net

Jill Zarin's husband Bobby Zarin hospitalized with cancer complications 'He's not doing well'
Starcasm.net
Real Housewives of New York alum Jill Zarin's husband Bobby Zarin has been battling thyroid cancer since June, 2009. He went through a period of remission, but the cancer returned to his brain November last year. Now, Jill is revealed to news outlets ...
RHONY Star Jill Zarin Is 'Hoping For A Miracle' As Husband's ...Celebrity Insider (blog)

all 2 news articles »

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Ha 98 lesioni al cervello e gli danno 6 settimane di vita, dopo 5 anni ... - Il Gazzettino

Schermata%202017-07-28%20alle%2019.03.34

Ha 98 lesioni al cervello e gli danno 6 settimane di vita, dopo 5 anni ...
Il Gazzettino
Incredibile in Colorado. Gli avevano dato 6 settimane di vita al massimo, ma Leland Fay, 46 anni, papà di due bimbi, dopo 5 anni è ancora in vita e ha anche ...

and more »

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Clinical presentation and airway management of tracheal atresia: A systematic review

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Mariana M. Smith, Amy Huang, Mathilde Labbé, Joshua Lubov, Lily H.P. Nguyen
ObjectivesTracheal atresia (TA) is a rare congenital condition that typically requires an unexpected and emergent resuscitation in the delivery room. The mortality rate associated is very high, with only a few long-term survival cases reported. We describe the findings of a systematic review on the clinical presentation and airway management of TA.MethodsUsing the keywords "tracheal atresia", "tracheal agenesis" and "tracheal hypoplasia" a search through Embase and Pubmed databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Articles published from 1950 to 2015 in English, French, Italian, Portuguese and Spanish were included. Exclusion criteria were cases of stillborn, and unclear diagnosis or outcome.Results149 cases of TA were identified after reviewing 1125 initial references. There was a male preponderance (65%), and associated malformations were described in 94.2% of patients. Prenatal ultrasound was abnormal in 56.3% of cases, with polyhydramnios being the most common finding. The most frequent type of TA was Faro Type C. 94 (41.3%) patients did not survive beyond the first 24 h of life. Only 13 (8.4%) patients survived more than three months of life, after undergoing a variety of surgical approaches.ConclusionThis review, which to our knowledge is the largest one to date, confirms that TA is a rare malformation, occurs more frequently in males, and has a very high mortality rate. Depending on the presence and type of concomitant malformation, as well of the length of the remaining trachea, different surgical management options are described.

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Evaluation of transient-evoked otoacoustic emissions in a healthy 1 to 10 year pediatric cohort in Sub-Saharan Africa

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Daniel Dejaco, Fabian C. Aregger, Helene V. Hurth, Josua Kegele, Veronika Muigg, Lukas Oberhammer, Sebastian Bunk, Natalie Fischer, Leyla Pinggera, David Riedl, Allan Otieno, Tsiri Agbenyega, Ayola A. Adegnika, Herbert Riechelmann, Peter Lackner, Patrick Zorowka, Peter Kremsner, Joachim Schmutzhard
ObjectiveTransient-evoked otoacoustic emissions (TEOAEs) monitor cochlear function. High pass rates have been reported for industrialized countries. Pass rates in low and middle income countries such as Sub-Saharan Africa are rare, essentially lower and available for children up to 4 years of age and frequently based on hospital recruitments.This study aims at providing additional TEOAE pass rates of a healthy Sub-Saharan cohort aged 1–10 years with data from Gabon, Ghana and Kenya. Potentially confounding factors (recruitment site, age) are taken into consideration.MethodsHealthy children were recruited in hospitals, schools and kindergartens. Inclusion criteria were age 1–10 years and normal otoscopic findings. Exclusion criteria were any sickness or physical ailment potentially impairing the hearing capacity. Five measurements per ear were performed with Capella Cochlear Emission Analyzer (MADSEN, Germany). An overall wave reproducibility of above 60% served as pass-criterion. Pass rates were compared between recruitment sites and age groups (1–5 and 6–10 years).ResultsOverall pass rate was 87.5% (n = 264; 231 passes vs. 33 fails). Of these 84.0% of hospital recruited children passed (n = 156; 131 passes vs. 25 fails), compared to 92.6% of community recruitments (n = 108; 100 passes vs. 8 fails), which was significantly different p = 0.039). If analyzed by age groups, this difference was only observed in children younger than 6 years (p = 0.007).ConclusionHospitals as recruitment sites for healthy controls seem to affect TEOAE pass rates. We advise for a cautious approach when recruiting healthy TEOAE control collectives under the age of 6 in a hospital setting. In children older than 6 years conventional pure-tone audiometry remains the standard method for hearing screening.

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Clinical presentation and airway management of tracheal atresia: A systematic review

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Mariana M. Smith, Amy Huang, Mathilde Labbé, Joshua Lubov, Lily H.P. Nguyen
ObjectivesTracheal atresia (TA) is a rare congenital condition that typically requires an unexpected and emergent resuscitation in the delivery room. The mortality rate associated is very high, with only a few long-term survival cases reported. We describe the findings of a systematic review on the clinical presentation and airway management of TA.MethodsUsing the keywords "tracheal atresia", "tracheal agenesis" and "tracheal hypoplasia" a search through Embase and Pubmed databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Articles published from 1950 to 2015 in English, French, Italian, Portuguese and Spanish were included. Exclusion criteria were cases of stillborn, and unclear diagnosis or outcome.Results149 cases of TA were identified after reviewing 1125 initial references. There was a male preponderance (65%), and associated malformations were described in 94.2% of patients. Prenatal ultrasound was abnormal in 56.3% of cases, with polyhydramnios being the most common finding. The most frequent type of TA was Faro Type C. 94 (41.3%) patients did not survive beyond the first 24 h of life. Only 13 (8.4%) patients survived more than three months of life, after undergoing a variety of surgical approaches.ConclusionThis review, which to our knowledge is the largest one to date, confirms that TA is a rare malformation, occurs more frequently in males, and has a very high mortality rate. Depending on the presence and type of concomitant malformation, as well of the length of the remaining trachea, different surgical management options are described.

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Evaluation of transient-evoked otoacoustic emissions in a healthy 1 to 10 year pediatric cohort in Sub-Saharan Africa

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Daniel Dejaco, Fabian C. Aregger, Helene V. Hurth, Josua Kegele, Veronika Muigg, Lukas Oberhammer, Sebastian Bunk, Natalie Fischer, Leyla Pinggera, David Riedl, Allan Otieno, Tsiri Agbenyega, Ayola A. Adegnika, Herbert Riechelmann, Peter Lackner, Patrick Zorowka, Peter Kremsner, Joachim Schmutzhard
ObjectiveTransient-evoked otoacoustic emissions (TEOAEs) monitor cochlear function. High pass rates have been reported for industrialized countries. Pass rates in low and middle income countries such as Sub-Saharan Africa are rare, essentially lower and available for children up to 4 years of age and frequently based on hospital recruitments.This study aims at providing additional TEOAE pass rates of a healthy Sub-Saharan cohort aged 1–10 years with data from Gabon, Ghana and Kenya. Potentially confounding factors (recruitment site, age) are taken into consideration.MethodsHealthy children were recruited in hospitals, schools and kindergartens. Inclusion criteria were age 1–10 years and normal otoscopic findings. Exclusion criteria were any sickness or physical ailment potentially impairing the hearing capacity. Five measurements per ear were performed with Capella Cochlear Emission Analyzer (MADSEN, Germany). An overall wave reproducibility of above 60% served as pass-criterion. Pass rates were compared between recruitment sites and age groups (1–5 and 6–10 years).ResultsOverall pass rate was 87.5% (n = 264; 231 passes vs. 33 fails). Of these 84.0% of hospital recruited children passed (n = 156; 131 passes vs. 25 fails), compared to 92.6% of community recruitments (n = 108; 100 passes vs. 8 fails), which was significantly different p = 0.039). If analyzed by age groups, this difference was only observed in children younger than 6 years (p = 0.007).ConclusionHospitals as recruitment sites for healthy controls seem to affect TEOAE pass rates. We advise for a cautious approach when recruiting healthy TEOAE control collectives under the age of 6 in a hospital setting. In children older than 6 years conventional pure-tone audiometry remains the standard method for hearing screening.

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Mechanism of antagonistic effects of Andrographis paniculata methanolic extract against Staphylococcus aureus

Publication date: Available online 29 July 2017
Source:Asian Pacific Journal of Tropical Medicine
Author(s): Roslinah Mohamad Hussain, Zayan Nabilah Rasyidah Abd. Razak, Wan Mazlina Md Saad, Maimunah Mustakim
ObjectiveTo investigate the effects of Andrographis paniculata (Burm.f.) Wall. Ex Nees (A. paniculata) on expressions and activities of catalase, superoxide dismutase and alkylhydroperoxide reductase C in Staphylococcus aureus (S. aureus) with respect to its survival in vitro.MethodsAntioxidative property of methanolic leaves extract of A. paniculata (0.06 mg/mL). Minimum inhibitory concentration (MIC) was determined by its ability to reduce hydrogen peroxide (H2O2) toxicity against S. aureus ATCC 25923 (3.8 × 10⁸ cfu/mL). Effects of the extract on expressions of katA (encoding catalase), sodA and sodM [encoding superoxide dismutases (SODs)], and ahpC [encoding alkylhydroperoxide reductase C (AhpC)] in S. aureus were determined by RT-qPCR and corresponding enzyme activity assays were performed. Nitroblue tetrazolium reduction (NBT) assay was performed to determine effects of the extract on intracellular and extracellular levels of O ^2- in S. aureus.ResultsCells challenged with 7.5 mmol/L H2O2 showed 0% survival in 30 min whereas 25% survived after treatment with the extract and H2O2. Cells that were treated with the extract alone had 43% survival in the same exposure period. Expressions of sodA and sodM genes in extract-treated cells were lowered 0.8-fold and 0.7-fold, respectively with decrease in total SOD activity of 26.8 U compared to untreated cells, 32.4 U (P<0.05). In contrast, extract-treated S. aureus cells showed 3.3-fold increase in katA expression with corresponding increase in catalase activity of 1.828 U compared to untreated cells which was 1.248 U, (P<0.05). More profoundly, ahpC expression was increased 61-fold in extract-treated cells, (P<0.05) with corresponding increase in AhpC activity of 0.018 U compared to untreated cells, 0.012 U, (P<0.05). Extract - treated cells had significantly lower intra- and extracellular O2^- levels with absorbance readings (A575nm) of 0.340 and 0.524 compared to untreated cells which were 0.516 and 0.928 (P<0.05), respectively.ConclusionsTaken together these results suggest that the low MIC of A. paniculata methanolic leaves extract (0.06 mg/mL) reduce H2O2 toxicity and more importantly, was in itself effectively inhibitory against S. aureus. Further, our observations suggest that a probable mode of its inhibitory mechanism against S. aureus is by reducing total SOD activity through downregulation of sodA and sodM expressions.

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Can patients with chronic rhinosinusitis recover normal sleep after endoscopic sinus surgery?

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Σάββατο 29 Ιουλίου 2017

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