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

Παρασκευή 25 Αυγούστου 2017

A smoking cessation programme for current and recent ex-smokers following diagnosis of a potentially curable cancer.

http:--media.wiley.com-assets-7315-19-Wi

A smoking cessation programme for current and recent ex-smokers following diagnosis of a potentially curable cancer.

Intern Med J. 2016 Sep;46(9):1089-96

Authors: Ong J, Plueckhahn I, Cruickshank D, Churilov L, Mileshkin L

Abstract
BACKGROUND: Cancer patients who quit smoking have improved survival rates. The time of diagnosis provides a 'teachable moment' when healthcare providers can offer smoking-cessation treatment.
AIMS: To assess the impact on quit rates of a tailored smoking-cessation intervention for patients diagnosed with a potentially curable cancer.
METHODS: A prospective, one-arm cohort study of current smokers and recent quitters (<30 days) who had commenced treatment for a potentially curable cancer was performed. Intervention involved an initial motivational interview, regular follow up and pharmacotherapy when appropriate. Quit rates were measured at 1, 3, 6 and 12 months by self-reported abstinence and biochemical confirmation. The primary end point was prolonged abstinence at 12 months. Changes in quality of life parameters and distress were also assessed.
RESULTS: Seventy-one patients were recruited, with a median age of 56 years. Forty-one patients (58%) had a smoking-related cancer. The prolonged abstinence rate at 12 months was 24% (95% confidence interval 14-36%). Factors associated with successful quitting included being in the preparation or action phase of readiness to change at study entry (P = 0.012) and having complications of treatment requiring hospitalisation (P = 0.024). Between baseline and 12 months, quitters reported improvement in self-control (P < 0.001) and reduced levels of distress (P = 0.03) compared to non-quitters.
CONCLUSION: Patients who continue to smoke after being diagnosed with cancer require intensive support to quit. An individualised behavioural and pharmacological intervention can be successful in helping patients quit smoking, with quality of life improvements seen amongst successful quitters. Population measures to stop people starting smoking remain essential.

PMID: 27389637 [PubMed - indexed for MEDLINE]

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Effectiveness and response predictors of omalizumab in a severe allergic asthma population with a high prevalence of comorbidities: the Australian Xolair Registry.

Effectiveness and response predictors of omalizumab in a severe allergic asthma population with a high prevalence of comorbidities: the Australian Xolair Registry.

Intern Med J. 2016 Sep;46(9):1054-62

Authors: Gibson PG, Reddel H, McDonald VM, Marks G, Jenkins C, Gillman A, Upham J, Sutherland M, Rimmer J, Thien F, Katsoulotos GP, Cook M, Yang I, Katelaris C, Bowler S, Langton D, Robinson P, Wright C, Yozghatlian V, Burgess S, Sivakumaran P, Jaffe A, Bowden J, Wark PA, Yan KY, Kritikos V, Peters M, Hew M, Aminazad A, Bint M, Guo M

Abstract
BACKGROUND: Severe asthma is a high impact disease. Omalizumab targets the allergic inflammatory pathway; however, effectiveness data in a population with significant comorbidities are limited.
AIMS: To describe severe allergic asthma, omalizumab treatment outcomes and predictors of response among the Australian Xolair Registry participants.
METHODS: A web-based post-marketing surveillance registry was established to characterise the use, effectiveness and adverse effects of omalizumab (Xolair) for severe allergic asthma.
RESULTS: Participants (n = 192) (mean age 51 years, 118 female) with severe allergic asthma from 21 clinics in Australia were assessed, and 180 received omalizumab therapy. They had poor asthma control (Asthma Control Questionnaire, ACQ-5, mean score 3.56) and significant quality of life impairment (Asthma-related Quality of Life Questionnaire score 3.57), and 52% were using daily oral corticosteroid (OCS). Overall, 95% had one or more comorbidities (rhinitis 48%, obesity 45%, cardiovascular disease 23%). The omalizumab responder rate, assessed by an improvement of at least 0.5 in ACQ-5, was high at 83%. OCS use was significantly reduced. The response in participants with comorbid obesity and cardiovascular disease was similar to those without these conditions. Baseline ACQ-5 ≥ 2.0 (P = 0.002) and older age (P = 0.05) predicted the magnitude of change in ACQ-5 in response to omalizumab. Drug-related adverse events included anaphylactoid reactions (n = 4), headache (n = 2) and chest pains (n = 1).
CONCLUSION: Australian patients with severe allergic asthma report a high disease burden and have extensive comorbidity. Symptomatic response to omalizumab was high despite significant comorbid disease. Omalizumab is an effective targeted therapy for severe allergic asthma with comorbidity in a real-life setting.

PMID: 27350385 [PubMed - indexed for MEDLINE]

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Hearing-related quality of life outcomes for Singaporean children using hearing aids or cochlear implants.

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Hearing-related quality of life outcomes for Singaporean children using hearing aids or cochlear implants.

Eur Ann Otorhinolaryngol Head Neck Dis. 2016 Jun;133 Suppl 1:S25-30

Authors: Looi V, Lee ZZ, Loo JH

Abstract
OBJECTIVES: The Children Using Hearing Devices Quality of Life Questionnaire (CuHDQOL) is a new parent-administered hearing-specific questionnaire for children fitted with hearing devices. The aim of this study was to assess outcomes for hearing-impaired children in Singapore using this measure, as well as to examine its applicability for use in a clinical setting.
MATERIALS AND METHODS: The CuHDQOL has 26 items, uses a recall period of 1 month, and is divided into three sections: parental perspectives and expectations (eight items), impact on the family (eight items) and hearing-related quality of life (QOL) of the child (10 items). Responses are made on a 5-point Likert scale, and transformed to a score from 0-100. Twenty-two parents of children with hearing aids and 14 parents of children with cochlear implants completed the CuHDQOL.
RESULTS: The mean total CuHDQOL scores was 62/100 for the children using hearing aids and 53/100 for children with cochlear implants. Scores for the children using hearing aids were higher across all subscales, with a linear regression showing this to be significant for the parental perspectives and expectations subscale (B=-10.58, P=0.041). Analyses of Variance showed that both the 'Parent Perspective and Expectations' and the 'Hearing-related QOL' subscales were significantly higher than the 'Impact on Family' subscale for both groups (P≤0.003).
CONCLUSIONS: The CuHDQOL was found to be a simple, efficient questionnaire that could easily be incorporated into clinical practice to provide a more holistic evaluation of a child's outcomes post intervention, and/or to monitor their progress over time.

PMID: 27267231 [PubMed - indexed for MEDLINE]

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Research misconduct: time for a re-think?

Research misconduct: time for a re-think?

Intern Med J. 2016 Jun;46(6):728-33

Authors: Breen KJ

Abstract
The incidence of research misconduct appears to be increasing, drawing attention in the general media and academic literature. Concerns have been expressed about probable under-reporting, harms arising, lack of an agreed international definition, welfare of whistleblowers and the adequacy of the investigation processes and any subsequent sanctions. A fully satisfactory approach to prevention, detection, investigation and adjudication has yet to emerge. While the definition of research misconduct contained in the Australian Code for the Responsible Conduct of Research is comprehensive, universities and other research institutions at times struggle in their task of investigating and adjudicating allegations of research misconduct. A more centralised, independent process of oversight and monitoring of this role played by the universities and institutions would help support those institutions and help maintain community confidence in the research endeavour.

PMID: 27257149 [PubMed - indexed for MEDLINE]

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Fibromyalgia onset has a high impact on work ability in Australians.

Fibromyalgia onset has a high impact on work ability in Australians.

Intern Med J. 2016 Sep;46(9):1069-74

Authors: Guymer EK, Littlejohn GO, Brand CK, Kwiatek RA

Abstract
BACKGROUND: Although the disabling effects of fibromyalgia (FM) are well recognised, there are no published data regarding the impact of FM on work ability in Australians. The impact of the development of FM symptoms on ability to work in Australians was explored in a pilot survey project.
METHOD: Members of the Fibromyalgia Support Network of Western Australia were invited to undertake an anonymous online survey. Information was gathered regarding demographics, symptom onset, the timing of diagnosis, employment status and changes in the ability to work.
RESULTS: Two hundred and eighty-seven responses were analysed. Of the respondents, 90.6% were female, with a mean age of 51.1 ± 10.6 years and had experienced symptoms between 2 and 20 years; 52.8% were diagnosed less than 5 years previously. Of the participants, 54.2% were working full time and 21.5% working part time at symptom onset; however, only 15.6% were currently working full time, with 44.8% not currently working at all. Because of FM, 24.3% stopped and 32.6% reduced paid work directly within 5 years of symptom development, with 15.3% ceasing and an additional 17.4% reducing work because of symptoms before diagnosis. Due to FM symptoms, 35.1% currently received financial support because they were unable to work. While 24.3% reported FM medication increased their ability to work, 20.8% reported it reduced their ability to work.
CONCLUSION: A community pilot survey of Australians with FM indicates a high impact on work ability. This occurs from symptom onset and often before diagnosis. Early diagnosis and intervention may provide a window of opportunity to prevent work disability in FM.

PMID: 27242134 [PubMed - indexed for MEDLINE]

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Long-term outcomes after transcatheter aortic valve implantation: the impact of intraoperative tissue Doppler echocardiography.

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Long-term outcomes after transcatheter aortic valve implantation: the impact of intraoperative tissue Doppler echocardiography.

Interact Cardiovasc Thorac Surg. 2016 Sep;23(3):403-9

Authors: Eidet J, Dahle G, Bugge JF, Bendz B, Rein KA, Aaberge L, Offstad JT, Fosse E, Aakhus S, Halvorsen PS

Abstract
OBJECTIVES: Transcatheter aortic valve implantation improves survival in patients with severe aortic stenosis who are ineligible for surgical valve replacement; however, not all patients benefit from the procedure. We endeavoured to identify these patients using intraoperative echocardiography and hypothesized that intraoperative left ventricular function in response to the acute afterload reduction during the procedure was related to long-term outcomes.
METHODS: We prospectively included 64 patients who were scheduled for transcatheter aortic valve implantation and divided them into responders and non-responders based on their left ventricular intraoperative responses to the acute afterload reduction after valve deployment. Responders were defined by increases of ≥20% in left ventricular longitudinal peak systolic velocities determined by tissue Doppler echocardiography. All patients were assessed for the following outcomes at 12 months: cardiac mortality, adverse cardiac events, quality of life, New York Heart Association class, N-terminal pro-brain natriuretic peptide (NT-proBNP) and echocardiography.
RESULTS: Thirty-five patients (55%) were classified as responders and 29 patients (45%) as non-responders. Compared with responders, non-responders had higher risks of death (28 vs 9%, respectively, P = 0.04) and cardiac events (66 vs 26%, respectively, P < 0.01) during the 12-month follow-up. Significant long-term improvements in quality of life, NT-proBNP and left ventricular function were observed only in the responders. Preoperative risk stratification, intraoperative handling, aortic gradient and valve area were similar between groups.
CONCLUSIONS: Intraoperative assessment of left ventricular function by tissue Doppler echocardiography predicted long-term outcomes after transcatheter aortic valve implantation. Our results suggest that a preoperative test of myocardial contractile reserve might improve risk stratification and patient selection prior to the procedure.

PMID: 27241050 [PubMed - indexed for MEDLINE]

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Effect of negative pressure wound therapy followed by tissue flaps for deep sternal wound infection after cardiovascular surgery: propensity score matching analysis.

Effect of negative pressure wound therapy followed by tissue flaps for deep sternal wound infection after cardiovascular surgery: propensity score matching analysis.

Interact Cardiovasc Thorac Surg. 2016 Sep;23(3):397-402

Authors: Morisaki A, Hosono M, Murakami T, Sakaguchi M, Suehiro Y, Nishimura S, Sakon Y, Yasumizu D, Kawase T, Shibata T

Abstract
OBJECTIVES: Deep sternal wound infection (DSWI) after cardiovascular surgery via median sternotomy remains a severe complication associated with a drastic decrease in the quality of life. We assessed the risk factors for in-hospital death caused by DSWI and the available treatments for DSWI.
METHODS: Between January 1991 and August 2015, we retrospectively reviewed 73 patients (51 males and 22 females, mean age 67.5 ± 10.3 years) who developed DSWI after cardiovascular surgery via median sternotomy. Pathogenic bacteria mainly comprised methicillin-resistant Staphylococcus aureus (MRSA) (49.3%). Fifteen patients (20.5%) died in hospital with DSWI. Treatment of DSWI consisted of open daily irrigation (up to 2006) or negative pressure wound therapy (NPWT) (2007 onwards), followed by primary closure or reconstruction of tissue flaps. We assessed the risk factors for in-hospital mortality from DSWI by comparing data from the 15 patients who died and the 58 survivors using propensity score matching analysis of the treatments used for DSWI.
RESULTS: Univariate analysis identified age, use of intra-aortic balloon pumping, prolonged mechanical ventilation, tracheotomy, prolonged intensive care unit stay, postoperative low output syndrome, postoperative myocardial infarction, postoperative renal failure, postoperative use of haemodialysis, postoperative pneumonia, postoperative cerebral disorder, MRSA infection, NPWT and tissue flaps as being associated with in-hospital mortality (P < 0.05). Multivariate analysis identified NPWT (odds ratio, 0.062; 95% confidence interval, 0.004-0.897; P = 0.041) and tissue flaps (odds ratio, 0.022; 95% confidence interval, 0.000-0.960; P = 0.048) as independently associated with reduced in-hospital mortality after DSWI. On comparing 22 patients receiving NPWT with 22 not on NPWT using propensity score matching, patients on NPWT had significantly lower in-hospital mortality than those without NPWT (NPWT vs non-NPWT, 5 vs 36%, P = 0.021). In DSWI infected by MRSA, NPWT significantly reduced the in-hospital mortality caused by DSWI (NPWT vs non-NPWT, 0 vs 52%, P = 0.003).
CONCLUSIONS: NPWT and tissue flaps may be favourable factors associated with reduced in-hospital mortality attributable to DSWI. NPWT as a bridge therapy to tissue flaps may play a major role in treating DSWI and improve the prognosis for patients with MRSA-infected DSWI.

PMID: 27199380 [PubMed - indexed for MEDLINE]

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Quality of Life in Women With Breast Cancer Treated With or Without Chemotherapy.

Quality of Life in Women With Breast Cancer Treated With or Without Chemotherapy.

Cancer Nurs. 2017 Mar/Apr;40(2):108-116

Authors: Tiezzi MF, de Andrade JM, Romão AP, Tiezzi DG, Lerri MR, Carrara HA, Lara LA

Abstract
BACKGROUND: The diagnosis and treatment of breast cancer may negatively affect the quality of life (QOL) of women.
OBJECTIVES: The aim of this study is to assess QOL in women with breast cancer who were treated with or without chemotherapy and to identify factors associated with improved or worsening QOL in these women.
METHODS: This cross-sectional study enrolled 112 women who were treated with chemotherapy (CTX group, with 85 [75.9%] women) or without chemotherapy (non-CTX group, with 27 [24.1%] women) for breast cancer. The Short-Form Health Survey (SF-36) assessed QOL and the Hospital Anxiety and Depression scale assessed anxiety and depression.
RESULTS: The overall mean SF-36 score was below 50 in all domains. Relative to CTX women, non-CTX women were significantly older (P = .001) and more likely to engage in physical exercise (P = .002). The non-CTX group had higher scores in the Physical Functioning (P = .001) and Role-Physical (P = .0009) domains of the SF-36 relative to the CTX group, and the fluoruracil + epirubicin + cyclophosphamide group had significantly lower scores in the SF-36 domains Physical Functioning (P = .009) and Role-Physical (P = .02).
CONCLUSION: Chemotherapy treatment for breast cancer worsens QOL in the Physical Functioning and the Role-Physical domains of the SF-36 relative to women treated without chemotherapy.
IMPLICATIONS FOR PRACTICE: Nurses should assess Physical Functioning and the Role-Physical before treatment, as a woman who was not physically active before breast cancer is not likely to become physically active after treatment. Establishing support groups and providing educational sessions about the disease and its management, supportive care can improve the QOL of this population.

PMID: 27070221 [PubMed - indexed for MEDLINE]

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Haemoglobin disorders in Australia: where are we now and where will we be in the future?

Haemoglobin disorders in Australia: where are we now and where will we be in the future?

Intern Med J. 2016 Jul;46(7):770-9

Authors: Crighton G, Wood E, Scarborough R, Ho PJ, Bowden D

Abstract
Inherited disorders of haemoglobin (Hb), such as thalassaemia and sickle cell disease (SCD) are common and responsible for significant morbidity and mortality on a global scale. As Australia becomes increasingly ethnically diverse, their prevalence will increase. However, we lack important demographic and epidemiological data to manage these disorders and their consequences and to support affected individuals and communities. Thalassaemia and SCD are lifelong conditions. Affected individuals have reduced life expectancies, poorer quality of life and complex healthcare needs. Treatment strategies currently focus on prenatal diagnosis, red blood cell transfusion, iron chelation, management of iron-related complications, haemopoietic stem cell transplantation (HSCT) and hydroxyurea. Currently, the only curative therapy is HSCT; however, gene therapy offers the possibility of cure and trials are currently underway. These therapies are associated with significant complications and substantial costs; there is also evidence of variation in approaches to diagnosis and care. Optimal strategies for many aspects of management are not yet defined and more research is necessary to inform clinical care and health service delivery.

PMID: 27040044 [PubMed - indexed for MEDLINE]

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Erratum to: Factors associated with malaria infection in Honde valley, Mutasa district, Zimbabwe, 2014: a case control study

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Laryngeal trauma with and without tracheal separation

Publication date: Available online 24 August 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Charissa N. Kahue, Alexander Gelbard
External laryngotracheal trauma is a rare occurrence and requires specialized evaluation and management. Airway compromise from laryngotracheal injury can be catastrophic. The stability of an airway must be ensured with rapid and repeated clinical evaluation. Additionally, bedside and operative endoscopy combined with radiographic studies should guide treatment planning. Repair may include open reduction and internal fixation of laryngeal fractures, endolaryngeal mucosal repair (via either endoscopic or open approaches), endoluminal stenting or open repair of laryngotracheal separation.

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Introduction

Publication date: Available online 24 August 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): William Yao

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Management of Retrobulbar Hematoma

Publication date: Available online 24 August 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Matthew A. Tyler, Martin J. Citardi, William C. Yao
Retrobulbar hemorrhage is regarded as one of the most feared conditions in otolaryngology -- its onset can be rapid and can result in irreversible blindness. While a rare occurrence, the otolaryngologist should be compulsive about recognizing this entity, as he or she may be faced with managing this condition either as a consultant, or as one of his or her personal surgical complications. Regardless, prompt recognition and swift action can prevent catastrophic visual loss. This article presents a stepwise discussion of the surgical management of retrobulbar hematoma. Specifically, we discuss lateral canthotomy, cantholysis, and endoscopic orbital decompression.

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Laryngeal trauma with and without tracheal separation

Publication date: Available online 24 August 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Charissa N. Kahue, Alexander Gelbard
External laryngotracheal trauma is a rare occurrence and requires specialized evaluation and management. Airway compromise from laryngotracheal injury can be catastrophic. The stability of an airway must be ensured with rapid and repeated clinical evaluation. Additionally, bedside and operative endoscopy combined with radiographic studies should guide treatment planning. Repair may include open reduction and internal fixation of laryngeal fractures, endolaryngeal mucosal repair (via either endoscopic or open approaches), endoluminal stenting or open repair of laryngotracheal separation.

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IJERPH, Vol. 14, Pages 959: Bisphenol A and Metabolic Diseases: Challenges for Occupational Medicine

IJERPH, Vol. 14, Pages 959: Bisphenol A and Metabolic Diseases: Challenges for Occupational Medicine

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090959

Authors: Lidia Caporossi Bruno Papaleo

The prevalence of metabolic diseases has markedly increased worldwide during the last few decades. Lifestyle factors (physical activity, energy-dense diets), together with a genetic predisposition, are well known factors in the pathophysiology of health problems. Bisphenol A (BPA) is a chemical compound used for polycarbonate plastics, food containers, epoxy resins coating metallic cans for food and beverage conservation. The ability of BPA to act as an endocrine disruptor—xenoestrogen in particular—is largely documented in literature, with numerous publications of in vivo and in vitro studies as well as epidemiological data on humans. Recently, different researchers studied the involvement of BPA in the development of insulin resistance; evidences in this way showed a potential role in etiology of metabolic disease, both for children and for adults. We review the epidemiological literature in the relation between BPA exposure and the risk of metabolic diseases in adults, with a focus on occupational exposure. Considering published data and the role of occupational physicians in promoting Workers' Health, specific situations of exposure to BPA in workplace are described, and proposals for action to be taken are suggested. The comparison of the studies showed that exposure levels were higher in workers than in the general population, even if, sometimes, the measurement units used did not permit rapid comprehension. Nevertheless, occupational medicine focus on reproductive effects and not metabolic ones.

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Introduction

Publication date: Available online 24 August 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): William Yao

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Management of Retrobulbar Hematoma

Publication date: Available online 24 August 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Matthew A. Tyler, Martin J. Citardi, William C. Yao
Retrobulbar hemorrhage is regarded as one of the most feared conditions in otolaryngology -- its onset can be rapid and can result in irreversible blindness. While a rare occurrence, the otolaryngologist should be compulsive about recognizing this entity, as he or she may be faced with managing this condition either as a consultant, or as one of his or her personal surgical complications. Regardless, prompt recognition and swift action can prevent catastrophic visual loss. This article presents a stepwise discussion of the surgical management of retrobulbar hematoma. Specifically, we discuss lateral canthotomy, cantholysis, and endoscopic orbital decompression.

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Gut Microbiota and Atherosclerosis

Abstract

Purpose of Review

Studies in microbiota-mediated health risks have gained traction in recent years since the compilation of the Human Microbiome Project. No longer do we believe that our gut microbiota is an inert set of microorganisms that reside in the body without consequence. In this review, we discuss the recent findings which further our understanding of the connection between the gut microbiota and the atherosclerosis.

Recent Findings

We evaluate studies which illustrate the current understanding of the relationship between infection, immunity, altered metabolism, and bacterial products such as immune activators or dietary metabolites and their contributions to the development of atherosclerosis. In particular, we critically examine rec ent clinical and mechanistic findings for the novel microbiota-dependent dietary metabolite, trimethylamine N-oxide (TMAO), which has been implicated in atherosclerosis. These discoveries are now becoming integrated with advances in microbiota profiling which enhance our ability to interrogate the functional role of the gut microbiome and develop strategies for targeted therapeutics.

Summary

The gut microbiota is a multi-faceted system that is unraveling novel contributors to the development and progression of atherosclerosis. In this review, we discuss historic and novel contributors while highlighting the TMAO story mainly as an example of the various paths taken beyond deciphering microbial composition to elucidate downstream mechanisms that promote (or protect from) atherogenesis in the hopes of translating these findings from bench to bedside.

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Pomegranate peel extract attenuates D-galactose-induced oxidative stress and hearing loss by regulating PNUTS/PP1 activity in the mouse cochlea.

Pomegranate peel extract attenuates D-galactose-induced oxidative stress and hearing loss by regulating PNUTS/PP1 activity in the mouse cochlea.

Neurobiol Aging. 2017 Jul 25;59:30-40

Authors: Liu S, Xu T, Wu X, Lin Y, Bao D, Di Y, Ma T, Dang Y, Jia P, Xian J, Wang A, Liu Y

Abstract
Oxidative stress is considered to be a major contributor to age-related hearing loss (ARHL). Here, we investigated whether pomegranate peel extract (PPE) protected against hearing loss by decreased oxidative stress in the cochlea of D-galactose-induced accelerated aging mice. The aging mice exhibited an increase in hearing threshold shifts and hair cells loss, which were improved in the PPE-treated aging mice. The aging mice also exhibited an increase in 4-hydroxynonenal, the expression of protein phosphatase 1 nuclear targeting subunit (PNUTS), p53 and caspase-3, and a decrease in protein phosphatase 1 (PP1) and MDM2 in the cochlea. PPE treatment reversed the changes in aforementioned molecules. Our results suggested that PPE can protect against ARHL, the underlying mechanisms may involve in the inhibition of oxidative damage of cochlea, possibly by regulating PNUTS/PP1 pathway. The results from the present study provide a new therapeutic strategy to use PPE for prevention of ARHL.

PMID: 28837860 [PubMed - as supplied by publisher]

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Systemic antibiotics for treating malignant wounds.

Systemic antibiotics for treating malignant wounds.

Cochrane Database Syst Rev. 2017 Aug 24;8:CD011609

Authors: Ramasubbu DA, Smith V, Hayden F, Cronin P

Abstract
BACKGROUND: Malignant wounds are a devastating complication of cancer. They usually develop in the last six months of life, in the breast, chest wall or head and neck regions. They are very difficult to treat successfully, and the commonly associated symptoms of pain, exudate, malodour, and the risk of haemorrhage are extremely distressing for those with advanced cancer. Treatment and care of malignant wounds is primarily palliative, and focuses on alleviating pain, controlling infection and odour from the wound, managing exudate and protecting the surrounding skin from further deterioration. In malignant wounds, with tissue degradation and death, there is proliferation of both anaerobic and aerobic bacteria. The aim of antibiotic therapy is to successfully eliminate these bacteria, reduce associated symptoms, such as odour, and promote wound healing.
OBJECTIVES: To assess the effects of systemic antibiotics for treating malignant wounds.
SEARCH METHODS: We searched the following electronic databases on 8 March 2017: the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library, 2017, Issue 3), Ovid MEDLINE, Ovid Embase and EBSCO CINAHL Plus. We also searched the clinical trial registries of the World Health Organization (WHO) International Clinical Trials Registry Platform (http://ift.tt/1VXDXYs) and ClinicalTrials.gov on 20 March 2017; and OpenSIGLE (to identify grey literature) and ProQuest Dissertations & Theses Global (to retrieve dissertation theses related to our topic of interest) on 13 March 2017.
SELECTION CRITERIA: Randomised controlled trials that assessed the effects of any systemic antibiotics on malignant wounds were eligible for inclusion.
DATA COLLECTION AND ANALYSIS: Two review authors independently screened and selected trials for inclusion, assessed risk of bias and extracted study data. A third reviewer checked extracted data for accuracy prior to analysis.
MAIN RESULTS: We identified only one study for inclusion in this review. This study was a prospective, double-blind cross-over trial that compared the effect of systemic metronidazole with a placebo on odour in malignant wounds. Nine participants with a fungating wound and for whom the smell was troublesome were recruited and six of these completed both the intervention and control (placebo) stages of the trial. Each stage lasted fourteen days, with a fourteen day gap (washout period) between administration of the metronidazole and the placebo.The study, in comparing metronidazole and placebo, reported on two of this review's pre-specified primary outcomes (malodour and adverse effects of the treatment) and on none of the review's pre-specified secondary outcomes.MalodourThe mean malodour (smell) scores for the metronidazole group was 1.17 (standard deviation (SD) 1.60) and the mean for the placebo group was 3.33 (SD 0.82). It is unclear if systemic antibiotics were associated with a difference in malodour (1 study with 6 participants; MD -2.16, 95% CI -3.6 to -0.72) as the quality of the evidence (GRADE) was very low for this outcome. The study was downgraded due to high risk of attrition bias (33% loss to follow-up) and very serious imprecision due to the small sample size.Adverse effectsNo adverse effects of the treatment were reported in either the intervention or control group by the trial authors.
AUTHORS' CONCLUSIONS: It is uncertain whether systemic metronidazole leads to a reduction in malodour in patients with malignant wounds. This is because we were only able to include a single study at high risk of bias with a very small sample size, which focused only on patients with breast cancer. More research is needed to substantiate these findings and to investigate the effects of systemic metronidazole and other antibiotics on quality of life, pain relief, exudate and tumour containment in patients with malignant wounds.

PMID: 28837757 [PubMed - as supplied by publisher]

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Functional outcomes and quality of life after total laryngectomy with noncircumferential radial forearm free tissue transfer.

Functional outcomes and quality of life after total laryngectomy with noncircumferential radial forearm free tissue transfer.

Head Neck. 2017 Aug 24;:

Authors: Graville DJ, Palmer AD, Chambers CM, Ottenstein L, Whalen B, Andersen PE, Wax MK, Cohen JI

Abstract
BACKGROUND: The purpose of this study was to compare long-term functional and quality of life (QOL) outcomes after total laryngectomy with primary closure and those who underwent reconstruction with noncircumferential radial free forearm tissue transfer (RFFTT).
METHODS: Sixty-seven patients were identified by chart review and underwent long-term follow-up using QOL surveys and standardized interviews.
RESULTS: The RFFTT group had significantly higher rates of chemotherapy, gastric tube (G-tube) at surgery, and postoperative stricture. At follow-up, most patients (88%) had a tracheoesophageal prosthesis (TEP) and were using it as their primary communication method. Diet and swallowing outcomes were comparable and no one had a G-tube. Device life and TEP complications did not differ significantly. Only voice-related QOL differed significantly between the RFFTT group and those who had undergone total laryngectomy without adjuvant treatment.
CONCLUSION: Despite more extensive treatment, the reconstructed group achieved comparable outcomes to those who had undergone total laryngectomy with adjuvant treatment.

PMID: 28837753 [PubMed - as supplied by publisher]

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Comparison of Output Volume Thresholds for Drain Removal After Selective Lateral Neck Dissection: A Randomized Clinical Trial.

Comparison of Output Volume Thresholds for Drain Removal After Selective Lateral Neck Dissection: A Randomized Clinical Trial.

JAMA Otolaryngol Head Neck Surg. 2017 Aug 24;:

Authors: Tamplen ML, Tamplen J, Shuman E, Heaton CM, George JR, Wang SJ, Ryan WR

Abstract
Importance: Limited evidence is available to guide drain removal after selective lateral neck dissection (SLND). Patients may have drains left in longer than necessary, leading to patient discomfort, longer hospitalizations, and increased costs.
Objective: To compare 2 output volume thresholds for drain removal after SLND.
Design, Setting, and Participants: This single-blind randomized clinical trial included a consecutive sample of all adult patients undergoing unilateral or bilateral SLND of levels I to III, I to IV, II to III, or II to IV from March 1, 2015, to December 1, 2016, at a tertiary academic medical center. Eligible patients had at least 30 days of follow-up. Patients undergoing a parotidectomy, a level V lymphadenectomy, or an SLND that communicated with the upper aerodigestive tract or who had a suspected chylous fistula on the first postoperative day were excluded from enrollment. Sixty-five patients were offered enrollment and 12 refused. Fifty-three patients who underwent 67 SLNDs were included in the final analysis, with no patients lost to follow-up. Analysis was based on intention to treat.
Interventions: On the first postoperative day, patients were randomized to either a drain removal threshold of less than 30 mL or less than 100 mL during a 24-hour period.
Main Outcomes and Measures: Duration of drain use, hospital length of stay, and wound complications for both groups.
Results: Among the 53 patients with 67 SLNDs included in the analysis (45 men [85%] and 8 women [15%]; mean age, 58.5 years [95% CI, 53.2-64.5 years]), 32 SLNDs were randomized to the 100-mL group and 35 were randomized to the 30-mL group. No meaningful differences in preoperative characteristics were noted between groups. Two seromas occurred in the 100-mL group (2 of 32 [6.3%; 95% CI, 0%-13.5%]) and in the 30-mL group (2 of 35 [5.7%; 95% CI, 0%-14.6%]). No hematomas, chylous fistulas, or wound infections occurred. The 100-mL group had a 1.87-day reduction in mean hospital length of stay (95% CI, 0.66-3.10 days).
Conclusions and Relevance: A volume threshold for drain removal of 100 mL during a 24-hour period after SLNDs appears to be safe and may significantly reduce duration of drain use and hospital length of stay.
Trial Registration: clinicaltrials.gov Identifier: NCT03113526.

PMID: 28837725 [PubMed - as supplied by publisher]

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Repair of Lateral Wall Insufficiency.

Repair of Lateral Wall Insufficiency.

JAMA Facial Plast Surg. 2017 Aug 24;:

Authors: Vaezeafshar R, Moubayed SP, Most SP

Abstract
Importance: Lateral wall insufficiency (LWI) is classified by the zone in which it occurs. Multiple techniques for treating LWI are described in the literature and are used, but no treatment approach has been widely adopted.
Objective: To establish an algorithm for treatment of LWI by evaluating subjective and objective outcomes of patients who underwent LWI repair and comparing these results with those of a control group who received no specific LWI repair.
Design, Setting, and Participants: This case-control study was conducted in a tertiary referral center. In group 1, there were 44 patients who underwent septorhinoplasty to repair LWI between February 1, 2014, and May 31, 2016. In group 2, there were 44 age- and sex-matched patients who underwent cosmetic septorhinoplasty without LWI repair. Data analysis was conducted from February 1, 2014, to May 31, 2016.
Intervention: Open septorhinoplasty.
Main Outcomes and Measures: Nasal Obstruction Symptom Evaluation (NOSE) scores and LWI grades.
Results: Forty-four patients (8 men and 36 women, with a mean [SD] age of 46 [16] years) who underwent open septorhinoplasty to repair LWI and 44 age- and sex-matched patients (composed of 8 men and 36 women, with a mean [SD] age of 41 [12] years) were included in the study. The mean (SD) preoperative NOSE scores were 69.4 (22) in group 1 and 20.5 (20.8) in group 2 (P < .001). The NOSE scores in both groups significantly improved after surgery (44.7 [95% CI, -28.9 to -49.9; P < .001] and -14.5 [95% CI, -2.7 to -18.5; P = .02]), although the improvement in group 2 was not clinically significant. The mean preoperative LWI grades were higher in group 1 than in group 2 for each zone (P < .001 and P = .001) but were similar between groups for each zone after surgery. Postoperative LWI scores significantly decreased in group 1 to levels similar to that of group 2. A positive linear correlation was noted between NOSE scores and LWI grades, with the strongest correlation between preoperative zone 1 LWI grades and NOSE scores (R = 0.68). Lateral crural strut grafts were used for zone 1 LWI and alar rim grafts were used for zone 2 LWI.
Conclusions and Relevance: The LWI grading system enables surgeons to localize LWI, tailor the surgical treatment to the patient, and monitor improvements in the postoperative period.
Level of Evidence: 3.

PMID: 28837711 [PubMed - as supplied by publisher]

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Hearing Loss and Patient-Physician Communication: The Role of an Otolaryngologist.

Hearing Loss and Patient-Physician Communication: The Role of an Otolaryngologist.

JAMA Otolaryngol Head Neck Surg. 2017 Aug 24;:

Authors: Weinreich HM

PMID: 28837710 [PubMed - as supplied by publisher]

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Extranodal spread of primary and secondary metastatic nodes: The dominant risk factor of survival in patients with head and neck squamous cell carcinoma.

Extranodal spread of primary and secondary metastatic nodes: The dominant risk factor of survival in patients with head and neck squamous cell carcinoma.

PLoS One. 2017;12(8):e0183611

Authors: Sumi M, Sato S, Nakamura T

Abstract
Extranodal spread (ENS) in patients with head and neck squamous cell carcinoma (HNSCC) can greatly influence the prognostic outcomes. However, the relative risks of ENS in the primary (1st) and secondary (2nd) metastatic nodes (mets) are not well documented. We retrospectively analyzed the hazard ratios (HRs) of ENS in the 1st and 2nd mets from 516 HNSCC patients who had undergone primary tumor excision. The impact of clinically and/or histologically confirmed ENS-positive mets on prognosis in terms of cancer-specific survival was analyzed. Cox proportional hazard regression analysis indicated that ENS-positive 1st met (adjusted HR = 3.15; 95% CI, 1.40-7.56; p = 0.006) and ENS-positive 2nd met (adjusted HR = 4.03; 95% CI, 1.41-16.96; p = 0.007) significantly and independently predicted poor prognosis; however, other variables including primary site, met size or numbers, and met location in the contralateral side of the primary lesion, did not. Cumulative incidence function and Cox analyses indicated that differences in ENS profiles of 1st and 2nd mets stratified HNSCC patients with varying risks of poor outcome; HRs relative to patients with ENS-positive 1st met (-)/ENS-positive 2nd met (-) were 4.02 (95% CI, 1.78-8.24; p = 0.002), 8.29 (95% CI, 4.58-14.76; p <0.001), and 25.80 (95% CI, 10.15-57.69; p <0.001) for patients with ENS-positive 1st met (+)/ENS-positive 2nd met (-), ENS-positive 1st met (-)/ENS-positive 2nd met (+), and ENS-positive 1st met (+)/ENS-positive 2nd met (+) patients, respectively. Kaplan-Meier analysis indicated that the 2nd met that appeared in the neck side with a history of 1st met and neck dissection had a higher risk of ENS than the 2nd met in the neck side without the history (p = 0.003). These results suggested that ENS is a dominant prognostic predictor of HNSCC patients, with double-positive ENS in the 1st and 2nd mets predicting the most devastating outcome.

PMID: 28837620 [PubMed - in process]

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LL-37 causes cell death of human nasal epithelial cells, which is inhibited with a synthetic glycosaminoglycan.

LL-37 causes cell death of human nasal epithelial cells, which is inhibited with a synthetic glycosaminoglycan.

PLoS One. 2017;12(8):e0183542

Authors: Thomas AJ, Pulsipher A, Davis BM, Alt JA

Abstract
LL-37 is an immune peptide that regulates innate and adaptive immune responses in the upper airways. Elevated levels of LL-37 have been linked to cell death and inflammatory diseases, such as chronic rhinosinusitis (CRS). Glycosaminoglycans (GAGs) are polysaccharides that are found on respiratory epithelial cells and serve important roles in mucosal surface repair. Recent findings suggest that a synthetic glycosaminoglycan (GM-0111) can protect against LL-37-induced sinonasal mucosal inflammation and cell death in a murine model of acute RS. Herein, we elucidated the mechanisms by which LL-37 causes sinonasal inflammation and how GM-0111 can prevent these mechanisms. When challenged with LL-37, human nasal epithelial cells (HNEpCs) and mouse macrophages (J774.2) demonstrated increased release of adenosine triphosphate (ATP) and interleukin (IL)-6 and -8, as well as cell death and lysis. These cellular responses were all blocked dose-dependently by pre-treatment with GM-0111. We identified that LL-37-induced cell death is associated with caspase-1 and -8 activation, but not activation of caspase-3/7. These responses were again blocked by GM-0111. Our data suggest that LL-37 causes cellular death of HNEpCs and macrophages through the pro-inflammatory necrotic and/or pyroptotic pathways rather than apoptosis, and that a GM-0111 is capable of inhibiting these pro-inflammatory cellular events.

PMID: 28837619 [PubMed - in process]

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Activation of Matrix Hyaluronan-Mediated CD44 Signaling, Epigenetic Regulation and Chemoresistance in Head and Neck Cancer Stem Cells.

Activation of Matrix Hyaluronan-Mediated CD44 Signaling, Epigenetic Regulation and Chemoresistance in Head and Neck Cancer Stem Cells.

Int J Mol Sci. 2017 Aug 24;18(9):

Authors: Bourguignon LYW, Earle C, Shiina M

Abstract
Head and neck squamous cell carcinoma (HNSCC) is a solid tumor composed by a genotypically and phenotypically heterogeneous population of neoplastic cells types. High recurrence rate and regional metastases lead to major morbidity and mortality. Recently, many studies have focused on cellular and molecular mechanisms of tumor progression that can help to predict prognosis and to choose the best therapeutic approach for HNSCC patients. Hyaluronan (HA), an important glycosaminoglycan component of the extracellular matrix (ECM), and its major cell surface receptor, CD44, have been suggested to be important cellular mediators influencing tumor progression and treatment resistance in head and neck cancer. HNSCC contains a small subpopulation of cells that exhibit a hallmark of CD44-expressing cancer stem cell (CSC) properties with self-renewal, multipotency, and a unique potential for tumor initiation. HA has been shown to stimulate a variety of CSC functions including self-renewal, clone formation and differentiation. This review article will present current evidence for the existence of a unique small population of CD44v3(high)ALDH(high)-expressing CSCs in HNSCC. A special focus will be placed on the role of HA/CD44-induced oncogenic signaling and histone methyltransferase, DOT1L activities in regulating histone modifications (via epigenetic changes) and miRNA activation. Many of these events are essential for the CSC properties such as Nanog/Oct4/Sox2 expression, spheroid/clone formation, self-renewal, tumor cell migration/invasion, survival and chemotherapeutic drug resistance in HA-activated head and neck cancer. These newly-discovered HA/CD44-mediated oncogenic signaling pathways delineate unique tumor dynamics with implications for defining the drivers of HNSCC progression processes. Most importantly, the important knowledge obtained from HA/CD44-regulated CSC signaling and functional activation could provide new information regarding the design of novel drug targets to overcome current therapeutic drug resistance which will have significant treatment implications for head and neck cancer patients.

PMID: 28837080 [PubMed - in process]

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Synthesis and Characterization of Tissue Plasminogen Activator-Functionalized Superparamagnetic Iron Oxide Nanoparticles for Targeted Fibrin Clot Dissolution.

Synthesis and Characterization of Tissue Plasminogen Activator-Functionalized Superparamagnetic Iron Oxide Nanoparticles for Targeted Fibrin Clot Dissolution.

Int J Mol Sci. 2017 Aug 24;18(9):

Authors: Heid S, Unterweger H, Tietze R, Friedrich RP, Weigel B, Cicha I, Eberbeck D, Boccaccini AR, Alexiou C, Lyer S

Abstract
Superparamagnetic iron oxide nanoparticles (SPIONs) have attracted great attention in many biomedical fields and are used in preclinical/experimental drug delivery, hyperthermia and medical imaging. In this study, biocompatible magnetite drug carriers, stabilized by a dextran shell, were developed to carry tissue plasminogen activator (tPA) for targeted thrombolysis under an external magnetic field. Different concentrations of active tPA were immobilized on carboxylated nanoparticles through carbodiimide-mediated amide bond formation. Evidence for successful functionalization of SPIONs with carboxyl groups was shown by Fourier transform infrared spectroscopy. Surface properties after tPA immobilization were altered as demonstrated by dynamic light scattering and ζ potential measurements. The enzyme activity of SPION-bound tPA was determined by digestion of fibrin-containing agarose gels and corresponded to about 74% of free tPA activity. Particles were stored for three weeks before a slight decrease in activity was observed. tPA-loaded SPIONs were navigated into thrombus-mimicking gels by external magnets, proving effective drug targeting without losing the protein. Furthermore, all synthesized types of nanoparticles were well tolerated in cell culture experiments with human umbilical vein endothelial cells, indicating their potential utility for future therapeutic applications in thromboembolic diseases.

PMID: 28837060 [PubMed - in process]

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Frozen Section Evaluation of Margin Status in Primary Squamous Cell Carcinomas of the Head and Neck: A Correlation Study of Frozen Section and Final Diagnoses.

Frozen Section Evaluation of Margin Status in Primary Squamous Cell Carcinomas of the Head and Neck: A Correlation Study of Frozen Section and Final Diagnoses.

Head Neck Pathol. 2017 Aug 23;:

Authors: Layfield EM, Schmidt RL, Esebua M, Layfield LJ

Abstract
Frozen section is routinely used for intraoperative margin evaluation in carcinomas of the head and neck. We studied a series of frozen sections performed for margin status of head and neck tumors to determine diagnostic accuracy. All frozen sections for margin control of squamous carcinomas of the head and neck were studied from a 66 month period. Frozen and permanent section diagnoses were classified as negative or malignant. Correlation of diagnoses was performed to determine accuracy. One thousand seven hundred and ninety-six pairs of frozen section and corresponding permanent section diagnoses were obtained. Discordances were found in 55 (3.1%) pairs. In 35 pairs (1.9%), frozen section was reported as benign, but permanent sections disclosed carcinoma. In 21 cases, the discrepancy was due to sampling and in the remaining cases it was an interpretive error. In 20 cases (1.1%), frozen section was malignant, but the permanent section was interpreted as negative. Frozen section is an accurate method for evaluation of operative margins for head and neck carcinomas with concordance between frozen and permanent results of 97%. Most errors are false negative results with the majority of these being due to sampling issues.

PMID: 28836224 [PubMed - as supplied by publisher]

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Cystic lesions of the parotid gland: radiologic-pathologic correlation according to the latest World Health Organization 2017 Classification of Head and Neck Tumours.

Cystic lesions of the parotid gland: radiologic-pathologic correlation according to the latest World Health Organization 2017 Classification of Head and Neck Tumours.

Jpn J Radiol. 2017 Aug 23;:

Authors: Takita H, Takeshita T, Shimono T, Tanaka H, Iguchi H, Hashimoto S, Kuwae Y, Ohsawa M, Miki Y

Abstract
The latest World Health Organization 2017 Classification of Head and Neck Tumours includes a new chapter on tumors and tumor-like lesions of the neck and lymph nodes. Tumor-like lesions include a variety of cystic lesions of the parotid gland. Cystic lesions of the parotid gland can be divided into three groups: non-neoplastic cysts, benign tumors with macrocystic change, and malignant tumors with macrocystic change. It is important to distinguish these lesions from one another because treatment and patient management differ among the three groups. The purpose of this review is to describe the magnetic resonance imaging and scintigraphy findings and the histopathologic characteristics of each parotid gland lesion based on the latest World Health Organization 2017 Classification of Head and Neck Tumours and to summarize the key points of differential diagnosis for cystic lesions of the parotid gland.

PMID: 28836142 [PubMed - as supplied by publisher]

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Checkpoint immunotherapy in head and neck cancers.

Checkpoint immunotherapy in head and neck cancers.

Cancer Metastasis Rev. 2017 Aug 23;:

Authors: Zolkind P, Uppaluri R

Abstract
Checkpoint inhibitors have recently gained FDA approval for the treatment of cisplatin-resistant recurrent and metastatic head and neck squamous cell carcinoma (HNSCC) by outperforming standard of care chemotherapy and inducing durable responses in a subset of patients. These monoclonal antibodies unleash the patient's own immune system to target cancer cells. HNSCC is a good target for these agents as there is ample evidence of active immunosurveillance in the head and neck and a number of immune evasion mechanisms by which HNSCCs form progressive disease including via the PD-1/PD-L1 axis. As HNSCCs typically possess a moderately high mutation burden, they should express numerous mutation-derived antigen targets for immune detection. However, with response rates less than 20% in clinical trials, there is a need for biomarkers to screen patients as well as clinical trials evaluating novel combinations to improve outcomes. The aim of this review is to provide historical and mechanistic context for the use of checkpoint inhibitors in head and neck cancer and provide a perspective on the role of novel checkpoints, biomarkers, and combination therapies that are evolving in the near term for patients with HNSCC.

PMID: 28836124 [PubMed - as supplied by publisher]

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Involvement of aberrantly expressed microRNAs in the pathogenesis of head and neck squamous cell carcinoma.

Involvement of aberrantly expressed microRNAs in the pathogenesis of head and neck squamous cell carcinoma.

Cancer Metastasis Rev. 2017 Aug 23;:

Authors: Koshizuka K, Hanazawa T, Arai T, Okato A, Kikkawa N, Seki N

Abstract
MicroRNAs (miRNAs) are small noncoding RNAs that act as fine-tuners of the post-transcriptional control of protein-coding or noncoding RNAs by repressing translation or cleaving RNA transcripts in a sequence-dependent manner in cells. Accumulating evidence have been indicated that aberrantly expressed miRNAs are deeply involved in human pathogenesis, including cancers. Surprisingly, these small, single-stranded RNAs (18-23 nucleotides) have been shown to function as antitumor or oncogenic RNAs in several types of cancer cells. A single miRNA has regulating hundreds or thousands of different mRNAs, and individual mRNA has been regulated by multiple different miRNAs in normal cells. Therefore, tightly controlled RNA networks can be disrupted by dysregulated of miRNAs in cancer cells. Investigation of novel miRNA-mediated RNA networks in cancer cells could provide new insights in the field of cancer research. In this review, we focus on head and neck squamous cell carcinoma (HNSCC) and discuss current findings of the involvement of aberrantly expressed miRNAs in the pathogenesis of HNSCC.

PMID: 28836104 [PubMed - as supplied by publisher]

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Endoscopic electrocauterization of pyriform sinus fistula.

Endoscopic electrocauterization of pyriform sinus fistula.

Eur Arch Otorhinolaryngol. 2017 Aug 23;:

Authors: Ishinaga H, Kobayashi M, Qtsu K, Nishida K, Sakaida H, Kitano M, Nakamura S, Chiyonobu K, Takeuchi K

Abstract
To determine the efficacy of endoscopic electrocauterization for pyriform sinus fistula (PSF) using a flexible Bugbee cautery electrode. From 2009 to 2016, a total of eight patients with acute suppurative thyroiditis or cervical abscess secondary to PSF were retrospectively registered in our study (three males, five females; median age 6.5 years). All patients underwent endoscopic electrocauterization as treatment for PSF. Six of eight patients had no recurrence after the initial endoscopic electrocauterization of PSF. One patient with recurrence developed symptoms 9 days after cauterization and another experienced recurrence after 2 years. Mean follow-up for the eight patients was 50 months (range 5-96 months). No post-operative complication was reported. Endoscopic electrocauterization appears to be a less-invasive, safe, and effective method for the treatment of PSF.

PMID: 28836049 [PubMed - as supplied by publisher]

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Enhanced survival of ischemic skin flap by combined treatment with bone marrow-derived stem cells and low-level light irradiation.

Enhanced survival of ischemic skin flap by combined treatment with bone marrow-derived stem cells and low-level light irradiation.

Lasers Med Sci. 2017 Aug 23;:

Authors: Moon JH, Rhee YH, Ahn JC, Kim B, Lee SJ, Chung PS

Abstract
The aim of this study is to examine the enhanced survival effect of ischemic skin flap by combined treatment with bone marrow-derived stem cells (BMSCs) and low-level light irradiation (LLLI). The neovasculogenic effect of BMSCs induced by LLLI was detected using a wound healing and tube formation assay. ICR mice were divided into four groups: control group, LLLI group, BMSCs group, and combine-treated group. The percentage of skin flap necrosis area was calculated on the seventh post-operative day. Specimens were harvested for histologic analyses. LLLI promoted BMSC migration and tube formation. The flap survival rate of combined treated group was significantly higher than that of the control group. Histologic results demonstrated a significant increase in neovascularization in the combined treatment group. This study demonstrates that combination treatment of BMSCs and LLLI could enhance the survival of ischemic skin flap in a mouse model.

PMID: 28836013 [PubMed - as supplied by publisher]

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Grading Dysphagia as a Toxicity of Head and Neck Cancer: Differences in Severity Classification Based on MBS DIGEST and Clinical CTCAE Grades.

Grading Dysphagia as a Toxicity of Head and Neck Cancer: Differences in Severity Classification Based on MBS DIGEST and Clinical CTCAE Grades.

Dysphagia. 2017 Aug 23;:

Authors: Goepfert RP, Lewin JS, Barrow MP, Warneke CL, Fuller CD, Lai SY, Weber RS, Hutcheson KA

Abstract
Clinician-reported toxicity grading through common terminology criteria for adverse events (CTCAE) stages dysphagia based on symptoms, diet, and tube dependence. The new dynamic imaging grade of swallowing toxicity (DIGEST) tool offers a similarly scaled five-point ordinal summary grade of pharyngeal swallowing as determined through results of a modified barium swallow (MBS) study. This study aims to inform clinicians on the similarities and differences between dysphagia severity according to clinical CTCAE and MBS-derived DIGEST grading. A cross-sectional sample of 95 MBS studies was randomly selected from a prospectively-acquired MBS database among patients treated with organ preservation strategies for head and neck cancer. MBS DIGEST and clinical CTCAE dysphagia grades were compared. DIGEST and CTCAE dysphagia grades had "fair" agreement per weighted κ of 0.358 (95% CI .231-.485). Using a threshold of DIGEST ≥ 3 as reference, CTCAE had an overall sensitivity of 0.50, specificity of 0.84, and area under the curve (AUC) of 0.67 to identify severe MBS-detected dysphagia. At less than 6 months, sensitivity was 0.72, specificity was 0.76, and AUC was 0.75 while at greater than 6 months, sensitivity was 0.22, specificity was 0.90, and AUC was 0.56 for CTCAE to detect dysphagia as determined by DIGEST. Classification of pharyngeal dysphagia on MBS using DIGEST augments our understanding of dysphagia severity according to the clinically-derived CTCAE while maintaining the simplicity of an ordinal scale. DIGEST likely complements CTCAE toxicity grading through improved specificity for physiologic dysphagia in the acute phase and improved sensitivity for dysphagia in the late-phase.

PMID: 28836005 [PubMed - as supplied by publisher]

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Lemierre's syndrome, necrotizing pneumonia and staphylococcal septic shock treated with extracorporeal life support.

Lemierre's syndrome, necrotizing pneumonia and staphylococcal septic shock treated with extracorporeal life support.

SAGE Open Med Case Rep. 2017;5:2050313X17722726

Authors: Mattke AC, Prabhu S, Clark J, Labrom R, Burns H, Schlapbach LJ

Abstract
OBJECTIVES: Lemierre's syndrome cause by methicillin-sensitive Staphylococcus aureus is rare, but can lead to necrotizing pneumonia and septicaemia. When treating such patient with extracorporeal life support source control can be both challenging and controversial.
METHODS: In this report we present a 12 year old male who presented with Lemierre's syndrome from which he developed septic shock and severe necrotizing pneumonia. He also showed multiple pulmonary embolisms from the internal jugular vein thrombi, resulting in acute respiratory distress syndrome.
RESULTS: The patient was treated with extracorporeal life support. Subsequent computed tomography revealed multiple abscesses throughout his lungs and around vertebral bodies C1 and C2, for which source control with drainage of the cervical abscesses was achieved while on extracorporeal life support. The necrotizing pneumonia gradually improved, and partial pneumectomy was avoided. He was successfully separated from extracorporeal life support and respiratory support and recovered from his illness. Follow-up imaging showed almost complete resolution of the pulmonary abscesses. Osteomyelitis of C1/C2 and severe muscle wasting required a prolonged hospital stay.
CONCLUSION: This case highlights the challenges of supporting patients suffering from disseminated staphylococcal sepsis with extracorporeal life support and the key role of source control and demonstrates the value of using extracorporeal life support in necrotizing pneumonia.

PMID: 28835825 [PubMed]

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Fusion or Fission: The Destiny of Mitochondria In Traumatic Brain Injury of Different Severities.

Fusion or Fission: The Destiny of Mitochondria In Traumatic Brain Injury of Different Severities.

Sci Rep. 2017 Aug 23;7(1):9189

Authors: Di Pietro V, Lazzarino G, Amorini AM, Signoretti S, Hill LJ, Porto E, Tavazzi B, Lazzarino G, Belli A

Abstract
Mitochondrial dynamics are regulated by a complex system of proteins representing the mitochondrial quality control (MQC). MQC balances antagonistic forces of fusion and fission determining mitochondrial and cell fates. In several neurological disorders, dysfunctional mitochondria show significant changes in gene and protein expression of the MQC and contribute to the pathophysiological mechanisms of cell damage. In this study, we evaluated the main gene and protein expression involved in the MQC in rats receiving traumatic brain injury (TBI) of different severities. At 6, 24, 48 and 120 hours after mild TBI (mTBI) or severe TBI (sTBI), gene and protein expressions of fusion and fission were measured in brain tissue homogenates. Compared to intact brain controls, results showed that genes and proteins inducing fusion or fission were upregulated and downregulated, respectively, in mTBI, but downregulated and upregulated, respectively, in sTBI. In particular, OPA1, regulating inner membrane dynamics, cristae remodelling, oxidative phosphorylation, was post-translationally cleaved generating differential amounts of long and short OPA1 in mTBI and sTBI. Corroborated by data referring to citrate synthase, these results confirm the transitory (mTBI) or permanent (sTBI) mitochondrial dysfunction, enhancing MQC importance to maintain cell functions and indicating in OPA1 an attractive potential therapeutic target for TBI.

PMID: 28835707 [PubMed - in process]

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Emergency Sleep Medicine.

Emergency Sleep Medicine.

Semin Neurol. 2017 Aug;37(4):471-480

Authors: Guay CS, Ellenbogen JM

PMID: 28837994 [PubMed - in process]

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Clinical Overview of REM Sleep Behavior Disorder.

Clinical Overview of REM Sleep Behavior Disorder.

Semin Neurol. 2017 Aug;37(4):461-470

Authors: Porter VR, Avidan AY

PMID: 28837993 [PubMed - in process]

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Diagnosis and Management of Narcolepsy.

Diagnosis and Management of Narcolepsy.

Semin Neurol. 2017 Aug;37(4):446-460

Authors: Schneider L, Mignot E

PMID: 28837992 [PubMed - in process]

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The Role of Iron in Pediatric Restless Legs Syndrome and Periodic Limb Movements in Sleep.

The Role of Iron in Pediatric Restless Legs Syndrome and Periodic Limb Movements in Sleep.

Semin Neurol. 2017 Aug;37(4):439-445

Authors: Munzer T, Felt B

PMID: 28837991 [PubMed - in process]

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Chronic Insomnia.

Chronic Insomnia.

Semin Neurol. 2017 Aug;37(4):433-438

Authors: Bianchi MT

PMID: 28837990 [PubMed - in process]

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TBI and Sleep-Wake Disorders: Pathophysiology, Clinical Management, and Moving towards the Future.

TBI and Sleep-Wake Disorders: Pathophysiology, Clinical Management, and Moving towards the Future.

Semin Neurol. 2017 Aug;37(4):419-432

Authors: Werner JK, Baumann CR

PMID: 28837989 [PubMed - in process]

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Sleep in Autism.

Sleep in Autism.

Semin Neurol. 2017 Aug;37(4):413-418

Authors: Maxwell-Horn A, Malow BA

PMID: 28837988 [PubMed - in process]

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Sleep and Epilepsy.

Sleep and Epilepsy.

Semin Neurol. 2017 Aug;37(4):407-412

Authors: Bazil CW

PMID: 28837987 [PubMed - in process]

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Sleep Disturbance, Cognitive Decline, and Dementia: A Review.

Sleep Disturbance, Cognitive Decline, and Dementia: A Review.

Semin Neurol. 2017 Aug;37(4):395-406

Authors: Wennberg AMV, Wu MN, Rosenberg PB, Spira AP

PMID: 28837986 [PubMed - in process]

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Sleep Medicine.

Sleep Medicine.

Semin Neurol. 2017 Aug;37(4):393-394

Authors: Ellenbogen JM

PMID: 28837985 [PubMed - in process]

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Modifiable cardiometabolic risk factors in youth with at-risk mental states: A cross-sectional pilot study.

Modifiable cardiometabolic risk factors in youth with at-risk mental states: A cross-sectional pilot study.

Psychiatry Res. 2017 Aug 16;257:424-430

Authors: Lederman O, Rosenbaum S, Maloney C, Curtis J, Ward PB

Abstract
Young people experiencing psychotic illness engage in low amounts of physical activity have poor fitness levels and poor sleep quality. This study aimed to determine the prevalence of these modifiable cardiometabolic risk factors among individuals with at-risk mental states (ARMS), who are at increased risk of developing psychosis. A cross-sectional study was conducted in a community-based youth mental health service. Thirty participants (23%♀, 21.3 ± 1.7 years old) were recruited, 10 with ARMS, 10 with first-episode psychosis (FEP) and 10 healthy volunteers. Physical activity levels were assessed using self-report and objective measures. Aerobic capacity, upper body strength, hamstring flexibility, forearm grip strength and core endurance were assessed. Sleep quality, depression and anxiety were measured by self-report questionnaire. The ARMS group did not differ significantly on anthropometric measures from FEP or healthy volunteers. They engaged in significantly less physical activity (p < 0.05) and had poorer sleep quality (p < 0.05) than healthy volunteers. Our results are consistent with other studies that found that youth with ARMS are at greater cardiometabolic risk. Interventions aimed at improving these modifiable risk factors may assist with preventing the decline in physical health associated with the development of psychiatric illness.

PMID: 28837931 [PubMed - as supplied by publisher]

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Sleep-related problems and minor psychiatric disorders among Brazilian shift workers.

Sleep-related problems and minor psychiatric disorders among Brazilian shift workers.

Psychiatry Res. 2017 Aug 14;257:412-417

Authors: Olinto MTA, Garcez A, Henn RL, Macagnan JBA, Paniz VMV, Pattussi MP

Abstract
The aim of this study was to explore the association between sleep-related problems with the occurrence of minor psychiatric disorders in shift workers of southern Brazil. A cross-sectional study with 1202 workers (785 females) aged 18-50 years was carried out. Minor psychiatric disorders were assessed using the Self-Reporting Questionnaire (SRQ-20), and four sleep problems were collected and analyzed: sleep deprivation (≤ 5h), difficulty falling asleep, waking up during sleep, and sleep medication use. Results show that the overall prevalence of minor psychiatric disorders was 26.8%, but it was more prevalent among females than males (30.2% vs. 20.4%). Nightshift work was significantly associated with the occurrence of sleep-related problems. After adjusting for confounding factors, the number of sleep-related problems showed a positive linear trend with psychiatric disorders in both sexes. Having two or more sleep-related problems was associated with increased probability of psychiatric disorders approximately three-fold among males and two-fold among females, when compared with those without sleep problems. In conclusion, this study demonstrated that sleep-related problems have a strong and independent association with psychiatric disorders among shift workers. Furthermore, the prevalence of both conditions was higher among females than males; however, the strength of these associations was higher in males.

PMID: 28837929 [PubMed - as supplied by publisher]

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Reply: Unilateral Pulmonary Edema after Visiting High Altitude.

Reply: Unilateral Pulmonary Edema after Visiting High Altitude.

Ann Am Thorac Soc. 2017 Aug 24;:

Authors: Cherian SV, Estrada-Y-Martin RM

Abstract
N/A.

PMID: 28837781 [PubMed - as supplied by publisher]

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National estimates of 30-day readmissions among children hospitalized for asthma in the United States.

National estimates of 30-day readmissions among children hospitalized for asthma in the United States.

J Asthma. 2017 Aug 24;:0

Authors: Veeranki SP, Ohabughiro MU, Moran J, Mehta HB, Ameredes BT, Kuo YF, Calhoun WJ

Abstract
Objective Previous single-center studies have reported that up to 40% of children hospitalized for asthma will be readmitted. The study objectives are to investigate the prevalence and timing of 30-day readmissions in children hospitalized with asthma, and to identify factors associated with 30-day readmissions. Methods Data (n = 12,842) for children aged 6-18 years hospitalized for asthma were obtained from the 2013 Nationwide Readmission Database (NRD). The primary study outcome was time to readmission within 30 days after discharge attributable to any cause. Several predictors associated with risk of admission were included: patient (age, sex, median household income, insurance type, county location, pediatric chronic complex condition), admission (type, day, emergency services utilization, length of stay (LOS), discharge disposition) and hospital (ownership, bed size, teaching status). Cox's Proportional Hazards model was used to identify predictors. Results Of 12,842 asthma-related index hospitalizations, 2.5% were readmitted within 30 days post discharge. Time to event models identified significantly higher risk of readmission among asthmatic children aged 12-18 years, those who resided in in micropolitan counties, those with >4 days LOS during index hospitalization, those who were hospitalized in urban hospital, who had unfavorable discharge (HR 2.53, 95% CI 1.33-4.79), and those who were diagnosed with PCCC, respectively than children in respective referent categories. Conclusion A multi-dimensional approach including effective asthma discharge action plans and follow-up processes, home-based asthma education, and neighborhood/community-level efforts to address disparities should be integrated into routine clinical care of asthma children.

PMID: 28837382 [PubMed - as supplied by publisher]

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Family-based childhood obesity prevention interventions: a systematic review and quantitative content analysis.

Family-based childhood obesity prevention interventions: a systematic review and quantitative content analysis.

Int J Behav Nutr Phys Act. 2017 Aug 24;14(1):113

Authors: Ash T, Agaronov A, Young T, Aftosmes-Tobio A, Davison KK

Abstract
BACKGROUND: A wide range of interventions has been implemented and tested to prevent obesity in children. Given parents' influence and control over children's energy-balance behaviors, including diet, physical activity, media use, and sleep, family interventions are a key strategy in this effort. The objective of this study was to profile the field of recent family-based childhood obesity prevention interventions by employing systematic review and quantitative content analysis methods to identify gaps in the knowledge base.
METHODS: Using a comprehensive search strategy, we searched the PubMed, PsycIFO, and CINAHL databases to identify eligible interventions aimed at preventing childhood obesity with an active family component published between 2008 and 2015. Characteristics of study design, behavioral domains targeted, and sample demographics were extracted from eligible articles using a comprehensive codebook.
RESULTS: More than 90% of the 119 eligible interventions were based in the United States, Europe, or Australia. Most interventions targeted children 2-5 years of age (43%) or 6-10 years of age (35%), with few studies targeting the prenatal period (8%) or children 14-17 years of age (7%). The home (28%), primary health care (27%), and community (33%) were the most common intervention settings. Diet (90%) and physical activity (82%) were more frequently targeted in interventions than media use (55%) and sleep (20%). Only 16% of interventions targeted all four behavioral domains. In addition to studies in developing countries, racial minorities and non-traditional families were also underrepresented. Hispanic/Latino and families of low socioeconomic status were highly represented.
CONCLUSIONS: The limited number of interventions targeting diverse populations and obesity risk behaviors beyond diet and physical activity inhibit the development of comprehensive, tailored interventions. To ensure a broad evidence base, more interventions implemented in developing countries and targeting racial minorities, children at both ends of the age spectrum, and media and sleep behaviors would be beneficial. This study can help inform future decision-making around the design and funding of family-based interventions to prevent childhood obesity.

PMID: 28836983 [PubMed - in process]

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Pain, Bullying Involvement, and Mental Health Problems Among Children and Adolescents With ADHD in Taiwan.

Pain, Bullying Involvement, and Mental Health Problems Among Children and Adolescents With ADHD in Taiwan.

J Atten Disord. 2017 Aug 01;:1087054717724514

Authors: Yeh YC, Huang MF, Wu YY, Hu HF, Yen CF

Abstract
OBJECTIVE: The aim of this study was to examine the relationships of pain and pain-induced functional impairment with bullying involvement, as well as the relationships between pain and mental health problems among 474 children and adolescents with ADHD.
METHOD: The levels of pain, pain-induced functional impairment, involvement in bullying, depression, anxiety, ADHD symptoms, and sleep quality were assessed.
RESULTS: Both victims of verbal and relational bullying and victims of physical bullying were more likely to have pain and pain-induced functional impairment than nonvictims. The perpetrators of verbal and relational bullying were more likely to have pain than the nonperpetrators. Participants with pain and pain-induced functional impairment experienced more severe depression and anxiety and worse sleep quality than did those without pain or pain-induced functional impairment.
CONCLUSION: Clinical and educational professionals should consider the possibility of involvement in bullying and comorbid depression, anxiety, and poor sleep quality among ADHD children and adolescents with pain problems.

PMID: 28836888 [PubMed - as supplied by publisher]

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Early intervention for bipolar disorder in adolescents: A psychosocial perspective.

Early intervention for bipolar disorder in adolescents: A psychosocial perspective.

Early Interv Psychiatry. 2017 Aug 23;:

Authors: McAulay C, Mond J, Touyz S

Abstract
AIM: Early intervention in bipolar disorder (BD) has received increasing attention in recent years. The identification of risk factors has improved, but researchers continue to struggle to find an effective treatment once the illness has become established. The aetiology of BD and feasibility of early intervention present a challenge, making it difficult to decide who to target, as well as how.
METHODS: This essay seeks to address the lack of guidance for managing patients with a possible emerging bipolar illness, by presenting a rough roadmap to psychological care. The psychological techniques currently showing the most potential for this challenging group are reviewed. Markers of risk and supplementary clinical targets, such as anxiety and sleep disruption, are also discussed.
RESULTS: While research in this group remains in its infancy, various avenues of enquiry show promise, such as family-based approaches, CBT that targets features beyond the core illness, psychoeducation, and interventions that consider physical health. However, clearer pathways for establishing the course and stage of the illness are required to inform the intensity and type of treatment.
CONCLUSION: It is argued that treating early, indistinct symptoms of psychological distress, that may or may not signify prodromal BD, is valuable beyond its utility as an early intervention tool, as it has the capacity to improve help-seeking behaviour, quality of life and the likelihood of functional recovery in those who go on to develop the illness as adults.

PMID: 28836352 [PubMed - as supplied by publisher]

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Association between left atrial enlargement and obstructive sleep apnea in a general population of 71-year-old men.

Association between left atrial enlargement and obstructive sleep apnea in a general population of 71-year-old men.

J Sleep Res. 2017 Aug 24;:

Authors: Holtstrand Hjälm H, Fu M, Hansson PO, Zhong Y, Caidahl K, Mandalenakis Z, Morales D, Ergatoudes C, Rosengren A, Grote L, Thunström E

Abstract
Left atrial enlargement has been shown to be associated with obstructive sleep apnea in patients with coronary artery disease and in sleep clinic cohorts. However, data from the general population are limited. The aim of this study was to investigate whether there is an association between obstructive sleep apnea and left atrial enlargement in a random sample from a general population of 71-year-old men. As part of the longitudinal population study The Study of Men Born in 1943, we analysed cross-sectional data for 411 men, all 71 years old, who had participated in an overnight home sleep study and a standardized echocardiographic examination. Of the 411 men, 29.4% had moderate to severe obstructive sleep apnea [apnea-hypopnea index score of ≥15 (n = 121)]. These participants showed a significantly higher frequency of systolic heart failure, hypertension, overweight, had greater waist circumference as well as higher left atrial areas compared with men with no or mild obstructive sleep apnea (23.7 ± 5.5 cm(2) versus 21.6 ± 4.5 cm(2) , P < 0.001). In a linear regression analysis, obstructive sleep apnea was significantly associated with left atrial enlargement after adjusting for overweight, atrial fibrillation, heart failure with reduced ejection fraction, hypertension and mitral regurgitation. Compared with individuals without obstructive sleep apnea, the mean left atrial area was 1.7 ± 1.5 cm(2) larger in men with severe obstructive sleep apnea (P < 0.05) and 1.3 ± 1.1 cm(2) larger among men with moderate obstructive sleep apnea (P < 0.05). In this cross-sectional study of 71-year-old men from the general population, left atrial area was independently associated with prevalence and severity of obstructive sleep apnea.

PMID: 28836321 [PubMed - as supplied by publisher]

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Association Between Spousal Caregiver Well-Being and Care Recipient Healthcare Expenditures.

Association Between Spousal Caregiver Well-Being and Care Recipient Healthcare Expenditures.

J Am Geriatr Soc. 2017 Aug 24;:

Authors: Ankuda CK, Maust DT, Kabeto MU, McCammon RJ, Langa KM, Levine DA

Abstract
OBJECTIVES: To measure the association between spousal depression, general health, fatigue and sleep, and future care recipient healthcare expenditures and emergency department (ED) use.
DESIGN: Prospective cohort study.
SETTING: Health and Retirement Study.
PARTICIPANTS: Home-dwelling spousal dyads in which one individual (care recipient) was aged 65 and older and had one or more activity of daily living or instrumental activity of daily living disabilities and was enrolled in Medicare Part B (N = 3,101).
EXPOSURE: Caregiver sleep (Jenkins Sleep Scale), depressive symptoms (Center for Epidemiologic Studies Depression-8 Scale), and self-reported general health measures.
MEASUREMENTS: Primary outcome was care recipient Medicare expenditures. Secondary outcome was care recipient ED use. Follow-up was 6 months.
RESULTS: Caregiver depressive symptoms score and six of 17 caregiver well-being measures were prospectively associated with higher care recipient expenditures after minimal adjustment (P < .05). Higher care recipient expenditures remained significantly associated with caregiver fatigue (cost increase, $1,937, 95% confidence interval (CI) = $770-3,105) and caregiver sadness (cost increase, $1,323, 95% CI = $228-2,419) after full adjustment. Four of 17 caregiver well-being measures, including severe fatigue, were significantly associated with care recipient ED use after minimal adjustment (P < .05). Greater odds of care recipient ED use remained significantly associated with caregiver fatigue (odds ratio (OR) = 1.24, 95% CI = 1.01-1.52) and caregiver fair to poor health (OR = 1.23, 95% CI = 1.04-1.45) after full adjustment. Caregiver total sleep score was not associated with care recipient outcomes.
CONCLUSION: Poor caregiver well-being, particularly severe fatigue, is independently and prospectively associated with higher care recipient Medicare expenditures and ED use.

PMID: 28836269 [PubMed - as supplied by publisher]

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Effect of atopic dermatitis on quality of life and its psychosocial impact in Asian adolescents.

Effect of atopic dermatitis on quality of life and its psychosocial impact in Asian adolescents.

Australas J Dermatol. 2017 Aug 24;:

Authors: Ng MS, Tan S, Chan NH, Foong AY, Koh MJ

Abstract
BACKGROUND/OBJECTIVES: Atopic dermatitis (AD) is a common condition affecting up to 20% of the paediatric population in Singapore. It is often associated with significant psychosocial morbidity and can affect patients' quality of life (QOL) tremendously. This study investigated the varying lifestyle impacts, and psychosocial domains most affected by AD in adolescent children in Singapore.
METHODS: A prospective study evaluating the impact of AD on the QOL of adolescents was conducted over a 6-month period from July to December 2014. Adolescents aged 11-16 years with varying eczema severity were recruited. Eczema severity was determined by using the eczema area and severity index (EASI) scores. Lifestyle impact of AD was evaluated using patient-reported children's dermatology life quality index (CDLQI) scores. Statistical analysis was performed using an analysis of one-way variance and Student's t-test.
RESULTS: A total of 50 patients were enrolled and divided into three groups: mild (<10.3), moderate (10.3-20.9) and severe (>20.9) eczema based on EASI scores. Patients with mild and moderate eczema had lower CDLQI scores. Adolescents were most affected by the disruption that their symptoms had on their leisure and physical activities and sleep as a result of itch and scratching, respectively.
CONCLUSION: Chronic sufferers of severe eczema experience poorer QOL than those with mild or moderate eczema. They also experience significant psychosocial impact as a consequence of their condition.

PMID: 28836265 [PubMed - as supplied by publisher]

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Postoperative Blutdruckschwankungen nach Karotisendarteriektomie

Zusammenfassung

Hintergrund

Postoperative Blutdruckschwankungen nach Karotisendarteriektomie (CEA) sind bekannte Faktoren für ein erhöhtes Morbiditäts- und Mortalitätsrisiko.

Ziel der Arbeit

Darstellung des Einflusses der zwei etablierten gefäßchirurgischen Rekonstruktionsverfahren, der Eversions-CEA (E-CEA) und der konventionellen CEA mit Patchplastik (K-CEA), sowie der neueren sinuserhaltenden Eversions-CEA (SE-E-CEA) auf die postoperative Hämodynamik unter Berücksichtigung bisheriger wissenschaftlicher Erkenntnisse.

Material und Methoden

Auswertung klinisch-wissenschaftlicher Evidenz aus der PubMed (NLM) -Datenbank zu der jeweiligen Operationstechnik aus dem Zeitraum 1974 bis 2017 unter Ausschluss von Fallberichten.

Ergebnisse

Insgesamt wurden 34 Literaturstellen sowie eine Metaanalyse identifiziert, die sich mit der beschriebenen Thematik wissenschaftlich auseinandersetzen. Die Ergebnisse der Studien sowie der Metaanalyse zeigen, dass die E‑CEA mit einer Beeinträchtigung der lokalen Barorezeptorfunktion und einem erhöhten Bedarf an Vasodilatatoren in der frühen postoperativen Phase vergesellschaftet ist, wohingegen die K‑CEA und SE-E-CEA einen günstigeren Effekt auf den postoperativen Blutdruck auszuüben scheinen.

Schlussfolgerung

Unabhängig von der angewendeten Operationstechnik übt die CEA einen direkten Einfluss auf die Regulation des Blutdrucks aus. Eine engmaschige Überwachung des Blutdrucks sollte zumindest im postoperativen stationären Verlauf stattfinden. Der Stellenwert der SE-E-CEA als Alternative zu der klassischen E‑CEA muss zunächst ausführlicher wissenschaftlich untersucht werden.

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Minimalinvasive und roboterassistierte Chirurgie bei zystischen Pankreastumoren

Zusammenfassung

Hintergrund

Die Indikationsstellung zur chirurgischen Resektion zystischer Pankreastumoren ist komplex und das operative Risiko für den Patienten muss häufig gegenüber dem Risiko einer malignen Entartung abgewogen werden. Ziel der Arbeit ist ein Überblick über die Ergebnisse der minimalinvasiven Operationstechniken bei zystischen Pankreastumoren.

Methoden

Es erfolgte eine orientierende, systematische Literatursuche unter Verwendung der Medline-Datenbank (PubMed) sowie eine selektive Übersichtsdarstellung.

Ergebnisse

Es liegen bisher keine randomisierten kontrollierten Studien zum Vergleich der offenen und minimalinvasiven Resektion zystischer Tumoren vor. Retrospektive Fallserien bescheinigen den minimalinvasiven Techniken die Machbarkeit und Sicherheit sowie eine vergleichbare Morbidität nach distaler Pankreatektomie (DP), Pankreatoduodenektomie (PD), zentraler (CP) und totaler Pankreatektomie sowie der Enukleation. Während die meisten DP laparoskopisch durchgeführt werden, ist die Erfahrung für die minimalinvasive PD mit dem Roboter größer, jedoch auf wenige spezialisierte Zentren verteilt. Insgesamt ist die Zahl der publizierten Fälle minimalinvasiver organsparender Pankreasresektionen (CP oder Enukleation) bei zystischen Tumoren sehr gering; die verfügbaren selektionierten Ergebnisse jedoch zunächst positiv.

Diskussion

Die minimalinvasive Chirurgie bei zystischen Pankreastumoren hat das Potenzial, das operative Trauma der Patienten bei gleichen oder geringeren Komplikationsraten zu reduzieren. Voraussetzung ist eine zunehmende Spezialisierung insbesondere bei komplexen Operationen. Bei diesen Eingriffen wird der klinische Einsatz des Roboters ansteigen. Eine prospektive Dokumentation der Ergebnisse ist im Rahmen der Qualitätssicherung anzustreben.

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Αρχειοθήκη ιστολογίου

Ετικέτες

Πληροφορίες

Παρασκευή 25 Αυγούστου 2017

Abstract

Purpose of Review

Recent Findings

Summary

Zusammenfassung

Hintergrund

Ziel der Arbeit

Material und Methoden

Ergebnisse

Schlussfolgerung

Zusammenfassung

Hintergrund

Methoden

Ergebnisse

Diskussion

Αναζήτηση αυτού του ιστολογίου

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