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

Σάββατο 2 Σεπτεμβρίου 2017

Developing a quality of life questionnaire for Oral submucous fibrosis patients

Abstract

I would like to congratulate the authors for an informative article titled - Impact of Oral Potentially Malignant Disorders on Quality of Life, by Tadakamadala et al¹, which was an interesting read. The authors have included 50 patients each of Oral Leukoplakia (OL), Oral Lichen Planus (OLP) and Oral Submucous Fibrosis (OSF) who were administered Oral potentially malignant disorders quality of life (OPMDQoL) questionnaire and a short form 12 item (version 2) health survey questionnaire (SF-12v2). The authors concluded that OLP and OSF have a significant impact on the quality of life (QoL) of affected individuals especially in the domains 'Physical impairment and functional limitations' and increasing stage of the disease is associated with worsening QoL.

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Chronic treatment with Zoledronic Acid increases inflammatory markers in periodontium of rats

Abstract

Background

Bisphosphonates (BF) rises proinflammatory markers and irreversibly binds to bone. Chronically BF can lead to an inflammatory status and can increase the local oxidative stress in periodontium. Therefore, the objective of this study was evaluated if the chronic infusion of Zoledronic Acid (ZA) increases inflammatory markers in periodontium of rats.

Methods and results

Chronically infusion therapy was performed with ZA (0.04, 0.2 or 1 mg/kg or saline) by four doses in over a 70-day period to analysis periodontium of the first right inferior molar using histologic, histochemical (toluidine blue) and immunohistochemical (CD68, Tumor Necrosis Factor-α (TNF-α), Interleukin-1beta (IL-1β), Inducible Nitric Oxide Synthase (iNOS) and Nuclear Factor kappa B (NF-kB)) tests. The experiment was replicated (ZA 0.2 mg/kg versus saline) for myeloperoxidase (MPO) assay and dose TNF-α, IL-1β, Malondialdehyde (MDA) and Glutathione (GSH) in gingiva of the same tooth. Despite there is no alteration in mast cells (p=0.608) and CD68-mononuclear positive cells (p=0.351), in the periodontium of the ZA-treated group, was observed and increase presence of inflammatory cells (p=0.001) and cytoplasmic immunostaining for TNF-α (p=0.003), IL-1β (p=0.004), iNOS (p=0.008) and NF-kB (p=0.025). Levels of MPO (p<0.001), TNF-α (p=0.002), IL-1β (p<0.001) and GSH (p=0.005) were augmented in gingiva of ZA-treated group but MDA (p=0.993) levels and NF-kB nuclear staining (p=0.923) were not altered.

Conclusions

Chronic treatment with ZA increase proinflammatory cytokines and the number of inflammatory cells in periodontium of rats and GSH are expressed probably in a compensatory manner.

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Release of phosphorus from sewage sludge during ozonation and removal by magnesium ammonium phosphate

Abstract

The release rule of phosphorus from sewage sludge during ozonation and removal by the magnesium ammonium phosphate (MAP) method were investigated. The results showed that the concentrations of total phosphorus in aqueous phase (TP_(A)) and orthophosphate (PO₄³⁻-P) in ozonized sludge supernatant rose obviously with increasing ozone dose when ozone dose was below 61.2 mg O₃/gSS then almost kept constant. The TP_(A) and PO₄³⁻-P contents in the ozonized sludge supernatant were 70.9 and 63.3 mg/L when ozone dose was 61.2 mg O₃/gSS, respectively. Total phosphorus in the sludge solid (TP_(S)) was mostly distributed in inorganic phosphorus (IP) (more than 81.5% of TP_(S)), and non-apatite inorganic phosphorus (NAIP) was the major component of IP in the sludge (more than 78.7% of IP) during ozonation. The release contribution (RC) of IP to TP_(A) accounted for over 73.9%. The optimized conditions for the removal of phosphorus from ozonized sludge supernatant were set at an initial Mg²⁺/PO₄³⁻-P molar ratio of 1.8, pH 9.5, and reaction time of 5 min, under which the removal efficiencies of TP_(A) and PO₄³⁻-P were 43.1 and 52.2%, respectively.

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IJMS, Vol. 18, Pages 1892: Critical Role of the Human ATP-Binding Cassette G1 Transporter in Cardiometabolic Diseases

IJMS, Vol. 18, Pages 1892: Critical Role of the Human ATP-Binding Cassette G1 Transporter in Cardiometabolic Diseases

International Journal of Molecular Sciences doi: 10.3390/ijms18091892

Authors: Lise Hardy Eric Frisdal Wilfried Le Goff

ATP-binding cassette G1 (ABCG1) is a member of the large family of ABC transporters which are involved in the active transport of many amphiphilic and lipophilic molecules including lipids, drugs or endogenous metabolites. It is now well established that ABCG1 promotes the export of lipids, including cholesterol, phospholipids, sphingomyelin and oxysterols, and plays a key role in the maintenance of tissue lipid homeostasis. Although ABCG1 was initially proposed to mediate cholesterol efflux from macrophages and then to protect against atherosclerosis and cardiovascular diseases (CVD), it becomes now clear that ABCG1 exerts a larger spectrum of actions which are of major importance in cardiometabolic diseases (CMD). Beyond a role in cellular lipid homeostasis, ABCG1 equally participates to glucose and lipid metabolism by controlling the secretion and activity of insulin and lipoprotein lipase. Moreover, there is now a growing body of evidence suggesting that modulation of ABCG1 expression might contribute to the development of diabetes and obesity, which are major risk factors of CVD. In order to provide the current understanding of the action of ABCG1 in CMD, we here reviewed major findings obtained from studies in mice together with data from the genetic and epigenetic analysis of ABCG1 in the context of CMD.

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Sinonasal quality of life after endoscopic resection of malignant sinonasal and skull base tumors

Objectives

Improvement in sinonasal quality of life (QoL) following sinus surgery has been well-documented across the literature. To our knowledge, only one series has evaluated long-term QoL in patients undergoing tumor resection, and that study demonstrated no improvement in rhinologic QoL following malignant tumor resection at 2-year follow-up. The objective of the present study was to evaluate QoL in the 2 years following endoscopic malignant tumor resection.

Methods

A prospective cohort study was performed, including patients with both malignant and benign sinonasal tumors in a tertiary academic medical center. Patients undergoing endoscopic tumor resection who had completed Sinonasal Outcome Test 22 (SNOT-22) questionnaires were included in the cohort. SNOT-22 questionnaires were administered preoperatively and over a 2-year follow-up period at clinic visits. Longitudinal linear mixed-effects regression was used to compare preoperative QoL to QoL over the 2 years following surgery.

Results

Among 145 patients included in this study, 64 had malignant tumors. There was a statistically significant improvement in SNOT-22 score from baseline to 2 years for patients with both malignant tumors (37.0, 95% confidence Interval [CI] 32.0–42.1 at baseline; 26.5 95% CI 20.8–32.2 at 2 years; P < 0.001) and benign tumors (26.5, 95% CI 21.4–30.4 at baseline; 12.9 95% CI 7.6–18.2 at 2 years; P < 0.001).

Conclusion

In contrast to previously reported series, in this cohort endoscopic resection of sinonasal tumors appears to be followed by an improvement in QoL, which is sustained over a 2-year period.

Level of Evidence

2b. Laryngoscope, 2017

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Eosinophilic esophagitis in children under the age of 5 years: Clinical characteristics

Objectives/Hypothesis

To delineate clinical characteristics and treatment outcomes of eosinophilic esophagitis (EoE) in the youngest of children.

Study Design

Retrospective chart review.

Methods

A 7-year retrospective chart review of children with clinicopathologic diagnosis of EoE was performed with specific analysis of patients under 5 years old. EoE was defined as the presence of symptoms of esophageal dysfunction with pathologically proven eosinophilic inflammation (≥15 eosinophils per high-power field [EOS/HPF]) unresponsive to reflux therapy. Patient parameters and clinical results were systematically reviewed.

Results

Of 558 children diagnosed with EoE, 127 (22.8%) were younger than 5 years old (mean age 2.5 years). This subgroup presented with reflux symptoms (90.1%), vomiting (86.2%), diarrhea (55.3%), liquid dysphagia (52.0%), and constipation (50.0%), whereas food impaction (1.6%) was rare. Liquid dysphagia was present at all ages but significantly more common in younger children (P = .0101). The most common food and environmental allergens were egg whites (39.7%), cow's milk (36.5%), peanuts (34.9%), animal dander (15.1%), and weed pollen (11.1%). Patients were managed with antireflux medication (100%), elimination diet (83.5%), and steroid medication (68.5%). After treatment, 86% of parents reported symptom improvement. Mean reduction of EOS in pos-treatment biopsy was 33.5 EOS/HPF (P < .0001), and 67 patients showed histologic resolution of EoE (56.8%, P < .0001).

Conclusions

Approximately one-quarter of children with EoE present under 5 years of age with multiple esophageal symptoms, comorbidities, and allergen-sensitization profiles. These patients demonstrate substantial clinicohistologic improvement following therapy.

Level of Evidence

4 Laryngoscope, 2017

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Unmet Needs in Systemic Sclerosis Understanding and Treatment: the Knowledge Gaps from a Scientist’s, Clinician’s, and Patient’s Perspective

Abstract

Systemic sclerosis (SSc) is a highly heterogeneous disease caused by a complex molecular circuitry. For decades, clinical and molecular research focused on understanding the primary process of fibrosis. More recently, the inflammatory, immunological and vascular components that precede the actual onset of fibrosis, have become a matter of increasing scientific scrutiny. As a consequence, the field has started to realize that the early identification of this syndrome is crucial for optimal clinical care as well as for understanding its pathology. The cause of SSc cannot be appointed to a single molecular pathway but to a multitude of molecular aberrances in a spatial and temporal matter and on the backbone of the patient's genetic predisposition. These alterations underlie the plethora of signs and symptoms which patients experience and clinicians look for, ultimately culminating in fibrotic features. To solve this complexity, a close interaction among the patient throughout its "journey," the clinician through its clinical assessments and the researcher with its experimental design, seems to be required. In this review, we aimed to highlight the features of SSc through the eyes of these three professionals, all with their own expertise and opinions. With this unique setup, we underscore the importance of investigating the role of environmental factors in the onset and perpetuation of SSc, of focusing on the earliest signs and symptoms preceding fibrosis and on the application of holistic research approaches that include a multitude of potential molecular alterations in time in an unbiased fashion, in the search for a patient-tailored cure.

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Late Temporal Lobe Extensive Osteoradionecrosis Post Radiation for Nasopharyngeal Carcinoma: Case Series

Abstract

Osteoradionecrosis is one of the most serious complications of radiotherapy for nasopharyngeal carcinoma. We report three cases of osteoradionecrosis in temporal lobe who presented differently few years after completion of radiotherapy. Cranial magnetic resonance image showed lesions in temporal lobe either unilateral or bilateral with mass effect. One of the cases even showed disease progression few years after the initial diagnosis of osteoradionecrosis. Diagnosis of osteoradionecrosis for all three patients was confirmed by biopsy.

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Surgical Treatment of Retrosternal Goitre

Abstract

This study aims to evaluate surgical approaches to the management of retrosternal goitre. Between 2004 and 2014, 35 patients (eight males; mean age 67.4 ± 10.9 years) with retrosternal goitre (mainly right-sided in 9, left-sided in 14 and bilateral in 12) underwent surgery. A palpable neck mass was found in 11 (31.4%), stridor in 10 (28.6%) and thyrotoxicosis in 4 (11.4%) cases. 4 (11.4%) patients were asymptomatic. Tracheal compression was detected radiologically in 27 (77.2%) patients with deviation in 18 (51.4%). A collar incision was performed in 34 patients, 6 (17.1%) of whom required additional sternotomy, 1 (2.9%) was assisted by an anterior mediastinotomy. 1 (2.9%) had a right lateral thoracotomy. There was no operative mortality. Transient vocal changes occurred in 3 (8.6%) patients, recurrent laryngeal nerve palsy in 3, atrial fibrillation in 2, and wound complications in 2 (5.7%). Hospital stay ranged from 2 to 12 days (5.5 ± 2.0). Multinodular goitre was found in 33 patients, diffuse goitre in 1 and ectopic thyroid in 1. The average vertical length of goitres in the collar incision group was 7.6 cm compared to 10.6 cm in the sternotomy group. The average weight of specimens was 156.3 g in patients with collar incisions and 307.5 g in the sternotomy group. Removal of retrosternal goitre is more commonly performed via a cervical collar incision with mandatory availability of sternotomy. Radiological measurement of craniocaudal length may predict the risk of sternotomy. Surgical outcomes are not affected by surgical approach.

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Type 1 Tympanoplasty by Cartilage Palisade and Temporalis Fascia Technique: A Comparison

Abstract

(1) To compare graft take up of type-1 tympanoplasty with cartilage palisade technique with those of type-1 tympanoplasty using autotemporalis fascia. (2) To compare hearing results of type 1 tympanoplasty with cartilage palisade technique with those of type-1 tympanoplasty using autotemporalis fascia. A prospective clinical study. It consisted of 60 patients divided into two groups of 30 patients each. After randomization 30 patients underwent type 1 tympanoplasty using cartilage palisade technique and 30 underwent type 1 tympanoplasty using autotemporalis fascia. In follow up, pure tone audiogram were carried out at 2nd, 4th and 6th month. Clinical assessment was done at 2nd 4th and 6th month. The graft uptake rate between the group 1 and group 2 are 93.33 and 90% respectively. As p value was greater than 0.05 so statistically there is no significant difference between the two group. The post operative air bone gap of the two groups were compared using student t test. The pre op mean of group 1 was 32.5 db and pre op mean of group 2 was 30.66 db. The post op mean of group 1 was 21.33, with standard deviation of 3.6984 and standard error of 0.67523. The post op mean of group 2 was 21.09 with standard deviation of 3.29 and standard error of 0.58261. t value was 0.1357. Analysis was done using student t test and p value was found to be greater than 0.05. p value is greater than 0.05 which shows that there is no statistical difference between the two groups. This study establishes the fact that hearing results after performing type 1 tympanoplasty by autotemporalis fascia when compared with type 1 tympanoplasty performed by cartilage palisade technique showed similar hearing gain and post operatively graft take up rate was also similar in two groups. The disadvantage of reducing the mechanical vibration of the tympanic membrane was overcome by the palisade reconstruction of the tympanic membrane. This study definitely emphasizes upon usage of new grafting materials in reconstruction of tympanic membrane, with similar, if not better functional results, without compromising the acoustic transfer characteristics.

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Unilateral Fungal Sphenoiditis Presenting with Diplopia and Ptosis

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Comparative Study of Management of Attico-antral CSOM by Conventional Mastoidectomy with Inside Out Technique

Abstract

This prospective study was undertaken to compare the different aspects of inside out and conventional mastoidectomy techniques in attico-antral type of chronic suppurative otitis media. 100 cases of unsafe ear selected in this study were divided in 2 groups—(1) Group A—50 patients operated by conventional technique of canal wall down mastoidectomy. (2) Group B—50 patients operated by inside out technique of canal wall down mastoidectomy. The patients in our series were regularly followed to assess the condition of the postoperative cavity for three months. Post operative results were better by inside out as compared to conventional technique of mastoidectomy. Hearing and air-bone gap improvement was more in patients operated by inside out mastoidectomy. Less number of patients suffered with post operative residual disease like cholesteatoma, granulation, discharge and residual perforation as compared to conventional mastoidectomy.

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An Evaluation of the Surgical Trauma to Intracochlear Structures After Insertion of Cochlear Implant Electrode Arrays: A Comparison by Round Window and Antero-Inferior Cochleostomy Techniques

Abstract

To evaluate the extent of intracochlear damage by histologic assessment of cadaveric temporal bones after insertion of cochlear implants by: round window approach and cochleostomy approach. Cochlear implantation was performed by transmastoid facial recess approach in 10 human cadaveric temporal bones. In 5 temporal bones, electrode insertion was acheieved by round window approach and in the remaining 5 bones, by cochleostomy approach. The bones were fixed, decalcified, sectioned and studied histologically. Grading of insertion trauma was assessed. In the round window insertion group, 2 bones had to be excluded from the study: one was damaged during handling with electrode extrusion and another bone did not show any demonstrable identifiable cochlear structure. Out of the 3 temporal bones, a total of 35 sections were examined: 24 demonstrated normal cochlea, 4 had basilar membrane bulging and 7 had fracture of bony spiral lamina. In the cochleostomy group, histology of 2 bones had to be discarded due to lack of any identifiable inner ear structures. Out of the 3 bones studied, 18 sections were examined: only 3 were normal, 4 sections had some bulge in spiral lamina and 11 had fracture of bony spiral lamina. The fracture of spiral lamina and bulge of basement membrane proportion is relatively higher if we perform cochleostomy as compared to round window approach. Therefore, round window insertion is relatively less traumatic as compared to cochleostomy. However, our sample size was very small and a study with a larger sample is required to further validate these findings.

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Laser Assisted Double-Layer Endoscopic Repair of Laryngeal Clefts: Our Experience in 11 Cases

Abstract

Laryngeal cleft is a rare congenital malformation of the respiratory tract leading to a high level of morbidity and mortality, recently being diagnosed with increased frequency. Management throughout the years included medical and surgical. The open surgical technique is more commonly used although it has higher risk and need longer post-operative care. Recently surgical endoscopic repair was introduced using different techniques. To evaluate the clinical features of infants and children presenting with laryngeal clefts, and review endoscopic management modality especially the technique and results of repair using double-layer (2 layers) technique. Outlining our experience with the surgical technique, complications arising from surgery as well as surgical outcome by evaluating the decannulation rate and cessation of the assisted feeding by the end of treatment. Retrospective case series study. Review of infant and children seen in our clinic with the diagnosis of laryngeal cleft from January 2012 till June 2014., and treated by CO₂ laser assisted double-layer endoscopic closure. The presenting symptoms, patient demographics, diagnostic procedure, cleft type, surgical outcome and complications all were evaluated. We revised the case notes of 34 patients with a workable diagnosis of Laryngeal cleft. A total of 11 patients met our criteria and were included in the study. Clefts typing was according to modified Benjamin–Ingles classification, type 1 (n = 9) and type 2 (n = 2). All clefts were closed endoscopically by CO₂ laser incision of the mucosa and two-layer endoscopic closure of the cleft without postoperative intubation or tracheotomy. They accepted oral feeding within 5 postoperative days (range 3–11 days). 5 out of 6 patients (83.3%) successfully stopped nasogastric feeding and 1 out of 2 patients successfully weaned from nasal cannula. One patient deceased few months after surgery due to other medical problems. Two patients needed redo after burst of the upper cleft stitches immediately after repair by iatrogenic cause during suctioning. The repair was stable in all patients during the second look 6 weeks after surgery with no recurrence or fistula formed. There were no clinically significant observed complications with this technique. After a mean follow up of 24 months, all children have a good voice, have no sign of residual aspiration, and less hospital admissions. Laryngeal cleft should be suspected in children presenting with recurrent pneumonia and difficulties during feeding. Endoscopic repair is a successful and safe technique for treating laryngeal clefts, and has short post-operative recovery without postoperative intubation or tracheotomy. Using the double-layer technique appeared to be promising but needs more comparative studies in the future.

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The Use of Lexical Neighborhood Test (LNT) in the Assessment of Speech Recognition Performance of Cochlear Implantees with Normal and Malformed Cochlea

Abstract

The present study aims to use the model-based test Lexical Neighborhood Test (LNT), to assess speech recognition performance in early and late implanted hearing impaired children with normal and malformed cochlea. The LNT was administered to 46 children with congenital (prelingual) bilateral severe-profound sensorineural hearing loss, using Nucleus 24 cochlear implant. The children were grouped into Group 1-(early implantees with normal cochlea-EI); n = 15, 31/2–61/2 years of age; mean age at implantation—3½ years. Group 2-(late implantees with normal cochlea-LI); n = 15, 6–12 years of age; mean age at implantation—5 years. Group 3-(early implantees with malformed cochlea-EIMC); n = 9; 4.9–10.6 years of age; mean age at implantation—3.10 years. Group 4-(late implantees with malformed cochlea-LIMC); n = 7; 7–12.6 years of age; mean age at implantation—6.3 years. The following were the malformations: dysplastic cochlea, common cavity, Mondini's, incomplete partition-1 and 2 (IP-1 and 2), enlarged IAC. The children were instructed to repeat the words on hearing them. Means of the word and phoneme scores were computed. The LNT can also be used to assess speech recognition performance of hearing impaired children with malformed cochlea. When both easy and hard lists of LNT are considered, although, late implantees (with or without normal cochlea), have achieved higher word scores than early implantees, the differences are not statistically significant. Using LNT for assessing speech recognition enables a quantitative as well as descriptive report of phonological processes used by the children.

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Keratosis Obturans: A Disease of the Tropics?

Abstract

Keratosis obturans appears to be an obscure and relatively uncommon entity, even in literature search of journals and reference texts, so much so that there is not even any prevalence or incidence statistics available. However, the condition did not appear to be as uncommon based on our clinical observations. We have managed to obtain 64 patients representing 67 ears with keratosis obturans in our study period of about 18 months with a pattern of occurrence during this period. Humid weather seemed to play a role in the frequency of its appearance during certain period in our observation. There also appears to be a correlation between the severity of symptoms (predominantly pain and hearing loss) and the presenting appearance of the condition, i.e., presence or absence of granulation tissue, as well as that the degree of difficulty in exenteration of the keratosis obturans (matrix and content) depending on the expansion of the bony canal. Our figures showed the majority of the patients are females and young individuals, the majority of them occur unilaterally. The condition also appear to stop short of involving the tympanic membrane with only the bony canal being expanded with the surrounding oedema creating an apparent "canal stenosis".

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Comparative Study of Outcome of Endoscopic Myringoplasty in Active and Inactive Mucosal Chronic Otitis Media Patients

Abstract

The objective of this study was to compare graft uptake and hearing improvement in active and inactive mucosal chronic otitis media patients after endoscopic myringoplasty. This is prospective study conducted at a government medical college and hospital from February 2014 to August 2015. A total of 40 active (wet) ears with mucoid discharge and 40 inactive (dry) ears (at least 6 weeks dry before surgery) with mucosal chronic otitis media were operated on by endoscopic myringoplasty by transcanal approach. Graft uptake and hearing gain rates 3 months after surgery were compared for both groups. Endoscopic myringoplasty using temporal fascia graft via transcanal approach was used. The graft take rate was 77.5% for the active ear group and 85% for the inactive ear group. The hearing gain rate was 82.5% for the inactive ear group and 72.5% for the active ear group. Differences were found to be statistically insignificant for both graft uptake and hearing gain. The success of endoscopic myringoplasty is not adversely affected by the presence of mucoid ear discharge at the time of surgery, and outcomes are comparable to those of the operation done for inactive ear.

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Per Operative Study of Relation of Zuckerkandl Tubercle with Recurrent Laryngeal Nerve in Thyroid Surgery

Abstract

To identify Zuckerkandl tubercle and to determine relationship between the recurrent laryngeal nerve and Zuckerkandl tubercle (ZT). Peroperative study. Intraoperatively Zuckerkandl tubercle was identified. Size of the thyroid lobe and Zuckerkandl tubercle were co-related and direction of tubercle in relation to recurrent laryngeal nerve was examined. Grading of tubercle on the basis of size was done. We studied its direction and relation with recurrent laryngeal nerve. ZT was identified in 87.86% (179 out of 206) of cases. In the study amongst the 179 cases in whom ZT could be identified, ZT was found on the right side (85.41% i.e. 123 out of 144), 81.41% (92 out of 113) to the left side and 15.68% (8 out of 51) were B/L. ZT was found posterior to the tubercle in 97.22%(175 out of 179) cases and anterior to the tubercle in 2.77% (5 out of 179) cases. The relationship between recurrent laryngeal nerve and ITA was studied. ITA was anterior to RLN (in 70.89%) and posterior to RLN in 29.10%. Thus, ZT is an important landmark for identification of RLN during thyroidectomy (p value 0.001).

Level of evidence III

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Primary Ewing’s Sarcoma of the Temporal Bone: A Rare Case Report and Literature Review

Abstract

Ewing's sarcoma is a malignant, round cell tumor arising from the bones and primarily affecting children and adolescent, accounting for 3 % of all childhood malignancies. Although the long bones and the trunk are typically affected, rare cases of it involving isolated bones throughout the body have been reported. Involvement of the skull bones is rare, constituting 1–6 % of the total Ewing's sarcoma cases but those affecting the cranial bones are rarer still, constituting only 1 %. We describe an 8 months old infant having Ewing sarcoma, of the petrous and mastoid parts of temporal bone along with the occipital bone, whose clinical presentation mimicked mastoiditis with facial nerve palsy. We discuss the clinical and therapeutic course of an extensive primary Ewing sarcoma of the temporal bone, which was treated without performing surgery and review this entity's literature in detail.

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Lymph Node Central Necrosis on the Computed Tomography as the Predictor of the Extra Capsular Spread in Metastatic Head and Neck Squamous Cell Carcinoma

Abstract

The aim of this study is to investigate the relationship between the presence of the cervical lymph node with central necrosis as on the preoperative imaging and postoperative histopathological identification of the lymph node extra capsular spread. This study is a prospective study conducted at J.L.N. Hospital and Research Centre, Bhilai (C.G), from August 2011 to January 2014. Thirty patients with metastatic head and neck squamous cell carcinoma were enrolled. All candidates were subjected to a detailed history taking and clinical examination. Their preoperative computed tomography (CT) scans were assessed with attention to the presence and absence of lymph node, lymph node size, shape, level, presence or absence of the lymph node central necrosis and other signs of the ECS such as thick walled enhancing nodal margin, loss of margin definition, alteration of adjacent fat planes. These patients then underwent surgery which included resection of the primary with the neck dissection. The preoperative records of the lymph node size and location were observed radio-graphically and analyzed with the resected lymph node histopathologically. These data was used for finding out correlation. Of the total 30 patients studied, 24 patients were male and 6 patients female with ratio of 4:1. The most common group of the patients were of malignancy of gingivobuccal sulcus. Out of the 30 patients 19 patients had the radiographic evidence of the central necrosis, out of which 11 had the extra capsular spread on the histological analysis. In no patients did we found histopathology extra capsular spread without central necrosis. Thus the central necrosis on the CT has the high sensitivity for detection of the extra capsular spread. Out of the 19 lymph node without extra capsular spread, 11 lymph nodes had no central necrosis on the preoperative CT, remaining 8 lymph node were having central necrosis on CT whereas post op histopathology of these 8 lymph nodes showed metastatic deposit, indicating the low specificity of the central necrosis in detection of the ECS. Lymph node central necrosis on pre-operative CT is sensitive indicator with a high negative predictive value for lymph node extra capsular spread. Future studies focusing on identifying molecular mediator involved in ECS to determine targets for adjuvant therapies in this subset of patients are recommended.

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Incidence of Facial Nerve Canal Dehiscence in Primary and Revision Cholesteatoma Surgery

Abstract

The aim of this retrospective study was to determine the incidence of facial canal dehiscence (FCD) in primary and revision cholesteatoma surgery in a tertiary referral center. Moreover, our second goal was to identify association between FCD and other intra-operative pathological findings in a group of patients with cholesteatoma surgery. Inclusion criteria were primary and revision canal wall up and canal wall down tympanomastoidectomy in patients who suffers from chronic otitis media (COM) with cholesteatoma. An exclusion criterion was charts with in adequate documentation. In addition tympanoplasty cases were excluded due to evaluate both tympanic and mastoid segments of facial nerve canal. Preoperative clinical data and intra-operative findings were documented in a formatted questionnaire. We found the incidence of FCD in COM surgery was 18%. There was no difference between the primary and revision surgeries regarding its incidence. In addition, there was association between some preoperative or intra-operative findings of COM, such as middle fossa dural dehiscence, external auditory canal polyp, facial nerve paralysis, labyrinthine fistula, and FCD. In conclusions we found that there was no difference between primary and revision surgeries regarding the incidence of FCD. Surgeons should consider effective measures to prevent intra-operative facial nerve trauma in COM surgeries.

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Septorhinoplasty: Our Experience

Abstract

Rhinoplasty is one of the oldest known surgeries to the human kind. However, being a cosmetic of surgery of utmost importance, it has been an attractive and fascinating surgery for the otolaryngologists and plastic surgeons. Along with the evolution of improved techniques and better surgical modalities, this surgery has been growing in panorama including its indications, needs and techniques. We present our experience with rhinoplasty in a tertiary care center of north India. We have included all cases operated with septorhinoplasty from 2001 to 2014 by the senior author in the manuscript. We reviewed their presentations, investigations, preoperative counselling records, operative details and post-operative clinical records to audit our results and hence to document our experiences in septorhinoplasties. A total of 53 cases including 37 males and 16 females had undergone rhinoplasty surgeries. The most common reason of disfigurement was road traffic accident (58.5%). All these patients included different deformities and required varied corrections. There were no major post-operative complications except persistent edema with longest lasting for 23 weeks. Thermal splints gave a better patient satisfaction in post-op compared to POP splints. Results were completely and partially satisfying for 50 patients and not satisfying for three. Unrealistic expectations from the procedure might be the reason for non-satisfactory results in rhinoplasty. Rhinoplasty is a delicate procedure and has greater aesthetic implications in planning surgical techniques and approaches. For better satisfaction of patients, adequate preoperative counseling and realistic expectations are warranted. Skillful surgical techniques null chances of complications.

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Laser Assisted Double-Layer Endoscopic Repair of Laryngeal Clefts: Our Experience in 11 Cases

Abstract

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Incidence of Facial Nerve Canal Dehiscence in Primary and Revision Cholesteatoma Surgery

Abstract

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Prognostic implication of NOTCH1 in early stage oral squamous cell cancer with occult metastases

Abstract

Objective

The objective of this study was to explore the prognostic value of cancer stem cell markers, namely CD133, NANOG, and NOTCH1, in early stage oral squamous cell carcinoma (OSCC).

Materials and methods

One hundred forty-four patients with early stage (cT1T2N0) OSCC were identified from a pre-existing database of patients with oral cancer. We examined the impact of the immunohistochemical expression of CD133, NANOG, and NOTCH1 in OSCC. Overall survival (OS) curves were calculated using the Kaplan–Meier method. Predictors of outcome were identified using multivariate analysis.

Results

We found that CD133, NANOG, and NOTCH1 were significantly associated with lymph node metastasis, and NOTCH1 was also significantly associated with depth of invasion and locoregional recurrence.

Conclusions

NOTCH1 was identified as an independent prognostic factor for OS.

Clinical relevance

NOTCH1 might prove to be a useful indicator for high-risk patients with occult metastases from early stage OSCC.

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Relationship Between Laryngeal Sensory Deficits, Aspiration, and Pneumonia in Patients with Dysphagia

Abstract

The laryngeal adductor reflex (LAR) is an airway protective reflex that manifests as a brief vocal fold closure in response to laryngeal stimulation. This study examined if the absence of the LAR in response to touch delivered by a laryngoscope is associated with penetration/aspiration or pneumonia in patients with dysphagia. Inpatients at a teaching hospital with clinical symptoms of dysphagia were recruited upon referral to the otolaryngology clinic for a swallowing evaluation. Otolaryngologists observed the status of secretions and touched each arytenoid with the tip of the laryngoscope. The patients were then asked to swallow 3–5 mL grape gelatin and 3–5 mL colored water. All procedures were video-recorded. Two independent raters noted absence/presence of the LAR and penetration/aspiration of pharyngeal secretions, gelatin, and water on the recorded videos. A diagnosis of pneumonia during the patient's entire hospital stay was determined by a review of the hospital's medical records. Statistical analyses were performed using Fisher's exact test. Sixty-one patients were included. Twenty-one patients (34.5%) did not exhibit the LAR. No association was found between the absent LAR and penetration or aspiration. There was, however, a significant association between an absence of the LAR and pneumonia development. Patients with an absent LAR had 6.8 times the odds of developing pneumonia as compared to those with a present LAR (OR 6.75; 95% CI 1.76–25.96; p < 0.01). Using the LAR as a marker of laryngeal sensory function appears to be valuable for identifying patients at high risk of pneumonia.

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Health-Related Quality of Life and Oropharyngeal Dysphagia: A Systematic Review

Abstract

The negative impact of increased bolus modification on health-related quality of life (HRQoL) in persons with oropharyngeal dysphagia (OD) has been described in previous literature; however, findings may have been influenced by the severity of OD and underlying etiology. The current systematic review therefore aims to investigate the relationships between HRQoL and OD and to report on changes in HRQoL and OD following intervention. This review was conducted in accordance with the PRISMA statement. A systematic search of the literature was performed using PubMed and Embase. All available English publications up to February 2016 that reported on OD and HRQoL were included. Articles that studied OD arising from esophageal dysfunction or included less than 15 participants with OD, were excluded. Thirty-five studies met the inclusion criteria. Inverse bidirectional relationships were found between decreased HRQoL and increased OD severity. Following intervention, changes were evident through improved HRQoL with decreased OD severity. The findings of this paper highlight the importance of targeting HRQoL in patients with OD. However, because of the heterogeneity in methodology, terminology, and assessment procedures used in the retrieved articles, the generalization of study results is limited. More research investigating the relationships between HRQoL and OD is needed. Future studies should implement study designs that lead to stronger levels of evidence, quantify the severity of OD and underlying diseases, use validated measures and less ambiguous terminology.

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Comparing perceived effectiveness of FDA-proposed cigarette packaging graphic health warnings between sexual and gender minorities and heterosexual adults

Abstract

Background

In 2012, the U.S. Food and Drug Administration proposed nine graphic health warnings (GHWs) on cigarette packaging that were rated equally effective across racial/ethnic, education, or income groups of adult smokers. However, data on GHW effectiveness among sexual and gender minority (SGM) adults, who have higher smoking prevalence, are currently lacking. This study analyzed whether perceived effectiveness of GHWs differed by gender and sexual orientation.

Methods

Data came from a randomized experiment among 1,200 adults with an oversample from low socioeconomic status groups, conducted between 2013 and 2014 in three Massachusetts communities. Participants viewed and rated the effectiveness of nine GHWs. Mixed effects regression models predicted perceived effectiveness with gender and sexual orientation, adjusting for repeated measurements, GHWs viewed, age, race, ethnicity, smoking status, and health status.

Results

Female heterosexuals rated GHWs as more effective than male heterosexual, lesbian, and transgender and other gender respondents. There was no significant difference between female and male heterosexuals versus gay, male bisexual, or female bisexual respondents. Differences by gender and sexual orientation were consistent across all nine GHWs. Significant correlates of higher perceived effectiveness included certain GHWs, older age, being African-American (vs white), being Hispanic (vs non-Hispanic), having less than high school education (vs associate degree or higher), and being current smokers (vs non-smokers).

Conclusions

Perceived effectiveness of GHWs was lower in certain SGM groups. We recommend further studies to understand the underlying mechanisms for these findings and investments in research and policy to communicate anti-smoking messages more effectively to SGM populations.

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Image-guided ablations in patients with thyroid tumors

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Horstman fighting cancer with 'every ounce of energy' he has - Midland Daily News

Midland Daily News

Horstman fighting cancer with 'every ounce of energy' he has
Midland Daily News
With the help of Medical Oncologist and Hematologist Jeffrey Letzer, D.O., Terry Horstman is fighting his pancreatic cancer with everything he has. ... "I took a lot of IVs to keep hydrated and I used popsicles to reduce the swelling in my tongue," he ...

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Editorial Board/Reviewing Committee

Publication date: October 2017
Source:International Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 10

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IJMS, Vol. 18, Pages 1891: “Dicing and Splicing” Sphingosine Kinase and Relevance to Cancer

IJMS, Vol. 18, Pages 1891: "Dicing and Splicing" Sphingosine Kinase and Relevance to Cancer

International Journal of Molecular Sciences doi: 10.3390/ijms18091891

Authors: Nahal Haddadi Yiguang Lin Ann Simpson Najah Nassif Eileen McGowan

Sphingosine kinase (SphK) is a lipid enzyme that maintains cellular lipid homeostasis. Two SphK isozymes, SphK1 and SphK2, are expressed from different chromosomes and several variant isoforms are expressed from each of the isozymes, allowing for the multi-faceted biological diversity of SphK activity. Historically, SphK1 is mainly associated with oncogenicity, however in reality, both SphK1 and SphK2 isozymes possess oncogenic properties and are recognized therapeutic targets. The absence of mutations of SphK in various cancer types has led to the theory that cancer cells develop a dependency on SphK signaling (hyper-SphK signaling) or "non-oncogenic addiction". Here we discuss additional theories of SphK cellular mislocation and aberrant "dicing and splicing" as contributors to cancer cell biology and as key determinants of the success or failure of SphK/S1P (sphingosine 1 phosphate) based therapeutics.

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IJMS, Vol. 18, Pages 1893: The Lactate/Albumin Ratio: A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU

IJMS, Vol. 18, Pages 1893: The Lactate/Albumin Ratio: A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU

International Journal of Molecular Sciences doi: 10.3390/ijms18091893

Authors: Michael Lichtenauer Bernhard Wernly Bernhard Ohnewein Marcus Franz Bjoern Kabisch Johanna Muessig Maryna Masyuk Alexander Lauten Paul Schulze Uta Hoppe Malte Kelm Christian Jung

The lactate/albumin ratio has been reported to be associated with mortality in pediatric patients with sepsis. We aimed to evaluate the lactate/albumin ratio for its prognostic relevance in a larger collective of critically ill (adult) patients admitted to an intensive care unit (ICU). A total of 348 medical patients admitted to a German ICU for sepsis between 2004 and 2009 were included. Follow-up of patients was performed retrospectively between May 2013 and November 2013. The association of the lactate/albumin ratio (cut-off 0.15) and both in-hospital and post-discharge mortality was investigated. An optimal cut-off was calculated by means of Youden's index. The lactate/albumin ratio was elevated in non-survivors (p < 0.001). Patients with an increased lactate/albumin ratio were of similar age, but clinically in a poorer condition and had more pronounced laboratory signs of multi-organ failure. An increased lactate/albumin ratio was associated with adverse in-hospital mortality. An optimal cut-off of 0.15 was calculated and was associated with adverse long-term outcome even after correction for APACHE2 and SAPS2. We matched 99 patients with a lactate/albumin ratio >0.15 to case-controls with a lactate/albumin ratio <0.15 corrected for APACHE2 scores: The group with a lactate/albumin ratio >0.15 evidenced adverse in-hospital outcome in a paired analysis with a difference of 27% (95%CI 10–43%; p < 0.01). Regarding long-term mortality, again, patients in the group with a lactate/albumin ratio >0.15 showed adverse outcomes (p < 0.001). An increased lactate/albumin ratio was significantly associated with an adverse outcome in critically ill patients admitted to an ICU, even after correction for confounders. The lactate/albumin ratio might constitute an independent, readily available, and important parameter for risk stratification in the critically ill.

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Editorial Board/Reviewing Committee

Publication date: October 2017
Source:International Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 10

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Viruses, Vol. 9, Pages 249: Die Another Day: Inhibition of Cell Death Pathways by Cytomegalovirus

Viruses, Vol. 9, Pages 249: Die Another Day: Inhibition of Cell Death Pathways by Cytomegalovirus

Viruses doi: 10.3390/v9090249

Authors: Wolfram Brune Christopher Andoniou

Multicellular organisms have evolved multiple genetically programmed cell death pathways that are essential for homeostasis. The finding that many viruses encode cell death inhibitors suggested that cellular suicide also functions as a first line of defence against invading pathogens. This theory was confirmed by studying viral mutants that lack certain cell death inhibitors. Cytomegaloviruses, a family of species-specific viruses, have proved particularly useful in this respect. Cytomegaloviruses are known to encode multiple death inhibitors that are required for efficient viral replication. Here, we outline the mechanisms used by the host cell to detect cytomegalovirus infection and discuss the methods employed by the cytomegalovirus family to prevent death of the host cell. In addition to enhancing our understanding of cytomegalovirus pathogenesis we detail how this research has provided significant insights into the cross-talk that exists between the various cell death pathways.

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Bone Health is Maintained, While Fat Mass is Reduced in Pre-pubertal Children with Obesity Participating in a 1-Year Family-Centered Lifestyle Intervention

Abstract

Diet and physical activity (PA) influence bone health in children. This study tested whether increasing milk and milk products and weight-bearing types of PA favorably changed bone outcomes assessed by dual-energy X-ray absorptiometry (DXA) and bone biomarkers in children with obesity participating in a 1-year family-centered lifestyle intervention. Children were randomized to one of three groups: Control (Ctrl; no intervention), Standard treatment (StnTx: two servings milk and milk products/day; meet PA guidelines plus weight-bearing PA three times/week), or Modified treatment (ModTx: four servings milk and milk products/day; meet PA guidelines plus daily weight-bearing PA). Baseline and 12-month measurements included DXA scans for whole body (WB), lumbar spine (LS), lumbar lateral spine (LLS), and ultra-distal (UD) ulna + radius for bone mineral content (BMC), areal bone mineral density (aBMD) and BMD z-scores. Fat mass index (FMI), fat-free mass index (FFMI), and biomarkers of bone metabolism were assessed. Seventy-eight children 6–8 years old were recruited (mean body mass index for-age z-score: 3.3 ± 1.2). Compared to baseline, all groups increased BMC of WB, LS, and LLS (p < 0.001), whereas only StnTx increased UD ulna + radius BMC at 12 months (p < 0.05). At 12 months, WB-BMD z-scores were significantly lower in Ctrl (p < 0.05), whereas WB and LLS aBMD increased in StnTx and ModTx (p < 0.001) but not in Ctrl. All groups increased FFMI (p < 0.001), while only Ctrl increased FMI (p < 0.001). Bone biomarkers did not change over time. Participating in a family-centered lifestyle intervention based on Canadian diet and PA guidelines maintained bone health in obese children.

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Detection of a new species of torque teno mini virus from the gingival epithelium of patients with periodontitis

Abstract

We describe a novel species of torque teno mini virus called TTMV-204, which was isolated from the gingival epithelium of patients with periodontitis and characterized using viral metagenomics. The sequence of the full genome is 2824 nt in length. Phylogenetic analysis and genetic analyses show classic Betatorquevirus species organization with less than 40% amino acid similarity in ORF1. The prevalence of TTMV-204 in the periodontitis patient population was 18.75% (15/80), which was higher than in periodontally healthy individuals (10.00%, 10/80). However, the difference of the TTMV-204 prevalence between two groups was not statistically significant (p = 0.115). Further investigation is required to determine whether this new virus is associated with inflammation.

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Reply to the letter “Nasal nitric oxide as biomarker in the evaluation and management of chronic rhino-sinusitis with nasal polyposis”

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Accuracy of preoperative MRI to assess lateral neck metastases in papillary thyroid carcinoma

Abstract

Primary treatment of papillary thyroid carcinoma (PTC) with lateral lymph node metastasis is surgery, but the extent of lateral neck dissection remains undefined. Preoperative imaging is used to guide the extent of surgery, although its sensitivity and specificity for defining the number and level of affected lymph nodes on the lateral neck is relatively modest. Our aim was to assess the role of preoperative magnetic resonance imaging (MRI) in predicting the requisite levels of neck dissection in patients with regionally metastatic PTC, with a focus on Levels II and V. All patients with PTC and lateral neck metastasis who had undergone neck dissection at the Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland from 2013 to 2016 and had a preoperative MRI available were retrospectively reviewed. A head and neck radiologist re-evaluated all MRIs, and the imaging findings were compared with histopathology after neck dissection. In the cohort of 39 patients, preoperative MRI showed concordance with histopathology for Levels II and V as follows: sensitivity of 94 and 67%, specificity of 20 and 91%, positive predictive value of 56 and 75%, and negative predictive value of 75 and 87%, respectively. In PTC, MRI demonstrated fairly high specificity and negative predictive value for Level V metastasis, and future studies are needed to verify our results to omit prophylactic dissection of this level. Routine dissection of Level II in patients with regionally metastatic PTC needs to be considered, as MRI showed low specificity.

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IJERPH, Vol. 14, Pages 1005: Enhancing Youth Participation Using the PREP Intervention: Parents’ Perspectives

IJERPH, Vol. 14, Pages 1005: Enhancing Youth Participation Using the PREP Intervention: Parents' Perspectives

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091005

Authors: Dana Anaby Coralie Mercerat Stephanie Tremblay

Pathways and Resources for Engagement and Participation (PREP), an innovative intervention aimed at modifying the environment and coaching youth/parents, was found to be effective in improving youth participation in chosen community activities. In order to complement existing quantitative evidence, this study examined parents' perspectives on the PREP approach. Twelve parents of youth with physical disabilities (12 to 18 years old) who received the PREP approach participated in individual semi-structured interviews following the 12-week intervention delivered by an occupational therapist. Thematic analysis revealed three inter-linked themes, the first of which was informative, describing the "nature of intervention", and led to two reflective themes: "multi-faceted effects of care" and "process of care". Parents highlighted the effect of the PREP intervention in a broad sense, extending beyond the accomplishment of the selected activities. This involved improvements on the physical, emotional, and social levels as well as in autonomy. Parents also discussed how their own needs were acknowledged through the intervention and recognized the unique role of the occupational therapist in supporting this process. The findings provide additional information about the usefulness of the PREP approach and describe the various benefits generated by a single intervention. Such knowledge can expand the therapeutic options for positive, health-promoting participation.

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Teoria dei giochi e scienza della complessità - Comolive (Comunicati Stampa)

Teoria dei giochi e scienza della complessità
Comolive (Comunicati Stampa)
L'obiettivo è quello di analizzare i recenti progressi in un campo di ricerca che offre diversi argomenti, dalla classificazione dei sistemi, alla valutazione del potere effettivo degli agenti, compreso il comportamento dei membri, elementi casuali ...

and more »

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Dispositional use of emotion regulation strategies and resting-state cortico-limbic functional connectivity

Abstract

Neuroimaging functional connectivity (FC) analyses have shown that the negative coupling between the amygdala and cortical regions is linked to better emotion regulation in experimental settings. Nevertheless, no studies have examined the association between resting-state cortico-amygdalar FC and the dispositional use of emotion regulation strategies. We aim at assessing the relationship between the resting-state FC patterns of two different amygdala territories, with different functions in the emotion response process, and trait-like measures of cognitive reappraisal and expressive suppression. Forty-eight healthy controls completed the Emotion Regulation Questionnaire (ERQ) and underwent a resting-state functional magnetic resonance imaging acquisition. FC maps of basolateral and centromedial amygdala (BLA/CMA) with different cortical areas were estimated with a seed-based approach, and were then correlated with reappraisal and suppression scores from the ERQ. FC between left BLA and left insula and right BLA and the supplementary motor area (SMA) correlated inversely with reappraisal scores. Conversely, FC between left BLA and the dorsal anterior cingulate cortex correlated directly with suppression scores. Finally, FC between left CMA and the SMA was inversely correlated with suppression. Top-down regulation from the SMA seems to account for the dispositional use of both reappraisal and suppression depending on the specific amygdala nucleus being modulated. In addition, modulation of amygdala activity from cingulate and insular cortices seem to also account for the habitual use of the different emotion regulation strategies.

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Anatomical connections between the buccinator and the tendons of the temporalis

Publication date: Available online 1 September 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Mi-Sun Hur
The aim of this study was to clarify the anatomical relationship between the buccinator and the temporalis in order to improve understanding of the precise and coordinated movements of the mouth and the mandible. The buccinator and the temporalis were investigated in 72 hemifaces from Korean cadavers. Removing the buccal fat pad from the buccinator revealed that the fascia encircled the space between the superficial and deep tendons of the temporalis laterally, and the external surface of the buccinator medially in all specimens (100%). The fascia was located between the buccinator and the tendons of the temporalis, thereby connecting these two muscles. The fascial space was filled with connective tissue, and the buccal nerve and artery passed through this space. The inferior fibers of the buccinator arose from the anterior portion of the deep tendon of the temporalis in all specimens (100%). The anterior portion of the deep tendon of the temporalis extended forward obliquely between the ramus and body of the mandible. Thus, both the anterior portion of the deep tendon of the temporalis and its attaching inferior muscle fibers of the buccinator coursed obliquely. The above observations indicate that the connecting fascia between the buccinator and tendons of the temporalis and the inferior fibers of the buccinator that were attached to the deep tendon of the temporalis could assist in coordinatation of the movements of the mandibular region and the mouth angle in the timing and strength of contraction of the muscles during mastication, facial expression, and speech.

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Can Skull Form Predict the Shape of the Temporomandibular Joint? A Study Using Geometric Morphometrics on the Skulls of Wolves and Domestic Dogs

Publication date: Available online 1 September 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Stefan Curth, Martin S. Fischer, Kornelius Kupczik
The temporomandibular joint (TMJ) conducts and restrains masticatory movements between the mammalian cranium and the mandible. Through this functional integration, TMJ morphology in wild mammals is strongly correlated with diet, resulting in a wide range of TMJ variations. However, in artificially selected and closely related domestic dogs, dietary specialisations between breeds can be ruled out as a diversifying factor although they display an enormous variation in TMJ morphology. This raises the question of the origin of this variation. Here we hypothesise that, even in the face of reduced functional demands, TMJ shape in dogs can be predicted by skull form; i.e. that the TMJ is still highly integrated in the dog skull. If true, TMJ variation in the dog would be a plain by-product of the enormous cranial variation in dogs and its genetic causes. We addressed this hypothesis using geometric morphometry on a data set of 214 dog and 60 wolf skulls. We digitized 53 three-dimensional landmarks of the skull and the TMJ on CT-based segmentations and compared (1) the variation between domestic dog and wolf TMJs (via principal component analysis) and (2) the pattern of covariation of skull size, flexion and rostrum length with TMJ shape (via regression of centroid size on shape and partial least squares analyses). We show that the TMJ in domestic dogs is significantly more diverse than in wolves: its shape covaries significantly with skull size, flexion and rostrum proportions in patterns which resemble those observed in primates. Similar patterns in canids, which are carnivorous, and primates, which are mostly frugivorous imply the existence of basic TMJ integration patterns which are independent of dietary adaptations. However, only limited amounts of TMJ variation in dogs can be explained by simple covariation with overall skull geometry. This implies that the final TMJ shape is gained partially independently of the rest of the skull.

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In vivo characterization of the murine venous system before and during dobutamine stimulation: implications for preclinical models of venous disease

Publication date: Available online 1 September 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Olivia R. Palmer, Calvin B. Chiu, Amos Cao, Ulrich M. Scheven, Jose A. Diaz, Joan M. Greve
Although widely used as a preclinical model for studying venous diseases, there is a scarcity of in vivo characterizations of the naïve murine venous system. Additionally, previous studies on naïve veins (ex vivo) have not included the influence of surrounding structures and biomechanical forces. Using MRI, we noninvasively quantified the cross-sectional area, cyclic strain, and circularity of the venous system in young and old, male and female C57BL/6 mice. We investigated the most common venous locations used to perform venous disease research: the common jugular vein, suprarenal inferior vena cava (IVC), infrarenal IVC, common iliac vein, and common femoral vein. Our results elucidate age-dependent changes in venous cross-sectional area, which varied by location. Maximum cyclic strain, a parameter of lumen expansion, showed 10% change across the cardiac cycle, approximately half the magnitude of arteries. Veins demonstrated noncircular shapes, particularly in the core vasculature. The cardiovascular stressor dobutamine had only a small impact on the venous system. Also, our data demonstrate that the peripheral veins tend to decrease in cross-sectional area and circularity with age. Conversely, the IVC tends to increase in size and circularity with age, with males exhibiting larger variability in response to dobutamine compared to females. This work provides a foundation for drawing age and sex comparisons in disease models, and represents the first in vivo characterization of the murine venous system at rest and during the application of a pharmacological exercise surrogate.

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Expression of myosin heavy chain isoforms mRNA transcripts in the temporalis muscle of common chimpanzees (Pan troglodytes)

Publication date: Available online 1 September 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Neus Ciurana, Rosa Artells, Carmen Muñoz, Júlia Arias-Martorell, Gaëlle Bello-Hellegouarch, Aroa Casado, Elisabeth Cuesta, Alejandro Pérez-Pérez, Juan Francisco Pastor, Josep Maria Potau
PurposeThe common chimpanzee (Pan troglodytes) is the primate that is phylogenetically most closely related to humans (Homo sapiens). In order to shed light on the anatomy and function of the temporalis muscle in the chimpanzee, we have analyzed the expression patterns of the mRNA transcripts of the myosin heavy chain (MyHC) isoforms in different parts of the muscle.Basic proceduresWe dissected the superficial, deep and sphenomandibularis portions of the temporalis muscle in five adult P. troglodytes and quantified the expression of the mRNA transcripts of the MyHC isoforms in each portion using real-time quantitative polymerase chain reaction.Main findingsWe observed significant differences in the patterns of expression of the mRNA transcripts of the MyHC-IIM isoform between the sphenomandibularis portion and the anterior superficial temporalis (33.6% vs 47.0%; P=0.032) and between the sphenomandibularis portion and the anterior deep temporalis (33.6% vs 43.0; P=0.016). We also observed non-significant differences between the patterns of expression in the anterior and posterior superficial temporalis.Principal conclusionsThe differential expression patterns of the mRNA transcripts of the MyHC isoforms in the temporalis muscle in P. troglodytes may be related to the functional differences that have been observed in electromyographic studies in other species of primates. Our findings can be applicable to the fields of comparative anatomy, evolutionary anatomy, and anthropology.

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Prognostic implication of NOTCH1 in early stage oral squamous cell cancer with occult metastases

Abstract

Objective

The objective of this study was to explore the prognostic value of cancer stem cell markers, namely CD133, NANOG, and NOTCH1, in early stage oral squamous cell carcinoma (OSCC).

Materials and methods

Results

We found that CD133, NANOG, and NOTCH1 were significantly associated with lymph node metastasis, and NOTCH1 was also significantly associated with depth of invasion and locoregional recurrence.

Conclusions

NOTCH1 was identified as an independent prognostic factor for OS.

Clinical relevance

NOTCH1 might prove to be a useful indicator for high-risk patients with occult metastases from early stage OSCC.

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Reply to the letter “Nasal nitric oxide as biomarker in the evaluation and management of chronic rhino-sinusitis with nasal polyposis”

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Accuracy of preoperative MRI to assess lateral neck metastases in papillary thyroid carcinoma

Abstract

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Remediation mechanisms of mercapto-grafted palygorskite for cadmium pollutant in paddy soil

Abstract

The immobilization agent was the key factor that determined the success of remediation of heavy metal polluted soil. In this study, mercapto-grafted palygorskite (MP) as a novel and efficient immobilization agent was utilized for the remediation of Cd-polluted paddy soil in pot trials, and the remediation mechanisms were investigated in the aspect of soil chemistry and plant physiology with different rice cultivars as model plants. Mercapto-grafted palygorskite at applied doses of 0.1–0.3% could reduce Cd contents of brown rice and straws of different cultivars significantly. Both reduced DTPA-extractable Cd contents in rhizosphere and non-rhizosphere soil and decreasing Cd contents in iron plaques on rice root surfaces confirmed that MP was an efficient immobilization agent for Cd pollutant in paddy soil. In the aspect of soil chemistry, the pH values of rhizosphere and non-rhizosphere soils had no statistical changes in the MP treatment groups, but their zeta potentials decreased obviously, indicating that MP could enhance the fixation or sorption of Cd on soil compositions. In the aspect of antioxidant system, MP could increase POD activity of rice roots significantly to alleviate the stress of Cd to roots, and resulted in the decrease of T-AOC, SOD, and CAT activities of rice roots of the selected cultivars. MP had no inhabitation or enhancement effects on TSH of rice roots but enhance the contents of MTs and NPT to binding Cd to complete detoxification process. MP as a novel and efficient immobilization agent could complete the remediation effects through soil chemistry and plant physiological mechanisms.

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Reply to the letter “Nasal nitric oxide as biomarker in the evaluation and management of chronic rhino-sinusitis with nasal polyposis”

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Accuracy of preoperative MRI to assess lateral neck metastases in papillary thyroid carcinoma

Abstract

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Clinical activity of eribulin in advanced desmoplastic small round-cell tumor.

Desmoplastic small round-cell tumor is a rare but highly aggressive tumor occurring mainly in adolescents and young adults. Prolonged progression-free survival has been documented in patients who have undergone aggressive multimodality therapy - that is, multiagent intensive chemotherapy, debulking surgery, and radiation therapy. Eribulin is a microtubule-dynamics inhibitor, and it has recently been shown to be active in liposarcomas. In preclinical models, eribulin activities have also been shown to occur in Ewing's sarcoma cell lines, rhabdomyosarcomas and osteosarcomas. In this study, we report three cases of male patients suffering from desmoplastic small round-cell tumor and the clinical response to eribulin in two of them. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Colistin nephrotoxicity in the ICU: Is it different in the geriatric patients?

Abstract

Objective

Most significant side effect of colistin therapy which is used for the treatment of multi-drug resistant Gram-negative infections is nephrotoxicity. Our aim was to investigate the differences of colistin nephrotoxicity between the geriatric age group (≥65 years) and the younger age group (<65 years) in critically ill medical intensive care unit (ICU) patients.

Material and method

The medical records of the 76 patients who were taken colistin therapy due to multi-resistant Gram-negative infections between January 2010 and June 2014 in the our medical ICU were retrospectively investigated. Demographic characteristics, reasons for colistin use, daily colistin dose, duration of colistin use were recorded. Colistin-dependent renal dysfunction was evaluated according to the risk, injury, failure, loss and end-stage renal failure (RIFLE) criterias.

Results

The median age of the patients was 65 (65.8% male). Nephrotoxicity was developed in 36 (47.4%) patients. Thirty-nine (51.3%) patients were in geriatric age group, 37 (48.7%) were in younger age group. In geriatric age group, the rates of male gender (53.8 vs 78.4%, p = 0.031), pulmonary (48.7 vs 16.2%, p = 0.003) and cardiac diseases (71.8 vs 29.7%, p < 0.001), post-nephrotoxicity BUN levels (p = 0.023) and urine output during nephrotoxicity (p = 0.016) were higher than younger age group. Nephrotoxicity was developed in 22 (56.4%) patients of geriatric age group, and in 14 (37.8%) patients in younger age group (p = 0.115). The presence of cardiac disease, renal pathology and high creatinin value on admission, daily amount of colistin per body mass, total amount of colistin, use of colistin for pulmonary infection, use of amphotericin and vasopressor on admission were found as risk factors for colistin nephrotoxicity development in all study group; the daily amount of colistin per body mass (risk ratio:0.41; 95% CI 0.19–0.89) and vasopressor use during hospitalization were found independent risk factors (risk ratio:13.54; 95% CI 2.21–83.09).

Conclusion

In our study, in geriatric patient group colistin nephrotoxicity was not different from the younger age group. In the ICU, the age for nephrotoxicity does not appear to be a point to be considered for the initiation of colistin.

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Primary osteoporosis in children

Osteoporosis in childhood is uncommon, and it may be secondary to a spectrum of diverse conditions. Idiopathic juvenile osteoporosis is a primary osteoporosis of unknown aetiology present in previously well children and is a diagnosis of exclusion. We describe a 10-year-old prepubertal boy who presented with back pain of 1-week duration. His spinal X-ray showed generalised loss of vertebral body heights in keeping with osteoporosis. Endocrine and haematological work-up were normal. He was treated with vitamin D supplement and intravenous pamidronate. This case illustrates the general work-up and causes for paediatric osteoporosis, and the management for idiopathic juvenile osteoporosis.

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Strategies to reduce line infections in a small child with homozygous familial hypercholesterolaemia who cannot yet receive LDL apheresis

Patients with homozygous familial hypercholesterolaemia are optimally treated with low-density lipoprotein apheresis. Young patients who do not meet a weight threshold (25 kg) receive regular plasmapheresis. This approach may remove excessive immunoglobulins and vascular access set-up can be challenging. We report the case of a 4 year-old child who exhibited repeated septic infections (5 in 6 months) and had recurrent access issues before two interventions were implemented: (1) the percutaneous central venous line was modified to two implanted paediatric ports, and (2) the patient started receiving two bags of Octaplasma at the end of each plasmapheresis treatment to account for the excessive loss of immunoglobulins. For the paediatric plasmapheresis access port, a 19-gauge Huber needle had to be used for the arterial port to prevent the collapse of the extension. These two simple changes have left the patient infection-free for 9 months.

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Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement

Abstract

Background

Guidelines discourage the use of systemic corticosteroids for atopic dermatitis but their use remains widespread.

Objective

To reach consensus among an international group of atopic dermatitis experts on the use of systemic corticosteroids for atopic dermatitis.

Methods

A survey consisting of statements accompanied by visual analog scales ranging from "strongly disagree" to "neutral" to "strongly agree" was distributed to the International Eczema Council (IEC). Consensus was reached in agreement on a statement if <30% of respondents marked to the left of "neutral" towards "strongly disagree."

Results

Sixty of 77 (79%) IEC members participated. Consensus was reached on 12 statements, including that systemic corticosteroids should generally be avoided but can be used rarely for severe atopic dermatitis under certain circumstances, including a lack of other treatment options, as a bridge to other systemic therapies or phototherapy, during acute flares in need of immediate relief, in anticipation of a major life event or in the most severe cases. If used, treatment should be limited to short-term. Most respondents agreed that systemic corticosteroids should never be used in children, but consensus was not reached on that statement. The conclusions of our expert group are limited by a dearth of high-quality published evidence. If more stringent consensus criteria were applied (e.g., requiring <20% of respondents marking towards "strongly disagree," consensus would have been reached on fewer statements.

Conclusions

Based on expert opinion from the IEC, routine use of systemic corticosteroids for atopic dermatitis is generally discouraged and should be reserved for special circumstances.

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Laser Nd:YAG to treat primary pilonidal cysts: an alternative treatment

Abstract

A pilonidal cyst is an acquired inflammatory disease that affects young adults. Many treatments have been described, although no clear consensus has been reported. At present, surgical intervention is the first line of treatment. The main problem after treatment is the high recurrence of the pilonidal sinus (PNS).

We treated six patients with clinical PNS in the natal cleft (with different time of evolution) and 1.5 cm diameter approximately with Nd:YAG (1064nm). It took 3-4 treatments to resolve the sinus. It is important to remove the residual hairs into the cyst. All of our patients healed. Six lesions were eradicated, and no symptoms were described after the treatment. The mean follow-up period was 52 months (12 to 100 months) without any recurrences.

The early management of pilonidal cysts, with Nd:YAG (1064nm) could be an interesting way of treatment versus conventional surgery, because it causes few side effects and the clinical and aesthetic results are optimal.

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Sunburn and ambient temperature

Abstract

On days during the summer months when high temperatures are expected, weather forecasters frequently warn about the dangers of UV and high UV indices. It is not surprising, therefore, that it is a common belief that high ambient air temperatures are a major risk factor for burning. Although the UV index is generally higher on cloudless, hot days compared with cloudy, cool days, reliance should not be placed on ambient temperature alone as a guide to the need for sun protection.

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Acquired erythropoietic uroporphyria secondary to myelodysplastic syndrome with chromosome 3 alterations. A case report

Abstract

Congenital erythropoietic porphyria (CEP) is a rare, autosomal recessive disease caused by a deficiency of uroporphyrinogen III synthase (UROS), due to mutations in the UROS gene in chromosome 10. On occasion, patients show a mild late-onset disease, without germline UROS mutations, associated with hematologic malignancies. We report a 65-year-old patient with photosensitivity, porphyrins overexcretion and thrombocytopenia. Bone marrow analysis gave a diagnosis of myelodysplastic syndrome (MDS) with the presence of a derivative chromosome 3, possible due to an inversion including 3q21 and 3q26 breakpoints. After allogeneic stem cell transplantation a complete remission of MDS and uroporphyria was achieved. To our knowledge, this is the first reported case of acquired erythropoietic uroporphyria associated with MDS, with chromosome 3 alterations.

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Minimally-invasive and targeted therapeutic cell delivery to the skin using microneedle devices

Summary

Background

Translation of cell therapies to the clinic is accompanied by numerous challenges, including controlled and targeted delivery of the cells to their site of action, without compromising cell viability and functionality.

Objectives

To explore the use of hollow microneedle devices (to date only used for the delivery of drugs and vaccines into the skin and for the extraction of biological fluids) to deliver cells into skin in a minimally-invasive, user-friendly and targeted fashion.

Methods

Melanocyte, keratinocyte and mixed epidermal cell suspensions were passed through various types of microneedles and subsequently delivered into the skin.

Results

Cell viability and functionality is maintained after injection through hollow microneedles with a bore size ≥75 μm. Healthy cells are delivered into skin at clinically relevant depths.

Conclusions

Hollow microneedles provide an innovative and minimally-invasive method for delivering functional cells into the skin. Microneedle cell delivery represents a potential new treatment option for cell therapy approaches including skin re-pigmentation, wound repair, scar and burn remodelling, immune therapies, and cancer vaccines.

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Oral mucosa is a useful substrate for detecting autoantibodies of mucous membrane pemphigoid

Abstract

Mucous membrane pemphigoid (MMP) is a rare autoimmune blistering disease targeting various autoantigens, including the C-terminus of collagen XVII (COL17) and laminin332. Bullous pemphigoid (BP) is the most common autoimmune blistering disease, affecting the mucosae in 10-20% of cases. COL17, particularly, the non-collagenous (NC)16A domain is the pathogenic epitope for BP.

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The radiographically diagnosed adrenal myelolipoma: what do we really know?

Abstract

Purpose

Adrenal myelolipomas are uncommon, benign tumors of the adrenal glands that are not routinely evaluated for autonomous hormone secretion or followed by repeat imaging, but may lead to retroperitoneal hemorrhage. Little is known about the natural history these tumors with the majority of previous publications being confined to case reports and small case series.

Methods

We reviewed the computed tomography (CT) reports of 62,279 patients evaluated at a tertiary referral center between 2002 and 2015 for the presence of an adrenal myelolipoma >1 cm in size. We then reviewed the CT imaging and patient charts to determine tumor size, growth, evidence of retroperitoneal hemorrhage, and endocrine dysfunction.

Results

We identified 150 (0.24%) patients with 155 radiographically diagnosed adrenal myelolipomas found on a CT scan during our study period. The median tumor size at discovery was 2.1 cm. Twelve (7.7%) tumors were >6 cm. Sixty-nine (46%) patients had a follow-up CT with a mean time interval between scans of 3.9 years. Eleven tumors (16%) grew over our follow-up period with a median growth rate of 0.16 cm/year. No patient developed a retroperitoneal hemorrhage. Twenty (13%) patients underwent an evaluation for endocrine dysfunction. Three patients had evidence of hypercortisolism and one patient had primary aldosteronism.

Conclusion

The majority of radiographically diagnosed adrenal myelolipomas found on abdominal CT imaging are small and slow growing. Retroperitoneal hemorrhage is uncommon, but the rate of associated endocrine dysfunction may be underestimated.

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Insulin and osteocalcin: further evidence for a mutual cross-talk

Abstract

Purpose

In the last few years, bone has been recognized as an endocrine organ that modulates glucose metabolism by secretion of osteocalcin, an osteoblast-specific hormone, that influences fat deposition and blood sugar levels. To date, however, very few in vitro models have been developed to investigate, at the molecular levels, the relationship between glucose, insulin and osteocalcin. This study aims at covering this gap.

Methods

We studied osteogenic differentiation, osteocalcin gene expression, and osteblast-mediated insulin secretion, using cultured MG-63 human osteoblast-like cells that underwent glucotoxicity and insulin resistance. In addition, we investigated whether a correlation existed between hyperglycemia and/or insulin resistance and total osteocalcin serum concentrations in patients.

Results

While insulin and low glucose increased osteocalcin gene expression, disruption of insulin signaling in MG-63 osteoblasts and high glucose concentration in cell culture medium decreased osteocalcin gene transcription and reduced osteogenic differentiation. Concomitantly, insulin secretion was significantly impaired in rat INS-1 β-cells treated with conditioned medium from insulin resistant MG-63 cells or cells exposed to high glucose concentrations. Also, chronic hyperglycemia, but not insulin resistance, inversely correlated with circulating osteocalcin levels in patients.

Conclusion

Our results further support the existence of an endocrine axis between bone, where osteocalcin is produced, and pancreatic β-cells, and add new insights into the molecular details of this relationship. These findings may contribute to the understanding of osteocalcin regulation and its role in metabolism.

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EGFR-targeted therapies in the post-genomic era

Abstract

Over 90% of head and neck cancers overexpress the epidermal growth factor receptor (EGFR). In diverse tumor types, EGFR overexpression has been associated with poorer prognosis and outcomes. Therapies targeting EGFR include monoclonal antibodies, tyrosine kinase inhibitors, phosphatidylinositol 3-kinase (PI3K) inhibitors, and antisense gene therapy. Few EGFR-targeted therapeutics are approved for clinical use. The monoclonal antibody cetuximab is a Food and Drug Administration (FDA)-approved EGFR-targeted therapy, yet has exhibited modest benefit in clinical trials. The humanized monoclonal antibody nimotuzumab is also approved for head and neck cancers in Cuba, Argentina, Colombia, Peru, India, Ukraine, Ivory Coast, and Gabon in addition to nasopharyngeal cancers in China. Few other EGFR-targeted therapeutics for head and neck cancers have led to as significant responses as seen in lung carcinomas, for instance. Recent genome sequencing of head and neck tumors has helped identify patient subgroups with improved response to EGFR inhibitors, for example, cetuximab in patients with the KRAS-variant and the tyrosine kinase inhibitor erlotinib for tumors harboring MAPK1^E322K mutations. Genome sequencing has furthermore broadened our understanding of dysregulated pathways, holding the potential to enhance the benefit derived from therapies targeting EGFR.

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Woman suspected of faking cancer may lose license - The Register-Guard

KOIN.com

Woman suspected of faking cancer may lose license
The Register-Guard
TUALATIN — The Oregon State Board of Nursing may suspend the license of a Tualatin woman suspected of profiting financially by faking a cancer diagnosis. Jenifer Gaskin announced in 2014 that she had been diagnosed with thyroid cancer. A friend ...
Woman suspected of faking cancer may lose nursing licenseKOIN.com

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Αρχειοθήκη ιστολογίου

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Σάββατο 2 Σεπτεμβρίου 2017

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