Radiologic Findings in Intimate Partner Violence.

Radiologic Findings in Intimate Partner Violence.

Radiology. 2019 Feb 05;:180801

Authors: George E, Phillips CH, Shah N, Lewis-O'Connor A, Rosner B, Stoklosa HM, Khurana B

Abstract
Purpose To assess the radiologic findings associated with intimate partner violence (IPV). Materials and Methods Electronic medical records of 185 patients referred to the IPV support program from the emergency department (ED) between January 2015 and October 2016 were retrospectively reviewed and compared with an age- and sex-matched control group of 555 subjects (1:3 ratio of IPV victims to control subjects) who presented to the ED. Reports of all imaging studies performed within 5 years prior to the index ED visit were reviewed. Results The majority of patients who experienced IPV (mean age, 34.2 years ± 12.2 [standard deviation]) were female (178 of 185 [96.2%]) and were largely African American (69 of 185 [37.3%]). Demographic and clinical variables independently associated with IPV were race (odds ratio [OR] range, 3.2-5.9; 95% confidence interval [CI]: 1.8, 12.7), psychiatric comorbidities (OR, 5.4; 95% CI: 3.4, 8.8), and homelessness (OR, 13.0; 95% CI: 5.4, 31.2). IPV victims underwent more imaging studies in the preceding 5 years (median, four studies) than did control subjects (median, one study). Obstetric-gynecologic findings (OR, 4.4; 95% CI: 2.1, 9.6) and acute fractures (OR, 2.4, 95% CI: 1.1, 5.3) seen on images were independently associated with IPV. The addition of imaging findings to demographic and clinical variables increased the area under the receiver operating characteristic curve (AUC) of the multivariate model to detect IPV (0.87 vs 0.86, P < .01), and the cross-validated multivariate model had an AUC of 0.85. Acute fractures involved the face or skull (range, P < .01 to P = .05), and chronic fractures affected the extremities and nasal bone (P < .01 and P = .05, respectively) more frequently in the IPV group than in the control group. Conclusion Intimate partner violence victims undergo more imaging studies and have a higher frequency of potential violence-related imaging findings when compared with age- and sex-matched control subjects. © RSNA, 2019 See also the editorial by Flores and Narayan in this issue.

PMID: 30720401 [PubMed - as supplied by publisher]

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Automated Calculation of the Alberta Stroke Program Early CT Score: Feasibility and Reliability.

Automated Calculation of the Alberta Stroke Program Early CT Score: Feasibility and Reliability.

Radiology. 2019 Feb 05;:181228

Authors: Maegerlein C, Fischer J, Mönch S, Berndt M, Wunderlich S, Seifert CL, Lehm M, Boeckh-Behrens T, Zimmer C, Friedrich B

Abstract
Background The Alberta Stroke Program Early CT Score (ASPECTS) evaluation is a qualitative method to evaluate focal hypoattenuation at brain CT in early acute stroke. However, interobserver agreement is only moderate. Purpose To compare ASPECTS calculated by using an automatic software tool to neuroradiologist evaluation in the setting of acute stroke. Materials and Methods For this retrospective study, consensus ASPECTS were defined by two neuroradiologists based on baseline noncontrast CTs collected from January 2017 to December 2017 from patients with an occlusion in the middle cerebral artery and from an additional cohort of patients suspected of having stroke and no large vessel occlusion. Imaging data from both baseline and follow-up CT was evaluated for the consensus reading. After 6 weeks, the same two neuroradiologists again determined ASPECTS by using only the baseline CT. For comparison, ASPECTS was also calculated from baseline CT images by using a commercially available software (RAPID ASPECTS). Both methods were compared by using weighted κ statistics. Results CT scans from 100 patients with middle cerebral artery occlusion (44 women [mean age ± standard deviation, 75 years ± 14] and 56 men [mean age, 71 years ± 14]) and 52 patients suspected of having stroke and no large vessel occlusion (19 women [mean age, 69 years ± 18] and 33 men [68 years ± 15]) were evaluated. Neuroradiologists showed moderate agreement with the consensus score (κ = 0.57 and κ = 0.56). Software analysis showed substantial agreement (κ = 0.9) with the consensus score. Software analysis showed a substantial agreement (κ = 0.78) after greater than 1 hour between symptom onset and imaging, which increased to high agreement (κ = 0.92) in the time window greater than 4 hours. The neuroradiologist raters did not achieve comparable results to the software until the time interval of greater than 4 hours (κ = 0.83 and κ = 0.76). Conclusion In acute stroke of the middle cerebral artery, the Alberta Stroke Program Early CT score calculated with automated software had better agreement than that of human readers with a predefined consensus score. © RSNA, 2019 Online supplemental material is available for this article.

PMID: 30720400 [PubMed - as supplied by publisher]

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Imaging-guided Percutaneous Ablation: A Step Forward to Minimize the Invasiveness of Breast Cancer Treatment.

Imaging-guided Percutaneous Ablation: A Step Forward to Minimize the Invasiveness of Breast Cancer Treatment.

Radiology. 2019 Feb 05;:182448

Authors: Mauri G, Sconfienza LM, Sardanelli F

PMID: 30720399 [PubMed - as supplied by publisher]

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Basal Forebrain Resting Functional Activity Associated with Brain Amyloid-β Burden in ε4 Carriers and Older Women: Possible Implications for Baseline Cognition and Response to Amyloid-β-based Preventive Trials.

Basal Forebrain Resting Functional Activity Associated with Brain Amyloid-β Burden in ε4 Carriers and Older Women: Possible Implications for Baseline Cognition and Response to Amyloid-β-based Preventive Trials.

Radiology. 2019 Feb 05;:182659

Authors: Pomara N, Bruno D

PMID: 30720398 [PubMed - as supplied by publisher]

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Seizure outcome and epilepsy patterns in patients with cerebral palsy.

Seizure outcome and epilepsy patterns in patients with cerebral palsy.

Seizure. 2019 Jan 04;65:166-171

Authors: El Tantawi NT, Abd Elmegid DS, Atef E

Abstract
PURPOSE: The aim of the present study was to investigate epilepsy patterns and outcomes in patients with cerebral palsy (CP) and identify the variables that determine remission.
METHODS: This was a retrospective cohort study. We followed 107 CP patients aged 1-16 years with newly diagnosed epilepsy. The patients were categorized according to their remission outcome, uninterrupted freedom of seizure for 2 years or longer, and 4 epilepsy patterns: A) sustained freedom from seizures before 6 months of treatment; B) delayed but sustained seizure freedom; C) relapsing-remitting course; and D) seizure freedom never attained. The variables were analysed for their prognostic relevance to the outcomes RESULTS: A total of 107 patients were included; their mean age at epilepsy diagnosis was 4.2 years (SD 2.5). By the end of the 8-year follow up, 19.6% 26.1%, 31.7%, and 22.4% were in sustained remission, terminal remission, relapse, and no remission respectively. Pattern A was identified in 6.5% of the patients, pattern B in 27.1%, pattern C in 43.9%, and pattern Din 22.4%. Univariate analysis revealed that the type of CP, mobility, and number of seizure types, are among the other factors that significantly affected remission.
CONCLUSION: A total of 45% of patients with CP and epilepsy achieved remission (with and without antiepileptics) but after a relatively long treatment duration. Remission was affected by patient- and epilepsy-related factors. More studies are required to further evaluate these factors.

PMID: 30721873 [PubMed - as supplied by publisher]

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[Immediate outcomes of microsurgical treatment of cerebral arteriovenous malformations in non-hemorrhagic patients].

[Immediate outcomes of microsurgical treatment of cerebral arteriovenous malformations in non-hemorrhagic patients].

Zh Vopr Neirokhir Im N N Burdenko. 2018;82(6):30-37

Authors: Gorozhanin VA, Eliava SS, Pilipenko YV, Shekhtman OD, Sazonova OB

Abstract
Arteriovenous malformations (AVMs) are some of the most frequent congenital abnormalities of the cerebral vascular system and usually occur at a young age. Given the fact that AVMs can manifest, in addition to hemorrhages, as symptomatic epilepsy (17-40%) that occurs more often at a young age and may lead to significant disability, investigation of this pathology remains topical. Particular attention has recently been paid to the management of AVM patients without clinical signs of hemorrhage at the time of pathology diagnosis.
OBJECTIVE: The objective of this study was to optimize the management of patients with unruptured AVMs based on analysis of the immediate outcomes of microsurgical treatment.
MATERIAL AND METHODS: We retrospectively analyzed the immediate outcomes of microsurgical treatment of AVM patients hospitalized to the Burdenko Neurosurgical Institute in the period from 2009 to 2017. The patients included in the study met the following criteria: age over 18 years; microsurgical resection of AVM. The main exclusion criterion was a hemorrhage history confirmed by clinical data or verified by a neuroimaging study (MRI/CT). The study included 160 patients (58.1% males and 41.9% females) aged 18 to 67 years (mean, 33.5 years). According to the clinical course, patients with epileptic syndrome prevailed: 99 (61.9%) cases. Headaches occurred in 49 (30.6%) patients; 8 (5%) patients had asymptomatic AVMs; 4 (2.5%) patients had ischemic stroke. The surgical risk was assessed by using the Spetzler-Martin (S-M) scale: Grade I - 18 (11.3%) patients, Grade II - 71 (44.4%) patients, Grade III - 60 (37.5%) patients, and Grade IV - 11 (6.8%) patients. Direct surgery in patients with AVMs classified as S-M V was not planned.
RESULTS: Postoperative analysis revealed that 33 patients included in the study group in accordance with the above criteria had silent AVM hemorrhage that was confirmed only based on the intraoperative picture. The best surgical treatment outcomes were observed in patients with S-M I and II AVMs. The outcome scored 4 and 5 on the Glasgow Outcome Scale (GOS) was in 100% of cases in the S-M I group, 98.6% in the S-M II group, 86.7% in the S-M III group, and 81.8% in the S-M IV group. The relatively good outcomes of S-M IV AVM resection are explained by careful selection of patients for surgery. In general, good postoperative outcomes (GOS score of 4 and 5) were in 93.2% of patients. The main newly developed postoperative symptoms were visual impairments - visual field defects (64.7% of all complications). Postoperative mortality was 1.3%.
CONCLUSION: Surgical treatment is indicated for patients with unruptured AVMs and S-M I or II surgical risk, regardless of clinical manifestations. In other cases, the treatment approach depends on a number of risk factors.

PMID: 30721215 [PubMed - in process]

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Fenfluramine, a serotonin-releasing drug, prevents seizure-induced respiratory arrest and is anticonvulsant in the DBA/1 mouse model of SUDEP.

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Fenfluramine, a serotonin-releasing drug, prevents seizure-induced respiratory arrest and is anticonvulsant in the DBA/1 mouse model of SUDEP.

Epilepsia. 2019 Feb 04;:

Authors: Tupal S, Faingold CL

Abstract
OBJECTIVE: Prevention of sudden unexpected death in epilepsy (SUDEP) is a critical goal for epilepsy therapy. The DBA/1 mouse model of SUDEP exhibits an elevated susceptibility to seizure-induced death in response to electroconvulsive shock, hyperthermia, convulsant drug, and acoustic stimulation. The serotonin hypothesis of SUDEP is based on findings that treatments which modify serotonergic function significantly alter susceptibility to seizure-induced sudden death in several epilepsy models, including DBA/1 mice. Serotonergic abnormalities have also recently been observed in human SUDEP. Fenfluramine is a drug that enhances serotonin release in the brain. Recent studies have found that the addition of fenfluramine improved seizure control in patients with Dravet syndrome, which has a high incidence of SUDEP. Therefore, we investigated the effects of fenfluramine on seizures and seizure-induced respiratory arrest (S-IRA) in DBA/1 mice.
METHODS: The dose and time course of the effects of fenfluramine (i.p.) on audiogenic seizures (Sz) induced by an electric bell in DBA/1 mice were determined. Videos of Sz-induced behaviors were recorded for analysis. Statistical significance (P < 0.05) was evaluated using the chi-square test.
RESULTS: Sixteen hours after administration of 15 mg/kg of fenfluramine, a high incidence of selective block of S-IRA susceptibility (P < 0.001) occurred in DBA/1 mice without blocking any convulsive behavior. Thirty minutes after 20-40 mg/kg of fenfluramine, significant reductions of seizure incidence and severity, as well as S-IRA susceptibility occurred, which were long-lasting (≥48 hours). The median effective dose (ED50 ) of fenfluramine for significantly reducing Sz at 30 minutes was 21 mg/kg.
SIGNIFICANCE: This study presents the first evidence for the effectiveness of fenfluramine in reducing seizure incidence, severity, and S-IRA susceptibility in a mammalian SUDEP model. The ability of fenfluramine to block S-IRA selectively suggests the potential usefulness of fenfluramine in prophylaxis of SUDEP. These results further confirm and extend the serotonin hypothesis of SUDEP.

PMID: 30719703 [PubMed - as supplied by publisher]

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Effect of Co-administration of Bumetanide and Phenobarbital on Seizure Attacks in Temporal Lobe Epilepsy.

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Effect of Co-administration of Bumetanide and Phenobarbital on Seizure Attacks in Temporal Lobe Epilepsy.

Basic Clin Neurosci. 2018 Nov-Dec;9(6):408-416

Authors: Rahmanzadeh R, Mehrabi S, Barati M, Ahmadi M, Golab F, Kazmi S, Joghataei MT, Seifi M, Gholipourmalekabadi M

Abstract
Introduction: The resistance of temporal lobe epilepsy to classic drugs is thought to be due to disruption in the excitation/inhibition of this pathway. Two chloride transporters, NKCC1 and KCC2, are expressed differently for the excitatory state of Gamma-Amino Butyric Acid (GABA). The present study explored the effect of bumetanide as a selective NKCC1 inhibitor either alone or in combination with the phenobarbital in the pilocarpine model of epilepsy.
Methods: An animal model of Status Epilepticus (SE) was induced with pilocarpine in Wistar male rats followed by phenobarbital and or bumetanide or saline administration for 45 days after the induction of SE by Intraperitoneal (IP) injection. The rats were monitored, their behavior was recorded, and after 24 hours they were sacrificed to study the expression of NKCC1 and KCC2 using real time PCR.
Results: The data showed that the effects of a combination of bumetanide with phenobarbital on frequency rate and duration of seizure attack were more than those of the phenobarbital alone. In addition, in the bumetanide and combined treatment groups, NKCC1 expression decreased significantly, compared with untreated epileptic animals. A delayed decrement in NKCC1/KCC2 expression ratio after bumetanide application was also observed.
Conclusion: The combination of bumetanide with phenobarbital increases the inhibition of SE and maximizes the potential of GABA signaling pathway, and can be considered as an effective therapeutic strategy in patients with epilepsy.

PMID: 30719255 [PubMed]

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Orexin in the anxiety spectrum: association of a HCRTR1 polymorphism with panic disorder/agoraphobia, CBT treatment response and fear-related intermediate phenotypes.

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Orexin in the anxiety spectrum: association of a HCRTR1 polymorphism with panic disorder/agoraphobia, CBT treatment response and fear-related intermediate phenotypes.

Transl Psychiatry. 2019 Feb 04;9(1):75

Authors: Gottschalk MG, Richter J, Ziegler C, Schiele MA, Mann J, Geiger MJ, Schartner C, Homola GA, Alpers GW, Büchel C, Fehm L, Fydrich T, Gerlach AL, Gloster AT, Helbig-Lang S, Kalisch R, Kircher T, Lang T, Lonsdorf TB, Pané-Farré CA, Ströhle A, Weber H, Zwanzger P, Arolt V, Romanos M, Wittchen HU, Hamm A, Pauli P, Reif A, Deckert J, Neufang S, Höfler M, Domschke K

Abstract
Preclinical studies point to a pivotal role of the orexin 1 (OX1) receptor in arousal and fear learning and therefore suggest the HCRTR1 gene as a prime candidate in panic disorder (PD) with/without agoraphobia (AG), PD/AG treatment response, and PD/AG-related intermediate phenotypes. Here, a multilevel approach was applied to test the non-synonymous HCRTR1 C/T Ile408Val gene variant (rs2271933) for association with PD/AG in two independent case-control samples (total n = 613 cases, 1839 healthy subjects), as an outcome predictor of a six-weeks exposure-based cognitive behavioral therapy (CBT) in PD/AG patients (n = 189), as well as with respect to agoraphobic cognitions (ACQ) (n = 483 patients, n = 2382 healthy subjects), fMRI alerting network activation in healthy subjects (n = 94), and a behavioral avoidance task in PD/AG pre- and post-CBT (n = 271). The HCRTR1 rs2271933 T allele was associated with PD/AG in both samples independently, and in their meta-analysis (p = 4.2 × 10-7), particularly in the female subsample (p = 9.8 × 10-9). T allele carriers displayed a significantly poorer CBT outcome (e.g., Hamilton anxiety rating scale: p = 7.5 × 10-4). The T allele count was linked to higher ACQ sores in PD/AG and healthy subjects, decreased inferior frontal gyrus and increased locus coeruleus activation in the alerting network. Finally, the T allele count was associated with increased pre-CBT exposure avoidance and autonomic arousal as well as decreased post-CBT improvement. In sum, the present results provide converging evidence for an involvement of HCRTR1 gene variation in the etiology of PD/AG and PD/AG-related traits as well as treatment response to CBT, supporting future therapeutic approaches targeting the orexin-related arousal system.

PMID: 30718541 [PubMed - in process]

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Ser46 phosphorylation of p53 is an essential event in prolyl-isomerase Pin1-mediated p53-independent apoptosis in response to heat stress.

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Ser46 phosphorylation of p53 is an essential event in prolyl-isomerase Pin1-mediated p53-independent apoptosis in response to heat stress.

Cell Death Dis. 2019 Feb 04;10(2):96

Authors: Li L, Su Z, Zou Z, Tan H, Cai D, Su L, Gu Z

Abstract
Heat stroke has increased in frequency worldwide in recent years and continues to have a high morbidity and mortality. Identification of the mechanisms mediating heat stoke is important and necessary. Our preliminary study revealed heat stress (HS)-induced apoptosis of vascular endothelial cells was associated with reactive oxygen species (ROS)-induced p53 translocation into mitochondria. Previous studies have suggested the prolyl-isomerase Pin1 regulates p53 functioning through specific binding to p53 phosphorylation sites. Based on these studies, we presumed Pin1 is a key intermediate in regulation of mitochondrial p53 translocation through a HS-induced ROS-p53 transcription-independent apoptosis pathway. In this context, we revealed p53 had a crucial role in a HS-induced mitochondrial apoptotic pathway, where p53 protein rapidly translocated into mitochondria in endothelial cells both in vitro and in vivo. In particular, HS caused an increase in p53 phosphorylation at Ser46 that facilitated interactions with phosphorylation-dependent prolyl-isomerase Pin1, which has a key role in promoting HS-induced localization of p53 to mitochondria. Furthermore, we also found ROS production was a critical mediator in HS-induced Pin1/p53 signaling and was involved in regulating mitochondrial apoptosis pathway activation. Therefore, we have contributed to our profound understanding of the mechanism underlying HS-induced endothelial dysfunction in an effort to reduce the mortality and morbidity of heat stroke.

PMID: 30718466 [PubMed - in process]

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Concordance between the interictal focal EEG pattern and MRI lesions as a predictor of a favorable surgical outcome in patients with epileptic spasms: a Chinese study.

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Concordance between the interictal focal EEG pattern and MRI lesions as a predictor of a favorable surgical outcome in patients with epileptic spasms: a Chinese study.

J Neurosurg Pediatr. 2019 Feb 01;:1-10

Authors: Xu C, Yu T, Zhang G, Rajah GB, Wang Y, Li Y

Abstract
OBJECTIVEThe aim of this study was to evaluate the electro-clinical features, etiology, treatment, and postsurgical seizure outcomes in patients with intractable epileptic spasms (ESs).METHODSThe authors retrospectively studied the medical records of all patients who had presented with medically intractable ESs and had undergone surgery in the period between October 2009 and August 2015. The interictal electroencephalography (EEG) pattern, MRI studies, magnetoencephalography findings, and postsurgical seizure outcomes were compared.RESULTSTwenty-six patients, 12 boys and 14 girls (age range 3-22 years), were eligible for study inclusion. Of these 26 patients, 84.6% (22) presented with multiple seizure types including partial seizures (PSs) independent of the ESs (30.8%); ESs followed by tonic seizures (30.8%); myoclonic seizures (19.2%); tonic seizures (19.2%); ESs followed by PSs (19.2%); focal seizures with secondary generalization (15.4%); atypical absence (11.5%); PSs followed by ESs (7.7%); and myoclonic followed by tonic seizures (7.7%). Seventeen patients underwent multilobar resection and 9 underwent unilobar resection. At the last follow-up (mean 36.6 months), 42.3% of patients were seizure free (outcome classification [OC] 1), 23.1% had > 50% reduction in seizure frequency (OC2-OC4), and 34.6% had < 50% reduction in seizure frequency or no improvement (OC5 and OC6). Predictors of favorable outcomes included an interictal focal EEG pattern and concordance between interictal EEG and MRI-demonstrated lesions (p = 0.001 and 0.004, respectively).CONCLUSIONSA favorable surgical outcome is achievable in a highly select group of patients with ESs secondary to structural lesions. Interictal EEG can help in identifying patients with the potential for favorable resective outcomes.

PMID: 30717039 [PubMed - as supplied by publisher]

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Clinical validation of automated hippocampal segmentation in temporal lobe epilepsy.

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Clinical validation of automated hippocampal segmentation in temporal lobe epilepsy.

Neuroimage Clin. 2018;20:1139-1147

Authors: Hadar PN, Kini LG, Coto C, Piskin V, Callans LE, Chen SH, Stein JM, Das SR, Yushkevich PA, Davis KA

Abstract
OBJECTIVE: To provide a multi-atlas framework for automated hippocampus segmentation in temporal lobe epilepsy (TLE) and clinically validate the results with respect to surgical lateralization and post-surgical outcome.
METHODS: We retrospectively identified 47 TLE patients who underwent surgical resection and 12 healthy controls. T1-weighted 3 T MRI scans were acquired for all subjects, and patients were identified by a neuroradiologist with regards to lateralization and degree of hippocampal sclerosis (HS). Automated segmentation was implemented through the Joint Label Fusion/Corrective Learning (JLF/CL) method. Gold standard lateralization was determined from the surgically resected side in Engel I (seizure-free) patients at the two-year timepoint. ROC curves were used to identify appropriate thresholds for hippocampal asymmetry ratios, which were then used to analyze JLF/CL lateralization.
RESULTS: The optimal template atlas based on subject images with varying appearances, from normal-appearing to severe HS, was demonstrated to be composed entirely of normal-appearing subjects, with good agreement between automated and manual segmentations. In applying this atlas to 26 surgically resected seizure-free patients at a two-year timepoint, JLF/CL lateralized seizure onset 92% of the time. In comparison, neuroradiology reads lateralized 65% of patients, but correctly lateralized seizure onset in these patients 100% of the time. When compared to lateralized neuroradiology reads, JLF/CL was in agreement and correctly lateralized all 17 patients. When compared to nonlateralized radiology reads, JLF/CL correctly lateralized 78% of the nine patients.
SIGNIFICANCE: While a neuroradiologist's interpretation of MR imaging is a key, albeit imperfect, diagnostic tool for seizure localization in medically-refractory TLE patients, automated hippocampal segmentation may provide more efficient and accurate epileptic foci localization. These promising findings demonstrate the clinical utility of automated segmentation in the TLE MR imaging pipeline prior to surgical resection, and suggest that further investigation into JLF/CL-assisted MRI reading could improve clinical outcomes. Our JLF/CL software is publicly available at http://bit.ly/2GdVUSl.

PMID: 30380521 [PubMed - indexed for MEDLINE]

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Survival Impact of Adjuvant Therapy in Salivary Gland Cancers following Resection and Neck Dissection.

Survival Impact of Adjuvant Therapy in Salivary Gland Cancers following Resection and Neck Dissection.

Otolaryngol Head Neck Surg. 2019 Feb 05;:194599819827851

Authors: Aro K, Ho AS, Luu M, Kim S, Tighiouart M, Yoshida EJ, Mallen-St Clair J, Shiao SL, Leivo I, Zumsteg ZS

Abstract
OBJECTIVE: To evaluate the impact of postoperative radiotherapy (PORT) and chemotherapy on survival in salivary gland cancer (SGC) treated with curative-intent local resection and neck dissection.
STUDY DESIGN: Retrospective population-based cohort study.
SETTING: National Cancer Database.
SUBJECTS AND METHODS: Patients with SGC who were undergoing surgery were identified from the National Cancer Database between 2004 and 2013. Neck dissection removing a minimum of 10 lymph nodes was required. Because PORT violated the proportional hazards assumption, this variable was treated as a time-dependent covariate.
RESULTS: Overall, 4145 cases met inclusion criteria (median follow-up, 54 months). PORT was associated with improved overall survival in multivariable analysis, both ≤9 months from diagnosis (hazard ratio [HR], 0.26; 95% CI, 0.20-0.34; P < .001) and >9 months (HR, 0.75; 95% CI, 0.66-0.86; P < .001). In propensity score-matched cohorts, 5-year overall survival was 67.1% and 60.6% with PORT and observation, respectively ( P < .001). Similar results were observed in landmark analysis of patients surviving at least 6 months following diagnosis. Adjuvant chemotherapy was not associated with improved survival (HR, 1.15; 95% CI, 0.99-1.34; P = .06).
CONCLUSION: PORT, but not chemotherapy, is associated with improved survival among patients with SGC for whom neck dissection was deemed necessary. These results are not applicable to low-risk SGCs not requiring neck dissection.

PMID: 30721113 [PubMed - as supplied by publisher]

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Health Care Utilization and Prescribing Patterns for Adult Eustachian Tube Dysfunction.

Health Care Utilization and Prescribing Patterns for Adult Eustachian Tube Dysfunction.

Otolaryngol Head Neck Surg. 2019 Feb 05;:194599819826959

Authors: McCoul ED, Weinreich HM, Mulder H, Man LX, Schulz K, Shin JJ

Abstract
OBJECTIVE: Eustachian tube dysfunction (ETD) prompts >2 million adult visits in the United States annually. While disease prevalence and health care utilization are established for children, practice patterns for adults remain unknown. Our objective was to determine national resource utilization for adult ETD.
STUDY DESIGN: Cross-sectional study.
SETTING: National database sample.
SUBJECTS AND METHODS: The Truven Health MarketScan Databases (2010-2014) analytic cohort included health care encounters of patients ≥18 years of age with a diagnosis of ETD, otitis media with effusion, or tympanic membrane retraction. Visits associated with recent diagnoses of acute upper respiratory infection, head and neck cancer, or radiation therapy were excluded. Acute ETD (<3 months) and chronic ETD (≥3 months) were subgroups. Medication usage was quantified by class.
RESULTS: ETD was diagnosed for 1,298,987 patients, 11% of which was chronic. Over 92% of patients were seen in outpatient clinics, most often by otolaryngology (57%) for chronic ETD and by general medicine (49%) for acute ETD. Medications were frequently utilized, as 530,146 (53.7%) patients received ≥1 prescription. Top prescriptions for chronic ETD included intranasal corticosteroids (22%), antibiotics (22%), oral corticosteroids (13%), and analgesics (6%). The overall annual cost of prescribed medications associated with visits in which either acute or chronic ETD was diagnosed exceeded $8.5 million for a mean of $80.78 per patient who filled a prescription.
CONCLUSION: Adult ETD is frequently treated with several medication classes by a variety of provider types. Understanding the potential adverse effects and cost associated with these practices should be a priority.

PMID: 30721112 [PubMed - as supplied by publisher]

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Effects of Preoperative Iodine Administration on Thyroidectomy for Hyperthyroidism: A Systematic Review and Meta-analysis.

Effects of Preoperative Iodine Administration on Thyroidectomy for Hyperthyroidism: A Systematic Review and Meta-analysis.

Otolaryngol Head Neck Surg. 2019 Feb 05;:194599819829052

Authors: Tsai CH, Yang PS, Lee JJ, Liu TP, Kuo CY, Cheng SP

Abstract
OBJECTIVE: The current guidelines recommend that potassium iodide be given in the immediate preoperative period for patients with Graves' disease who are undergoing thyroidectomy. Nonetheless, the evidence behind this recommendation is tenuous. The purpose of this study is to clarify the benefits of preoperative iodine administration from published comparative studies.
DATA SOURCES: We searched PubMed, Embase, Cochrane, and CINAHL from 1980 to June 2018.
REVIEW METHODS: Studies were included that compared preoperative iodine administration and no premedication before thyroidectomy. For the meta-analysis, studies were pooled with the random-effects model.
RESULTS: A total of 510 patients were divided into the iodine (n = 223) and control (n = 287) groups from 9 selected studies. Preoperative iodine administration was significantly associated with decreased thyroid vascularity and intraoperative blood loss. Significant heterogeneity was present among studies. We found no significant difference in thyroid volume or operative time. Furthermore, the meta-analysis showed no difference in the risk of postoperative complications, including vocal cord palsy, hypoparathyroidism/hypocalcemia, and hemorrhage or hematoma after thyroidectomy.
CONCLUSION: Preoperative iodine administration decreases thyroid vascularity and intraoperative blood loss. Nonetheless, it does not translate to more clinically meaningful differences in terms of operative time and postoperative complications.

PMID: 30721111 [PubMed - as supplied by publisher]

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Submental Flap for Soft Tissue Reconstruction following Radical Parotidectomy.

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Submental Flap for Soft Tissue Reconstruction following Radical Parotidectomy.

Otolaryngol Head Neck Surg. 2019 Feb 05;:194599819827822

Authors: Bayon R, Davis AB

Abstract
This study analyzed our institution's experience with a buried submental flap for soft tissue reconstruction following radical parotidectomy. A retrospective chart review was conducted of patients who had parotid malignancies requiring radical parotidectomy, who also underwent a buried submental flap reconstruction. Analysis included patient demographics and clinical, surgical, and outcome data. Three patients met criteria for this study who underwent a buried submental flap at a tertiary medical center between 2012 and 2016. All patients had oncologic surgery and reconstruction using a deepithelialized submental island flap, which was used to fill the radical parotidectomy surgical defect with no complications and good aesthetic results. Each patient received appropriate adjuvant therapy. This case series shows that the buried submental island flap is a versatile flap that is adequate bulk after radical parotidectomy. It also has no impact on hospital length of stay and provides excellent cosmetic outcomes with minimal donor site morbidity.

PMID: 30717640 [PubMed - as supplied by publisher]

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The Impact of RVU-Based Compensation on Patient Safety Outcomes in Outpatient Otolaryngology Procedures.

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The Impact of RVU-Based Compensation on Patient Safety Outcomes in Outpatient Otolaryngology Procedures.

Otolaryngol Head Neck Surg. 2019 Feb 05;:194599819827881

Authors: Stanisce L, Ahmad N, Deckard N, Solomon D, Spalla TC, Gaughan JP, Koshkareva Y

Abstract
OBJECTIVE: To determine the effects an incentive-based physician compensation model has on safety outcomes related to outpatient otolaryngology surgical procedures.
STUDY DESIGN: A retrospective analysis of a prospectively maintained database assessing the difference in outpatient surgical volume and postoperative adverse outcomes before and after the implementation of a relative value unit (RVU)-based payment structure.
SETTING: Single-center academic otolaryngology practice operating at a hospital-owned ambulatory surgery center.
SUBJECTS AND METHODS: Data prospectively collected from outpatient otolaryngology surgical cases performed at the surgery center from April 2013 to April 2018 were retrospectively reviewed. Equal pre-RVU and post-RVU study periods were calculated for 4 surgeons based on their chronological transition in payment structure (range, 46-56 months). Case volume and incidence rates of adverse outcomes, including postoperative infections, emergency department visits, unplanned hospital admissions, and returns to the operating room, were compared between the pre-RVU and post-RVU study periods at both the surgeon and group levels.
RESULTS: At the group level, the post-RVU period was associated with a higher volume of surgical cases ( P = .001). No significant differences were observed in the overall incidence of adverse outcomes ( P = .21) or among the specific rates of postoperative hospitalizations ( P = .39), infections ( P = .45), unplanned returns to the operating room ( P = 1.00), or emergency department visits ( P = .39). Comparable results were observed at the individual surgeon level.
CONCLUSION: The implementation of an incentive-based salary was not associated with a change in the incidence of adverse safety outcomes in the setting of increased outpatient otolaryngology procedures.

PMID: 30717639 [PubMed - as supplied by publisher]

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Diagnostic Accuracy of Midline Pediatric Neck Masses.

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Diagnostic Accuracy of Midline Pediatric Neck Masses.

Otolaryngol Head Neck Surg. 2019 Feb 05;:194599819827845

Authors: Pitner H, Elmaraghy C, Fischer B, Onwuka A, Rabe A, Walz P

Abstract
OBJECTIVE: To assess clinical evaluation, ultrasound, and previously published predictive score at preoperatively diagnosing midline neck masses and demographic or clinical associations that aid in differentiation of thyroglossal duct and dermoid cysts.
STUDY DESIGN: Retrospective chart review.
SETTING: Tertiary care children's hospital.
SUBJECTS: Patients <18 years undergoing primary midline neck mass surgery with histopathologic diagnosis of thyroglossal duct or dermoid cyst who had preoperative ultrasound performed were included.
METHODS: An electronic medical record query generated 142 patients whose histopathologic diagnosis was thyroglossal duct cysts (TGDCs) or dermoid cysts (DCs). Charts were reviewed for demographic and clinical features. A radiologist blindly reviewed patients' ultrasounds for SIST (septae + irregular walls + solid components = thyroglossal) score components. Each patient received 3 preoperative diagnoses: clinical, ultrasound, and SIST. Statistical analyses were conducted to determine association of demographic, clinical, or radiographic variables with diagnoses. Specificity, sensitivity, and predictive values were evaluated for each candidate diagnosis.
RESULTS: There were 83 TGDCs and 59 DCs. Tenderness, infection history, depth relative to strap muscles, and SIST components were more common among TGDCs. Sensitivity and positive and negative predictive values surpassed 63% for each diagnostic modality. SIST score outperformed other diagnostic modalities with sensitivity, positive predictive value, and negative predictive value of 84%, 91%, and 81%, respectively. Clinical and ultrasound assessments were largely inconclusive for dermoid cysts, but SIST correctly identified 89% of DCs.
CONCLUSION: SIST score was the most accurate predictor of pediatric midline neck masses. Clinical and radiographic findings may help guide preoperative diagnosis, although further evaluation is required to develop more efficacious diagnostic tools.

PMID: 30717638 [PubMed - as supplied by publisher]

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Basaloid Squamous Cell Carcinoma of the Larynx: A National Cancer Database Analysis.

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Basaloid Squamous Cell Carcinoma of the Larynx: A National Cancer Database Analysis.

Otolaryngol Head Neck Surg. 2019 Feb 05;:194599818816299

Authors: Jumaily M, Faraji F, Zhang D, Walker RJ, Ward GM

Abstract
OBJECTIVE: Basaloid squamous cell histology is a rare variant that accounts for about 2% of all head and neck squamous cell laryngeal carcinomas. The purpose of this study was to examine overall survival rates of patients according to treatment, stage, and laryngeal subsite.
STUDY DESIGN: Retrospective analysis.
SETTING: National Cancer Database (NCDB).
SUBJECTS AND METHODS: The NCDB was queried for patients with basaloid squamous cell carcinoma (BSCC) who were treated from 2004 to 2014. Five-year overall survival rates were determined by the Kaplan-Meier method. Univariate and multivariate analysis was used to identify factors correlated with 5-year overall survival.
RESULTS: The NCDB identified 440 patients meeting inclusion criteria. Median follow-up time was 31.2 months. On univariate analysis, the treatment modalities assessed (surgery alone, surgery with radiotherapy, surgery with chemoradiotherapy, radiotherapy, chemoradiotherapy) did not differ in their survival benefit. On multivariate analysis, only chemoradiotherapy (hazard ratio, 0.587; 95% CI, 0.37-0.93; P = .022) was associated with improved survival. All treatment modalities performed similarly between stage I and II tumors ( P = .340) and stage III and IV tumors ( P = .154).
CONCLUSION: This study represents the largest laryngeal BSCC series to date. We found that chemoradiotherapy was associated with improved 5-year overall survival of laryngeal BSCC on multivariate analysis.

PMID: 30717636 [PubMed - as supplied by publisher]

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Impact of Aspirin and Other NSAID Use on Volumetric and Linear Growth in Vestibular Schwannoma.

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Impact of Aspirin and Other NSAID Use on Volumetric and Linear Growth in Vestibular Schwannoma.

Otolaryngol Head Neck Surg. 2019 Feb 05;:194599819827812

Authors: Marinelli JP, Lees KA, Tombers NM, Lohse CM, Carlson ML

Abstract
OBJECTIVES: Conflicting research exists surrounding the utility of aspirin to prevent tumor growth in the medical management of vestibular schwannoma (VS). Recent studies demonstrated no association between aspirin and VS growth using linear tumor measurements. Given the heightened sensitivity of volumetric analyses to monitor tumor growth, the current study was conceived with the chief objective of assessing the association between aspirin or other nonsteroidal anti-inflammatory drug (NSAID) use and VS growth using volumetric analyses.
STUDY DESIGN: Retrospective review.
SETTING: Tertiary referral center.
SUBJECTS AND METHODS: A total of 361 patients totaling 1601 volumetrically analyzed magnetic resonance imaging studies who underwent initial observation since January 1, 2003.
RESULTS: In total, 123 (35%) patients took 81 mg aspirin daily, 23 (7%) took 325 mg aspirin daily, and 41 (11%) reported other NSAID use. Among those taking aspirin, 112 (72%) exhibited volumetric tumor growth during observation compared to 33 (80%) among other NSAID users and 137 (67%) among nonaspirin users. Patients taking aspirin or other NSAIDs were significantly older at time of diagnosis (median, 66 vs 56 years; P < .001). Neither aspirin use (hazard ratio [HR], 0.96; P = .73) nor other NSAID use (HR, 1.39; P = .081) was significantly associated with a reduced risk of volumetric tumor growth. These results were similar following age adjustment ( P = .81 and .087, respectively). When separating aspirin users by 81-mg or 325-mg dosing, neither group exhibited a reduced risk of growth ( P = .95 and .73, respectively).
CONCLUSION: Despite promising initial results, the preponderance of existing literature suggests that aspirin and other NSAID use does not prevent tumor growth in VS.

PMID: 30717626 [PubMed - as supplied by publisher]

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Evaluating Perineural Spread to the Intratemporal Facial Nerve on Magnetic Resonance Imaging.

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Evaluating Perineural Spread to the Intratemporal Facial Nerve on Magnetic Resonance Imaging.

Otolaryngol Head Neck Surg. 2019 Feb 05;:194599819827848

Authors: Nader ME, Ginsberg LE, Bell D, Roberts DB, Gidley PW

Abstract
OBJECTIVES: To determine the sensitivity and specificity of magnetic resonance imaging (MRI) for the detection of perineural spread (PNS) along the intratemporal facial nerve (ITFN) in patients with head and neck cancers.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary care center.
SUBJECTS AND METHODS: We included 58 patients with head and neck malignancies who underwent sacrifice of the ITFN between August 1, 2002, and November 30, 2015. Demographics, preoperative facial nerve function, prior oncologic treatment, and timing between MRI and surgery were recorded. Histopathology slides and preoperative MRI were reviewed retrospectively by a neuropathologist and a neuroradiologist, respectively, both blinded to clinical data. The mastoid segment of the facial nerve (referred to as the descending facial nerve [DFN]) and stylomastoid foramen (SMF) were evaluated separately. A grading system was devised when radiographically assessing PNS along the DFN.
RESULTS: Histopathologic evidence of PNS was found in 21 patients (36.2%). The sensitivity and specificity of MRI in detecting PNS to the DFN were 72.7% and 87.8%, respectively. MRI showed higher sensitivity but slightly lower specificity when evaluating the SMF (80% and 82.8%, respectively). Prior oncologic treatment did not affect the false-positive rate ( P = .7084). Sensitivity was 100% when MRI was performed within 2 weeks of surgery and was 62.5% to 73.3% when the interval was greater than 2 weeks. This finding was not statistically significant (SMF, P = .7076; DFN, P = .4143).
CONCLUSION: MRI shows fair to good sensitivity and good specificity when evaluating PNS to the ITFN.

PMID: 30717625 [PubMed - as supplied by publisher]

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Artificial Intelligence for the Otolaryngologist: A State of the Art Review.

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Artificial Intelligence for the Otolaryngologist: A State of the Art Review.

Otolaryngol Head Neck Surg. 2019 Feb 05;:194599819827507

Authors: Bur AM, Shew M, New J

Abstract
OBJECTIVE: To provide a state of the art review of artificial intelligence (AI), including its subfields of machine learning and natural language processing, as it applies to otolaryngology and to discuss current applications, future impact, and limitations of these technologies.
DATA SOURCES: PubMed and Medline search engines.
REVIEW METHODS: A structured search of the current literature was performed (up to and including September 2018). Search terms related to topics of AI in otolaryngology were identified and queried to identify relevant articles.
CONCLUSIONS: AI is at the forefront of conversation in academic research and popular culture. In recent years, it has been touted for its potential to revolutionize health care delivery. Yet, to date, it has made few contributions to actual medical practice or patient care. Future adoption of AI technologies in otolaryngology practice may be hindered by misconceptions of what AI is and a fear that machine errors may compromise patient care. However, with potential clinical and economic benefits, it is vital for otolaryngologists to understand the principles and scope of AI.
IMPLICATIONS FOR PRACTICE: In the coming years, AI is likely to have a major impact on biomedical research and the practice of medicine. Otolaryngologists are key stakeholders in the development and clinical integration of meaningful AI technologies that will improve patient care. High-quality data collection is essential for the development of AI technologies, and otolaryngologists should seek opportunities to collaborate with data scientists to guide them toward the most impactful clinical questions.

PMID: 30717624 [PubMed - as supplied by publisher]

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Harris Peyton Mosher, MD: The Educator, Artist, and Pioneer behind the Mosher Award.

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Harris Peyton Mosher, MD: The Educator, Artist, and Pioneer behind the Mosher Award.

Otolaryngol Head Neck Surg. 2019 Feb 05;:194599818823734

Authors: Casale J

Abstract
Harris P. Mosher, MD, was a pioneer in the development of modern-day otolaryngology. The prestigious Mosher Award was named after him and is awarded annually for recognition of excellence in otolaryngology clinical research. Dr Mosher's contributions to the field include innovative research, technique and instrument development, and advancement of all national otolaryngology societies that function to this day. He was regarded as an expert and forerunner in sinus anatomy and started the first sinus anatomy course in the United States. He was also the recipient of many prestigious awards, including the Royal Society of Medicine of London's Semon Medal as well as the American Laryngological Association Gold Medal. The yearly administration of the Mosher award highlights the legacy and passion of Dr Mosher for the advancement of the field of otolaryngology.

PMID: 30717623 [PubMed - as supplied by publisher]

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Laryngotracheal Reconstruction in Adults Aged 60 Years and Older.

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Laryngotracheal Reconstruction in Adults Aged 60 Years and Older.

Otolaryngol Head Neck Surg. 2019 Feb 05;:194599818825471

Authors: Rehman SC, Xie DX, Bekeny JR, Gelbard A, Wootten CT

Abstract
OBJECTIVE: The primary aim of this study is to evaluate the safety, efficacy, and execution of major open laryngotracheal operations for patients in the advanced decades.
STUDY DESIGN: Case series with chart review.
SETTING: Multidisciplinary clinic at a tertiary care academic hospital.
SUBJECTS AND METHODS: Patient characteristics, operative course, and postoperative outcomes were retrospectively recorded for all airway reconstruction operations performed between 1999 and 2016 on patients aged ≥60 years Long-term success was defined as prosthesis-free survival at last follow-up. Descriptive statistics were performed.
RESULTS: Twenty-nine patients met inclusion criteria, and the median age was 71 years (interquartile range, 63-74). Tracheal resection was the most common procedure (13 patients), followed by laryngotracheal reconstruction (7 patients). Fifteen patients began their operation with a tracheostomy, 6 of whom underwent decannulation prior to leaving the operating room. Three additional patients underwent decannulation at follow-up appointments and were prosthesis-free at most recent follow-up. The mean time to decannulation among these patients was 3 months. Of the 14 patients beginning their procedure without a tracheostomy, only 2 required permanent airway prosthesis. The overall long-term rate of prosthesis-free survival was 72.4% (21 of 29 patients). Factors suggestive of long-term success include lower McCaffrey grade and lack of pulmonary disease, hypertension, or diabetes, as well as decreased red blood cell distribution width on preoperative complete blood count.
CONCLUSION: Through careful patient selection, preoperative workup, and meticulous postoperative care, airway reconstruction procedures in patients aged ≥60 years are reasonably successful. Of 29 patients, 21 (72.4%) were successfully breathing long-term without airway prosthesis.

PMID: 30717620 [PubMed - as supplied by publisher]

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Postoperative Tachycardia in Head and Neck Microvascular Free Flap Patients.

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Postoperative Tachycardia in Head and Neck Microvascular Free Flap Patients.

Otolaryngol Head Neck Surg. 2019 Feb 05;:194599819827816

Authors: Ziegler A, Schneider A, Pittman A, Thorpe E

Abstract
OBJECTIVE: The goal of this study was to determine the incidence of postoperative tachycardia and its predictive value of complications in patients following microvascular free flap surgery in the head and neck.
STUDY DESIGN: Retrospective chart review.
SETTING: Single tertiary care academic medical center.
SUBJECTS AND METHODS: All patients who underwent a microvascular free flap of the head and neck by surgeons in the department of otolaryngology from 2013 to 2017 were included in this study.
RESULTS: Of the 344 who patients met inclusion criteria, 40.4% had a maximum heart rate (HR) of the hospitalization over 110 beats per minute (bpm). Patients with a maximum HR greater than 110 bpm were 19 times more likely to experience a composite vascular complication (myocardial infarction, myocardial necrosis, or pulmonary embolism) than patients with a maximum HR <110 bpm ( P = .0063). Patients with a history of chronic kidney disease were also noted to have an increased risk of experiencing a postoperative composite vascular event.
CONCLUSION: Postoperative tachycardia is significantly associated with adverse outcomes and should not be dismissed as a normal variant. Identifying patients at an increased risk of having an underlying complication can help guide interpretation, workup, and management of postoperative patients in the head and neck population.

PMID: 30717618 [PubMed - as supplied by publisher]

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Dehydrocostus lactone (DHC) Suppresses Estrogen Deficiency-Induced Osteoporosis.

Dehydrocostus lactone (DHC) Suppresses Estrogen Deficiency-Induced Osteoporosis.

Biochem Pharmacol. 2019 Feb 02;:

Authors: Li Z, Yuan G, Lin X, Liu Q, Xu J, Lian Z, Song F, Zheng J, Xie D, Chen L, Wang X, Feng H, Zhou M, Yao G

Abstract
Osteoporosis is a chronic bone lytic disease, because of inadequate bone ossification and/or excessive bone resorption. Even though drugs are currently available for the treatment of osteoporosis, there remains an unmet need for the development of more specific novel agents with less adverse effects. Dehydrocostus lactone (DHC), a natural sesquiterpene lactone, was previously found to affect the differentiation of inflammatory cells by the inhibiting NF-κB pathways, and garnered much interest for its anti-cancer properties via SOCS-mediated cell cycle arrest and apoptosis. As NF-κB pathway plays an essential role in osteoclast differentiation, we sought to discover the biological effects of DHC on osteoclast differentiation and resorptive activity, as well as the underlying mechanisms on these effects. Our research found that DHC inhibited RANKL-induced osteoclast differentiation, bone resorption and osteoclast specific genes expression via suppression of NF-κB and NFAT signaling pathways in vitro. We further demonstrated that DHC protected against ovariectomy (OVX)-induced osteoprosis in the mouse model and the protective effects may be mediated through the attenuation of NF-κB signaling pathway. Thus, this study provides insight that DHC might be used as a potential pharmacological treatment for osteoporosis.

PMID: 30721671 [PubMed - as supplied by publisher]

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Targeting cyclin-dependent kinases in gastrointestinal cancer therapy.

Targeting cyclin-dependent kinases in gastrointestinal cancer therapy.

Discov Med. 2019 Jan;27(146):27-36

Authors: Zhang J, Su G, Lin Y, Meng W, Lai JKL, Qiao L, Li X, Xie X

Abstract
Cyclin-dependent kinases (CDKs) play an important role in cell-cycle progression. CDKs are positively modulated by regulatory mitotic cyclins and negatively controlled by endogenous CDK inhibitors (CDKIs) cyclically as cells progress through different cell cycles of transitions. When activated by cyclins, cyclin-CDK complexes were able to facilitate the transition of cell cycle from one phase to the next, e.g., from G1 to S or from G2 to M. DNA damages may cause inhibition of CDKs leading to cell-cycle arrest, while unrepairable DNA damage causes cells to undergo apoptosis. Disruption of cell cycle progression is an important cancer hallmark to mediate uncontrolled cell proliferation, tumorigenesis, and metastasis. Aberrantly expressed CDKs are causally linked to the development of gastrointestinal cancers, and as such, CDKs may not only form a class of potential biomarkers for the diagnosis and therapy of gastrointestinal cancers. In this review article, we summarized the data from translational studies using CDKs as a target for gastrointestinal cancer treatment.

PMID: 30721649 [PubMed - in process]

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Phillygenin exhibits anti-inflammatory activity through modulating multiple cellular behaviors of mouse lymphocytes.

Phillygenin exhibits anti-inflammatory activity through modulating multiple cellular behaviors of mouse lymphocytes.

Immunopharmacol Immunotoxicol. 2019 Feb 05;:1-10

Authors: Du B, Zhang L, Sun Y, Zhang G, Yao J, Jiang M, Pan L, Sun C

Abstract
CONTEXT: Phillygenin (PHI) is an intestinal metabolite of phillyrin from the genus Forsythia. Although the regulatory activity of Forsythia on immune system has been investigated, the effect of PHI on activated lymphocytes is poorly understood.
OBJECTIVE: This study was aimed to discuss the possible anti-inflammation potential of PHI on mitogen-activated stimulated lymphocytes in vitro.
METHODS: Mice spleen lymphocytes were incubated with PHI for 4 h, and then stimulated with concanavalin A (Con A) or phorbol 12-myristate 13-acetate/ionomycin (PMA + Ion). Cell viability was assayed by cell counting kit-8 (CCK-8). The expression of CD69 and CD25, proliferation, cell cycle, intracellular Ca2+ concentration, apoptosis, mitochondrial inner membrane potential (ΔΨm), mitochondrial permeability transition (MPT), interleukin-2 (IL-2), interferon-γ (IFN-γ), and tumor necrosis factor-α (TNF-α) were analyzed by flow cytometry. The expression of cyclin B1, cyclin D1, Cyclin E, and the phosphorylation of c-jun N-terminal kinase (JNK), extracellular signal-regulated kinase 1/2 (Erk1/2) and p38 were assayed by western blotting.
RESULTS: The results showed that PHI inhibited the proliferation of Con A-activated lymphocytes and induced a G0/G1 phase arrest by suppressing cyclin D1 and cyclin E. Meanwhile, PHI antagonized Con A-induced T cells activation through blocking intracellular Ca2+ overload and suppressing the phosphorylation of JNK and Erk1/2. Both Con A and PMA + Ion-induced secretion of IL-2, IFN-γ, and TNF-α were attenuated by PHI. PHI enhanced Con A-induced lymphocytes apoptosis through decreasing ΔΨm and increasing MPT.
CONCLUSION: These results suggest that PHI exhibits its anti-inflammatory activity through modulating multiple cellular behaviors, leading to the suppression of the adaptive immune response.

PMID: 30721636 [PubMed - as supplied by publisher]

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RABL6A inhibits tumor-suppressive PP2A/AKT signaling to drive pancreatic neuroendocrine tumor growth.

RABL6A inhibits tumor-suppressive PP2A/AKT signaling to drive pancreatic neuroendocrine tumor growth.

J Clin Invest. 2019 Feb 05;:

Authors: Umesalma S, Kaemmer CA, Kohlmeyer JL, Letney BL, Schab AM, Reilly JA, Sheehy RM, Hagen J, Tiwari N, Zhan F, Leidinger MR, O'Dorisio TM, Dillon JS, Merrill RA, Meyerholz DK, Perl AL, Brown BJ, Braun TA, Scott AT, Ginader T, Taghiyev AF, Zamba GK, Howe JR, Strack S, Bellizzi AM, Narla G, Darbro BW, Quelle FW, Quelle DE

Abstract
Hyperactivated AKT/mTOR signaling is a hallmark of pancreatic neuroendocrine tumors (PNETs). Drugs targeting this pathway are used clinically but tumor resistance invariably develops. A better understanding of factors regulating AKT/mTOR signaling and PNET pathogenesis is needed to improve current therapies. We discovered that RABL6A, a new oncogenic driver of PNET proliferation, is required for AKT activity. Silencing RABL6A caused PNET cell cycle arrest that coincided with selective loss of AKT-S473 (not T308) phosphorylation and AKT/mTOR inactivation. Restoration of AKT phosphorylation rescued the G1 phase block triggered by RABL6A silencing. Mechanistically, loss of AKT-S473 phosphorylation in RABL6A depleted cells resulted from increased protein phosphatase 2A (PP2A) activity. Inhibition of PP2A restored phosphorylation of AKT-S473 in RABL6A depleted cells whereas PP2A reactivation using a specific small molecule activator of PP2A (SMAP) abolished that phosphorylation. Moreover, SMAP treatment effectively killed PNET cells in a RABL6A-dependent manner and suppressed PNET growth in vivo. This work identifies RABL6A as a new inhibitor of the PP2A tumor suppressor and essential activator of AKT in PNET cells. Our findings offer what we believe is a novel strategy of PP2A reactivation for treatment of PNETs as well as other human cancers driven by RABL6A overexpression and PP2A inactivation.

PMID: 30721156 [PubMed - as supplied by publisher]

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3,17β-Bis-sulfamoyloxy-2-methoxyestra-1,3,5(10)-triene (STX140) and Non-Steroidal Sulfamate Derivatives Inhibit Carbonic Anhydrase IX: Structure-Activity Optimization for Isoform Selectivity.

3,17β-Bis-sulfamoyloxy-2-methoxyestra-1,3,5(10)-triene (STX140) and Non-Steroidal Sulfamate Derivatives Inhibit Carbonic Anhydrase IX: Structure-Activity Optimization for Isoform Selectivity.

J Med Chem. 2019 Feb 05;:

Authors: Andring J, Dohle W, Tu C, Potter BVL, McKenna R

Abstract
STX140, a bis-sulfamate derivative of the endogenous steroid 2-methoxyestradiol, has shown promising anti-cancer potency both in vitro and in vivo, with excellent bioavailability. Its activity against taxane-resistant xenografts make it a potential drug candidate against triple negative breast cancer (TNBC). These properties are linked to the ability of STX140 to act in a multi-targeting fashion in vivo as a microtubule disruptor, leading to cell cycle arrest and with both pro-apoptotic and anti-angiogenic activities. Carbonic Anhydrase IX (CA IX) is a well-established biomarker for aggressive cancers, including TNBC. This study reports, for the first-time, the inhibitory activities of a series of steroidal and non-steroidal sulfamate derivatives against CA IX in comparison to the ubiquitous CA II, with some compounds demonstrating 100-200 fold selectivity for CA IX over CA II. X-ray crystallographic studies of four of the most promising compounds reveal isoform specific residue interactions responsible for the high specificity.

PMID: 30721041 [PubMed - as supplied by publisher]

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Diabetes Impairs Angiogenesis and Induces Endothelial Cell Senescence by Up-Regulating Thrombospondin-CD47-Dependent Signaling.

Diabetes Impairs Angiogenesis and Induces Endothelial Cell Senescence by Up-Regulating Thrombospondin-CD47-Dependent Signaling.

Int J Mol Sci. 2019 Feb 04;20(3):

Authors: Bitar MS

Abstract
Endothelial dysfunction, impaired angiogenesis and cellular senescence in type 2 diabetes constitute dominant risk factors for chronic non-healing wounds and other cardiovascular disorders. Studying these phenomena in the context of diabetes and the TSP1-CD-47 signaling dictated the use of the in vitro wound endothelial cultured system and an in vivo PVA sponge model of angiogenesis. Herein we report that diabetes impaired the in vivo sponge angiogenic capacity by decreasing cell proliferation, fibrovascular invasion and capillary density. In contrast, a heightened state of oxidative stress and elevated expression of TSP1 and CD47 both at the mRNA and protein levels were evident in this diabetic sponge model of wound healing. An in vitro culturing system involving wound endothelial cells confirmed the increase in ROS generation and the up-regulation of TSP1-CD47 signaling as a function of diabetes. We also provided evidence that diabetic wound endothelial cells (W-ECs) exhibited a characteristic feature that is consistent with cellular senescence. Indeed, enhanced SA-β-gal activity, cell cycle arrest, increased cell cycle inhibitors (CKIs) p53, p21 and p16 and decreased cell cycle promoters including Cyclin D1 and CDK4/6 were all demonstrated in these cells. The functional consequence of this cascade of events was illustrated by a marked reduction in diabetic endothelial cell proliferation, migration and tube formation. A genetic-based strategy in diabetic W-ECs using CD47 siRNA significantly ameliorated in these cells the excessiveness in oxidative stress, attenuation in angiogenic potential and more importantly the inhibition in cell cycle progression and its companion cellular senescence. To this end, the current data provide evidence linking the overexpression of TSP1-CD47 signaling in diabetes to a number of parameters associated with endothelial dysfunction including impaired angiogenesis, cellular senescence and a heightened state of oxidative stress. Moreover, it may also point to TSP1-CD47 as a potential therapeutic target in the treatment of the aforementioned pathologies.

PMID: 30720765 [PubMed - in process]

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Potential of Schisandra chinensis (Turcz.) Baill. in Human Health and Nutrition: A Review of Current Knowledge and Therapeutic Perspectives.

Potential of Schisandra chinensis (Turcz.) Baill. in Human Health and Nutrition: A Review of Current Knowledge and Therapeutic Perspectives.

Nutrients. 2019 Feb 04;11(2):

Authors: Nowak A, Zakłos-Szyda M, Błasiak J, Nowak A, Zhang Z, Zhang B

Abstract
Schisandra chinensis (Turcz.) Baill. (SCE) is a plant with high potential for beneficial health effects, confirmed by molecular studies. Its constituents exert anti-cancer effects through the induction of cell cycle arrest and apoptosis, as well as inhibition of invasion and metastasis in cancer cell lines and experimental animals. SCE displays antimicrobial effects against several pathogenic strains. It has anti-diabetic potential, supported by hypoglycemic activity. A diet rich in SCE improves pancreatic functions, stimulates insulin secretion, and reduces complications in diabetic animals. SCE prevents lipid accumulation and differentiation of preadipocytes, indicating its anti-obesity potential. SCE exerts a protective effect against skin photoaging, osteoarthritis, sarcopenia, senescence, and mitochondrial dysfunction, and improves physical endurance and cognitive/behavioural functions, which can be linked with its general anti-aging potency. In food technology, SCE is applied as a preservative, and as an additive to increase the flavour, taste, and nutritional value of food. In summary, SCE displays a variety of beneficial health effects, with no side effects. Further research is needed to determine the molecular mechanisms of SCE action. First, the constituents responsible for its beneficial effects should be isolated and identified, and recommended as preventative nutritional additives, or considered as therapeutics.

PMID: 30720717 [PubMed - in process]

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Natural language processing to identify ureteric stones in radiology reports

Abstract

Introduction

Natural language processing (NLP) is an emerging tool which has the ability to automate data extraction from large volumes of unstructured text. One of the main described uses of NLP in radiology is cohort building for epidemiological studies. This study aims to assess the accuracy of NLP in identifying a group of patients positive for ureteric stones on Computed Tomography – Kidneys, Ureter, Bladder (CT KUB) reports.

Methods

Retrospective review of all CT KUB reports in a single calendar year. A locally available NLP tool was used to automatically classify the reports based on positivity for ureteric stones. This was validated by manual review and refined to maximize the accuracy of stone detection.

Results

A total of 1874 CT KUB reports were identified. Manual classification of ureteric stone positivity was 36% compared with 27% using NLP. The accuracy of NLP was 85% with a sensitivity of 66% and specificity of 95%. Incorrect classification was due to misspellings, variable syntax, terminology, pluralization and the inability to exclude clinical request details from the search algorithm.

Conclusions

Our NLP tool demonstrated high specificity but low sensitivity at identifying CT KUB reports that are positive for ureteric stones. This was attributable to the lack of feature extraction tools tailored for analysing radiology text, incompleteness of the medical lexicon database and heterogeneity of unstructured reports. Improvements in these areas will help improve data extraction accuracy.

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Tainted water: the scientists tracing thousands of fluorinated chemicals in our environment

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Intrahepatic Cerebrospinal Fluid Pseudocyst: A Case Report and Systematic Review.

Intrahepatic Cerebrospinal Fluid Pseudocyst: A Case Report and Systematic Review.

World Neurosurg. 2019 Feb 02;:

Authors: Arsanious D, Sribnick E

PMID: 30721775 [PubMed - as supplied by publisher]

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A Quality Analysis of Disc Herniation Videos on YouTube.

A Quality Analysis of Disc Herniation Videos on YouTube.

World Neurosurg. 2019 Feb 02;:

Authors: Gokcen HB, Gumussuyu G

Abstract
BACKGROUND: An increasing number of patients are investigating health information by using the Internet due to its exponential growth. Therefore, it is important to test the accuracy of the information presented to determine that which information should not be shared. This study investigated the information available on YouTube with regard to disc herniation.
METHODS: The first 50 videos found after using the keyword "disc hernia" in the YouTube search engine were included in the study. Video popularity was evaluated with an index called the video power index (VPI). The quality and accuracy of the information were evaluated by two independent spinal surgeons using the Journal of American Medical Association (JAMA) score and the DISCERN scoring system. Inter-observer agreement and individual correlations of the data of each video were statistically analyzed.
RESULTS: Of the 50 videos evaluated, 16 (32%) contained animation and 34 (64%) contained real images. The mean duration was 6.587 minutes and mean view was 423.472. The mean DISCERN score was 30.7 (+10.3), and the mean JAMA score was 1.8 (+0.5). There was good agreement between the two researchers in terms of DISCERN and JAMA scores. No statistically significant correlation was found between the JAMA and DISCERN scores of both researchers and VPI values, video lengths, animation, or real images.
CONCLUSIONS: The quality of the disc herniation information offered on YouTube are low. The evaluation of medical information obtained from the Internet by health professionals is an important step in guiding the correct flow of medical information to patients.

PMID: 30721774 [PubMed - as supplied by publisher]

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Improving Survival with Tranexamic Acid in Cerebral Contusions or Traumatic Subarachnoid Hemorrhage: Univariate and Multivariate Analysis on Independent Factors associated with Lower Mortality.

Improving Survival with Tranexamic Acid in Cerebral Contusions or Traumatic Subarachnoid Hemorrhage: Univariate and Multivariate Analysis on Independent Factors associated with Lower Mortality.

World Neurosurg. 2019 Feb 02;:

Authors: Chan DYC, Tsang ACO, Li LF, Cheng KKF, Tsang FCP, Taw BBT, Pu JKS, Ho WWS, Lui WM, Leung GKK

Abstract
BACKGROUND: Fall with head injury is an epidemic challenge especially with the aging population. Contributing factors for mortality included the development of cerebral contusions and delayed traumatic intracerebral hematoma. Currently, there is no established treatment for these conditions.
OBJECT: This study aimed to investigate the impact of independent factors on the mortality rate of traumatic brain injury with contusions or traumatic subarachnoid hemorrhage.
METHODS: Data were collected from consecutive patients admitted for cerebral contusions or traumatic subarachnoid hemorrhage at an academic trauma center from 2010-2016. The primary outcome was 30-day mortality rate. Independent factors for analysis included patients' factors and treatment modalities. Univariate and multivariate analysis were conducted to identify independent factors related to mortality. Secondary outcomes including thrombo-embolic complication rates associated with the use of tranexamic acid.
RESULTS: In total 651 consecutive patients were identified. For the patients' factors, low Glasgow Coma Scale on admission, history of renal impairment and use of warfarin were identified as independent factors associated with higher mortality from univariate and multivariate analysis. For the treatment modalities, univariate analysis identified tranexamic acid as an independent factor associated with lower mortality (p=0.021). Thromboembolic events were comparable in patients with or without tranexamic acid.
CONCLUSION: Tranexamic acid was identified as an independent factor associated with lower mortality from univariate analysis in cerebral contusions or traumatic subarachnoid hemorrhage. Further prospective studies are needed to validate this finding.

PMID: 30721773 [PubMed - as supplied by publisher]

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Tracheomalacia as a Complication of Stenting for Esophageal Injury after a Transsternal Approach to High Thoracic Vertebral Metastasis.

Tracheomalacia as a Complication of Stenting for Esophageal Injury after a Transsternal Approach to High Thoracic Vertebral Metastasis.

World Neurosurg. 2019 Feb 02;:

Authors: Chung KC, Lin CH, Tsai CL, Li YH, Liao CH

Abstract
BACKGROUND: and Importance: Esophageal injury is a severe surgical complication of a transsternal approach to the high thoracic vertebral metastasis, which can result in mediastinitis and life-threatening consequences. A covered stent can be placed in the esophagus to prevent mediastinal leakage. However, tracheomalacia is a very rare complication following esophageal stenting.
CLINICAL PRESENTATION: A 56-year-old man had a pathologic fracture of the T3 vertebral body with spinal cord compression, myelopathy, and neurogenic bladder. An esophageal injury was noticed during the transsternal approach. Immediate suture repair, drainage tube placement, and subsequent esophageal stenting were carried out. One month after discharge, the endoscopic examination revealed non-healing of the esophagus, and a new covered stent was replaced. Episodes of severe stridor and dyspnea made him sent to the emergent department. CT scan of the chest revealed a focal collapse of the trachea at the thoracic inlet, and tracheomalacia was suspected. The covered stent was removed, despite non-healing of the esophagus. His stridor, dyspnea, and constant coughing subsided afterwards. The endoscopic examination at three-months after stent removal showed complete healing of the esophagus.
CONCLUSION: Esophageal stenting can be used to prevent mediastinal leakage due to esophageal injury in the transsternal approach for high thoracic vertebral metastasis, but the stent might be a cause of tracheomalacia. Stent removal should be considered if upper airway obstruction occurs. Awareness of the radial force of the stent, esophageal composition (e.g. status post suture repair), and esophageal diameter must be considered for optimal stent tolerance to avoid complications.

PMID: 30721772 [PubMed - as supplied by publisher]

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Subarachnoid hemorrhage due to flow-related dissection of the posterior inferior cerebellar artery associated with a distal arteriovenous malformation.

Subarachnoid hemorrhage due to flow-related dissection of the posterior inferior cerebellar artery associated with a distal arteriovenous malformation.

World Neurosurg. 2019 Feb 02;:

Authors: Akeret K, Germans M, Sun W, Kulcsar Z, Regli L

Abstract
BACKGROUND: and Importance: Cerebral arteriovenous malformations (CAVM) are characterized by altered hemodynamics and associated with angioanatomical changes, such as aneuryms. We encountered a patient with a CAVM-associated dissection of the medial trunk of the posterior inferior cerebellar artery (PICA) instead of an aneurysm.
CLINICAL PRESENTATION: We report the case of a 56-year old male patient with spontaneous subarachnoid hemorrhage within the cisterna magna and fourth ventricle. Digital subtraction angiography (DSA) revealed a cerebellar AVM located within the inferior semilunar lobule, however anatomically not matching the bleeding pattern. The left PICA, serving as primary feeding artery, showed a dissection of the proximal portion of the medial trunk with precise anatomical association to the blood in the telovelotonsillar space. CAVM induced hyperdynamic flow through the feeding vessel is the most plausible pathophysiological explanation for the dissection. Complete microsurgical resection of the CAVM was performed and three months follow-up DSA showed complete regression of the dissection, disappearance of the irregularities and significant caliber reductions of the medial PICA trunk.
CONCLUSION: This is the first report of a hyperdynamic flow-related dissection of a CAVM-associated feeding vessel. Microsurgical resection of the CAVM allowed for spontaneous resolution of the dissected area by restoration of normal rheodynamics.

PMID: 30721771 [PubMed - as supplied by publisher]

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Hate: A Worldwide Conundrum.

Related Articles

Hate: A Worldwide Conundrum.

World Neurosurg. 2019 Feb;122:xxxiii

Authors: Benzel E

PMID: 30716880 [PubMed - in process]

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Surgery for Intractable Seizures After Successful Radiosurgery of Cerebral Arteriovenous Malformation.

Related Articles

Surgery for Intractable Seizures After Successful Radiosurgery of Cerebral Arteriovenous Malformation.

World Neurosurg. 2019 Feb;122:724

Authors: Izawa M, Hayashi M, Chernov M

PMID: 30716879 [PubMed - in process]

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In Reply to the Letter to the Editor Regarding "Adjunctive Gamma Knife Surgery or Wait and Scan Policy After Optimal Resection of Large Vestibular Schwannomas: Clinical and Radiologic Outcomes".

Related Articles

In Reply to the Letter to the Editor Regarding "Adjunctive Gamma Knife Surgery or Wait and Scan Policy After Optimal Resection of Large Vestibular Schwannomas: Clinical and Radiologic Outcomes".

World Neurosurg. 2019 Feb;122:722-723

Authors: Troude L, Boucekine M, Montava M, Lavieille JP, Régis JM, Roche PH

PMID: 30716878 [PubMed - in process]

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Letter to the Editor Regarding "Adjunctive Gamma Knife Surgery or Wait and Scan Policy After Optimal Resection of Large Vestibular Schwannomas: Clinical and Radiologic Outcomes".

Related Articles

Letter to the Editor Regarding "Adjunctive Gamma Knife Surgery or Wait and Scan Policy After Optimal Resection of Large Vestibular Schwannomas: Clinical and Radiologic Outcomes".

World Neurosurg. 2019 Feb;122:719-721

Authors: Tuleasca C, Daniel RT, Starnoni D, George M, Maire R, Levivier M

PMID: 30716877 [PubMed - in process]

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In Reply to the Letter to the Editor Regarding "Percutaneous Endoscopic Lumbar Diskectomy versus Posterior Open Lumbar Microdiskectomy for Treatment of Symptomatic Lumbar Disk Herniation: Systemic Review and Meta-analysis".

Related Articles

In Reply to the Letter to the Editor Regarding "Percutaneous Endoscopic Lumbar Diskectomy versus Posterior Open Lumbar Microdiskectomy for Treatment of Symptomatic Lumbar Disk Herniation: Systemic Review and Meta-analysis".

World Neurosurg. 2019 Feb;122:718

Authors: Qin R, Zhou P, Hao J, Zhang F, Chen X

PMID: 30716876 [PubMed - in process]

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Letter to the Editor Regarding "Percutaneous Endoscopic Lumbar Discectomy Versus Posterior Open Lumbar Microdiscectomy for the Treatment of Symptomatic Lumbar Disc Herniation: A Systemic Review and Meta-Analysis": A Critical Appraisal.

Related Articles

Letter to the Editor Regarding "Percutaneous Endoscopic Lumbar Discectomy Versus Posterior Open Lumbar Microdiscectomy for the Treatment of Symptomatic Lumbar Disc Herniation: A Systemic Review and Meta-Analysis": A Critical Appraisal.

World Neurosurg. 2019 Feb;122:715-717

Authors: Gadjradj PS, van Tulder MW, Vleggeert-Lankamp CLAM, van Susante JL, Rubinstein SM, Peul WC, Harhangi BS

PMID: 30716875 [PubMed - in process]

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In Reply to the Letter to the Editor "Craniopharyngioma: 10 Selected Works Which Provide Comprehensive and Valuable Insight into These Complex Tumors".

Related Articles

In Reply to the Letter to the Editor "Craniopharyngioma: 10 Selected Works Which Provide Comprehensive and Valuable Insight into These Complex Tumors".

World Neurosurg. 2019 Feb;122:713-714

Authors: Jusue-Torres I, Hulbert A, Germanwala AA, Patel CR, Germanwala AV

PMID: 30716874 [PubMed - in process]

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Craniopharyngioma: 10 Selected Works That Provide Comprehensive and Valuable Insight into These Complex Tumors.

Related Articles

Craniopharyngioma: 10 Selected Works That Provide Comprehensive and Valuable Insight into These Complex Tumors.

World Neurosurg. 2019 Feb;122:710-712

Authors: Pascual JM, Prieto R, Carrasco R

PMID: 30716873 [PubMed - in process]

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Vascular Decompression Technique for Vertebrobasilar Dolichoectatic Pathology: Reposition or Interposition?

Related Articles

Vascular Decompression Technique for Vertebrobasilar Dolichoectatic Pathology: Reposition or Interposition?

World Neurosurg. 2019 Feb;122:709

Authors: Wang L, Qian H, Shi X

PMID: 30716872 [PubMed - in process]

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Letter to the Editor Regarding "The Efficacy of Tranexamic Acid on Blood Loss of Lumbar Spinal Fusion Surgery: A Meta-Analysis of Randomized Controlled Trials".

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Letter to the Editor Regarding "The Efficacy of Tranexamic Acid on Blood Loss of Lumbar Spinal Fusion Surgery: A Meta-Analysis of Randomized Controlled Trials".

World Neurosurg. 2019 Feb;122:708

Authors: Sun H, Deng J, Ning X, Wu F, Shang X, Yang H

PMID: 30716871 [PubMed - in process]

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Letter to the Editor Regarding "Combined Minimally Invasive Supraciliary and Transfacial Approach for Large Tumors with Skull Base and Sinonasal Involvement".

Related Articles

Letter to the Editor Regarding "Combined Minimally Invasive Supraciliary and Transfacial Approach for Large Tumors with Skull Base and Sinonasal Involvement".

World Neurosurg. 2019 Feb;122:707

Authors: Mittal P, Thakar A

PMID: 30716870 [PubMed - in process]

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Letter to the Editor Regarding "Bone Flap Conservation in the Scalp After Decompressive Craniectomy".

Related Articles

Letter to the Editor Regarding "Bone Flap Conservation in the Scalp After Decompressive Craniectomy".

World Neurosurg. 2019 Feb;122:704

Authors: Goel A

PMID: 30716869 [PubMed - in process]

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Unsatisfactory response to sirolimus in Maffucci syndrome‐associated spindle cell hemangiomas

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Improving Polymethyl Methacrylate Resin Using a Novel Titanium Dioxide Coating “Submitted in part as a master's thesis to UIC College of Dentistry by Dr. Ghaith Darwish”

Abstract

Purpose

The objective of this study was to improve the surface characteristics of poly (methyl methacrylate) (PMMA) by developing a novel, thin film coating process and to characterize the resulting coated surface.

Materials and Methods

An atomic layer deposition (ALD) technique was developed to deposit a titanium dioxide (TiO₂) nano‐thin film on PMMA. The surface wettability for both coated and uncoated PMMA was determined by measuring water contact angle. Wear resistance was assessed using a mechanical tooth‐brushing device with a 50 g load for 6000 strokes after 5 months of water storage. A denture cleanser challenge test was performed by using sonication in 3.8% sodium perborate for 1 hour with aged specimens. X‐ray photoelectron spectroscopy (XPS) was used before and after the brushing test and challenge test to analyze the PMMA surface chemical composition. The mechanical strength of coated and uncoated PMMA was measured using a three‐point bending test. Surface microbial interactions were also evaluated by assessing Candida albicans biofilm attachment.

Results

Nano‐TiO₂ coating (30 nm thick) was successfully deposited on PMMA at 65°C. After coating, water contact angle decreased from 70° to less than 5°. After brushing test, the coating remained intact. XPS analysis revealed no loss of TiO₂ from coated specimens following brushing and denture cleanser sonication for 1 hour. There was no statistically significant difference in mechanical strength (MPa) (mean ± SD) between PMMA (139.4 ± 11.3) and TiO₂‐PMMA (160.7 ± 37.1) (P = 0.0995). C. albicans attachment decreased by 63 to 77% on the coated PMMA surface.

Conclusions

ALD is a promising technique to modify surface properties of PMMA and resulted in a stable adherent thin film. By depositing a TiO₂ coating, PMMA surface properties may lead to significantly reduced microorganism adhesion and easier pathogen removal from PMMA. For patients who wear dentures, reducing the oral microbial biofilm burden using a TiO₂‐coated PMMA surface could positively impact their oral and systemic health.

This article is protected by copyright. All rights reserved

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Selective hematopoietic stem cell ablation using CD117-antibody-drug-conjugates enables safe and effective transplantation with immunity preservation

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Significant contribution of subseafloor microparticles to the global manganese budget

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Combining lifestyle risks to disentangle brain structure and functional connectivity differences in older adults

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Author Correction: Layer-dependent quantum cooperation of electron and hole states in the anomalous semimetal WTe2

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Collateral sensitivity constrains resistance evolution of the CTX-M-15 β-lactamase

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Hematopoietic chimerism and donor-specific skin allograft tolerance after non-genotoxic CD117 antibody-drug-conjugate conditioning in MHC-mismatched allotransplantation

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Pharmacological reactivation of MYC-dependent apoptosis induces susceptibility to anti-PD-1 immunotherapy

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BLADE-ON-PETIOLE genes temporally and developmentally regulate the sheath to blade ratio of rice leaves

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We need to talk about systematic fraud

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Nucleophilic Approach to Fully Substituted Cyclic Nitrones from N‐Hydroxylactam Derivatives: Development and Application to the Total Synthesis of Cylindricine C

A nucleophilic approach to cyclic nitrones from N‐hydroxylactam derivatives is documented. The nucleophilic addition of an organolithium reagent to an N‐OSEM lactam forms a five‐membered chelated intermediate, which undergoes both elimination and deprotection to give a fully substituted nitrone in a one‐pot process. When combined with the N‐oxidation of easily available chiral lactams, this method becomes especially useful for the quick synthesis of chiral nitrones in enantio pure form, enabling the concise total synthesis of cylindricine C.

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A Tetrasilicon Analogue of Bicyclo[1.1.0]but‐1(3)‐ene Containing a Si=Si Double Bond with an Inverted Geometry

Bicyclo[1.1.0]tetrasil‐1(3)‐ene 1, a tetrasilicon analogue of bicyclo[1.1.0]but‐1(3)‐ene, which contains a formal double bond between bridgehead silicon atoms in an inverted three‐coordinate geometry, was synthesized and isolated in the form of thermally stable orange crystals. The distance between the bridgehead Si atoms in 1 is much longer than those in typical Si=Si bonds, but still shorter than that of a previously reported pentasila[1.1.1]propellane. DFT calculations suggest that the bridgehead bond in 1 comprises a σ‐bond with an inverted geometry and a π‐bond. This notion is supported by the UV‐vis spectrum of 1, which exhibits several absorption bands in the UV‐vis region. While 1 is stable toward typical trapping agents for Si=Si double bonds, 1 reacts with carbon tetrachloride to furnish a hexachlorotetrasilane.

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Metabolic‐active fully hydrolysable polymersomes

The synthesis and aqueous self‐assembly of a new class of amphiphilic aliphatic polyesters are presented. These AB block polyesters comprise polycaprolactone (hydrophobe) and an alternating polyester from succinic acid and an ether substituted epoxide (hydrophile). They self‐assemble into biodegradable polymersomes capable of entering cells. Their degradation products are bioactive giving rise to differentiated cellular responses inducing stromal cell proliferation and macrophage apoptosis. Both effects emerge only when the copolymers enter cells as polymersomes and their magnitudes are size dependent.

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Fcc vs Non‐fcc Structural Isomerism of Gold Nanoparticles with Kernel Atom Packing‐Dependent Photoluminescence

Structural isomerism provides an excellent opportunity for the correlation between structure and property. Unfortunately, the structural isomers of metal nanoparticles are rarely reported in liquid/solid phase and genuine structural isomerism with distinctly different kernel atom packing (e.g., face‐centered cubic (fcc) vs non‐fcc) has not been reported until now, to the best of our knowledge. Herein we introduce a novel ion induction method to synthesize a unique gold nanocluster with an interesting twist mirror symmetry structure, which was precisely characterized by mass spectrometry, X‐ray crystallography, etc. The as‐synthesized novel gold nanocluster has the same composition but different kernel atom packing with an existing gold nanocluster Au42(TBBT)26 (TBBT = 4‐tert‐butylbenzenethiolate). The two Au42 nanoclusters represent the first pair of structural isomers with distinctly different kernel atom packing. Fcc‐structured Au42(TBBT)26 nanoclusters exhibit more enhanced photoluminescence than that of non‐fcc‐structured Au42(TBBT)26 nanoclusters, indicating that the fcc‐structure might be more beneficial for emission than the non‐fcc structure. This conceit was further supported by comparison of the emission intensity between another three pairs of gold nanoclusters with similar compositions and sizes but with different kernel atom packings (fcc vs non‐fcc).

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The history of distant worlds, a clear eye on renewables and environmental lessons from a tiger’s tale: Books in brief

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A Case of Bilateral Spontaneous Chylothorax with Respiratory Syncytial Virus Bronchiolitis

A case of bilateral spontaneous chylothorax with respiratory syncytial virus (RSV) bronchiolitis has never been reported. We report the case of a 7-month-old boy born at 33 weeks gestation with a history of Down syndrome, atrial septal defect, pulmonary hypertension, and chronic lung disease, hospitalized due to RSV bronchiolitis who developed bilateral spontaneous chylothorax with exacerbation of pulmonary hypertension (PH). The patient died after 9 weeks of mechanical ventilation and treatment for PH. The autopsy showed acute infectious signs, a chronic interstitial lung disease with pulmonary hypertensive changes and subpleural cysts with no evidence of congenital lymphangiectasia. The cause of chylothorax in this child could be multifactorial. However, worsening pulmonary hypertension with RSV infection might have partially contributed to the development of chylothorax through elevated superior venous cava pressure. Thoracentesis should be considered for patients with Down syndrome and PH associated with congenital heart disease who develop persistent pleural effusion during RSV bronchiolitis to rule out chylothorax.

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Relationship between the muscle relaxation effect and body muscle mass measured using bioelectrical impedance analysis: A nonrandomized controlled trial

Journal of International Medical Research, Ahead of Print.


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LMO2 Negative Expression Predicts the Presence of MYC Translocations in Aggressive B-Cell Lymphomas: Erratum

No abstract available

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Unusual duplication and vulnerable intrapancreatic course of the left gastroepiploic artery: a rare anatomical variation

Abstract

The left gastroepiploic artery (LGEA) is the least described artery in the medical literature. Unusual variations of this artery might lead to vascular injuries, causing intraoperative bleeding after surgery. We observed rare vascular variations in an adult male cadaver. The left gastroepiploic artery after its origin from splenic artery pierced the pancreatic parenchyma at its posterior surface. After a short intrapancreatic course, the LGEA emerged out from the superior border of the body of the pancreas. LGEA then trifurcated into an omental branch, duplicated LGEA and another branch that continued as the main trunk of LGEA. Main LGEA and duplicated LGEA coursed towards the greater curvature of the stomach. The main LGEA ended by anastomosing with the right gastroepiploic artery, while the duplicated LGEA ended at the greater curvature of the stomach by ramifying into minute branches on the walls of the stomach and gave few gastric branches to supply the stomach and also supplied the greater omentum. This variation was associated with the presence of an accessory splenic artery. Anatomists, surgeons, and radiologists should be aware of such anomalous vascular variations as it could help to minimize complications related to pancreatectomy, omentoplasty, and resection of pancreatic tumors.

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Effects of cerium oxide nanoparticles on bacterial growth and behaviors: induction of biofilm formation and stress response

Abstract

In this paper, the effects of cerium oxide nanoparticles (CeO₂ NPs) on the group bacterial behaviors were elaborated. After 36-h cultivation, the biofilm biomass was enhanced by the sub-lethal concentrations of 0.5 and 2 mg/L CeO₂ NP exposure. Meanwhile, the promoted production of total amino acids in microbes further resulted in the increased surface hydrophobicity and percentage aggregation. To resist the CeO₂ NPs stress, the biofilm exhibited a double-layer microstructure, with the protein (PRO) and living cells occupying the bottom, the polysaccharide (PS), and dead cells dominating the top. The bacterial diversity was highly suppressed and Citrobacter and Pseudomonas from the phylum of γ-Proteobacteria strongly dominated the biofilm, indicating the selective and enriched effects of CeO₂ NPs on resistant bacteria. The stimulated inherent resistance of biofilm was reflected by the reduced adenosine triphosphate (ATP) content after 4 h exposure. The increased levels of reactive oxygen species (ROS) in the treatments of 8 h CeO₂ NP exposure led to the upregulated quorum sensing signals of acylated homoserine lactone (AHL) and autoinducer 2 (AI-2), beneficial to mitigating the environmental disturbance of CeO₂ NPs. These results provide evidences for the accelerating effects of CeO₂ NPs on biofilm formation through oxidative stress, which expand the understanding of the ecological effects of CeO₂ NPs.

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A Fully Three-Dimensional Printed Inchworm-Inspired Soft Robot with Magnetic Actuation

Soft Robotics, Ahead of Print.


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To assess the prevalence of dental caries and to evaluate oral health-related quality of life in cleft lip and palate patient

Amit Manohar Reche, Shrutika Dhanrajji Chordiya, Sakshi Pradeep Joshi, Nikita Suresh Bhumbre, Shivani Kishore Jadhav, Nikita Pramod Dhange

Journal of Cleft Lip Palate and Craniofacial Anomalies 2019 6(1):38-42

Aim: The aim of this study was to assess the prevalence of dental caries and evaluate oral health-related quality of life (QoL) in patients with cleft lip and palate (CLP) in Vidarbha region. Settings and Design: A cross-sectional questionnaire study was conducted in the Department of Public Health Dentistry of our institute. The sample was divided into three groups. Subjects and Methods: Group A (110) patients with unilateral CLP (UCLP), Group B (110) patients with bilateral CLP (BCLP), and Group C (150) control group. From self-administered questionnaire, the patients were asked 10 questions based on eating, speaking, toothbrushing, sleeping, smiling, emotional status, carrying out work, and social contact and rated as 0, 1, 2, and 3 (no problem, mild, moderate, and severe). Statistical Analysis Used: ANOVA and Pearson's correlation tests were performed. Results: According to the results, there is no statistical difference for decayed, missing, and filled teeth score seen between UCLP and BCLP patients; however, there is significant difference (<0.001) seen between the cleft patients and control group. According to questionnaire result, the patients with bilateral cleft experienced more difficulty while eating, speaking, smiling, and maintaining social contact as compared to the control group. Conclusion: Patients suffering from CLP showed higher caries prevalence compared to the control group; on the other hand, negative impact has been seen on the QoL of CLP patients.

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