Κυριακή, 14 Ιανουαρίου 2018

Foreign body removal assisted by an intraoral ultrasound probe

Abstract

Ultrasonography has recently been applied to the field of oral and maxillofacial surgery because of its noninvasiveness and ease of use. However, traditional transducers are not used in the intraoral area because of their large size. A novel intraoral transducer was introduced with size, volume, and axis modifications. This new transducer allows the surgeon to approach the intraoral region during dental procedures. This report describes a case of successful removal of a foreign body using the newly developed intraoral ultrasound probe. Precise localization and minimally invasive removal of the foreign body using the intraoral transducer were simultaneously conducted. Because of its many advantages, this intraoral ultrasound transducer has the potential to be applied in oral and maxillofacial surgery.



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Is 123 I-metaiodobenzylguanidine heart-to-mediastinum ratio dependent on age? From Japanese Society of Nuclear Medicine normal database

Abstract

Background

Heart-to-mediastinum ratios (HMRs) of 123I-metaiodobenzylguanidine (MIBG) have usually been applied to prognostic evaluations of heart failure and Lewy body disease. However, whether these ratios depend on patient age has not yet been clarified using normal databases.

Methods

We analyzed 62 patients (average age 57 ± 19 years, male 45%) derived from a normal database of the Japanese Society of Nuclear Medicine working group. The HMR was calculated from early (15 min) and delayed (3–4 h) anterior planar 123I-MIBG images. All HMRs were standardized to medium-energy general purpose (MEGP) collimator equivalent conditions using conversion coefficients for the collimator types. Washout rates (WR) were also calculated, and we analyzed whether early and late HMR, and WR are associated with age.

Results

Before standardization of HMR to MEGP collimator conditions, HMR and age did not significantly correlate. However, late HMR significantly correlated with age after standardization: late HMR = − 0.0071 × age + 3.69 (r2 = 0.078, p = 0.028), indicating that a 14-year increase in age corresponded to a decrease in HMR of 0.1. Whereas the lower limit (2.5% quantile) of late HMR was 2.3 for all patients, it was 2.5 and 2.0 for those aged ≤ 63 and > 63 years, respectively. Early HMR tended to be lower in subjects with the higher age (p = 0.076), whereas WR was not affected by age.

Conclusion

While late HMR was slightly decreased in elderly patients, the lower limit of 2.2–2.3 can still be used to determine both early and late HMR.



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Manual on the proper use of lutetium-177-labeled somatostatin analogue (Lu-177-DOTA-TATE) injectable in radionuclide therapy (2nd ed.)

Abstract

Here we present the guideline for the treatment of neuroendocrine tumors using Lu-177-DOTA-TATE on the basis of radiation safety aspects in Japan. This guideline was prepared by a study supported by Ministry of Health, Labour, and Welfare, and approved by Japanese Society of Nuclear Medicine. Lu-177-DOTA-TATE treatment in Japan should be carried out according to this guideline. Although this guideline is applied in Japan, the issues for radiation protection shown in this guideline are considered internationally useful as well. Only the original Japanese version is the formal document.



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Parsonage-Turner syndrome: DAMS Unplugged



  • Parsonage-Turner syndrome  characterized by rapid onset of severe pain in the shoulder and arm. This acute phase may last for a few hours to a few weeks and is followed by wasting and weakness of the muscles (amyotrophy) in the affected areas.
  • The exact cause of PTS is unknown, but it is believed to be  caused by immune-mediated disorder
  •  Affected individuals may recover without treatment or experience recurrent episodes. 
  • The initial descriptions of this disorder in the medical literature date back to the late 1800s. In 1948, Drs. Parsonage and Turner were the first physicians to describe a large series of patients. They termed the disorder 'amyotrophic neuralgia'. 

Presenting DAMS unplugged video discussing a case report of this syndrome.
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Variant of a persistent hypoglossal artery supplying only the posterior inferior cerebellar artery diagnosed by magnetic resonance angiography: a case report.

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Variant of a persistent hypoglossal artery supplying only the posterior inferior cerebellar artery diagnosed by magnetic resonance angiography: a case report.

Surg Radiol Anat. 2018 Jan 12;:

Authors: Uchino A, Suzuki C

Abstract
Very rarely, a persistent hypoglossal artery supplies only the posterior inferior cerebellar artery without connection to the basilar artery. Few cases diagnosed by catheter angiography have been reported. We diagnosed a case using magnetic resonance angiography.

PMID: 29330558 [PubMed - as supplied by publisher]



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Title: Prognostic significance of arterial stiffness and osteoprotegerin in patients with stable coronary artery disease.

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Title: Prognostic significance of arterial stiffness and osteoprotegerin in patients with stable coronary artery disease.

Eur J Clin Invest. 2018 Jan 13;:

Authors: Siasos G, Oikonomou E, Maniatis K, Georgiopoulos G, Kokkou E, Tsigkou V, Zaromitidou M, Antonopoulos A, Vavuranakis M, Stefanadis C, Papavassiliou AG, Tousoulis D

Abstract
BACKGROUND: Arterial stiffness and vascular calcification significantly contribute to coronary atherosclerosis progression. The prognostic value of increased arterial stiffness and vascular calcification in subjects with stable coronary artery disease (CAD) after percutaneous coronary intervention(PCI) is currently under question.
MATERIALS AND METHODS: We randomly enrolled 262 patients with stable CAD one month after successful PCI. Carotid femoral pulse wave velocity (PWV) was measured as a well-established index of central aortic stiffness. Osteoprotegerin (OPG) plasma levels were measured as a biomarker of vascular calcification. Patients were followed up prospectively up to 52 months. The primary end point was the composite of death from cardiovascular causes, myocardial infarction, stroke or hospitalization for cardiovascular causes.
RESULTS: During the follow-up period 48 patients presented the primary composite endpoint. Subjects who presented the primary end point, compared to subjects free of cardiovascular events, had significantly increased PWV (9.45±2.19m/sec vs. 8.73±2.07m/sec,p=0.04) and OPG levels (4.21±2.19pmol/L vs. 3.18±1.74pmol/L,p=0.003). Survival analysis indicated that PWV predicted adverse cardiac events MACE (Hazard ratio=1.29 95%CI:1.07-1.57,p=0.008) independently from confounders such as age, sex, smoking habits, ejection fraction, extent of coronary artery disease, hypertension and diabetes mellitus. Interestingly, for every increase in pulse wave velocity by 1m/sec there is an anticipated increase in the risk of major adverse cardiovascular event (MACE) by 29%.
CONCLUSIONS: These findings extend the current knowledge concerning the role of arterial stiffness as powerful biomarkers in cardiovascular disease. Measurement of PWV might have a role in ascertaining prognosis and managing treatment in patients with stable CAD after PCI. This article is protected by copyright. All rights reserved.

PMID: 29330911 [PubMed - as supplied by publisher]



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Conformers, properties, and docking mechanism of the anticancer drug docetaxel: DFT and molecular dynamics studies.

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Conformers, properties, and docking mechanism of the anticancer drug docetaxel: DFT and molecular dynamics studies.

J Comput Chem. 2018 Jan 12;:

Authors: Sun C, Zhu L, Zhang C, Song C, Wang C, Zhang M, Xie Y, Schaefer HF

Abstract
The conformational structures and properties of the anticancer drug docetaxel (DTX) are studied theoretically. A total of 3888 trial structures were initially generated by all combinations of internal single-bond rotamers and screened with the B3LYP/3-21G* method. A total of 31 unique conformers were further optimized at the B3LYP/6-311G* method. Their relative energies, dipole moments, rotational constants, and harmonic vibrational frequencies were predicted. Single-point relative energies were then determined at the M06-L/6-311G(2df,p) level. The UV spectrum of the lowest-lying DTX conformer in methanol was investigated with the TD-CAM-B3LYP/6-311 + G(2df,p) method. The 31 unique DTX structures are mainly docked at three different sites within β-tubulin. Based on the results of molecular docking and double-float MD simulations, the lowest-lying DTX conformer consistently exhibits good docking performance with β-tubulin. We identified the residues LYS299, ARG215, GLN294, LEU275, THR216, GLU290, PRO274, and THR276 on β-tubulin as active sites forming a binding pocket responsible for locking DTX within β-tubulin to make the combination more stable. The RMSD values show that the predicted complexes are favorable, and the SASA analysis shows that the hydrophilic properties of DTX are better than paclitaxel. © 2018 Wiley Periodicals, Inc.

PMID: 29330902 [PubMed - as supplied by publisher]



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Pathogenesis of non-alcoholic fatty liver disease mediated by YAP.

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Pathogenesis of non-alcoholic fatty liver disease mediated by YAP.

Hepatol Int. 2018 Jan 12;:

Authors: Chen P, Luo Q, Huang C, Gao Q, Li L, Chen J, Chen B, Liu W, Zeng W, Chen Z

Abstract
OBJECTIVE: This study aimed to investigate the mechanism of the interaction between Yes-associated protein (YAP) and transforming growth factor-β (TGF-β)/Smad signaling pathways in the development of non-alcoholic fatty liver disease (NAFLD).
METHODS: Serum samples of monkeys with biopsy-proven NAFLD and healthy normal monkeys were used to measure fasting plasma glucose (FPG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG) and albumin (ALB) with the BECKMAN CX5 PRO. Hematoxylin-eosin staining (H&E) was used for pathologic analysis, Masson trichrome staining was used to assess for fibrosis staging, and Oil Red O staining was used to detect lipid droplet deposition. According to an NAFLD activity score of < 4 points and > 4 points, the samples were divided into groups: the steatosis group and fibrosing NASH group. Furthermore, monkeys with a fibrosis stage < 2 were assigned to the mild fibrosis group, while monkeys with fibrosis stage ≥ 2 were assigned to the significant fibrosis group. Moreover, the fibrosis stage was subdivided as follows: stages 1a, 1c and 2-3. Immunohistochemistry and real-time quantitative PCR were used to quantify protein and gene expression, respectively.
RESULTS: In the present study, 54 monkeys with NAFLD and 23 normal monkeys were recruited. Serum FPG and TG levels were higher in fibrosing NASH monkeys compared with simple steatosis and normal monkeys, and differences between simple steatosis and normal monkeys were not statistically significant (p > 0.05). YAP increased in NAFLD, which mainly localized in the nuclei of hepatocytes, perivascular cells and bile duct cells; the accumulation of YAP correlated with the severity of hepatocyte injury. Compared with normal monkeys, the expression of TGF-β, α-smooth muscle actin (α-SMA), Drosophila mothers against decapentaplegic protein 3 (Smad3) and connective tissue growth factor (CTGF) in the liver of simple steatosis monkeys significantly increased (p < 0.01). Compared with simple steatosis monkeys, the expression of TGF-β, α-SMA, Smad3 and CTGF in fibrosing NASH significantly increased (p < 0.01). However, the expression of Drosophila mothers against decapentaplegic protein 7 (Smad7) in the liver of fibrosing NASH monkeys significantly decreased (p < 0.01). With the severity of liver fibrosis, the expression of TGF-β, α-SMA, Smad3 and CTGF gradually increased, and the difference was statistically significant (p < 0.01). However, there was no significant difference in the expression of Smad3 between fibrosis stage 1a and 1c. Compared with normal monkeys, the expression of Smad7 in the liver of monkeys with fibrosis significantly decreased (p < 0.01), but was significantly higher at fibrosis stage 1c than at fibrosis stage 1a and 2.
CONCLUSION: The YAP and TGF-β signaling pathways and the interaction between them promote the development and progression of NAFLD.

PMID: 29330836 [PubMed - as supplied by publisher]



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Dialysis Increases the Risk of Bladder Recurrence in Patients with Upper Tract Urothelial Cancer: A Population-Based Study.

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Dialysis Increases the Risk of Bladder Recurrence in Patients with Upper Tract Urothelial Cancer: A Population-Based Study.

Ann Surg Oncol. 2018 Jan 12;:

Authors: Lin MY, Li WM, Huang CN, Lee HL, Niu SW, Chen LT, Wu WJ, Hwang SJ

Abstract
BACKGROUND: The relation of dialysis to tumor recurrence in patients with upper tract urothelial cancer (UTUC) is unknown; however, a limited number of small-scale studies suggest that patients with renal diseases prior to UTUC are more likely to exhibit bladder recurrence. We performed a population-based analysis to determine the effect of dialysis on bladder recurrence for patients with UTUC.
METHODS: This retrospective cohort study included patients diagnosed with UTUC (2002-2007) from the Taiwan National Cancer Registry and divided them into two groups-dialysis and non-dialysis groups. These patients were followed up until bladder recurrence, death, or the end of 2010. Competing risk analyses adjusting covariates and death were applied to determine the relation of dialysis and bladder recurrence.
RESULTS: Of the 5141 eligible patients, 548 (10.7%) were undergoing dialysis. The cumulative bladder recurrence was significantly higher in the dialysis group than in the non-dialysis group (29% vs. 21%, modified log-rank p < 0.001). In the multivariable analysis, the dialysis group exhibited a 64% increased bladder recurrence risk (cause-specific hazard ratio 1.64, 95% confidence interval 1.34-2.01, p < 0.001), which was confirmed using stratification and propensity score weighting methods. The other prognostic factors for bladder recurrence were sex, diabetes, cardiac disorder, Charlson Comorbidity Index, and tumor grade.
CONCLUSIONS: Despite unknown reasons, approximately one-tenth of patients with UTUC have experienced dialysis treatment. Patients undergoing dialysis have a higher risk of bladder recurrence. Various treatment and screening strategies should be developed for dialysis and non-dialysis patients.

PMID: 29330720 [PubMed - as supplied by publisher]



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Low-field magnetic resonance imaging offers potential for measuring tibial component migration.

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Low-field magnetic resonance imaging offers potential for measuring tibial component migration.

J Exp Orthop. 2018 Jan 12;5(1):4

Authors: Schröder FF, Verdonschot NJJ, Ten Haken B, Peters A, Vochteloo AJH, Pakvis DFM, Huis In't Veld R

Abstract
BACKGROUND: Roentgen stereophotogrammetric analysis (RSA) is used to measure early prosthetic migration and to predict future implant failure. RSA has several disadvantages, such as the need for perioperatively inserted tantalum markers. Therefore, this study evaluates low-field MRI as an alternative to RSA. The use of traditional MRI with prostheses induces disturbing metal artifacts which are reduced by low-field MRI. The purpose of this study is to assess the feasibility to use low-field (0.25 Tesla) MRI for measuring the precision of zero motion. This was assessed by calculating the virtual prosthetic motion of a zero-motion prosthetic reconstruction in multiple scanning sessions. Furthermore, the effects of different registration methods on these virtual motions were tested.
RESULTS: The precision of zero motion for low-field MRI was between 0.584 mm and 1.974 mm for translation and 0.884° and 3.774° for rotation. The manual registration method seemed most accurate, with μ ≤ 0.13 mm (σ ≤ 0.931 mm) for translation and μ ≤ 0.15° (σ ≤ 1.63°) for rotation.
CONCLUSION: Low-field MRI is not yet as precise as today's golden standard (marker based RSA) as reported in the literature. However, low-field MRI is feasible of measuring the relative position of bone and implant with comparable precision as obtained with marker-free RSA techniques. Of the three registration methods tested, manual registration was most accurate. Before starting clinical validation further research is necessary and should focus on improving scan sequences and registration algorithms.

PMID: 29330713 [PubMed]



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The associations of poor psychiatric well-being among incarcerated men with injecting drug use histories in Victoria, Australia.

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The associations of poor psychiatric well-being among incarcerated men with injecting drug use histories in Victoria, Australia.

Health Justice. 2018 Jan 13;6(1):1

Authors: Cossar R, Stoové M, Kinner SA, Dietze P, Aitken C, Curtis M, Kirwan A, Ogloff JRP

Abstract
BACKGROUND: Dual substance dependence and psychiatric and psychological morbidities are overrepresented in prison populations and associated with reoffending. In the context of an increasing prison population in Australia, investigating the needs of vulnerable people in prison with a dual diagnosis can help inform in-prison screening and treatment and improve prison and community service integration and continuation of care. In this study we quantified psychiatric well-being in a sample of people in prison with a history of injecting drug use in Victoria, Australia, and identified factors associated with this outcome.
METHODS AND RESULTS: Data for this paper come from baseline interviews undertaken in the weeks prior to release as part of a prospective cohort study of incarcerated men who reported regular injecting drug use prior to their current sentence. Eligible participants completed a researcher-administered structured questionnaire that canvassed a range of issues. Psychiatric well-being was assessed using the 12-item General Health Questionnaire (GHQ-12) and potential correlates were included based on a review of the literature. Of the 317 men included for analyses, 139 were classified as experiencing current poor psychiatric well-being. In the multivariate model using modified logistic regression, history of suicide attempt (aOR = 1.36, 95%CI 1.03-1.78), two or more medical conditions (aOR = 1.87, 95%CI 1.30-2.67) and use of crystal methamphetamine in the week prior to their current sentence (aOR = 1.52, 95%CI 1.05-2.22) were statistically significantly associated with current poor psychiatric well-being.
CONCLUSIONS: Comprehensively addressing the health-related needs for this vulnerable population will require a multidisciplinary approach and enhancing opportunities to screen and triage people in prison for mental health and other potential co-occurring health issues will provide opportunities to better address individual health needs and reoffending risk.

PMID: 29330606 [PubMed]



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A dedicated neurologist at the emergency department during out-of-office hours decreases patients' length of stay and admission percentages.

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A dedicated neurologist at the emergency department during out-of-office hours decreases patients' length of stay and admission percentages.

J Neurol. 2018 Jan 12;:

Authors: van der Linden MC, van den Brand CL, van den Wijngaard IR, de Beaufort RAY, van der Linden N, Jellema K

Abstract
BACKGROUND: Emergency departments (EDs) worldwide face crowding, which hampers patient flow. In this study, the impact of a dedicated neurologist present at the ED on patient flow during out-of-office hours was assessed.
METHODS: A cross-sectional, mixed methods study was undertaken at a Dutch ED, including a pre-post analysis of data of patients who had a primary neurological disease (n = 458) and staff surveys (n = 152). Descriptive statistics and content analysis were used for analyses.
RESULTS: Despite a 36% increase in the number of neurological patients (control period: n = 194, intervention period n = 264), a 30 min per patient decrease in ED median length of stay (LOS) was reached during the intervention period. Furthermore, the admission percentage decreased significantly (57.7% in the control period vs. 47.7% in the intervention period, p = 0.03). During half of the shifts neurologists stated that their presence had been valuable. Perceived reasons for this added value mentioned were improved quality of care, enhanced throughput of patients, and quicker consultations with other medical specialists.
CONCLUSIONS: In our hypothesis-generating study, a dedicated neurologist present at the ED during out-of-office hours was associated with decreased patients' LOS and a decreased admission percentage, indicating increased decisiveness when the neurologist is present at the ED.

PMID: 29330584 [PubMed - as supplied by publisher]



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RGS7 is recurrently mutated in melanoma and promotes migration and invasion of human cancer cells.

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RGS7 is recurrently mutated in melanoma and promotes migration and invasion of human cancer cells.

Sci Rep. 2018 Jan 12;8(1):653

Authors: Qutob N, Masuho I, Alon M, Emmanuel R, Cohen I, Di Pizio A, Madore J, Elkahloun A, Ziv T, Levy R, Gartner JJ, Hill VK, Lin JC, Hevroni Y, Greenberg P, Brodezki A, Rosenberg SA, Kosloff M, Hayward NK, Admon A, Niv MY, Scolyer RA, Martemyanov KA, Samuels Y

Abstract
Analysis of 501 melanoma exomes revealed RGS7, which encodes a GTPase-accelerating protein (GAP), to be a tumor-suppressor gene. RGS7 was mutated in 11% of melanomas and was found to harbor three recurrent mutations (p.R44C, p.E383K and p.R416Q). Structural modeling of the most common recurrent mutation of the three (p.R44C) predicted that it destabilizes the protein due to the loss of an H-bond and salt bridge network between the mutated position and the serine and aspartic acid residues at positions 58 as 61, respectively. We experimentally confirmed this prediction showing that the p.R44C mutant protein is indeed destabilized. We further show RGS7 p.R44C has weaker catalytic activity for its substrate Gαo, thus providing a dual mechanism for its loss of function. Both of these effects are expected to contribute to loss of function of RGS7 resulting in increased anchorage-independent growth, migration and invasion of melanoma cells. By mutating position 56 in the R44C mutant from valine to cysteine, thereby enabling the formation of a disulfide bridge between the two mutated positions, we slightly increased the catalytic activity and reinstated protein stability, leading to the rescue of RGS7's function as a tumor suppressor. Our findings identify RGS7 as a novel melanoma driver and point to the clinical relevance of using strategies to stabilize the protein and, thereby, restore its function.

PMID: 29330521 [PubMed - in process]



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Targeting Insulin-Like Growth Factor-I and Extracellular Matrix Interactions in Melanoma Progression.

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Targeting Insulin-Like Growth Factor-I and Extracellular Matrix Interactions in Melanoma Progression.

Sci Rep. 2018 Jan 12;8(1):583

Authors: Murekatete B, Shokoohmand A, McGovern J, Mohanty L, Meinert C, Hollier BG, Zippelius A, Upton Z, Kashyap AS

Abstract
Insulin-like growth factor (IGF)-I binds to the ECM protein vitronectin (VN) through IGF binding proteins (IGFBPs) to enhance proliferation and migration of skin keratinocytes and fibroblasts. Although evidence exists for the role of individual components of the complex (IGF-I, IGFBP-3 and VN), the cellular functions stimulated by these proteins together as a complex remains un-investigated in melanoma cells. We report here that the IGF-I:IGFBP-3:VN trimeric complex stimulates a dose-dependent increase in the proliferation and migration of WM35 and Sk-MEL28 melanoma cells. In 3D Matrigel™ and hydrogel cultures, both cell lines formed primary tumor-like spheroids, which increased in size in a dose-dependent manner in response to the trimeric complex. Furthermore, we reveal IGFBP-3:VN protein complexes in malignant melanoma and squamous cell carcinoma patient tissues, where the IGFBP-3:VN complex was seen to be predominantly tumor cell-associated. Peptide antagonists designed to target the binding of IGF-I:IGFBP-3 to VN were demonstrated to inhibit IGF-I:IGFBP-3:VN-stimulated cell migration, invasion and 3D tumor cell growth of melanoma cells. Overall, this study provides new data on IGF:ECM interactions in skin malignancies and demonstrates the potential usefulness of a growth factor:ECM-disrupting strategy for abrogating tumor progression.

PMID: 29330502 [PubMed - in process]



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Novel endogenous simian retroviral integrations in Vero cells: implications for quality control of a human vaccine cell substrate.

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Novel endogenous simian retroviral integrations in Vero cells: implications for quality control of a human vaccine cell substrate.

Sci Rep. 2018 Jan 12;8(1):644

Authors: Sakuma C, Sekizuka T, Kuroda M, Kasai F, Saito K, Ikeda M, Yamaji T, Osada N, Hanada K

Abstract
African green monkey (AGM)-derived Vero cells have been utilized to produce various human vaccines. The Vero cell genome harbors a variety of simian endogenous type D retrovirus (SERV) sequences. In this study, a transcriptome analysis showed that DNA hypomethylation released the epigenetic repression of SERVs in Vero cells. Moreover, comparative genomic analysis of three Vero cell sublines and an AGM reference revealed that the genomes of the sublines have ~80 SERV integrations. Among them, ~60 integrations are present within all three cell sublines and absent from the reference sequence. At least several of these integrations consist of complete SERV proviruses. These results strongly suggest that SERVs integrated in the genome of Vero cells did not retrotranspose after the establishment of the cell lineage as far as cells were maintained under standard culture and passage conditions, providing a scientific basis for controlling the quality of pharmaceutical cell substrates and their derived biologics.

PMID: 29330501 [PubMed - in process]



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Decoding hind limb kinematics from neuronal activity of the dorsal horn neurons using multiple level learning algorithm.

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Decoding hind limb kinematics from neuronal activity of the dorsal horn neurons using multiple level learning algorithm.

Sci Rep. 2018 Jan 12;8(1):577

Authors: Yeganegi H, Fathi Y, Erfanian A

Abstract
Decoding continuous hind limb joint angles from sensory recordings of neural system provides a feedback for closed-loop control of hind limb movement using functional electrical stimulation. So far, many attempts have been done to extract sensory information from dorsal root ganglia and sensory nerves. In this work, we examine decoding joint angles trajectories from the single-electrode extracellular recording of dorsal horn gray matter of the spinal cord during passive limb movement in anesthetized cats. In this study, a processing framework based on ensemble learning approach is propose to combine firing rate (FR) and interspike interval (ISI) information of the neuronal activity. For this purpose, a stacked generalization approach based on recurrent neural network is proposed to enhance decoding accuracy of the movement kinematics. The results show that the high precision neural decoding of limb movement can be achieved even with a single electrode implanted in the spinal cord gray matter.

PMID: 29330489 [PubMed - in process]



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A Novel Ultra-Stable, Monomeric Green Fluorescent Protein For Direct Volumetric Imaging of Whole Organs Using CLARITY.

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A Novel Ultra-Stable, Monomeric Green Fluorescent Protein For Direct Volumetric Imaging of Whole Organs Using CLARITY.

Sci Rep. 2018 Jan 12;8(1):667

Authors: Scott DJ, Gunn NJ, Yong KJ, Wimmer VC, Veldhuis NA, Challis LM, Haidar M, Petrou S, Bathgate RAD, Griffin MDW

Abstract
Recent advances in thick tissue clearing are enabling high resolution, volumetric fluorescence imaging of complex cellular networks. Fluorescent proteins (FPs) such as GFP, however, can be inactivated by the denaturing chemicals used to remove lipids in some tissue clearing methods. Here, we solved the crystal structure of a recently engineered ultra-stable GFP (usGFP) and propose that the two stabilising mutations, Q69L and N164Y, act to improve hydrophobic packing in the core of the protein and facilitate hydrogen bonding networks at the surface, respectively. usGFP was found to dimerise strongly, which is not desirable for some applications. A point mutation at the dimer interface, F223D, generated monomeric usGFP (muGFP). Neurons in whole mouse brains were virally transduced with either EGFP or muGFP and subjected to Clear Lipid-exchanged Acrylamide-hybridized Rigid Imaging/Immunostaining/In situ hybridization-compatible Tissue-hYdrogel (CLARITY) clearing. muGFP fluorescence was retained after CLARITY whereas EGFP fluorescence was highly attenuated, thus demonstrating muGFP is a novel FP suitable for applications where high fluorescence stability and minimal self-association are required.

PMID: 29330459 [PubMed - in process]



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Gongylonema pulchrum infection in the human oral cavity: A case report and literature review.

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Gongylonema pulchrum infection in the human oral cavity: A case report and literature review.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Dec 08;:

Authors: Xiaodan L, Zhensheng W, Ying H, Hongwei L, Jianqiu J, Peiru Z, Sha S, Zhimin Y

Abstract
Gongylonema infection is a zoonotic disease occurring throughout the world and is mainly caused by consumption of contaminated water and raw food. Adult Gongylonema worms can exist as parasites in the human body for up to 10 years and cause symptoms of local irritation in the oral cavity, esophagus, and pharynx. Herein, we report a rare case in which live Gongylonema pulchrum was detected and extracted from the oral cavity of a woman. The pathogen was confirmed as G. pulchrum on the basis of microscopic examination and morphologic analysis. The patient's symptoms resolved immediately after surgical removal of the parasite, and the patient has been advised not to drink water that has not been boiled and to avoid consuming unwashed raw vegetables.

PMID: 29329982 [PubMed - as supplied by publisher]



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quality of care; +20 new citations

20 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

quality of care

These pubmed results were generated on 2018/01/14

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.



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Submental artery island flap with simultaneous level I neck dissection.

Submental artery island flap with simultaneous level I neck dissection.

Head Neck. 2018 Jan 13;:

Authors: Eskander A, Strigenz D, Seim N, Ozer E

Abstract
BACKGROUND: The purpose of this study was to illustrate the submental island flap elevation technique with simultaneous level I neck dissection followed by the inset and reconstruction of an oropharyngeal defect.
METHODS: A 63-year-old patient with a T2N1M0 human papillomavirus-positive squamous cell carcinoma of the tonsil was treated with concurrent chemoradiotherapy (cisplatin + 66 Gy). A local recurrence 2.5 years after treatment was treated surgically and reconstructed with a submental island flap.
RESULTS: There were no complications and oral diet was initiated at 2 weeks and the gastrostomy tube was removed 1 month postoperatively. A video demonstration of the submental island flap elevation is included with a focus on how levels 1A and 1B can be dissected safely and this can be viewed online on Head & Neck's home page at http://ift.tt/13H5MtY.
CONCLUSION: The submental island flap can be performed safely with a level I neck dissection for head and neck reconstruction.

PMID: 29331076 [PubMed - as supplied by publisher]



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Dog bites in a US county: age, body part, and breed in pediatric dog bites.

Dog bites in a US county: age, body part, and breed in pediatric dog bites.

Acta Paediatr. 2018 Jan 13;:

Authors: Ramgopal S, Brungo LB, Bykowski M, Pitetti R, Hickey R

Abstract
AIM: To compare characteristics of gender, age, body part, and breed in dog bites.
METHODS: We reviewed 14,956 dog bites (4,195 pediatric) reported to the Allegehny County Health Department, USA, between 2007-2015. Using pre-defined age groups, we performed linear regression to assess for subject age and bite frequency and used binary logistic regression to evaluate for differences in gender and body part and chi-squared tests with Bonferroni correction to evaluate for differences in reported breeds with age.
RESULTS: There was a negative correlation (-0.80, r2=0.64) between age and bite frequency. Children 0-3 years had a higher odds ratio (OR) of bites to the face (21.12, 95% confidence interval [CI] 17.61-25.33) and a lower OR of bites to the upper (OR 0.14, 95% CI 0.12-0.18) and lower (OR 0.19, 95% CI 0.14-0.27) extremities. "Pit bulls" accounted for 27.2% of dog bites and were more common in children 13-18 years (p<0.01). Shih-Tzu bites were more common in children three years of age and younger (p<0.01).
CONCLUSION: Dog bites occur with higher frequency at younger ages, and head and neck injuries are more common in younger children. Pit bull bites are more common in adolescents and Shih-Tzu bites more common in younger children. This article is protected by copyright. All rights reserved.

PMID: 29331048 [PubMed - as supplied by publisher]



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Prevalence, severity, and risk factors for acute exacerbations of nasal and sinus symptoms by chronic rhinosinusitis status.

Prevalence, severity, and risk factors for acute exacerbations of nasal and sinus symptoms by chronic rhinosinusitis status.

Allergy. 2018 Jan 13;:

Authors: Kuiper JR, Hirsch AG, Bandeen-Roche K, Sundaresan AS, Tan BK, Schleimer RP, Kern RC, Stewart WF, Schwartz BS

Abstract
BACKGROUND: Nasal and sinus symptoms (NSS) are common to many health conditions, including chronic rhinosinusitis (CRS). Few studies have investigated the occurrence and severity of, and risk factors for, acute exacerbations of NSS (AENSS) by CRS status (current, past, or never met European Position Paper on Rhinosinusitis [EPOS] criteria for CRS).
METHODS: Four seasonal questionnaires were mailed to a stratified random sample of Geisinger primary care patients. Logistic regression was used to identify individual characteristics associated with AENSS occurrence and severity by CRS status (current long-term, current recent, past, never) using EPOS subjective symptoms-only (EPOSS ) CRS criteria. We operationalized three AENSS definitions based on prescribed antibiotics or oral corticosteroids, symptoms, and symptoms with purulence.
RESULTS: Baseline and at least one follow-up questionnaires were available from 4,736 subjects. Self-reported NSS severity with exacerbation was worst in the current long-term CRS group. AENSS was common in all subgroups examined and generally more common among those with current EPOSS CRS. Seasonal prevalence of AENSS differed by AENSS definition and CRS status. Associations of risk factors with AENSS differed by definition, but CRS status, body mass index, asthma, hay fever, sinus surgery history, and winter season consistently predicted AENSS.
CONCLUSIONS: In this first longitudinal, population-based study of three AENSS definitions, NSS and AENSS were both common, sometimes severe, and differed by EPOSS CRS status. Contrasting associations of risk factors for AENSS by the different definitions suggest a need for a standardized approach to definition of AENSS. This article is protected by copyright. All rights reserved.

PMID: 29331046 [PubMed - as supplied by publisher]



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Noninvasive optical spectroscopy for identification of non-melanoma skin cancer: Pilot study.

Noninvasive optical spectroscopy for identification of non-melanoma skin cancer: Pilot study.

Lasers Surg Med. 2018 Jan 13;:

Authors: Carpenter DJ, Sajisevi MB, Chapurin N, Brown CS, Cheng T, Palmer GM, Stevenson DS, Rao CL, Hall RP, Woodard CR

Abstract
OBJECTIVE: Optical spectroscopy offers a noninvasive alternative to biopsy as a first-line screening tool for suspicious skin lesions. This study sought to define several optical parameters across malignant and benign tissue types.
STUDY DESIGN: Prospective pilot trial utilizing the Zenalux IM1 optical spectroscopy device from April 2016 to February 2017. For each skin lesion, provider pre-biopsy probability of malignancy was compared to histolopathologic diagnosis. Optical data were characterized across basal cell carcinoma (BCC; n = 9), squamous cell carcinoma (SCC; n = 5), actinic keratosis (AK; n = 4), scar tissue (n = 6), nevus (n = 2), and neurofibroma (NF; n = 1). Across all patients, agreement was determined between control measurements collected adjacent to the lesion and from the upper extremity.
METHODS: Prospective single center pilot study. The optical properties of 27 cutaneous lesions were collected from 18 adult patients presenting to Otolaryngology and Dermatology clinics with suspicious skin lesions warranting biopsy. Spectroscopy measurements were recorded for each lesion: two at the lesion site, two at an adjacent site (internal control), and one at the central medial upper extremity (arm control). Variables of interest included absolute oxygenated hemoglobin (Hb), Hb saturation, total Hb concentration, and Eumelanin concentration. For each lesion, internal control averages were subtracted from lesion averages to provide delta parameter values, and lesion averages were divided by internal control averages to provide ratio parameter values.
RESULTS: Mean percent difference between pre-biopsy probability of malignancy and histology was 29%, with a difference of 75% or greater seen in 5 of 25 lesions. Mean values for BCC, SCC, AK, and scar tissue varied most between extracted mean reduced scatter estimate (μa'; cm- ) delta values (BCC: -2.2 ± 3.8; SCC: -3.9 ± 2.0; AK: -3.3 ± 4.2, Scar: -1.7 ± 1.2) and total Hb (µM) ratio (BCC: 2.0 ± 3.3; SCC: 3.0 ± 1.3; AK: 1.1 ± 0.6; Scar: 1.4 ± 1.1). Agreement between local and arm controls was poor.
CONCLUSION: This pilot trial utilizes optical spectroscopy as a noninvasive method for determining cutaneous lesion histology. Effect sizes observed across optical parameters for benign and malignant tissue types will guide larger prospective studies that may ultimately lead to prediction of lesional histology without need for invasive biopsy. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

PMID: 29331035 [PubMed - as supplied by publisher]



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Multidimensional endotypes of chronic rhinosinusitis and their association with treatment outcomes.

Multidimensional endotypes of chronic rhinosinusitis and their association with treatment outcomes.

Allergy. 2018 Jan 13;:

Authors: Liao B, Liu JX, Li ZY, Zhen Z, Cao PP, Yao Y, Long XB, Wang H, Wang Y, Schleimer R, Liu Z

Abstract
BACKGROUND: The expression of chronic rhinosinusitis (CRS) is multidimensional. Disease heterogeneity in patients with CRS remains poorly understood. This study aimed to identify endotypes of CRS using cluster analysis by integrating multidimensional characteristics and to explore their association with treatment outcomes.
METHODS: A total of 28 clinical variables and 39 mucosal cellular and molecular variables were analyzed using principal component analysis. Cluster analysis was performed on 246 prospectively recruited Chinese CRS patients with at least one-year post-operative follow-up. Difficult-to-treat CRS was characterized in each generated cluster.
RESULTS: Seven subject clusters were identified. Cluster 1 (13.01%) was comparable to the classic well-defined eosinophilic CRS with polyps, having severe disease and the highest proportion of difficult-to-treat CRS. Patients in cluster 2 (16.26%) and cluster 4 (13.82%) had relatively lower proportions of presence of polyps and presented mild inflammation with moderate proportions of difficult-to-treat cases. Subjects in cluster 2 were highly atopic. Cluster 3 (7.31%) and cluster 6 (21.14%) were characterized by severe or moderate neutrophilic inflammation, respectively, and with elevated levels of IL-8 and high proportions of difficult-to-treat CRS. Cluster 5 (4.07%) was a unique group characterized by the highest levels of IL-10 and lacked difficult-to-treat cases. Cluster 7 (24.39%) demonstrated the lowest symptom severity, a low proportion of difficult-to-treat CRS, and low inflammation load. Finally, we found that difficult-to-treat CRS was associated with distinct clinical features and biomarkers in the different clusters.
CONCLUSIONS: Distinct clinicopathobiologic clusters of CRS display differences in clinical response to treatments and characteristics of difficult-to-treat CRS. This article is protected by copyright. All rights reserved.

PMID: 29331025 [PubMed - as supplied by publisher]



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Safety of high-current stimulation for intermittent intraoperative neural monitoring in thyroid surgery: A porcine model.

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Safety of high-current stimulation for intermittent intraoperative neural monitoring in thyroid surgery: A porcine model.

Laryngoscope. 2018 Jan 13;:

Authors: Lu IC, Chang PY, Randolph GW, Chen HY, Tseng KY, Lin YC, Chiang FY, Wu CW

Abstract
OBJECTIVES: During monitored thyroidectomy, displacement of the recurrent laryngeal nerve (RLN) or vagus nerve (VN) in some complicated cases can increase the risk of injury. Although increasing the stimulus current can facilitate nerve mapping and localization, the safety of a high-current stimulus remains unknown. Therefore, this study evaluated the safety of a high-current stimulus in a porcine model.
METHODS: Short-duration (1 minute), high-current (3, 5, 10, 15, 20, 25, and 30 mA at 4Hz) stimulus pulses were repeatedly applied to the RLN or VN in six anesthetized piglets. The safety of the high-current stimulus pulses was assessed in terms of hemodynamic stability during VN stimulation and in terms of nerve function integrity after VN and RLN stimulation.
RESULTS: During VN stimulation with a high-current stimulus pulse, sinus rhythms in all six piglets showed stable heart rates, and mean arterial pressure was unaffected. High-current stimulation of the VN and the RLN did not affect electromyography amplitude or latency.
CONCLUSION: This porcine study showed that applying a short-duration, high-current stimulus pulse to the VN or RLN during monitored thyroidectomy has no harmful effects. In clinical practice, a short duration of high-current stimulus can be applied to facilitate neural mapping, especially in patients with disoriented nerve positions.
LEVEL OF EVIDENCE: NA. Laryngoscope, 2017.

PMID: 29330874 [PubMed - as supplied by publisher]



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Repair of high-grade posterior glottic stenosis: A novel criocarytenoid joint release technique.

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Repair of high-grade posterior glottic stenosis: A novel criocarytenoid joint release technique.

Laryngoscope. 2018 Jan 13;:

Authors: Weidenbecher M

PMID: 29330872 [PubMed - as supplied by publisher]



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A case of radiation induced osteosarcoma of the skull presenting as a cutaneous epidermotropic tumour with a short latent period.

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A case of radiation induced osteosarcoma of the skull presenting as a cutaneous epidermotropic tumour with a short latent period.

J Cutan Pathol. 2018 Jan 13;:

Authors: Rashidghamat E, Calonje E

Abstract
Radiation induced sarcoma is an unusual but well documented tumor. The frequency of radiation induced sarcoma of the head and neck region has been reported as 0.143%. In the literature the median interval between irradiation and development of sarcoma is 11 years. Cases of RIS with a short latent period i.e. less than four years are rare. We report a case of a 34 year-old female who developed an osteosarcoma of the scalp, over a previous craniotomy scar, three years after excision of a frontal anaplastic oligodendroglioma which had been followed by a course of 6 weeks radiotherapy (58 Gy) and 6 cycles of Temozolomide. The histological features were those of a high-grade osteosarcoma with epidermotropism of tumor cells. Lymph nodes were partially replaced by high-grade metastatic osteosarcoma with extra-nodal lymphatic tumor thrombi. To our knowledge the only other case report of post-radiation osteosarcoma with a short latency period was a case of osteosarcoma in the craniofacial bone three years after radiotherapy for maxillary squamous cell carcinoma. The histological finding of prominent replacement of the epidermis by osteosarcoma has not been reported before.

PMID: 29330865 [PubMed - as supplied by publisher]



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Hyoepiglottic ligament collagen and elastin fiber composition and changes associated with aging.

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Hyoepiglottic ligament collagen and elastin fiber composition and changes associated with aging.

Laryngoscope. 2018 Jan 13;:

Authors: Irvine LE, Yang Z, Kezirian EJ, Nimni ME, Han B

Abstract
OBJECTIVE: The epiglottis may contribute to upper airway obstruction in approximately 10% of patients with obstructive sleep apnea. Clinical experience indicates that older patients may be more likely to have epiglottis-related obstruction. This study was designed to examine tissue characteristics of the hyoepiglottic ligament as a possible factor in epiglottis-related obstruction based on previous research suggesting that older adults have fewer collagen, elastin, and muscle fibers in the hyoepiglottic ligament.
METHODS: This is a cross-sectional study of 25 human cadaver hyoepiglottic ligaments. Specimens were stained using Masson's trichrome and Picrosirius red for collagen fibers and with Verhoeff-Van Gieson for elastin fibers. Percentage of collagen and elastin fiber staining for each specimen was calculated and averaged over three regions of each ligament section. Regression analysis was used to determine the association between age, smoking history, and collagen and elastin composition of the hyoepiglottic ligament.
RESULTS: The average age of the specimens was 68.4 ± 15.1 years (range 30-90 years). Increasing age was associated with a lower percentage of collagen and elastin fibers. When accounting for tobacco use, each 1-year increase in age was associated with a 0.53% decrease in Masson's trichrome staining (P = 0.004), a 0.35% decrease in Picrosirius red staining (P = 0.023), and a 0.33% decrease in Verhoeff-Van Gieson staining (P = 0.008).
CONCLUSION: Increasing age is associated with decreases in the collagen and elastin content of the hyoepiglottic ligament.
LEVEL OF EVIDENCE: NA. Laryngoscope, 2017.

PMID: 29330863 [PubMed - as supplied by publisher]



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Validity evidence as a key marker of quality of technical skill assessment in OTL-HNS.

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Validity evidence as a key marker of quality of technical skill assessment in OTL-HNS.

Laryngoscope. 2018 Jan 13;:

Authors: Labbé M, Young M, Nguyen LHP

Abstract
OBJECTIVE: Quality monitoring of assessment practices should be a priority in all residency programs. Validity evidence is one of the main hallmarks of assessment quality and should be collected to support the interpretation and use of assessment data. Our objective was to identify, synthesize, and present the validity evidence reported supporting different technical skill assessment tools in otolaryngology-head and neck surgery (OTL-HNS).
METHODS: We performed a secondary analysis of data generated through a systematic review of all published tools for assessing technical skills in OTL-HNS (n = 16). For each tool, we coded validity evidence according to the five types of evidence described by the American Educational Research Association's interpretation of Messick's validity framework. Descriptive statistical analyses were conducted.
RESULTS: All 16 tools included in our analysis were supported by internal structure and relationship to variables validity evidence. Eleven articles presented evidence supporting content. Response process was discussed only in one article, and no study reported on evidence exploring consequences.
CONCLUSION: We present the validity evidence reported for 16 rater-based tools that could be used for work-based assessment of OTL-HNS residents in the operating room. The articles included in our review were consistently deficient in evidence for response process and consequences. Rater-based assessment tools that support high-stakes decisions that impact the learner and programs should include several sources of validity evidence. Thus, use of any assessment should be done with careful consideration of the context-specific validity evidence supporting score interpretation, and we encourage deliberate continual assessment quality-monitoring.
LEVEL OF EVIDENCE: NA. Laryngoscope, 2018.

PMID: 29330861 [PubMed - as supplied by publisher]



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Long-term outcomes of cochlear implantation in patients with high-frequency hearing loss.

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Long-term outcomes of cochlear implantation in patients with high-frequency hearing loss.

Laryngoscope. 2018 Jan 13;:

Authors: Roland JT, Gantz BJ, Waltzman SB, Parkinson AJ

Abstract
OBJECTIVE: To demonstrate the long-term benefits of implantation in patients with high-frequency sensorineural hearing loss, this report provides 5-year follow-up on a group of implant recipients who were subjects of the Cochlear™ Nucleus® Hybrid™ L24 Implant System pivotal clinical study.
METHODS: The results of three related clinical studies were compiled to provide outcome data after 1, 3, and 5 years of implant use in a group of subjects who presented with preoperative high-frequency hearing loss and were implanted with a Nucleus Hybrid L24 (Cochlear Ltd., Sydney, Australia) cochlear implant. A subset of the 50 adult subjects (N = 32) who participated in the Hybrid L24 pivotal Investigational Device Exemption (IDE) completed comprehensive evaluations at 12 months postactivation, 3 years postactivation, and then as part of a postapproval study at 5 years postactivation. Testing included audiometric, speech perception, and subjective satisfaction measures.
RESULTS: Mean unilateral speech perception performance was significantly improved at all postoperative intervals compared to preoperative best-aided results and has remained stable to 5 years postactivation. Ninety-four percent of subjects had measurable hearing, and 72% continued to use electric-acoustic stimulation in the implanted ear after 5 years of implant use. Subjective satisfaction results support objective performance improvements.
CONCLUSION: Results demonstrate long-term success of patients with high-frequency hearing loss following Hybrid L24 (Cochlear) cochlear implantation. Benefits include speech perception abilities significantly better than those in the preoperative best-aided condition, with additional benefit in those using electric-acoustic stimulation in the implanted ear.
LEVEL OF EVIDENCE: 2b. Laryngoscope, 2018.

PMID: 29330858 [PubMed - as supplied by publisher]



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[Autoimmune reactions to immune checkpoint inhibitors].

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[Autoimmune reactions to immune checkpoint inhibitors].

Z Rheumatol. 2017 Oct;76(Suppl 2):57-62

Authors: Pönisch W, Alten R, Baerwald C

Abstract
Immune checkpoint inhibitors (ICI) have dramatically changed the face of cancer treatment and are gaining in importance. The ICIs have now been approved for the treatment of advanced cancers, including melanoma, non-small-cell and small cell lung cancers, renal cell carcinoma, Hodgkin's lymphoma, head and neck cancers and urothelial carcinoma and further indications are to be expected. The organs most affected by an autoimmune reaction are the intestines, the musculoskeletal system, skin, endocrine organs, the liver and the lungs. As the indications for immune checkpoint blockade expand and ICIs are used in combination, it becomes increasingly more important for rheumatologists to recognize immune-related adverse events (irAEs), their connection to cancer immunotherapy and how to treat these events appropriately. The role of rheumatologists will take on growing importance as immunotherapies become more common as standard treatment of cancer and when used earlier in the course of the disease. Previously controlled autoimmune diseases can deteriorate when using ICIs, so this is a consideration when evaluating patients. Increased awareness of inflammatory arthritis, as well as other rheumatic manifestations as an adverse association with cancer immunotherapies, is imperative for making the diagnosis. Treatment algorithms are based on the severity of symptoms but in the case of rheumatic disease, treatment often needs to be tailored to the individual. The general strategy for evaluation and management of irAEs includes a thorough evaluation for infections. Mild irAE may be self-limiting, while more severe reactions are generally steroid responsive, albeit with potentially high dosage requirements.

PMID: 29330759 [PubMed - in process]



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SPECT/CT Adds Distinct Lymph Node Basins and Influences Radiologic Findings and Surgical Approach for Sentinel Lymph Node Biopsy in Head and Neck Melanoma.

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SPECT/CT Adds Distinct Lymph Node Basins and Influences Radiologic Findings and Surgical Approach for Sentinel Lymph Node Biopsy in Head and Neck Melanoma.

Ann Surg Oncol. 2018 Jan 12;:

Authors: Trinh BB, Chapman BC, Gleisner A, Kwak JJ, Morgan R, McCarter MD, Gajdos C, Kounalakis N

Abstract
BACKGROUND: Planar lymphoscintigraphy (PL) has a lower detection rate of sentinel lymph nodes (SLNs) in head and neck melanoma compared with other sites. We assessed situations when single-photon emission computed tomography/computed tomography (SPECT/CT) identified nodes not seen by PL. We also evaluated the impact of SPECT/CT on surgical approach and oncologic outcomes.
METHODS: Patients who underwent SLN biopsy (SLNB) for head and neck melanoma with PL and SPECT/CT between November 2011 and December 2016 were included. Surgeons and radiologists completed a real-time survey inquiring about the utility of SPECT/CT. Patients were divided into two groups: patients with nodal basins identified by both PL and SPECT/CT ('PL + SPECT/CT'), and patients in whom SPECT/CT identified additional nodal basins not seen on PL ('SPECT/CT only'). Patient demographics and long-term outcomes including follow-up duration, recurrence, and survival are described.
RESULTS: In the PL + SPECT/CT group, 73 (61.9%) patients were included and 45 (38.1%) patients were included in the SPECT/CT-only group. SPECT/CT added 51 basins to those seen on PL, primarily in the supraclavicular region (43.1%). Eighteen patients had positive node(s) in the PL + SPECT/CT group compared with two patients in the SPECT/CT-only group. Surgeons reported that 81% of the time, SPECT/CT influenced the location of incision for SLNB.
CONCLUSIONS: SPECT/CT influences the location of incision and contributes most to identification of nodes in the supraclavicular region. It also detects additional SLN basins when compared with PL. Further studies are necessary to determine when these additional basins require sampling.

PMID: 29330718 [PubMed - as supplied by publisher]



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The impact of acoustic neuroma on long-term quality-of-life outcomes in the United Kingdom.

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The impact of acoustic neuroma on long-term quality-of-life outcomes in the United Kingdom.

Eur Arch Otorhinolaryngol. 2018 Jan 12;:

Authors: Lodder WL, van der Laan BFAM, Lesser TH, Leong SC

Abstract
OBJECTIVE: To quantify the impact of acoustic neuroma on the quality-of-life (QOL) patients in the United Kingdom.
STUDY DESIGN: Online questionnaire survey.
PATIENTS: Members of the British Acoustic Neuroma Association received PANQOL questionnaires.
RESULTS: Of the 880 BANA members contacted, 397 (45.1%) responded, although only 359 had complete datasets for analysis. Composite QOL scores were as follows: for microsurgery 58 (SD 35), for radiotherapy 56 (SD18), for combination of surgery and radiotherapy 49 (SD 14), and for the observation group 54 (SD 20). No statistical significance with ANOVA (p = 0.532). Mean (SD) composite QOL scores were as follows: for follow-up < 6 52 (SD 18), for follow-up 6-10 55 (SD 20) and follow-up > 10 years 65 (SD 45). Overall, these values were significantly different compared by ANOVA (p < 0.001). Patients with facial paralysis showed no statistical significant differences between the different treatment groups.
CONCLUSIONS: Short- (< 6 years) and long-term (> 10 years) QOL outcomes show no significant differences between the different treatment groups.

PMID: 29330600 [PubMed - as supplied by publisher]



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Infraorbital foramen localization in orbitozygomatic fractures: a CT study with intraoperative finding.

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Infraorbital foramen localization in orbitozygomatic fractures: a CT study with intraoperative finding.

Eur Arch Otorhinolaryngol. 2018 Jan 12;:

Authors: El-Anwar MW, Sweed AH

Abstract
OBJECTIVE: The aim of this study was to assess the infraorbital foramen (IOF) using CT in patients with Zygomaticomaxillary complex (ZMC) fractures (midface fracture).
PATIENTS AND METHODS: This prospective study was carried out on 49 patients had ZMC fractures (98 sides) and 27 patients (54 sides) with craniomaxillofacial fractures rather than fractured ZMC as a control. Using CT, position of IOF was documented on 3D view in relation to inferior orbital rim, tooth root relation and finally with a novel imaginary line passing between anterior nasal spine and whitnall tubercle.
RESULTS: Position of IOF had fixed anatomical landmark: just lateral to a line drawn between the anterior nasal spine to whitnall tubercle (clinically between nasal tip-lateral canthal ligament) and lateral to vertical plane to root of maxillary canine also with variable distance from inferior orbital rim ranged from 4.56 to 18.03 mm with a mean of 7.9 ± 2.447 mm.
CONCLUSION: Even though ZMC fractures disturb the anatomical location of the ZMC bones, there are still preserved reliable fixed landmarks maxillofacial surgeons can depend on to identify and preserve ION.

PMID: 29330599 [PubMed - as supplied by publisher]



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Tissue and serum microRNA profile of oral squamous cell carcinoma patients.

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Tissue and serum microRNA profile of oral squamous cell carcinoma patients.

Sci Rep. 2018 Jan 12;8(1):675

Authors: Schneider A, Victoria B, Lopez YN, Suchorska W, Barczak W, Sobecka A, Golusinski W, Masternak MM, Golusinski P

Abstract
Head and neck cancer is characterized by malignant tumors arising from the epithelium covering the upper aerodigestive tract, and the majority of these epithelial malignancies are squamous cell carcinomas (SCCs) of the oral cavity (OSCCs). The aim of the current work was to identify miRNAs regulated in OSCC cancerous tissue when compared to a healthy adjacent tissue and to verify the presence of the same miRNAs in the circulation of these patients. For that serum samples and biopsies of healthy and tumor tissues were collected from five patients diagnosed with OSCC of the oral cavity, RNA was extracted from these samples and microRNAs libraries were prepared and sequenced. A total 255 miRNAs were identified in tissue and 381 different miRNAs were identified in serum samples. When comparing the miRNA expression between tumor and healthy tissue we identified 48 miRNAs (25 down- and 23 up-regulated) that were differentially expressed (FDR < 0.05). From these 48 differentially expressed miRNAs in tissue, 30 miRNAs were also found in the serum of the same patients. hsa-miR-32-5p was up-regulated in tumor compared to healthy tissue in our study, and was previously shown to be up-regulated in the serum of OSCC patients. Therefore, this suggests that miRNAs can be used as potential non-invasive biomarkers of OSCC.

PMID: 29330429 [PubMed - in process]



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High-risk TP53 mutations are associated with extra nodal extension (ENE) in oral cavity squamous cell carcinoma (OSCC).

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High-risk TP53 mutations are associated with extra nodal extension (ENE) in oral cavity squamous cell carcinoma (OSCC).

Clin Cancer Res. 2018 Jan 12;:

Authors: Sandulache VC, Michikawa C, Kataria P, Gleber-Netto FO, Bell D, Trivedi S, Rao X, Wang J, Zhao M, Jasser SA, Myers JN, Pickering CR

Abstract
PURPOSE:   Development of extra-nodal extension (ENE) has been associated with poor survival in patients with oral cavity squamous cell carcinoma (OSCC). Here we sought to confirm the role of ENE as a poor prognostic factor, and identify genomic and epigenetic markers of ENE in order to develop a predictive model and improve treatment selection.
EXPERIMENTAL DESIGN: An institutional cohort (University of Texas MD Anderson Cancer Center) was utilized to confirm the impact of ENE on clinical outcomes and evaluate the genomic signature of primary and ENE containing tissue. OSCC data from The Cancer Genome Atlas (TCGA) were analyzed for the presence of molecular events associated with nodal and ENE status.
RESULTS: ENE was associated with decreased overall and disease free survival. Mutation of the TP53 gene was the most common event in ENE+ OSCC. The frequency of TP53 mutation in ENE+ tumors was higher compared to ENE- tumors and wild-type (wt) TP53 was highly-represented in pN0 tumors. pN+ENE+ patients had the highest proportion of high-risk TP53 mutations. Both primary tumors (PT) and lymph nodes with ENE (LN) exhibited a high rate of TP53 mutations (58.8%, 58.8% respectively) with no significant change in allele frequency between the two tissue sites.
CONCLUSIONS: ENE is one of the most significant markers of OSCC OS and DFS. There is a shift toward a more aggressive biological phenotype associated with high-risk mutations of the TP53 gene. Prospective clinical trials are required to determine whether TP53 mutational status can be used for personalized treatment decisions.

PMID: 29330202 [PubMed - as supplied by publisher]



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Effectiveness and safety of foam sclerotherapy with 5% ethanolamine oleate in the treatment of low-flow venous malformations in the head and neck region: a case series.

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Effectiveness and safety of foam sclerotherapy with 5% ethanolamine oleate in the treatment of low-flow venous malformations in the head and neck region: a case series.

Int J Oral Maxillofac Surg. 2018 Jan 09;:

Authors: Ribeiro MC, de Mattos Camargo Grossmann S, do Amaral MBF, de Castro WH, Navarro TP, Procopio RJ, da Silva TA, de Nazaré Alves de Oliveira Kato C, Mesquita RA

Abstract
The aim of this study was to evaluate the effectiveness and safety of 5% ethanolamine oleate (EO) foam in the treatment of low-flow venous malformations in the head and neck region. Seventeen consecutive patients (six male, 11 female) and 34 low-flow venous malformations were enrolled. The vascular anomalies ranged between 20mm and 80mm in size. The typical clinical indication was a swelling (88.2%) with a purple colour (85.3%); the most frequent location was the tongue (23.5%). Ethanolamine oleate foam was produced via the Tessari method and applied at 10mg per 1cm to the vascular anomalies. This process resulted in the highest clinical healing score in 64.7% of cases, and half of the patients reported a high level of satisfaction (score >9). In the majority of cases (88.2%), the patients reported that the pain immediately postoperative was mild or moderate. There were direct relationships between vascular anomaly size and the volume of EO applied, the number of sessions, and healing (P<0.05). No recurrence was observed during 6 months of follow-up. This case series showed the effectiveness and safety of 5% EO foam for the treatment of venous malformations in the head and neck region.

PMID: 29329829 [PubMed - as supplied by publisher]



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Facile microencapsulation of olive oil in porous starch granules: Fabrication, characterization, and oxidative stability.

Related Articles

Facile microencapsulation of olive oil in porous starch granules: Fabrication, characterization, and oxidative stability.

Int J Biol Macromol. 2018 Jan 09;:

Authors: Lei M, Jiang FC, Cai J, Hu S, Zhou R, Liu G, Wang YH, Wang HB, He JR, Xiong XG

Abstract
In this study, starch with porous structures derived from purple sweet potato was prepared and used as a food-grade polymer for the microencapsulation of olive oil. The optimal reaction conditions for preparing porous starch were determined to improve its adsorption capacity as effective microcapsule-wall materials. Olive oil was then impregnated in microspheres, and loading ratio was optimized by investigating the restrictive factors, including the mass ratio of olive oil to porous starch, as well as the embedding temperature and time. The presence of olive oil in the starch matrix was confirmed by SEM, FTIR, and TGA. Results demonstrated that the porous starch-based microencapsulation exhibit a stable olive oil loading ratio and a significant improvement in oxidative stability compared with free olive oil. The newly-proposed process used in this work was easy to scale up for developing a new and attractive method for oil protection in the food industry.

PMID: 29329810 [PubMed - as supplied by publisher]



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Lateral lymph node metastasis in papillary thyroid carcinoma: A systematic review and meta-analysis for prevalence, risk factors, and location.

Related Articles

Lateral lymph node metastasis in papillary thyroid carcinoma: A systematic review and meta-analysis for prevalence, risk factors, and location.

Int J Surg. 2018 Jan 09;:

Authors: So YK, Kim MJ, Kim S, Son YI

Abstract
BACKGROUND: Lymph node metastasis (LNM) is frequent in papillary thyroid carcinoma (PTC) and is associated with a poor prognosis. Unlike central LNM (CLNM), there are few studies focusing on LLNM. We aimed to investigate the prevalence and the risk factors for LLNM, with its most prevalent sites.
METHODS: We performed a comprehensive literature search using the PubMed and EMBASE databases for relevant studies published prior to November 2016 that examined the risk factors for LLNM.
RESULTS: Twenty-three studies, including 18,741 patients, were included. The prevalence of LLNM was 20.9% in all patients. CLNM (pooled OR = 7.84, 95% CI = 6.13-10.02, p < .0001), extrathyroidal extension (pooled OR = 3.22, 95% CI = 2.21-4.70, p < .0001), tumor multifocality (pooled OR = 2.19, 95% CI = 1.67-2.89, p < .0001), male sex (pooled OR = 1.72, 95% CI = 1.50-1.98, p < .0001), upper pole location (pooled OR = 2.96, 95% CI = 1.93-4.53, p < .0001), tumor size ≥1.0 cm (pooled OR = 2.49, 95% CI = 1.71-3.61, p < .0001), lymphovascular invasion (pooled OR = 3.96, 95% CI = 2.61-6.03, p < .0001) and tumor bilaterality (pooled OR = 1.31, 95% CI = 1.12-1.53, p = .0006) were significantly associated with LLNM. Most frequently affected areas were levels III and IV.
CONCLUSIONS: The prevalence of LLNM was high although the prognostic impact is unknown. The significant risk factors for LLNM were not much different from known risk factors for CLNM.

PMID: 29329789 [PubMed - as supplied by publisher]



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IJMS, Vol. 19, Pages 244: Omega-3 Polyunsaturated Fatty Acids Time-Dependently Reduce Cell Viability and Oncogenic MicroRNA-21 Expression in Estrogen Receptor-Positive Breast Cancer Cells (MCF-7)

IJMS, Vol. 19, Pages 244: Omega-3 Polyunsaturated Fatty Acids Time-Dependently Reduce Cell Viability and Oncogenic MicroRNA-21 Expression in Estrogen Receptor-Positive Breast Cancer Cells (MCF-7)

International Journal of Molecular Sciences doi: 10.3390/ijms19010244

Authors: Lauren LeMay-Nedjelski Julie Mason-Ennis Amel Taibi Elena Comelli Lilian Thompson

The omega-3 polyunsaturated fatty acid (n-3 PUFA), α-linolenic acid (ALA), and its metabolites, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), independently reduce the growth of breast cancer cells in vitro, but the mechanisms, which may involve microRNA (miRNA), are still unclear. The expression of the oncomiR, miR-21, is reduced by DHA treatment, but the effects of ALA on miR-21, alone or combined with EPA and DHA under physiologically relevant concentrations, have not been investigated. The effects of ALA alone and +/−EPA and DHA at the blood molar ratios seen in either humans (1.0:1.0:2.5, ALA:EPA:DHA) or mice (1.0:0.4:3.1, ALA:EPA:DHA) post flaxseed oil consumption (containing ALA) were assessed in vitro in MCF-7 breast cancer cells. Cell viability and the expression of miR-21 and its molecular target, phosphatase and tension homolog (PTEN, gene and protein), at different time points, were examined. At 1, 3, 48 and 96 h ALA alone and 24 h animal ratio treatments significantly reduced MCF-7 cell viability, while 1 and 3 h ALA alone and human and animal ratio treatments all significantly reduced miR-21 expression, and 24 h animal ratio treatment reduced miR-21 expression; these effects were not associated with changes in PTEN gene or protein expressions. We showed for the first time that ALA alone or combined with EPA and DHA at levels seen in human and animal blood post-ALA consumption can significantly reduce cell viability and modulate miR-21 expression in a time- and concentration-dependent manner, with the animal ratio containing higher DHA having a greater effect. The time dependency of miR-21 effects suggests the significance of considering time as a variable in miRNA studies, particularly of miR-21.



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Interval-Valued Intuitionistic Fuzzy Einstein Geometric Choquet Integral Operator and Its Application to Multiattribute Group Decision-Making

With respect to the multiattribute decision-making (MADM) problem in which the attributes have interdependent or interactive phenomena under the interval-valued intuitionistic fuzzy environment, we propose a group decision-making approach based on the interval-valued intuitionistic fuzzy Einstein geometric Choquet integral operator (IVIFEGC). Firstly, the Einstein operational laws and some basic principle on interval-valued intuitionistic fuzzy sets are introduced. Then, the IVIFEGC is developed and some desirable properties of the operator are studied. Further, an approach to multiattribute group decision-making with interval-valued intuitionistic fuzzy information is developed, where the attributes have interdependent phenomena. Finally, an illustrative example is used to illustrate the developed approach.

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A Study of the Correlation between VEP and Clinical Severity in Children with Autism Spectrum Disorder

Visual evoked potential (VEP) is a technique used to assess the brain’s electrical response to visual stimuli. The aims of this study were to examine neural transmission within the visual pathway through VEP testing in preschool children with autism spectrum disorder (ASD) and compare it to age-matched controls, as well as search for a correlation between the VEP parameters and the symptoms of ASD. Participants were composed of ASD children (9 males) and typically developing children (8 males and 4 females), aged between 3 and 5 years. Checkerboards were chosen as the pattern-reversal VEP. The clinical severity of ASD was assessed using the Autism Treatment Evaluation Checklist (ATEC) and the Vineland Adaptive Behavior Scales 2nd edition (VABS-II). Our findings demonstrated that children with ASD had significantly longer N145 latency compared to the controls. A longer N145 latency correlated with a higher score of ATEC within the sensory/cognitive awareness subdomain. In addition, a slower N145 response was also associated with a lower VABS-II score within the socialization domain. The correlation between longer VEP latency and abnormal behaviors in children with ASD suggests a delayed neural communication within other neural circuits, apart from the visual pathway. These lines of evidence support the possibility of using VEP, along with clinical parameters, for the assessment of ASD severity.

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Influence of Cu Content on the Microstructure and Mechanical Properties of Cr-Cu-N Coatings

The Cr-Cu-N coatings with various Cu contents (0–25.18 (±0.17) at.%) were deposited on Si wafer and stainless steel (SUS 304) substrates in reactive Ar+N2 gas mixture by a hybrid coating system combining pulsed DC and RF magnetron sputtering techniques. The influence of Cu content on the coating composition, microstructure, and mechanical properties was investigated. The microstructure of the coatings was significantly altered by the introduction of Cu. The deposited coatings exhibit solid solution structure with different compositions in all of the samples. Addition of Cu is intensively favored for preferred orientation growth along (200) direction by restricting in (111) direction. With increasing Cu content, the surface and cross-sectional morphology of coatings were changed from triangle cone-shaped, columnar feature to broccoli-like and compact glassy microstructure, respectively. The mechanical properties including the residual stress, nanohardness, and toughness of the coatings were explored on the basis of Cu content. The highest hardness was obtained at the Cu content of 1.49 (±0.10) at.%.

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Advective Displacement Method for the Characterisation of Pore Water Chemistry and Transport Properties in Claystone

The advective displacement method applies large hydraulic gradients to a confined rock core sample to yield small aliquots of the preserved in situ pore water, applicable to aquitard rocks with hydraulic conductivities as low as 10−14 m/s. Examples from argillaceous rocks indicate that only minor artefacts are induced and that analytical methods optimized for small aliquots provide a comprehensive chemical and isotopic characterisation. Multicomponent transport properties are derived from extending experimental time and using a traced artificial pore water for injection. Examples include quantification of the anion exclusion effect that can even resolve a small difference between transport properties for chloride and bromide in claystone. Controls by mineral saturation and cation exchange processes are also constrained by data from this approach. Technical details are provided for construction, material selection, components, sensors, and analytical issues.

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Subacute Urinary Retention due to a Subpubic Cartilaginous Cyst Treated with Surgical Resection and Internal Fixation: A Case Report and Review of the Literature

A subpubic cartilaginous cyst is a rare mass lesion derived from the pubic symphysis, which can cause acute or subacute urinary retention. We report a case of a subpubic cartilaginous cyst in a 62-year-old woman that caused lower abdominal pain and subacute urinary retention, requiring surgical resection. On physical examination, a hard, flexible, nontender mass, 4 cm in diameter, was palpable along the lower border of the pubic bone, extending to the perineum. Magnetic resonance imaging revealed a clearly distinct (3.8 cm × 3.8 cm × 7.2 cm) mass on the midpelvic side of the pelvis, centered on the pubic joint. We proceeded with en bloc resection of the mass, including a resection margin of 1 cm on either side. The bony defect was fixed with a locking plate. On pathological assessment, the mass was diagnosed as a subpubic cartilaginous cyst arising from the cartilage of the pubic symphysis. No tumor recurrence was identified over a 4-year follow-up. Based on our experience, we propose that en bloc resection of the mass, including a wider resection centered on the pubic symphysis, with internal fixation, is a possible treatment for a subpubic cartilaginous cystic mass lesion.

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Extra-Anatomic Jump Graft from the Right Colic Vein: A Novel Technique to Manage Portal Vein Thrombosis in Liver Transplantation

Background. In the context of cirrhosis, portal vein thrombosis (PVT) is present in 2.1% to 26% of patients. PVT is no longer considered an absolute contraindication for liver transplantation, and nowadays, surgical strategies depend on the extent of PVT. Complete PVT is associated with higher morbidity rates and poor prognosis, while comparable long-term outcomes can be achieved as long as physiological portal inflow is restored. Materials and Methods. We report our experience with a 45-year-old patient undergoing liver transplant with a PVT (stage III-b). To restore portal vein inflow to the liver, an extra-anatomic jump graft from the right colic vein with donor iliac vein interposition was constructed. Results. The patient recovered well, with a progressive improvement of the general conditions, and was finally discharged on p.o.d. 14. No anastomotic defects were found at the postoperative CT scan 10 months after the surgery. Conclusion. Our technical innovation represents a valid and safe alternative to the cavoportal hemitransposition, providing a proper flow restoration and reproducing a physiological setting, while avoiding the complications related to the cavoportal shunt. We believe that the reconstitution of liver portal inflow should be obtained with the most physiological approach possible and considering long-term liver function.

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The Role and Impact of Salivary Zn Levels on Dental Caries

Introduction. Minimal attention has been given to the role of salivary microelements, the importance they have in reducing the intensity of caries, and the effect of caries prophylaxes. Aim. This research aimed to determine the concentration and quantity of Zn and its impact on the prevention and the reduction of the intensity of caries in schoolchildren aged 12-13 years with permanent dentition. Methods. For this research, we analyzed the stimulated and nonstimulated full saliva of 106 schoolchildren divided into three groups by mean decayed, missing, and filled teeth (DMFT) index. The control group consisted of 25 caries-free children, the second group had 47 children with mean DMFT index of 1 to 6, and the third group had 34 children with DMFT index of ≥ 6. Complete saliva was collected from all children in a sterile test tube. Results. The concentration of Zn in saliva before stimulation in caries-free children has variations of the order of 0.001+ to 0.01 mmol/l. The maximum concentration after stimulation is 6.72 mmol/l, while the maximum value is 64.38 mmol/l. Conclusion. The Zn concentration in the stimulated saliva showed a significant increase in the group of caries-free children and could be described as a positive value for the reduction of caries.

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Effect of Atropine Eye Drops on Choroidal Thinning Induced by Hyperopic Retinal Defocus

Purpose. To investigate the effects of atropine on choroidal thinning induced by hyperopic retinal defocus. Methods. Ten young adults with myopia (−1.00 D to −5.00 D) viewed a video at 6 metres for 60 minutes on successive days. On day 1, one eye (control) was distance corrected with a contact lens; the other (experimental) eye wore a contact lens imposing 2.00 D of hyperopic retinal defocus. Sub- and perifoveal choroidal thickness (SFCT, PFCT) were monitored with optical coherence tomography. On day 2, the procedure was repeated but the experimental eye had received one drop of 0.5% atropine 22 hours earlier. Results. On day 1, eyes exposed to hyperopic defocus developed progressively thinner choroids (SFCT (baseline) = 253 ± 32 μm versus SFCT (40 mins) = 244 ± 31 μm, ), whereas SFCT and PFCT in control eyes did not change (). On day 2 (22 hours after instilling atropine), baseline SFCT and PFCT were not different to day 1 () and hyperopic defocus failed to thin the choroid (max change in SFCT = +2 ± 2 μm, ). Conclusions. Atropine abolished choroidal thinning induced by hyperopic defocus without changing baseline choroidal thickness. The results suggest that atropine inhibits signals associated with hyperopic defocus, for example, from lag of accommodation during near work. This trial is registered with ACTRN12617001519347.

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Scaffold thrombosis following implantation of the ABSORB BVS in routine clinical practice: Insight into possible mechanisms from optical coherence tomography

Abstract

Objectives

To identify potential underlying mechanisms of early and (very) late scaffold thrombosis (ScT) by optical coherence tomography (OCT), in a frame-by-frame analysis.

Background

The absorb scaffold is associated with an increased risk of ScT compared with metallic stents. Several potential causes of bioresorbable ScT have been identified, however the precise etiology still remains unclear.

Methods

Between February 2013 and February 2016, 13 patients presenting with definite ScT underwent OCT imaging. After guidewire passage or balloon inflations, OCT images were acquired. Pullbacks were assessed offline at each 1 mm longitudinal interval within the treated segment and the 5 mm segments adjacent to both edges. Primary cause of ScT was assessed by reviewing medical records, baseline angiographic films, and OCT pullback and angiographic films at time of ScT.

Results

13 patients, with 14 thrombotic lesions presented either with early ScT (i.e., ≤30 days) or very (late) (i.e., >30 days). Analysis demonstrated a significantly smaller in-scaffold maximal lumen diameter in the early cases (2.75 ± 0.85 mm vs. 3.00 ± 0.46 mm; P = 0.033) and a nonsignificant smaller minimal scaffold diameter (2.44 ± 0.62 mm vs. 2.58 ± 0.37 mm P = 0.097). Per-strut analysis demonstrated significantly more malapposed scaffold struts in (very) late cases (6% versus 0.6%, P < 0.001). Assessment of the predominate cause showed underexpansion as the dominant factor in the early cases, while malapposition was predominantly seen in the (very)late cases.

Conclusions

OCT performed in patients presenting with Absorb ScT demonstrated that malapposition of scaffold struts was more prominent in patients presenting with (very) late ScT, while underexpansion was more frequent in the early cases.



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Transcatheter closure of patent foramen ovale for secondary prevention of ischemic stroke: Quantitative synthesis of pooled randomized trial data

Abstract

Objectives

To evaluate the safety and efficacy of percutaneous device closure of patent foramen ovale (PFO) for secondary prevention of ischemic stroke

Background

Stroke remains the leading cause of serious long-term disability in the United States. The effectiveness of a percutaneous PFO closure in the prevention of recurrent cryptogenic strokes has not been established.

Methods

We performed a literature search using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Google Scholar, and Internet-based sources from January 2003 to September 2017. Randomized controlled trails (RCTs) comparing percutaneous PFO closure to medical therapy alone.

Results

Five RCTs (CLOSURE I, PC Trial, REDUCE, RESPECT, and CLOSE) with 1,829 patients in the device group and 1,611 patients in the medical group met inclusion criteria. The cumulative incidence of recurrent stroke was 2.02% in the PFO closure arm and 4.4% in the medical therapy group (RR 0.42, 95%CI 0.20, 0.91; P = 0.03). There was no difference in the incidence of death [0.7% vs. 0.9%; RR 0.76 (95% CI 0.35, 1.64), P = 0.49] or adverse events during the follow-up period [24.6% vs. 23.7% (RR 1.03; 95% CI 0.91, 1.16), P = 0.65] between the closure and medical therapy groups. Incidence of atrial fibrillation was significantly higher in closure group compared to medical therapy [4% vs. 0.6% (RR 4.73; 95% CI 2.09, 10.70), P = 0.0002]. The comparative effectiveness of PFO closure (compared to medical therapy) was significantly more pronounced in those younger than 45 years, males, larger shunts and disc design platforms (P < 0.05).

Conclusions

Based on the results of this analysis of randomized trial data, percutaneous PFO closure appears to be a safe and effective therapeutic option for the secondary prevention of ischemic stroke in patients with PFO and cryptogenic stroke.



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Comparison of treatment strategies for femoro-popliteal disease: A network meta-analysis

Abstract

Objectives

We sought to compare treatment strategies in a Bayesian network meta-analysis of randomized controlled trials.

Background

Peripheral artery disease (PAD) is a prevalent morbidity that is treated with various strategies.

Methods

We performed a MEDLINE search for randomized studies comparing at least 2 treatment strategies, including bypass surgery, percutaneous transluminal angioplasty (PTA) balloons, stents, covered stents, drug-eluting stents (DES), and drug-coated balloons (DCB), in patients with native femoro-popliteal disease. Mixed treatment comparison model generation was performed to directly and indirectly compare the strategies in terms of restenosis and target lesion revascularization (TLR) presented as odds ratios (OR, [95% credible intervals]).

Results

Twenty-nine studies with 4,820 patients were included in the present study. PTA was the largest group with 1,900 patients, followed by DCB (n = 1,343), bare metal stents (n = 941), covered stents (n = 304), DES (n = 236), and bypass (n = 92). Mean age was 68 ± 9 years, 64% were male, 37% diabetic, and 55% smokers. Mean lesion length was 77 ± 44 mm, and 39% were total occlusions. Bayesian hierarchical random-effects model demonstrated all treatments were significantly better than, or had a trend toward superiority over, PTA, with DCB ranking well in both restenosis (OR = 0.29, [0.17-0.47]) and TLR (OR = 0.31, [0.20-0.46]). Nonetheless, none of the therapies showed superiority in terms of survival or amputations.

Conclusion

Treatment of femoro-popliteal disease has significantly evolved in recent years, with higher rates of patency and freedom from TLR. However, the utility of these treatment strategies in terms of reduction of amputations and overall survival remains in question.



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Superior Mesenteric Artery Syndrome: An Uncommon Cause of Abdominal Pain

Publication date: Available online 11 January 2018
Source:The Journal of Emergency Medicine
Author(s): Anita Lui, Marion-Vincent Mempin




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Are Geriatric Patients Placed in an Emergency Department Observation Unit on a Chest Pain Pathway More Likely Than Non-Geriatric Patients to Re-Present to the Hospital within 30 Days?

S07364679.gif

Publication date: Available online 11 January 2018
Source:The Journal of Emergency Medicine
Author(s): Christopher C. Gruenberg, Alan H. Breaud, James H. Liu, Patricia M. Mitchell, James A. Feldman, Kerrie P. Nelson, Joseph H. Kahn
BackgroundEmergency department observation units (EDOUs) are used frequently for low-risk chest pain evaluations.ObjectiveThe purpose of this study was to determine whether geriatric compared to non-geriatric patients evaluated in an EDOU for chest pain have differences in unscheduled 30-day re-presentation, length of stay (LOS), and use of stress testing.MethodsWe conducted an exploratory, retrospective, cohort study at a single academic, urban ED of all adult patients placed in an EDOU chest pain protocol from June 1, 2014 to May 31, 2015. Our primary outcome was any unscheduled return visits within 30 days of discharge from the EDOU. Secondary outcomes included EDOU LOS and stress testing. We used Wilcoxon non-parametric and χ2 tests to compare geriatric to non-geriatric patients.ResultsThere were 959 unique EDOU placements of geriatric (n = 219) and non-geriatric (n = 740) patients. Geriatric compared to non-geriatric patients had: no significant difference in unscheduled 30-day return visits after discharge from the EDOU (15.5% vs. 18.5%; p = 0.31); significantly longer median EDOU LOS (22.1 vs. 20.6 h; p < 0.01) with a greater percentage staying longer than 24 h (42% vs. 29.1%; p < 0.01). Geriatric patients had significantly fewer stress tests (39.7% vs. 51.4%; p < 0.01), more of which were nuclear stress tests (78.2% vs. 39.5%; p < 0.01).ConclusionsIn this exploratory retrospective study, geriatric EDOU chest pain patients did not have an increased rate of re-presentation to the hospital within 30 days compared to non-geriatric patients. Geriatric patients had a longer EDOU LOS than non-geriatric patients. Geriatric patients in the EDOU had fewer stress tests, but more of those were nuclear stress tests.



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Failure of Intracardiac Pacing After Fatal Propafenone Overdose: A Case Report

S07364679.gif

Publication date: Available online 11 January 2018
Source:The Journal of Emergency Medicine
Author(s): Ivan Zeljković, Nikola Bulj, Matea Kolačević, Vedran Čabrilo, Diana Delić Brkljačić, Šime Manola
BackgroundPropafenone is a sodium-channel blocker, class IC antiarrhythmic drug, frequently used to manage supraventricular dysrhythmias, especially atrial fibrillation. We report a self mono-intoxication with propafenone.Case ReportA 68-year-old woman presented with a decreased level of consciousness, hypotension, and electrocardiogram showing QRS widening with atrial asystole and extreme bradycardia < 20 beats/min. After initial stabilization with transcutaneous pacing, laboratory findings detected normal electrolyte ranges and metabolic acidosis, and her medical history revealed availability of propafenone due to paroxysmal atrial fibrillation and depressive syndrome, which led to the suspicion of intoxication. Despite intravenous sodium bicarbonate, calcium, norepinephrine, and aggressive fluid replacement (10% glucose with insulin), hemodynamic stability was not achieved. Temporary intracardiac pacing was implanted. However, even with multiple electrode positions, effective capture could not be achieved. At that time, transcutaneous pacing was also ineffective. Consequently, the patient died in refractory asystole due to complete myocardial nonexcitability. The concentration of 5270 ng/mL of propafenone was found in the blood at autopsy, using gas spectrometry–mass chromatography. It is the third highest reported propafenone lethal concentration and the first case in which the myocardial nonexcitability refractory to intracardiac pacing was seen despite normal electrode position in the right ventricle, with failure to achieve the patient's hemodynamic stability.Why Should an Emergency Physician Be Aware of This?Emergency physicians should be aware of possible propafenone ingestion causing toxicity, which is probably more frequent than previously described, especially because propafenone is widely available due to its use in managing atrial fibrillation, the most common arrhythmia nowadays.



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