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Πέμπτη, 25 Ιανουαρίου 2018

Melanoma of the Sinonasal Tract: Value of a Septate Pattern on Precontrast T1-Weighted MR Imaging [HEAD & NECK]

BACKGROUND AND PURPOSE:

Various tumors of the sinonasal tract can exhibit high signal intensity on T1WI. The purpose of this study was to determine the value of a septate pattern on precontrast T1WI for diagnosing sinonasal melanoma.

MATERIALS AND METHODS:

Retrospectively, 3 observers independently reviewed MR images of 31 histologically proved sinonasal melanomas with special attention to the presence or absence of a septate pattern on precontrast T1WI, defined as alternating hyperintense and hypointense striations on precontrast T1WI. For comparison, we evaluated the prevalence of a septate pattern on precontrast T1WI in 106 nonmelanomatous sinonasal malignant tumors with 16 different histologic types. We also tried to identify the histopathologic features responsible for the septate pattern on precontrast T1WI.

RESULTS:

Twenty-seven (87.1%) of 31 sinonasal melanomas showed hyperintense foci on T1WI, among which a septate pattern on precontrast T1WI was seen in 23 (74.2%), while 22 (20.8%) of 106 nonmelanomatous malignant tumors demonstrated hyperintense foci on T1WI, among which only 3 (2.8%) showed a septate pattern on precontrast T1WI. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of a septate pattern on precontrast T1WI for the diagnosis of sinonasal melanoma were 74%, 97%, 88%, 93%, and 92%, respectively. Although limited due to the retrospective nature, 4 of 23 histologically reviewed sinonasal melanomas revealed an uneven distribution of melanin with alternating melanin and fibrous bands within the tumors.

CONCLUSIONS:

A septate pattern on precontrast T1WI might be an adjunctive imaging finding for the diagnosis of sinonasal melanoma. This might be attributed histologically to an uneven distribution of melanin and hemorrhage within the tumors.



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Nonsphericity Index and Size Ratio Identify Morphologic Differences between Growing and Stable Aneurysms in a Longitudinal Study of 93 Cases [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Recent studies have strongly associated intracranial aneurysm growth with increased risk of rupture. Identifying aneurysms that are likely to grow would be beneficial to plan more effective monitoring and intervention strategies. Our hypothesis is that for unruptured intracranial aneurysms of similar size, morphologic characteristics differ between aneurysms that continue to grow and those that do not.

MATERIALS AND METHODS:

From aneurysms in our medical center with follow-up imaging dates in 2015, ninety-three intracranial aneurysms (23 growing, 70 stable) were selected. All CTA images for the aneurysm diagnosis and follow-up were collected, a total of 348 3D imaging studies. Aneurysm 3D geometry for each imaging study was reconstructed, and morphologic characteristics, including volume, surface area, nonsphericity index, aspect ratio, and size ratio were calculated.

RESULTS:

Morphologic characteristics were found to differ between growing and stable groups. For aneurysms of <3 mm, nonsphericity index (P < .001); 3–5 mm, nonsphericity index (P < .001); 5–7 mm, size ratio (P = .003); >7 mm, volume (P < .001); surface area (P < .001); and nonsphericity index (P = .002) were significant. Within the anterior communicating artery, the nonsphericity index (P = .008) and, within the posterior communicating artery, size ratio (P = .004) were significant. The nonsphericity index receiver operating characteristic area under the curve was 0.721 for discriminating growing and stable cases on the basis of initial images.

CONCLUSIONS:

Among aneurysms with similar sizes, morphologic characteristics appear to differ between those that are growing and those that are stable. The nonsphericity index, in particular, was found to be higher among growing aneurysms. The size ratio was found to be the second most significant parameter associated with growth.



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Early Hemodynamic Response Assessment of Stereotactic Radiosurgery for a Cerebral Arteriovenous Malformation Using 4D Flow MRI [INTERVENTIONAL]

SUMMARY:

Brain AVMs treated with stereotactic radiosurgery typically demonstrate a minimum latency period of 1–3 years between treatment and nidus obliteration. Assessment of treatment response is usually limited to evaluation of AVM nidus structural changes using conventional MR imaging and MRA techniques. This report describes the use of 4D Flow MRI to also measure radiation-induced hemodynamic changes in a Spetzler-Martin grade III AVM, which were detectable as early as 6 months after treatment.



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Quantitative Susceptibility Mapping of the Thalamus: Relationships with Thalamic Volume, Total Gray Matter Volume, and T2 Lesion Burden [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Both thalamic iron deposition and atrophy have been reported in patients with multiple sclerosis compared with healthy controls, but how they are related is unclear. The purpose of this study was to understand the pathophysiologic basis for this iron deposition.

MATERIALS AND METHODS:

Ninety-five patients with relapsing-remitting multiple sclerosis underwent 3T MR imaging with a standardized protocol that included quantitative susceptibility mapping to measure iron concentration and a 3D T1 echo-spoiled gradient-echo sequence to obtain thalamic volumes. Volumes of interest were manually delineated on the quantitative susceptibility map to encompass both thalami. Multivariate regression analyses were performed to identify the association between thalamic susceptibility and volume. Associations between thalamic susceptibility and total gray matter volume, cortical thickness, and T2 lesion volume were also assessed.

RESULTS:

The relative susceptibility of the thalamus was associated with T2 lesion volume (P = .015) and was higher in the presence of enhancing lesions (P = .013). The relative susceptibility of the thalami was not associated with thalamic volumes, total gray matter volumes, or cortical thickness (P > .05).

CONCLUSIONS:

Iron levels in the thalami are associated with T2 lesion burden and the presence of enhancing lesions, but not with thalamic or gray matter volumes, suggesting that iron accumulation is associated with white matter inflammation rather than gray matter neurodegeneration.



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Comparison of MR Imaging and Dual-Energy CT for the Evaluation of Cartilage Invasion by Laryngeal and Hypopharyngeal Squamous Cell Carcinoma [HEAD & NECK]

BACKGROUND AND PURPOSE:

Dual-energy CT can distinguish iodine-enhanced tumors from nonossified cartilage and has been investigated for evaluating cartilage invasion in patients with laryngeal and hypopharyngeal squamous cell carcinomas. In this study, we compared the diagnostic accuracy of MR imaging and of a combination of weighted-average and iodine overlay dual-energy CT images in detecting cartilage invasion by laryngeal and hypopharyngeal squamous cell carcinomas, in particular thyroid cartilage invasion.

MATERIALS AND METHODS:

Fifty-five consecutive patients who underwent 3T MR imaging and 128-slice dual-energy CT for preoperative initial staging of laryngeal or hypopharyngeal squamous cell carcinomas were included. Two blinded observers evaluated laryngeal cartilage invasion on MR imaging and dual-energy CT using a combination of weighted-average and iodine-overlay images. Pathologic findings of surgically resected specimens were used as the reference standard for evaluating sensitivity, specificity, and the areas under the receiver operating characteristic curve of both modalities for cartilage invasion by each type of cartilage and for all cartilages together. Sensitivity and specificity were compared using the McNemar test and generalized linear mixed models.

RESULTS:

Dual-energy CT showed higher specificity than MR imaging for diagnosing all cartilage together (84% for MR imaging versus 98% for dual-energy CT, P < .004) and for thyroid cartilage (64% versus 100%, P < .001), with a similar average area under the curve (0.94 versus 0.95, P = .70). The sensitivity did not differ significantly for all cartilages together (97% versus 81%, P = .16) and for thyroid cartilage (100% versus 89%, P = .50), though there was a trend toward increased sensitivity with MR imaging.

CONCLUSIONS:

Dual-energy CT showed higher specificity and acceptable sensitivity in diagnosing laryngeal cartilage invasion compared with MR imaging.



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Local Glioma Cells Are Associated with Vascular Dysregulation [FUNCTIONAL]

BACKGROUND AND PURPOSE:

Malignant glioma is a highly infiltrative malignancy that causes variable disruptions to the structure and function of the cerebrovasculature. While many of these structural disruptions have known correlative histopathologic alterations, the mechanisms underlying vascular dysfunction identified by resting-state blood oxygen level–dependent imaging are not yet known. The purpose of this study was to characterize the alterations that correlate with a blood oxygen level–dependent biomarker of vascular dysregulation.

Materials and Methods:

Thirty-two stereotactically localized biopsies were obtained from contrast-enhancing (n = 16) and nonenhancing (n = 16) regions during open surgical resection of malignant glioma in 17 patients. Preoperative resting-state blood oxygen level–dependent fMRI was used to evaluate the relationships between radiographic and histopathologic characteristics. Signal intensity for a blood oxygen level–dependent biomarker was compared with scores of tumor infiltration and microvascular proliferation as well as total cell and neuronal density.

Results:

Biopsies corresponded to a range of blood oxygen level–dependent signals, ranging from relatively normal (z = –4.79) to markedly abnormal (z = 8.84). Total cell density was directly related to blood oxygen level–dependent signal abnormality (P = .013, R2 = 0.19), while the neuronal labeling index was inversely related to blood oxygen level–dependent signal abnormality (P = .016, R2 = 0.21). The blood oxygen level–dependent signal abnormality was also related to tumor infiltration (P = .014) and microvascular proliferation (P = .045).

Conclusions:

The relationship between local, neoplastic characteristics and a blood oxygen level–dependent biomarker of vascular function suggests that local effects of glioma cell infiltration contribute to vascular dysregulation.



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Comparison of Blood Oxygenation Level-Dependent fMRI and Provocative DSC Perfusion MR Imaging for Monitoring Cerebrovascular Reserve in Intracranial Chronic Cerebrovascular Disease [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Loss of hemodynamic reserve in intracranial cerebrovascular disease reduces blood oxygenation level–dependent activation by fMRI and increases asymmetry in MTT measured by provocative DSC perfusion MR imaging before and after vasodilation with intravenous acetazolamide. The concordance for detecting hemodynamic reserve integrity has been compared.

MATERIALS AND METHODS:

Patients (n = 40) with intracranial cerebrovascular disease and technically adequate DSA, fMRI and provocative DSC perfusion studies were retrospectively grouped into single vessels proximal to and distal from the circle of Willis, multiple vessels, and Moyamoya disease. The vascular territories were classified as having compromised hemodynamic reserve if the expected fMRI blood oxygenation level–dependent activation was absent or if MTT showed increased asymmetry following vasodilation. Concordance was examined in compromised and uncompromised vascular territories of each group with the Fischer exact test and proportions of agreement.

RESULTS:

Extensive leptomeningeal collateral circulation was present in all cases. Decreased concordance between the methods was found in vascular territories with stenosis distal to but not proximal to the circle of Willis. Multivessel and Moyamoya diseases also showed low concordance. A model of multiple temporally displaced arterial inputs from leptomeningeal collateral flow demonstrated that the resultant lengthening MTT mimicked compromised hemodynamic reserve despite being sufficient to support blood oxygenation level–dependent contrast.

CONCLUSIONS:

Decreased concordance between the 2 methods for assessment of hemodynamic reserve for vascular disease distal to the circle of Willis is posited to be due to well-developed leptomeningeal collateral circulation providing multiple temporally displaced arterial input functions that bias the perfusion analysis toward hemodynamic reserve compromise while blood oxygenation level–dependent activation remains detectable.



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Looking Deep into the Eye-of-the-Tiger in Pantothenate Kinase-Associated Neurodegeneration [PEDIATRICS]

BACKGROUND AND PURPOSE:

A detailed delineation of the MR imaging changes in the globus pallidus in pantothenate kinase–associated neurodegeneration will be helpful for diagnosis and monitoring of patients. The aim of this study was to determine the morphologic spectrum of the "eye-of-the-tiger" sign and the topographic pattern of iron deposition in a group of patients with pantothenate kinase–associated neurodegeneration.

MATERIALS AND METHODS:

Seventy-four MR imaging scans from 54 individuals with PANK2 mutations were analyzed for signal patterns in the globus pallidus. Sixteen SWI data from 15 patients who underwent 1.5T (n = 7), 3T (n = 7), and 7T (n = 2) MR imaging were included to visualize the iron topography.

RESULTS:

The linear hyperintensity alongside the medial border of the globus pallidus was the earliest T2 signal change. This finding was evident before SWI changes from iron deposition became visible. T2WI performed in early childhood mostly showed isolated hyperintense signal. In adult patients, marked signal reduction within an earlier hyperintense center resulting from iron accumulation led to the loss of signal difference between the central and surrounding areas. Signal hypointensity on SWI progressed from the medial to the lateral portion of the globus pallidus with increasing age. The fiber connections between the medial globus pallidus and the anteromedial aspect of the substantia nigra and subthalamic nucleus were markedly hypointense on SWI.

CONCLUSIONS:

In pantothenate kinase–associated neurodegeneration, the globus pallidus MR imaging changes using SWI develop as region-specific and age-dependent phenomena. Signal inhomogeneity was observed across the globus pallidus in pantothenate kinase–associated neurodegeneration and should be considered when determining the concentration of iron.



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Intravoxel Incoherent Motion MR Imaging in the Differentiation of Benign and Malignant Sinonasal Lesions: Comparison with Conventional Diffusion-Weighted MR Imaging [HEAD & NECK]

BACKGROUND AND PURPOSE:

Intravoxel incoherent motion is a promising method for the differentiation of sinonasal lesions. This study aimed to evaluate the value of intravoxel incoherent motion in the differentiation of benign and malignant sinonasal lesions and to compare the diagnostic performance of intravoxel incoherent motion with that of conventional DWI.

MATERIALS AND METHODS:

One hundred thirty-one patients with histologically proved solid sinonasal lesions (56 benign and 75 malignant) who underwent conventional DWI and intravoxel incoherent motion were recruited in this study. The diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) values derived from intravoxel incoherent motion and ADC values derived from conventional DWI were measured and compared between the 2 groups using the Student t test. Receiver operating characteristic curve analysis, logistic regression analysis, and 10-fold cross-validation were performed to evaluate the diagnostic performance of single-parametric and multiparametric models.

RESULTS:

The mean ADC and D values were significantly lower in malignant sinonasal lesions than in benign sinonasal lesions (both P < .001). The mean f value was higher in malignant lesions than in benign lesions (P = .003). Multiparametric models can significantly improve the cross-validated areas under the curve for the differentiation of sinonasal lesions compared with single-parametric models (all corrected P < .05 except the D value). The model of D+f provided a better diagnostic performance than the ADC value (corrected P < .001).

CONCLUSIONS:

Intravoxel incoherent motion appears to be a more effective MR imaging technique than conventional DWI in the differentiation of benign and malignant sinonasal lesions.



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Generalized q-sampling imaging fiber tractography reveals displacement and infiltration of fiber tracts in low-grade gliomas

Abstract

Purpose

Low-grade gliomas (LGGs) are slow growing brain tumors that often cause displacement and/or infiltration of the surrounding white matter pathways. Differentiation between infiltration and displacement of fiber tracts remains a challenge. Currently, there is no reliable noninvasive imaging method capable of revealing such white matter alteration patterns. We employed quantitative anisotropy (QA) derived from generalized q-sampling imaging (GQI) to identify patterns of fiber tract alterations by LGGs.

Methods

Sixteen patients with a neuropathological diagnosis of LGG (WHO grade II) were enrolled. Peritumoral fiber tracts underwent qualitative and quantitative evaluation. Contralateral hemisphere counterparts were used for comparison. Tracts were qualitatively classified as unaffected, displaced, infiltrated or displaced, and infiltrated at once. The average QA of whole tract (W), peritumoral tract segment (S), and their ratio (S/W) were obtained and compared to the healthy side for quantitative evaluation.

Results

Qualitative analysis revealed 9 (13.8%) unaffected, 24 (36.9%) displaced, 13 (20%) infiltrated, and 19 (29.2%) tracts with a combination of displacement and infiltration. There were no disrupted tracts. There was a significant increase in S/W ratio among displaced tracts in the pre-operative scans in comparison with the contralateral side. QA values of peritumoral tract segments (S) were significantly lower in infiltrated tracts.

Conclusion

WHO grade II LGGs might displace, infiltrate, or cause a combination of displacement and infiltration of WM tracts. QA derived from GQI provides valuable information that helps to differentiate infiltration from displacement. Anisotropy changes correlate with qualitative alterations, which may serve as a potential biomarker of fiber tract integrity.



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Generalized q-sampling imaging fiber tractography reveals displacement and infiltration of fiber tracts in low-grade gliomas

Abstract

Purpose

Low-grade gliomas (LGGs) are slow growing brain tumors that often cause displacement and/or infiltration of the surrounding white matter pathways. Differentiation between infiltration and displacement of fiber tracts remains a challenge. Currently, there is no reliable noninvasive imaging method capable of revealing such white matter alteration patterns. We employed quantitative anisotropy (QA) derived from generalized q-sampling imaging (GQI) to identify patterns of fiber tract alterations by LGGs.

Methods

Sixteen patients with a neuropathological diagnosis of LGG (WHO grade II) were enrolled. Peritumoral fiber tracts underwent qualitative and quantitative evaluation. Contralateral hemisphere counterparts were used for comparison. Tracts were qualitatively classified as unaffected, displaced, infiltrated or displaced, and infiltrated at once. The average QA of whole tract (W), peritumoral tract segment (S), and their ratio (S/W) were obtained and compared to the healthy side for quantitative evaluation.

Results

Qualitative analysis revealed 9 (13.8%) unaffected, 24 (36.9%) displaced, 13 (20%) infiltrated, and 19 (29.2%) tracts with a combination of displacement and infiltration. There were no disrupted tracts. There was a significant increase in S/W ratio among displaced tracts in the pre-operative scans in comparison with the contralateral side. QA values of peritumoral tract segments (S) were significantly lower in infiltrated tracts.

Conclusion

WHO grade II LGGs might displace, infiltrate, or cause a combination of displacement and infiltration of WM tracts. QA derived from GQI provides valuable information that helps to differentiate infiltration from displacement. Anisotropy changes correlate with qualitative alterations, which may serve as a potential biomarker of fiber tract integrity.



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Remote effects in the ipsilateral thalamus and/or contralateral cerebellar hemisphere using FDG PET in patients with brain tumors

Abstract

Purpose

To evaluate reduced metabolism in the ipsilateral thalamus (TH) and/or contralateral cerebellum (CE) according to tumor localization and cortical metabolism around the tumor in patients with brain tumors based on FDG uptake.

Methods

This study investigated 48 consecutive patients with solitary cerebral hemisphere parenchymal brain tumors who underwent PET/CT and MRI. Patients were divided into 4 groups (A: reduced uptake in ipsilateral TH and contralateral CE, B: reduced uptake in ipsilateral TH only, C: reduced uptake in contralateral CE only, and D: no reduced uptake in ipsilateral TH or contralateral CE). FDG uptake and MRI findings were compared among these groups.

Results

Of 48 patients, group A included 24 (50%), group B included 10 (21%), group C included 0, and group D included 14 (29%). No significant tendencies were observed between the groups regarding tumor localization. However, reduced cortical metabolism around the tumor was observed in 22 patients in group A, 7 patients in group B, and 1 patient in group D. All patients in group B showed reduced metabolism from around the tumor up to the ipsilateral TH.

Conclusion

Reduced FDG uptake in ipsilateral TH and contralateral CE usually occur simultaneously in patients with solitary brain tumors.



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Evolving Medical-Legal Issues in Breast Imaging

Abstract

Because breast imaging practice is associated with a high number of medical malpractice lawsuits, understanding basic medical-legal parameters becomes even more important as new technology and conditions of practice evolve. Incorporating new supplementary breast screening in strategizing a response to the importance of breast density, recognizing the purpose and ramifications of issuing diagnostic imaging reports, understanding the role of expert witnesses in assisting standard of care determinations and employing reasonable applications for off-label use of medical devices exemplify the relevance of integrating defensible practice patterns in a changing medical environment. This article addresses these issues and provides a contextual discussion so that physicians and facilities are educated in their selection of a wide variety of approaches that can be applied to clinical use.



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Comparison of clinicopathological features in incidental and nonincidental papillary thyroid carcinomas in 308 patients.

Comparison of clinicopathological features in incidental and nonincidental papillary thyroid carcinomas in 308 patients.

Pol J Pathol. 2017;68(3):197-209

Authors: Can N, Ozyilmaz F, Celik M, Sezer AY, Sut N, Tastekin E, Ayturk S, Ustun F, Bulbul BY, Guldiken S

Abstract
Incidental papillary thyroid carcinomas (IPTCs) consist of a significant portion of increasing incidence in papillary thyroid carcinomas. This study investigated the clinicopathological features of IPTCs from different perspectives and by comparing nonincidental PTCs (NIPTCs) in patients who underwent total thyroidectomy and lymph node dissection. Basic results were as follows. IPTC was present in 27.9% of 308 patients. IPTCs were significantly accompanied by lymphocytic thyroiditis (LT), particularly, multinodular hyperplasia (MNH). IPTCs were more common in older patients (51.3 years vs. 47.2 years) and in female patients. IPTCs significantly differed from NIPTCs in terms of smaller tumour size, lymphatic vessel invasion (2.6% vs. 97.4%), extrathyroidal extension (4.3% vs. 95.7%), lymph node metastasis (3.6% vs. 96.4%), multifocality (21.2% vs. 78.8%), bilaterality (5.3% vs. 94.7%), and BRAFV600 mutation (6.7% vs. 93.3%). Older age, bilaterality, encapsulation, and radioactive iodine (RAI) were significantly more common in IPTCs > 5 mm than in those ≤ 5 mm. In conclusion, IPTCs are more commonly associated with LT and MNH. IPTCs may have a more favourable prognosis than NIPTCs, and tumour size > 5 mm may predict bilaterality and need for RAI. Nevertheless, the patient-based clinical approach in IPTCs may have benefits in the management of IPTCs.

PMID: 29363911 [PubMed - in process]



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Editorial Board

Publication date: February 2018
Source:European Journal of Radiology, Volume 99





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[The significance of circulating tumor cells in head and neck squamous cell carcinoma: a preliminary study].

[The significance of circulating tumor cells in head and neck squamous cell carcinoma: a preliminary study].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Jan 07;53(1):39-44

Authors: Zhang HD, Gong SC, Liu YQ, Liang LJ, He SB, Zhang QX, Si MY, Yu ZK

Abstract
Objective: To investigate the significance of circulating tumor cells (CTC) in squamous cell carcinoma of the head and neck (HNSCC). Methods: Twenty-four patients with HNSCC treated between October 2016 and July 2017 in our department were selected (experimental group), including 23 males and 1 females, aged 47-81 years. There were 14 cases of squamous cell carcinoma of larynx and 10 cases of hypopharynx, including I-Ⅱ stage (5 cases) and Ⅲ- Ⅳ stage (19 cases). All patients were primary and/or relapsed after treatment. Nine healthy volunteers were selected as control group. A novel in vivo capture technique (CellCellector system) was used to detect CTC. SPSS23.0 was used for statistical analysis. Results: The total capture rate of CTC in patients with HNSCC before treatment was 70.8% (17/24), with 40% (2/5) for patients at I-Ⅱ stage, and 78.9% (15/19) for patients at Ⅲ- Ⅳ stage, and was 0 in patients of control group. The total capture rate of CTC in patients with HNSCC after treatment was 50% (8/16). There was no significant correlation between CTC and age, sex, location of tumor or lymph node metastasis (P>0.05). CTC was related to tumor staging and tumor differentiation (P<0.05). The positive rate of EGFRVⅢ in CTC was 26.3% (5/19). Conclusions: The CellCollector system is a very efficient way of detecting CTC, and CTC plays an important role in the occurrence, progression and metastasis of HNSCC.

PMID: 29365378 [PubMed - in process]



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[Assessment of psychological status of inpatients with head and neck cancer before surgery].

[Assessment of psychological status of inpatients with head and neck cancer before surgery].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Jan 07;53(1):21-26

Authors: Li L, Wang BQ, Gao TH, Tian J

Abstract
Objective: To investigate the prevalence and psychosocial characteristics in inpatients with head and neck cancer before surgery. Method: From September 2015 to December 2016, 237 consecutive inpatients with head and neck cancer who had been scheduled for surgery were prospectively enrolled in Department of Head and Neck Surgery of Shanxi Provincial Tumor Hospital. Mental health symptoms were systematically investigated using three psychological instruments: symptom checklist-90 (SCL-90), Zung self-rating anxiety scale (SAS) and Zung self-rating depression scale (SDS). SPSS 17.0 software was used to analyze the data. And he results of SCL-90, SAS and SDS were compared with the Chinese norm. For all statistical analyses, a P value <0.05 was considered statistically significant. Result: Of 237 patients, 228 (96.2%) completed all the questionnaire. The scores of SCL-90 (1.60±0.44), SAS (46.67±8.51)and SDS(47.50±11.43)in patients with head and neck cancer were significantly higher than those of Chinese norm (t=3.093, t=17.29, t=4.29 respectively and P=0.003, P=0.001, P=0.001 respectively). Positive proportion identified by three measure tools are 32.9%, 35.5% and 36.8% respectively. And 42 patients (18.4%) suffered from both anxiety and depression. The SCL-90 scores were significantly higher than those of the normal standard population, including dimension of somatization obsessive-compulsive, anxiety, hostility, phobic-anxiety and psychoticism (t=4.47, 3.04, 2.87, 2.58, 5.46, 4.15 respectively, all P<0.05). Conclusions: This study offers important information regarding psychological status in inpatients with head and neck cancer before surgery. Identifying these patients using proper screening instrument is of great important clinical implications for the early detection, management, and reduction of the distress associated with head and neck cancer.

PMID: 29365375 [PubMed - in process]



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[Clinical application of supraclavicular flap for oncologic reconstruction of hypopharynx and upper esophagus].

[Clinical application of supraclavicular flap for oncologic reconstruction of hypopharynx and upper esophagus].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Jan 07;53(1):16-20

Authors: Wen YH, Wen WP, Wang ZF, Zhu XL, Jiang AY, Chai LP, Lei WB

Abstract
Objective: To assess the efficacy of supraclavicular artery island flap (SCAIF) for the reconstruction of hypopharynx and upper esophagus. Methods: The SCAIF procedure on was used in 10 patients, including 8 with hypopharygeal carcinomas, 1 with esophageal carcinoma and neck skin invasion and 1 with hypopharyngeal leiomyosarcoma, at the Otorhinolaryngology Hospital, the First Affiliated Hospital, Sun Yatsen University between December 2015 and June 2017. The sizes of the flaps were measured in (4-8) cm×(5-12) cm. Clinical indexes such as harvesting time and survival were recorded. Results: Harvesting time for SCAIF ranged from 20 to 30 minutes, averaging 26 minutes. Nine flaps survived, one flap had partially necrosis. Functional outcomes were excellent and the donor sites were direct closed without complications. Conclusions: SCAIF is a versatile, reliable, and easily harvested flap, with good cosmetic and functional outcomes for reconstructing the defects of hypopharynx and upper esophagus.

PMID: 29365374 [PubMed - in process]



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[Evaluation and treatment of children's laryngeal clefts].

[Evaluation and treatment of children's laryngeal clefts].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Jan 07;53(1):9-15

Authors: Chen C, Tan LT, Xu ZM

Abstract
Objectives: To provide the experience about the diagnostic process and following management, and to discuss the outcome and predictors in children with laryngeal cleft (LC). Methods: A retrospective case study was conducted at an academic children's hospital. Thirty children were diagnosed as laryngeal cleft between January 2016 and April 2017.Airway evaluations were performed using both flexible and rigid endoscopy, and swallowing evaluations were performed using fiberoptic endoscopic examination of swallowing or modified barium swallow. Results: Of 30 cases, 18 were male and 12 were female, ranging in age from birth to 8 years. Two cases were diagnosed as type 0 LC, and they were offered thickened liquid without medication. Throughout follow-up, they remained asymptomatic and showed no respiratory complications. Nineteen children were diagnosed as type Ⅰ LC. Six of them were significantly improved by anti-reflux therapy and feeding instructions. Four children were concomitant with swallowing dysfunction and/or neuromuscular disorders, and they were given a tracheotomy and routine management. Another 4 children were submitted surgical repair when routine treatment failed, and their symptoms were relieved. Five children were concomitant with larygomalacia, and their symptoms were totally ameliorated by supraglottoplasty. Three children were diagnosed as type Ⅱ LC. Two of them received surgical repair and clinically improved, and the rest one was treated by anti-reflux therapy and still under follow-up. Three children were diagnosed as type Ⅲ LC. One of them was underwent surgical repair and clinically improved. Two children were tracheotomized and treated by anti-reflux therapy. Three cases were diagnosed as type Ⅳ LC at birth and no one survived. Conclusions: Laryngeal cleft is a rare congenital anomaly manifesting with a variety of symptoms, including swallowing disorder, aspirations, dyspnea, stridor and hoarseness. Diagnosis and treatment of laryngeal clefts is a challenge. The best way to evaluate the LC is FEES by laryngeal endoscopy combined with MLB. Cases with type 0-Ⅰ mostly were significantly improved by anti-reflux therapy and feeding instructions. When routine treatment failed, surgical repair is needed. All the cases with LC type Ⅱ-Ⅲ need surgical repair as soon as possible. For type Ⅳ cases, early diagnosis, appropriate treatment and management help to reduce mortality and morbidity.

PMID: 29365373 [PubMed - in process]



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Effectiveness of clinical practice change strategies in improving dietitian care for head and neck cancer patients according to evidence-based clinical guidelines: a stepped-wedge, randomized controlled trial.

Effectiveness of clinical practice change strategies in improving dietitian care for head and neck cancer patients according to evidence-based clinical guidelines: a stepped-wedge, randomized controlled trial.

Transl Behav Med. 2018 Jan 22;:

Authors: McCarter K, Baker AL, Britton B, Beck AK, Carter G, Bauer J, Wratten C, Halpin SA, Holliday E, Oldmeadow C, Wolfenden L

Abstract
Best practice guidelines make a number of recommendations regarding dietitian management of head and neck cancer (HNC) patients. Randomized trials assessing the effectiveness of clinical practice change strategies for improving the nutritional management of HNC patients have not previously been conducted. The purpose of this study was to evaluate the effect of practice change strategies on improving the implementation of best practice guideline recommendations for the nutritional management of HNC patients. Four Australian radiotherapy departments participated in a stepped-wedge, randomized controlled trial. Baseline data were collected across all sites simultaneously, and the intervention was then introduced to each site sequentially, in a randomly determined order. During the intervention phase, sites received a range of supportive clinical practice change strategies to facilitate dietitian adherence to clinical practice guidelines. To assess the associated practice change by dietetic staff, we evaluated the change in implementation of six guideline recommendations for dietitians from preintervention to postintervention periods. Adherence to the clinical practice guidelines during the preintervention period was generally very low. The clinical practice change strategies significantly improved the odds of provision of four of the six guideline recommendations. The study found the intervention significantly enhanced dietitian provision of recommended care for HNC patients during the postintervention period. This finding holds clinical importance for clinician and health service effective implementation of guideline recommendations as well as HNC patient treatment outcomes. Trial registration number ACTRN12613000320752, http://ift.tt/1F0tq3G.

PMID: 29365187 [PubMed - as supplied by publisher]



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Structural brain abnormalities in the common epilepsies assessed in a worldwide ENIGMA study.

Structural brain abnormalities in the common epilepsies assessed in a worldwide ENIGMA study.

Brain. 2018 Jan 22;:

Authors: Whelan CD, Altmann A, Botía JA, Jahanshad N, Hibar DP, Absil J, Alhusaini S, Alvim MKM, Auvinen P, Bartolini E, Bergo FPG, Bernardes T, Blackmon K, Braga B, Caligiuri ME, Calvo A, Carr SJ, Chen J, Chen S, Cherubini A, David P, Domin M, Foley S, França W, Haaker G, Isaev D, Keller SS, Kotikalapudi R, Kowalczyk MA, Kuzniecky R, Langner S, Lenge M, Leyden KM, Liu M, Loi RQ, Martin P, Mascalchi M, Morita ME, Pariente JC, Rodríguez-Cruces R, Rummel C, Saavalainen T, Semmelroch MK, Severino M, Thomas RH, Tondelli M, Tortora D, Vaudano AE, Vivash L, von Podewils F, Wagner J, Weber B, Yao Y, Yasuda CL, Zhang G, Bargalló N, Bender B, Bernasconi N, Bernasconi A, Bernhardt BC, Blümcke I, Carlson C, Cavalleri GL, Cendes F, Concha L, Delanty N, Depondt C, Devinsky O, Doherty CP, Focke NK, Gambardella A, Guerrini R, Hamandi K, Jackson GD, Kälviäinen R, Kochunov P, Kwan P, Labate A, McDonald CR, Meletti S, O'Brien TJ, Ourselin S, Richardson MP, Striano P, Thesen T, Wiest R, Zhang J, Vezzani A, Ryten M, Thompson PM, Sisodiya SM

Abstract
Progressive functional decline in the epilepsies is largely unexplained. We formed the ENIGMA-Epilepsy consortium to understand factors that influence brain measures in epilepsy, pooling data from 24 research centres in 14 countries across Europe, North and South America, Asia, and Australia. Structural brain measures were extracted from MRI brain scans across 2149 individuals with epilepsy, divided into four epilepsy subgroups including idiopathic generalized epilepsies (n =367), mesial temporal lobe epilepsies with hippocampal sclerosis (MTLE; left, n = 415; right, n = 339), and all other epilepsies in aggregate (n = 1026), and compared to 1727 matched healthy controls. We ranked brain structures in order of greatest differences between patients and controls, by meta-analysing effect sizes across 16 subcortical and 68 cortical brain regions. We also tested effects of duration of disease, age at onset, and age-by-diagnosis interactions on structural measures. We observed widespread patterns of altered subcortical volume and reduced cortical grey matter thickness. Compared to controls, all epilepsy groups showed lower volume in the right thalamus (Cohen's d = -0.24 to -0.73; P < 1.49 × 10-4), and lower thickness in the precentral gyri bilaterally (d = -0.34 to -0.52; P < 4.31 × 10-6). Both MTLE subgroups showed profound volume reduction in the ipsilateral hippocampus (d = -1.73 to -1.91, P < 1.4 × 10-19), and lower thickness in extrahippocampal cortical regions, including the precentral and paracentral gyri, compared to controls (d = -0.36 to -0.52; P < 1.49 × 10-4). Thickness differences of the ipsilateral temporopolar, parahippocampal, entorhinal, and fusiform gyri, contralateral pars triangularis, and bilateral precuneus, superior frontal and caudal middle frontal gyri were observed in left, but not right, MTLE (d = -0.29 to -0.54; P < 1.49 × 10-4). Contrastingly, thickness differences of the ipsilateral pars opercularis, and contralateral transverse temporal gyrus, were observed in right, but not left, MTLE (d = -0.27 to -0.51; P < 1.49 × 10-4). Lower subcortical volume and cortical thickness associated with a longer duration of epilepsy in the all-epilepsies, all-other-epilepsies, and right MTLE groups (beta, b < -0.0018; P < 1.49 × 10-4). In the largest neuroimaging study of epilepsy to date, we provide information on the common epilepsies that could not be realistically acquired in any other way. Our study provides a robust ranking of brain measures that can be further targeted for study in genetic and neuropathological studies. This worldwide initiative identifies patterns of shared grey matter reduction across epilepsy syndromes, and distinctive abnormalities between epilepsy syndromes, which inform our understanding of epilepsy as a network disorder, and indicate that certain epilepsy syndromes involve more widespread structural compromise than previously assumed.

PMID: 29365066 [PubMed - as supplied by publisher]



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miR-654-5p Targets GRAP to Promote Proliferation, Metastasis, and Chemoresistance of Oral Squamous Cell Carcinoma Through Ras/MAPK Signaling.

miR-654-5p Targets GRAP to Promote Proliferation, Metastasis, and Chemoresistance of Oral Squamous Cell Carcinoma Through Ras/MAPK Signaling.

DNA Cell Biol. 2018 Jan 24;:

Authors: Lu M, Wang C, Chen W, Mao C, Wang J

Abstract
Oral squamous cell carcinoma (OSCC) is characterized by rapid local migration and invasion. This study was aimed at clarifying the effect of miR-654-5p on progression of OSCC. miR-654-5p promoted proliferation, metastasis, and chemoresistance of OSCC in vitro and in vivo. Consistently, miR-654-5p was upregulated in late-stage OSCC and was correlated with poor prognosis of OSCC patients. Furthermore, miR-654-5p was mechanistically verified to target Grb-2-related adaptor protein (GRAP), accompanied by the activation of Ras/MAPK signaling and the facilitation of epithelial-mesenchymal transition in OSCC cells. GRAP was downregulated in T1-2 stage versus T3-4 stage head and neck squamous cell carcinoma (HNSC) and was negatively correlated with tumor-node-metastases (TNM) stage in HNSC patients based on The Cancer Genome Atlas (TCGA) analysis. In addition, GRAP was positively correlated with good prognosis in HNSC patients. Our findings suggest that the miR-654-5p/GRAP/Ras/Erk signaling pathway in OSCC cells might contribute to the underlying mechanism through which miR-654-5p participates in the regulation of OSCC progression. miR-654-5p, as a potential biomarker for the clinical diagnosis and prognosis of OSCC, may be an effective anticancer target for the treatment of OSCC.

PMID: 29364705 [PubMed - as supplied by publisher]



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Discovering Middle Ear Anatomy by Transcanal Endoscopic Ear Surgery: A Dissection Manual.

Discovering Middle Ear Anatomy by Transcanal Endoscopic Ear Surgery: A Dissection Manual.

J Vis Exp. 2018 Jan 11;(131):

Authors: Anschuetz L, Presutti L, Marchioni D, Bonali M, Wimmer W, Villari D, Caversaccio M

Abstract
The middle ear is located in the center of the temporal bone and bears a highly complex anatomy. The recently introduced exclusively endoscopic transcanal approach to the middle ear is a minimally invasive technique sparing the bone and mucosa of the mastoid bone, since the middle ear is accessed through the external auditory canal. This emerging method has several advantages over the traditional (microscopic) approaches to the middle ear such as the panoramic wide-angle views of the anatomy, the possibility to approach and magnify tiny structures, and the possibility of looking around the corner using angled endoscopes. The cadaveric dissection method presented here consists of an overview on the technical requirements and a precise description of a step-by-step protocol to discover the anatomy of the middle ear. Each step and anatomical structure is carefully described in order to provide a comprehensive guide to endoscopic ear anatomy. In our opinion, this is particularly important to any novice in endoscopic ear surgery as it provides thorough anatomical knowledge and may improve surgical skills.

PMID: 29364219 [PubMed - in process]



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Human craniofacial evolution: A cause for obstructive sleep apnea.

Human craniofacial evolution: A cause for obstructive sleep apnea.

Cranio. 2018 Jan;36(1):1-2

Authors: Fernandez-Salvador C, Song SA, Chang ET, Camacho M

PMID: 29364088 [PubMed - in process]



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Amplitude modulation coding in awake mice and squirrel monkeys.

Amplitude modulation coding in awake mice and squirrel monkeys.

J Neurophysiol. 2018 Jan 24;:

Authors: Hoglen NEG, Larimer P, Phillips EAK, Malone BJ, Hasenstaub AR

Abstract
Both mice and primates are used to model the human auditory system. The primate order possesses unique cortical specializations that govern auditory processing. Given the power of molecular and genetic tools available in the mouse model, it is essential to understand the similarities and differences in auditory cortical processing between mice and primates. To address this issue, we directly compared temporal encoding properties of neurons in the auditory cortex of awake mice and awake squirrel monkeys (SQM). Stimuli were drawn from a sinusoidal amplitude modulation (SAM) paradigm, which has been previously used both to characterize temporal precision and to model the envelopes of natural sounds. Neural responses were analyzed using linear template-based decoders. In both species, spike timing information supported better modulation frequency discrimination than rate information, and multiunit responses generally supported more accurate discrimination than single unit responses from the same site. However, cortical responses in SQMs supported better discrimination overall, reflecting superior temporal precision and greater rate modulation relative to the spontaneous baseline, and suggesting that spiking activity in mouse cortex was less strictly regimented by incoming acoustic information. The quantitative differences we observed between SQM and mouse cortex support the idea that SQMs offer advantages for modeling precise responses to fast envelope dynamics relevant to human auditory processing. Nevertheless, our results indicate that cortical temporal processing is qualitatively similar in mice and SQMs and thus recommend the mouse model for mechanistic questions, such as development and circuit function, where its substantial methodological advantages can be exploited.

PMID: 29364073 [PubMed - as supplied by publisher]



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The Patient Concerns Inventory integrated as part of routine head and neck cancer follow-up consultations: frequency, case-mix, and items initiated by the patient.

The Patient Concerns Inventory integrated as part of routine head and neck cancer follow-up consultations: frequency, case-mix, and items initiated by the patient.

Ann R Coll Surg Engl. 2018 Jan 24;:1-7

Authors: Rogers SN, Thomson F, Lowe D

Abstract
Introduction The National Institute for Health and Care Excellence guidance Improving Supportive and Palliative Care for Adults with Cancer (2004) and the Cancer Reform Strategy (2007) support the premise that assessment and discussion of patients' needs for physical, social, psychological, and spiritual wellbeing should be undertaken during oncology follow-up. We report the use of the Patient Concerns Inventory in a routine head and neck cancer clinic setting over a seven-year period, summarising the number of available clinics, the number of patients completing the inventory within a clinic, the range of clinical characteristics and the concerns they wanted to discuss. Methods The data were analysed from oncology follow-up clinics between 1 August 2007 and 10 December 2014. Audit approval was given by the Clinical Audit Department, University Hospital Aintree. Results There were 386 patients with 1198 inventories completed at 220 clinics, median 6 (range 4-7) per clinic. The most common concerns raised by patients across all the clinic consultations were dry mouth (34%), fear of recurrence (33%), sore mouth (26%), dental health (25%), chewing (22%) and fatigue/tiredness (21%). Conclusions The incorporation of the Patient Concerns Inventory as part of routine oncology clinics allows for a more patient initiated and focused consultation available to the majority of patients throughout their follow-up. The inventory allows for greater opportunity to provide holistic targeted multiprofessional intervention and support.

PMID: 29364010 [PubMed - as supplied by publisher]



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Granulation Tissue-type Hemangioma in the Internal Jugular Vein.

Granulation Tissue-type Hemangioma in the Internal Jugular Vein.

Chin Med J (Engl). 2018 Feb 05;131(3):364-365

Authors: Li JH, Yuan YY, Yuan J, Huang DL, Liu MB

PMID: 29363657 [PubMed - in process]



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health technology; +181 new citations

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

health technology

These pubmed results were generated on 2018/01/25

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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Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Background: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. Findings: The highest globally observed HALE at birth for both women and men was in Singapore, at 75.2 years (95% uncertainty interval 71.9-78.6) for females and 72.0 years (68.8-75.1) for males. The lowest for females was in the Central African Republic (45.6 years [42.0-49.5]) and for males was in Lesotho (41.5 years [39.0-44.0]). From 1990 to 2016, global HALE increased by an average of 6.24 years (5.97-6.48) for both sexes combined. Global HALE increased by 6.04 years (5.74-6.27) for males and 6.49 years (6.08-6.77) for females, whereas HALE at age 65 years increased by 1.78 years (1.61-1.93) for males and 1.96 years (1.69-2.13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2.3% [-5.9 to 0.9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16.1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. Interpretation: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support.

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The mRNA silencing dual activity of the RNA-binding protein LIN41 and the role of its targets in C. elegans development

The microRNA let-7 is an ancient and fundamental regulator of stem cell self-renewal and differentiation in animals. In Caenorhabditis elegans (C. elegans), where let-7 was discovered, it controls self-renewal of stem-cell like cells in the worm skin, the seam cells. In this work, we find that let-7 controls seam cell self-renewal exclusively through one key target, the RNA-binding protein LIN41. Interestingly, LIN41 is a conserved let-7 target, and was shown to regulate developmental switches from a self-renewal to a differentiation program in mouse and human embryonic stem cells, as well as in mouse neural progenitor cells. Despite its prominent role in stem cell development, the physiologically relevant mRNA targets of LIN41, to which it binds to regulate stem cell development, have been unknown in both mammals and C. elegans. LIN41 is reported to repress target mRNAs by inducing mRNA degradation, but has also been speculated to be a translational repressor. In this work, we establish and optimize the ribosome profiling technique for C. elegans, to subsequently study gene expression changes at the level of mRNA abundance and translation, in mutant worms with abnormally high LIN41 levels. With these experiments, performed in vivo in a whole organism, we identify candidate physiological LIN41 target mRNAs. Of those, we confirm four as direct LIN41 targets, as they are enriched in RNA co-immunoprecipitations of LIN41. Surprisingly, the repression mechanisms differ among the four targets, with LIN41 destabilizing mab-10, mab-3, and dmd-3 transcripts, but translationally repressing the lin-29A mRNA. Consistent with its few reported mammalian targets, LIN41 silences three targets by binding to their 3’UTRs, but unexpectedly, it represses lin-29A through its 5’UTR, thereby achieving isoform-specific regulation. Strikingly, we find that it is the location of the binding site that instructs the silencing mechanism, with LIN41 bound to the 5’UTR causing translational repression, while causing mRNA degradation when bound to the 3’UTR. Furthermore, we identify the transcription factor lin-29A and its co-factor mab-10 as the key targets of LIN41 for controlling self-renewal of seam cells. Because their mammalian homologs, EGR and NAB proteins, are crucial regulators of stem cell proliferation and differentiation, we hypothesize that the uncovered pathway to control seam cell self-renewal is conserved in mammalian stem cells, potentially including a LIN41-mediated regulation of EGR and NAB mRNAs. While further characterizing the four LIN41 targets, we discover that they also explain the defects of lin-41 mutants in sexual organ development. Thus, LIN41 controls the morphogenesis of the vulva through lin-29A and mab-10, and the maturation of the male tail tip through mab-3 and dmd-3. Moreover, we find that the developmental transition from a larval to an adult C. elegans epidermis depends on the upregulation of both isoforms of LIN-29. To inhibit a premature expression, lin-29A is regulated by LIN41, while the expression of lin-29B is controlled through the transcription factor HBL-1.

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Presentation of automated procedural guidance in surgical simulation: results of two randomised controlled trials.

Presentation of automated procedural guidance in surgical simulation: results of two randomised controlled trials.

J Laryngol Otol. 2018 Jan 24;:1-7

Authors: Wijewickrema S, Zhou Y, Ioannou I, Copson B, Piromchai P, Yu C, Briggs R, Bailey J, Kennedy G, O'Leary S

Abstract
OBJECTIVE: To investigate the effectiveness and usability of automated procedural guidance during virtual temporal bone surgery.
METHODS: Two randomised controlled trials were performed to evaluate the effectiveness, for medical students, of two presentation modalities of automated real-time procedural guidance in virtual reality simulation: full and step-by-step visual presentation of drillable areas. Presentation modality effectiveness was determined through a comparison of participants' dissection quality, evaluated by a blinded otologist, using a validated assessment scale.
RESULTS: While the provision of automated guidance on procedure improved performance (full presentation, p = 0.03; step-by-step presentation, p < 0.001), usage of the two different presentation modalities was vastly different (full presentation, 3.73 per cent; step-by-step presentation, 60.40 per cent).
CONCLUSION: Automated procedural guidance in virtual temporal bone surgery is effective in improving trainee performance. Step-by-step presentation of procedural guidance was engaging, and therefore more likely to be used by the participants.

PMID: 29363437 [PubMed - as supplied by publisher]



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Gorham-Stout disease of the temporal bone involving the temporomandibular joint.

Gorham-Stout disease of the temporal bone involving the temporomandibular joint.

J Laryngol Otol. 2018 Jan 24;:1-3

Authors: Mulvihill D, Kumar RS, Muzaffar J, Irving R

Abstract
BACKGROUND: Gorham-Stout disease of the skull is a very rare entity. It presents with gradual bone resorption, and proliferation of lymphoid and vascular channels within the bony matrix. This is often a diagnosis of exclusion confirmed with serial imaging and based on radiological evidence.
CASE REPORT: A case of Gorham-Stout disease of the temporal bone involving the temporomandibular joint, and presenting with sensorineural hearing loss and recurrent temporomandibular joint dislocation, is reported. The findings are presented and the literature on this condition is reviewed.
CONCLUSION: ENT and maxillofacial surgeons should be aware of this extremely rare cause of temporomandibular joint dislocation and ear symptoms. Imaging comprising computed tomography and magnetic resonance imaging is crucial to achieving a diagnosis, which may only become evident after repeated imaging follow up. Symptomatic treatment is advised, with the option of anti-osteoclastic medication and radiotherapy indicated for advanced cases. Surgery is only recommended for complications including involvement of neurovascular structures.

PMID: 29363434 [PubMed - as supplied by publisher]



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[Neuromuscular properties of genioglossus activity in healthy adults and obstructive sleep apnea patients].

[Neuromuscular properties of genioglossus activity in healthy adults and obstructive sleep apnea patients].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Jan 07;53(1):70-72

Authors: Zhou YQ, Ye JY

Abstract
Upper airway patency closely contact with neuromuscular airway regulation during respiratory, especially the activity of the pharyngeal dilators. The genioglossus is the largest pharyngeal dilators with its contraction playing the most important role in keeping the pharyngeal airway open. In healthy individuals, genioglossus activation shows a negative correlation with pharyngeal collapsibility and upper airway resistance. Negative pressure during inspiration can stimulate airway mechanoreceptors to produce a muscle reflex activity. However, in obstructive sleep apnea (OSA) patients, the muscles cannot always compensate for the increased mechanical load, resulting in frequent obstructive breathing events. A number of studies have shown that the collapsibility of upper airway during sleep in OSA patients is closely related to the activity of genioglossus electromyography(GGEMG). The present article describes the current understanding regarding the characters of GGEMG during sleep in healthy adults, as well as the pathophysiology of GGEMG in OSA patients.

PMID: 29365388 [PubMed - in process]



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Vitamin D and respiratory health in the Busselton Healthy Ageing Study.

Vitamin D and respiratory health in the Busselton Healthy Ageing Study.

Respirology. 2018 Jan 24;:

Authors: Mulrennan S, Knuiman M, Walsh JP, Hui J, Hunter M, Divitini M, Zhu K, Cooke BR, Musk AWB, James A

Abstract
BACKGROUND AND OBJECTIVE: The relationship between vitamin D and respiratory disease was examined by cross-sectional analysis of a large community-based sample.
METHODS: Serum 25-hydroxyvitamin D (25OHD) and history of respiratory disease, symptoms (recorded by questionnaire) and spirometry were measured in 5011 adults aged 45-69 years. Adjustments were made for age, sex, season and smoking (Model A), plus body mass index (BMI) and physical activity level (Model B), plus history of chronic diseases (Model C).
RESULTS: Mean (SD) age was 58 (SD 6) years with 45% males, 10% current smokers and 12% taking vitamin D supplements. The prevalence of 25OHD level <50 nmol/L was 8.0%. In all the three models, 25OHD <50 nmol/L was significantly associated with asthma (Model C: odds ratio (OR): 1.32; 95% CI: 1.00, 1.73), bronchitis (1.54; 1.17, 2.01), wheeze (1.37; 1.10, 1.71) and chest tightness (1.42; 1.10, 1.83). Participants with vitamin D level > 100 nmol/L had higher forced vital capacity (FVC) in all the three models (1.17% higher, compared with the 50-100 nmol/L group in Model C).
CONCLUSION: Low levels of serum 25OHD were independently associated with asthma, bronchitis, wheeze and chest tightness after three levels of adjustment for potential confounders. Higher vitamin D levels were associated with higher levels of lung function.

PMID: 29365367 [PubMed - as supplied by publisher]



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Microparticulate Caspase-1 Regulates Gasdermin-D and Pulmonary Vascular Endothelial Cell Injury.

Microparticulate Caspase-1 Regulates Gasdermin-D and Pulmonary Vascular Endothelial Cell Injury.

Am J Respir Cell Mol Biol. 2018 Jan 24;:

Authors: Mitra S, Exline M, Habyarimana F, Gavrilin M, Baker P, Masters SL, Wewers MD, Sarkar A

Abstract
RATIONALE: Lung endothelial cell apoptosis and injury occurs throughout all stages of acute lung injury (ALI/ARDS) and impacts disease progression. Caspases 1, 4 and 5 are essential for completion of the apoptotic program known as pyroptosis that also involves pro-inflammatory cytokines.
OBJECTIVES: Because GSDM-D mediates pyroptotic death and is essential for pore formation, we hypothesized that it may direct caspase-1 encapsulated microparticle (MP) release and mediate endothelial cell death.
METHODS AND RESULTS: Our current work provides evidence that GSDM-D is released by LPS stimulated THP1 monocytic cells where it is packaged into microparticles along with active caspase-1. Furthermore, only MP released from stimulated monocytic cells that contain both cleaved GSDM-D and active caspase-1 induce endothelial cell apoptosis. MPs pretreated with caspase-1 inhibitor, YVAD, or pan-caspase inhibitor, ZVAD, do not contain cleaved GSDM-D. MPs from caspase-1KO cells are also deficient in p30 active GSDM-D, further confirming that caspase-1 regulates GSDM-D function. Although control MPs contained cleaved GSDM-D without caspase-1, these fractions were unable to induce cell death, suggesting that encapsulation of both caspase-1 and GSDM-D is essential for cell death induction. Release of microparticulate active caspase-1 was abrogated in GSDM-KO cells, although cytosolic caspase-1 activation was not impaired. Lastly, higher levels of microparticulate GSDM-D was detected in septic ARDS patient plasma when compared to healthy donors.
CONCLUSIONS: Taken together, these findings suggest that GSDM-D regulates the release of microparticulate active caspase-1 from monocytes essential for induction of cell death and thereby may play a critical role in sepsis-induced endothelial cell injury.

PMID: 29365280 [PubMed - as supplied by publisher]



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Leg Movement Activity during Sleep in School-Age Children and Adolescents: A Detailed Study in Normal Controls and Subjects with Restless Legs Syndrome and Narcolepsy Type 1.

Leg Movement Activity during Sleep in School-Age Children and Adolescents: A Detailed Study in Normal Controls and Subjects with Restless Legs Syndrome and Narcolepsy Type 1.

Sleep. 2018 Jan 22;:

Authors: Ferri R, DelRosso LM, Aricò D, Zucconi M, Ferini-Strambi L, Picchietti DL, Pizza F, Plazzi G, Manconi M, Bruni O

Abstract
Study Objectives: To evaluate leg movement activity during sleep (LMS) in normal school-age children and adolescents, to eventually establish age-specific periodic LMS (PLMS) index thresholds that support the diagnosis of restless legs syndrome (RLS) and to evaluate the utility of other LMS indices.
Methods: Polysomnographic recordings from 61 controls, 46 children with RLS, and 44 children with narcolepsy type 1 (NT1) were analyzed for total leg movements (LMS), PLMS, and isolated leg movements (ISOLMS) duration and indices, separately for school-age children and adolescents. Moreover, intermovement interval (IMI) graphs and time-of-night distribution of LMS were analyzed and cut-off thresholds for PLMS index and total LMS index were assessed for the separation of RLS from controls.
Results: All indices tended to decrease from school-age children to adolescents in normal controls and in NT1, while in RLS, only PLMS index increased. All school-age children had a similar IMI distribution with a single peak at IMI 2-4s followed by gradual decline. In adolescents with RLS a second peak at IMI 10-50s, was seen. Time-of-night distribution of most indices decreased in RLS while most tended to increase in NT1. A PLMS index cutoff of 2/h best differentiated RLS from controls in school-age children (accuracy 70.0%) and in adolescents (accuracy 70.8%); however, most NT1 subjects also showed PLMS indices higher than this threshold.
Conclusions: PLMS index alone does not reliably predict the diagnosis of RLS in children and adolescents. However, analyses of IMI distribution and time-of-night distribution provide additional elements to support a diagnosis of RLS.

PMID: 29365206 [PubMed - as supplied by publisher]



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Sleep deprivation affects fear memory consolidation: bi-stable amygdala connectivity with insula and ventromedial prefrontal cortex.

Sleep deprivation affects fear memory consolidation: bi-stable amygdala connectivity with insula and ventromedial prefrontal cortex.

Soc Cogn Affect Neurosci. 2018 Jan 22;:

Authors: Feng P, Becker B, Zheng Y, Feng T

PMID: 29365177 [PubMed - as supplied by publisher]



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Social relationships in physicians' work moderate relationship between workload and wellbeing-9-year follow-up study.

Social relationships in physicians' work moderate relationship between workload and wellbeing-9-year follow-up study.

Eur J Public Health. 2018 Jan 19;:

Authors: Aalto AM, Heponiemi T, Josefsson K, Arffman M, Elovainio M

Abstract
Background: Increasing wellbeing problems among physicians may lead to serious consequences in health care and means to prevent such development are called for. This study examined longitudinal associations between workload and changes in distress, sleep quality and workability in physicians and whether positive social relations at work would protect from such problems.
Methods: A baseline survey was conducted in 2006 for a random sample of 5000 physicians (n = 2841, response rate 57%). In 2015, the follow-up survey was sent to those 2 206 physicians who gave their consent (n = 1462, response rate 68.3%). The survey included scales for distress, sleeping problems, workability, workload, team climate, collegial support and questions for background information.
Results: Increased workload was associated with increased psychological distress, sleeping problems and decreased workability during the 9-year follow-up. Good team climate and collegial support were related to decreased distress and sleep quality and enhanced workability. Good collegial support buffered the associations of workload changes on distress and sleep quality changes. Team climate was more strongly associated with changes in sleep quality and workability among younger and middle aged physicians than older physicians. Also collegial support had a stronger association with sleep quality change among younger or middle aged physicians than older physicians. These associations were robust to adjustments for age, gender, specialization, leadership position, marital status and baseline wellbeing.
Conclusions: Health care organizations should take measures to decrease workload and to increase availability of social support for physicians in order to protect physicians from declining wellbeing.

PMID: 29365062 [PubMed - as supplied by publisher]



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Type of Menopause, Age at Menopause, and Risk of Developing Obstructive Sleep Apnea in Postmenopausal Women.

Type of Menopause, Age at Menopause, and Risk of Developing Obstructive Sleep Apnea in Postmenopausal Women.

Am J Epidemiol. 2018 Jan 22;:

Authors: Huang T, Lin BM, Redline S, Curhan GC, Hu FB, Tworoger SS

Abstract
Despite established sex differences and longstanding hypotheses of sex hormones in obstructive sleep apnea (OSA) etiology, no studies have evaluated type of menopause and age at menopause, which affect postmenopausal hormonal milieu, in relation to OSA risk in women. We followed 50,473 postmenopausal women from the Nurses' Health Study (NHS) between 2002-2012 and 53,827 postmenopausal women from the NHSII between 1995-2013, with 1,712 and 2,560 incident OSA diagnoses, respectively. Compared with natural menopause, the pooled HR for OSA was 1.27 (95% CI: 1.17, 1.38) for surgical menopause by hysterectomy/oophorectomy. The association remained the same after further accounting for age at menopause (HR=1.26; 95% CI: 1.15, 1.38). The risk associated with surgical menopause was higher in non-obese women as well as women who never used hormone therapy (P-interaction<0.05). Earlier menopause was associated with higher OSA risk prior to adjustment for type of menopause (HR comparing <40 years versus 50-54 years=1.21; 95% CI: 1.08, 1.35; p=0.008 for trend), although no association was observed after the adjustment. Surgical as compared with natural menopause was independently associated with higher OSA risk in postmenopausal women. Our results provide additional evidence for a role of sex hormones, particularly abrupt hormonal changes, in modulating OSA risk.

PMID: 29365014 [PubMed - as supplied by publisher]



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Sleep quality in medical students: a comparison across the various phases of the medical course.

Sleep quality in medical students: a comparison across the various phases of the medical course.

J Bras Pneumol. 2017 Jul-Aug;43(4):285-289

Authors: Corrêa CC, Oliveira FK, Pizzamiglio DS, Ortolan EVP, Weber SAT

Abstract
OBJECTIVE: To evaluate and compare subjective sleep quality in medical students across the various phases of the medical course.
METHODS: This was a cross-sectional study involving medical undergraduates at one medical school in the city of Botucatu, Brazil. All first- to sixth-year students were invited to complete the Pittsburgh Sleep Quality Index, which has been validated for use in Brazil. Participants were divided into three groups according to the phase of the medical course: group A (first- and second-years); group B (third- and fourth-years); and group C (fifth- and sixth-years). The results obtained for the instrument components were analyzed for the total sample and for the groups.
RESULTS: Of the 540 students invited to participate, 372 completed the instrument fully. Of those, 147 (39.5%) reported their sleep quality to be either very or fairly bad; 110 (29.5%) reported taking more than 30 min to fall asleep; 253 (68.0%) reported sleeping 6-7 h per night; 327 (87.9%) reported adequate sleep efficiency; 315 (84.6%) reported no sleep disturbances; 32 (8.6%) reported using sleeping medication; and 137 (36.9%) reported difficulty staying awake during the day at least once a week. Group comparison revealed that students in group A had worse subjective sleep quality and greater daytime dysfunction than did those in groups B and C.
CONCLUSIONS: Medical students seem to be more exposed to sleep disturbance than other university students, and first- and second-years are more affected than those in other class years because they have worse subjective sleep quality. Active interventions should be implemented to improve sleep hygiene in medical students.

PMID: 29365004 [PubMed - in process]



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Association of usual sleep quality and glycemic control in type 2 diabetes in Japanese: A cross sectional study. Sleep and Food Registry in Kanagawa (SOREKA).

Association of usual sleep quality and glycemic control in type 2 diabetes in Japanese: A cross sectional study. Sleep and Food Registry in Kanagawa (SOREKA).

PLoS One. 2018;13(1):e0191771

Authors: Sakamoto R, Yamakawa T, Takahashi K, Suzuki J, Shinoda MM, Sakamaki K, Danno H, Tsuchiya H, Waseda M, Takano T, Minagawa F, Takai M, Masutani T, Nagakura J, Shigematsu E, Ishikawa M, Nakajima S, Kadonosono K, Terauchi Y

Abstract
OBJECTIVES: Excessively short and long sleep durations are associated with type 2 diabetes, but there is limited information about the association between sleep quality and diabetes. Accordingly, the present study was performed to investigate this relationship.
MATERIALS AND METHODS: The subjects were 3249 patients with type 2 diabetes aged 20 years or older. Sleep quality was assessed by using the Pittsburgh Sleep Quality Index (PSQI). A higher global PSQI score indicates worse sleep quality, and a global PSQI score >5 differentiates poor sleepers from good sleepers.
RESULTS: The mean global PSQI score was 5.94 ± 3.33, and 47.6% of the patients had a score of 6 or higher. Regarding the components of the PSQI, the score was highest for sleep duration, followed by subjective sleep quality and then sleep latency in decreasing order. When the patients were assigned to HbA1c quartiles (≤ 6.5%, 6.6-7.0%, 7.1-7.8%, and ≥ 7.9%), the top quartile had a significantly higher global PSQI score than the other quartiles. The top HbA1c quartile had a sleep duration of only 6.23 ± 1.42 hours, which was significantly shorter than in the other quartiles. Also, sleep latency was 25.3 ± 31.8 minutes in the top quartile, which was significantly longer (by approximately 20 minutes) than in the other quartiles. When analysis was performed with adjustment for age, gender, BMI, smoking, and other confounders, the global PSQI score was still significantly higher and sleep duration was shorter in the top HbA1c quartile (HbA1c ≥ 7.9%).
CONCLUSIONS: Japanese patients with type 2 diabetes were found to have poor subjective sleep quality independently of potential confounders, especially those with inadequate glycemic control. Impairment of sleep quality was associated with both increased sleep latency and a shorter duration of sleep.

PMID: 29364963 [PubMed - in process]



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Effects of Mindfulness-Based Stress Reduction on employees' mental health: A systematic review.

Effects of Mindfulness-Based Stress Reduction on employees' mental health: A systematic review.

PLoS One. 2018;13(1):e0191332

Authors: Janssen M, Heerkens Y, Kuijer W, van der Heijden B, Engels J

Abstract
OBJECTIVES: The purpose of this exploratory study was to obtain greater insight into the effects of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) on the mental health of employees.
METHODS: Using PsycINFO, PubMed, and CINAHL, we performed a systematic review in October 2015 of studies investigating the effects of MBSR and MBCT on various aspects of employees' mental health. Studies with a pre-post design (i.e. without a control group) were excluded.
RESULTS: 24 articles were identified, describing 23 studies: 22 on the effects of MBSR and 1 on the effects of MBSR in combination with some aspects of MBCT. Since no study focused exclusively on MBCT, its effects are not described in this systematic review. Of the 23 studies, 2 were of high methodological quality, 15 were of medium quality and 6 were of low quality. A meta-analysis was not performed due to the emergent and relatively uncharted nature of the topic of investigation, the exploratory character of this study, and the diversity of outcomes in the studies reviewed. Based on our analysis, the strongest outcomes were reduced levels of emotional exhaustion (a dimension of burnout), stress, psychological distress, depression, anxiety, and occupational stress. Improvements were found in terms of mindfulness, personal accomplishment (a dimension of burnout), (occupational) self-compassion, quality of sleep, and relaxation.
CONCLUSION: The results of this systematic review suggest that MBSR may help to improve psychological functioning in employees.

PMID: 29364935 [PubMed - in process]



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Occupational needs and priorities of women experiencing homelessness: Les besoins et priorités occupationnels des femmes en situation d'itinérance.

Occupational needs and priorities of women experiencing homelessness: Les besoins et priorités occupationnels des femmes en situation d'itinérance.

Can J Occup Ther. 2017 Oct/Dec;84(4-5):229-241

Authors: Salsi S, Awadallah Y, Leclair AB, Breault ML, Duong DT, Roy L

Abstract
BACKGROUND: Women in unstable housing or who are homeless experience disruptions of occupational engagement and performance. Little is known about their perspective on their occupational needs and priorities.
PURPOSE: This study aimed to determine how patterns of occupational engagement and performance are facilitated or hindered by personal factors and resources available to sheltered women.
METHOD: A participatory, descriptive mixed-methods study design was used. Twenty-one residents were interviewed using the Canadian Occupational Performance Measure, the Goal Attainment Scale, and a time-use inventory. Nineteen residents participated in semistructured qualitative interviews. Qualitative data were analysed using interpretive description.
FINDINGS: Participants spent most time on sleep and passive leisure and identified occupational performance issues and goals related to active leisure and employment. Participants' occupational lives were described as transitional journeys comprising five subthemes: seeking safety and stability, being sheltered, shaping one's identity, developing resilience, and engaging in contemplation, contribution, and connectedness through occupation.
IMPLICATIONS: Trauma-informed and strengths-based approaches are recommended for this population. Future research should study the implementation of occupation-based interventions in community settings.

PMID: 29364710 [PubMed - in process]



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Examining Insomnia and PTSD Over Time in Veterans in Residential Treatment for Substance Use Disorders and PTSD.

Examining Insomnia and PTSD Over Time in Veterans in Residential Treatment for Substance Use Disorders and PTSD.

Behav Sleep Med. 2018 Jan 24;:1-12

Authors: Colvonen PJ, Ellison J, Haller M, Norman SB

Abstract
OBJECTIVE/BACKGROUND: Insomnia occurs in 66-90% of individuals with posttraumatic stress disorder (PTSD) and 36-72% of individuals with substance use disorder (SUD). Individuals with both PTSD and SUD are more likely to have insomnia than individuals with only one disorder. Insomnia is associated with poorer treatment outcomes for both PTSD and SUD, increased daytime symptomology for PTSD, and increased relapse for SUDs. As such, it is important to understand how sleep affects PTSD treatment among patients dually diagnosed with SUD and how sleep changes over time in a residential unit for SUDs.
PARTICIPANTS: Participants were 40 veterans with comorbid PTSD and SUD in a 28-day Substance Abuse Residential Rehabilitation Treatment Program (SARRTP) PTSD track.
METHODS: Analyses used mixed models with Time (baseline, posttreatment, 3-month follow-up) to examine PTSD and insomnia severity over time.
RESULTS: Results of the longitudinal mixed model showed that PTSD symptoms improved over time but that insomnia symptoms did not. Although baseline insomnia did not affect follow-up PTSD symptoms, individuals with greater insomnia severity at the start of treatment had more severe baseline PTSD symptomatology. However, there was not an interaction of insomnia and PTSD severity over time such that baseline insomnia did not affect PTSD trajectories.
CONCLUSIONS: These findings are consistent with the PTSD outpatient treatment findings and further adds evidence that insomnia is unremitting without direct intervention. Given the relationship insomnia has with PTSD severity, SUD, and relapse, directly targeting insomnia may further help improve both PTSD and SUD treatment outcomes.

PMID: 29364693 [PubMed - as supplied by publisher]



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Cross-sectional study of randomly selected 18-year-old students showed that body mass index was only associated with sleep duration in girls.

Cross-sectional study of randomly selected 18-year-old students showed that body mass index was only associated with sleep duration in girls.

Acta Paediatr. 2018 Jan 24;:

Authors: Kjartansdottir I, Arngrimsson SA, Bjarnason R, Olafsdottir AS

Abstract
AIM: This study investigated the associations, by sex, between sleep and adiposity, dietary habits, cardiorespiratory fitness and metabolic risk in 18-year-old students.
METHODS: We carried out a cross-sectional study of 199 randomly chosen, healthy 18-year-old students (53% girls) in Iceland's capital region. The data collection took place in the winter months of 2012 to 2015. The anthropometric measurements were body mass index, waist circumference and body fat percentage. Sleep duration and dietary habits were self-reported. Cardiorespiratory fitness was measured on a stationary bicycle. A subsample of 152 participants gave blood samples.
RESULTS: A quarter of the adolescents failed to reach the minimum recommended sleep duration of seven hours per night on weekdays. In girls, the average sleep score was associated with body mass index and waist circumference, after adjusting for cardiorespiratory fitness and unhealthy eating scores. In boys, the average sleep score was not associated with anthropometric measurements, but cardiorespiratory fitness was an independent predictor (p<0.001). No associations were found between average sleep scores and metabolic profiles in either sex.
CONCLUSION: Sleep duration and adiposity only appeared to be associated in girls and were independent of cardiorespiratory fitness and unhealthy eating. Sleep duration was not related to metabolic risk. This article is protected by copyright. All rights reserved.

PMID: 29364541 [PubMed - as supplied by publisher]



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Narrowband UV-B phototherapy in childhood atopic dermatitis: efficacy and safety.

Narrowband UV-B phototherapy in childhood atopic dermatitis: efficacy and safety.

An Bras Dermatol. 2017 Nov-Dec;92(6):801-806

Authors: Dayal S, Pathak K, Sahu P, Jain VK

Abstract
BACKGROUND: Narrow-band UVB is the most innovative steroid sparing treatment in atopic dermatitis. There are studies showing efficacy of Narrow-band UVB in childhood atopic dermatitis, but there is lack of clinical trials in the literature determining the length of remission. Therefore, we sought to highlight its efficacy, safety and its post-treatment efficacy in childhood atopic dermatitis.
OBJECTIVE: To assess the clinical efficacy, safety of Narrow-band UVB in the treatment of paediatric atopic dermatitis and length of remission during 2 years of post-treatment follow-up.
METHODS: Thirty children (4-14 years) having moderate to severe AD (SCORAD index > 25) were enrolled for 12 weeks. Narrow-band UVB phototherapy was administered twice a week on non-consecutive days for three months. SCORAD index was calculated by the same dermatologist at baseline, 6th, 12th, 18th and 24th treatment session. Secondary outcomes were measured using visual analog scale for pruritus and sleep loss. Patients were also followed-up for 2 years to know the length of remission after end of therapy.
RESULTS: There was a significant reduction in SCORAD index at 6th, 12th, 18th and 24th treatment session in comparison to baseline. This improvement in SCORAD was also maintained during the 2 years of post-treatment follow-up period. Consequently, pruritus and sleep loss improved significantly from baseline to end of therapy and even during the 1st and 2nd year of follow-up.
STUDY LIMITATION: Open-label trial without control group.
CONCLUSIONS: Narrow-band UVB is an efficacious and safe modality of treatment in childhood atopic dermatitis with good therapeutic index and minimal side effects.

PMID: 29364435 [PubMed - in process]



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Searching for neurological diseases in the Julio-Claudian dynasty of the Roman Empire.

Searching for neurological diseases in the Julio-Claudian dynasty of the Roman Empire.

Arq Neuropsiquiatr. 2018 Jan;76(1):53-57

Authors: Camargo CHF, Teive HAG

Abstract
The gens Julia was one of the oldest families in ancient Rome, whose members reached the highest positions of power. They made history because Julius Caesar, perpetual dictator, great-uncle of the first emperor, Augustus, passed his name on to the Julio-Claudian dynasty with the emperors Tiberius, Caligula, Claudius and Nero. Descriptions of the diseases of these emperors and some of his family members may indicate diagnoses such as epilepsy, dystonia, dementia, encephalitis, neurosyphilis, peripheral neuropathies, dyslexia, migraine and sleep disorders. In the historical context of ancient Rome, the possibility of infectious diseases related to the libertine way of life is quite large. However, there is a possibility that some of these diseases occurred from genetic transmission.

PMID: 29364395 [PubMed - in process]



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Targeting bladder cancer's Achilles heel: stem cells

Two different proteins work separately as well as synergistically to feed a small pool of stem cells that help bladder cancer resist chemotherapy, research led by a Johns Hopkins Kimmel Cancer Center scientist suggests. The finding, published online in...

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New guidelines for assessing severity of head and neck cancers

Cedars-Sinai investigators have developed a new, more accurate set of guidelines for assessing the severity of head and neck cancers and predicting patient survival. The new guidelines, outlined in a study recently published in the Journal of Clinical...

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Pharmacokinetics and in vitro/in vivo antitumor efficacy of aptamer-targeted Ecoflex® nanoparticles for docetaxel delivery in ovarian cancer

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Nanomedical studies of the restoration of nitric oxide/peroxynitrite balance in dysfunctional endothelium by 1,25-dihydroxy vitamin D3 – clinical implications for cardiovascular diseases

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Chimps are now dying of the common cold and they are all at risk

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The deaths of five Ugandan chimpanzees have been traced to a human cold virus, and DNA tests suggest all African chimps are vulnerable

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IJERPH, Vol. 15, Pages 201: Urinary Metabolite Levels of Flame Retardants in Electronic Cigarette Users: A Study Using the Data from NHANES 2013–2014

IJERPH, Vol. 15, Pages 201: Urinary Metabolite Levels of Flame Retardants in Electronic Cigarette Users: A Study Using the Data from NHANES 2013–2014

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15020201

Authors: Binnian Wei Maciej Goniewicz Richard O’Connor Mark Travers Andrew Hyland

Evaluating the safety of e-cigarettes and making informed judgement about developing potential standards require sufficient scientific evidence. Since e-cigarettes are highly engineered products containing plastic, glass and metal parts, and e-liquids are largely different matrices, many toxic compounds which are not typical hazards for the users of combustible tobacco products (e.g., cigarettes), could exist in e-liquids, and consequently, posing potential health risk to e-cigarette users. We combined the measurements of urinary metabolites of organophosphate flame retardants (OPFRs) with questionnaire data collected in the National Health and Nutrition Examination Surveys (NHANES) from 2013 to 2014, and we compared adjusted geometric means (GM) for each biomarker in e-cigarette users with levels in non-users and users of various tobacco products using multiple regression analyses to adjust for potential confounders. We found diphenyl phosphate (DPhP), bis(1,3-dichloro-2-propyl) phosphate (BDCPP), bis(2-chloroethyl) phosphate (BCEP), and dibutyl phosphate (DBUP) were detected in all e-cigarette users. The adjusted GM of BCEP, the metabolite of tris(2-chloroethyl) phosphate (TCEP), was 81% higher than nonusers (p = 0.0124) and significantly higher than those for both cigarette and cigar users (p &lt; 0.05). The findings in this pilot study suggest that certain OPFRs may present in e-cigarettes as contaminants, and consequently, resulting in higher exposure levels in e-cigarette users compared to nonusers. As we only identified 14 e-cigarette users in the survey, the findings in this study need to be confirmed in future study at a larger scale. A better examination of the types and levels of FRs and their potential contamination sources in e-cigarettes is also needed.



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Computational analysis of transcriptional and post-transcriptional regulation of gene expression

The regulation of gene expression is fundamental to all life on Earth. Dynamic but precise control is vital to cell survival and function, and takes place at various tightly interwoven levels. In this thesis, we review and study the crosstalk between different types of regulators, including epigenetic regulators, transcription factors (TFs), RNA-binding proteins (RBPs) and microRNAs (miRNAs). First, we focus on the interplay between miRNAs and other types of regulators, in particular TFs and epigenetic regulators, both of which are strongly enriched among the predicted targets of miRNAs. Indeed, the direct interplay of miRNAs with other regulators that have genome-wide impact is one possible explanation for the reported importance of miRNAs to fundamental biological processes, including cell fate. We introduce a computational strategy that we apply in order to infer the transcription regulatory circuitries that act downstream of embryonic miRNAs. More precisely, we analyze genome-wide expression changes with an extended motif activity response analysis (MARA) model in order to identify transcriptional regulators that are direct targets of embryonic miRNAs and change in activity upon expression of the miRNAs. We experimentally validate our most promising predictions and integrate the extended MARA model into an automated system in order to make it available to other researchers. We demonstrate its application by modeling diverse high-throughput datasets, including paired liver biopsies of patients with chronic hepatitis C virus infections. Finally, we study alternative cleavage and polyadenylation, a process that impacts gene expression in various ways, including modulating the presence of cis-regulatory elements, such as miRNA and RBP binding sites, which tend to be located at the 3' ends of transcripts. We demonstrate that global shortening of untranslated transcript regions, which is associated with proliferative states, has a very limited effect on mRNA stability and protein output. By analyzing a large array of high-throughput 3' end sequencing data, we create comprehensive catalogs of 3' end processing sites for both human and mouse. Moreover, we identify novel cis-regulatory motifs that are involved in cleavage and polyadenylation, and point out a regulator, HNRNPC, that binds to one of the motifs, thereby globally impacting the usage of cleavage and polyadenylation sites.

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Novel insights into telomere biology and virulence gene expression in plasmodium falciparum

Plasmodium falciparum malaria is still one of the most preeminent and deadliest infectious diseases worldwide, imposing a tremendous health and economic burden on endemic countries. The high virulence of P. falciparum is mostly attributable to the expression of P. falciparum erythrocyte membrane protein 1 (PfEMP1) on the surface of infected red blood cells. PfEMP1 mediates intravascular parasite sequestration in vital organs, which contributes substantially to severe disease and death. Mutually exclusive transcription of the 60 var genes (encoding PfEMP1) and switching to formerly silenced variants results in antigenic variation and allows the parasite to efficiently evade host immune responses and to establish chronic infection. Members of the var multigene family are predominantly positioned close to chromosome ends. Characteristically, these regions are transcriptionally inert and demarcated by the repressive histone mark H3K9me3 and the evolutionary conserved silencing factor P. falciparum heterochromatin protein 1 (PfHP1). It is believed that this specialised environment at chromosome ends generates a structural framework for the epigenetic control of var gene expression. Moreover, telomeres play a crucial role in preserving genome integrity by protecting chromosome ends from inappropriate fusion and recombination events, as well as in regulating telomere length. However, we still lack a detailed functional understanding of the underlying molecular mechanisms that regulate Plasmodium chromosome end biology. During my PhD thesis, I tackled chromosome end biology from three different angles to improve our understanding of how virulence gene expression is regulated and how genome integrity is preserved. In a first project I performed an in-depth functional analysis of the epigenetic silencing factor PfHP1 by generating an inducible loss-of-function mutant. We showed that upon PfHP1 depletion parasites display a complete breakdown of mutually exclusive var expression and antigenic variation. Intriguingly, we also found that over 50% of PfHP1-deprived parasites represented viable gametocytes that complete sexual development up to stage V maturity. This high conversion rate was linked to the targeted de-repression of the ap2-g locus that codes for the ApiAP2 transcription factor AP2-G, which is essential for gametocyte conversion. Thus, our data unveiled PfHP1 not only as a master regulator of variegated expression of exported virulence factors, but also as a crucial factor in the regulation of sexual cell differentiation. In a second project I aimed at the functional characterisation of the chromosome-end associated protein PfSIP2, which was shown to specifically interact with SPE2 elements in subtelomeric regions. In-depth analysis of the expression profile of endogenous PfSIP2 revealed that this protein is only expressed during a very narrow time window of approximately 10hrs in late stage parasites, which coincides with intra-erythrocytic schizogony. Genome-wide ChIP-Seq experiments confirmed the exclusive binding of endogenous PfSIP2 to subtelomeric SPE2 landmarks in upsB var promoter regions and subtelomeric non-coding regions. Surprisingly, however, neither phenotypic changes nor differential gene expression were observed in a conditional PfSIP2-loss-of-function mutant and hence this approach didn’t uncover novel insights into the function of this ApiAP2 factor. In a third project I aimed at the identification of the telomere repeat-binding factor (TRF) in P. falciparum. Although TRFs are highly conserved and play essential roles in preserving chromosome integrity and regulating chromosome length in model eukaryotes, so far no TRF homologue has been found in the malaria parasites. My work reports about the successful de novo identification of the P. falciparum telomere repeat-binding protein (PfTRF). Intriguingly, this protein appears to be evolutionary distinct from TRFs in other eukaryotes as it binds to telomere repeat DNA via a C-terminal C2H2-type zinc finger domain instead of a MYB domain. Genome-wide mapping by ChIP-Seq experiments not only confirmed that PfTRF indeed binds to all chromosome termini in vivo, but as well revealed an unexpected second binding hotspot at telomere repeat-like sequences found in subtelomeric var gene promoters. A comprehensive characterisation of PfTRF using a conditional loss-of-function mutant identified essential roles for this protein in mitotic cell cycle progression and telomere length regulation. Hence, our findings provide important new insight into mechanisms underlying genome maintenance and possibly virulence gene silencing in P. falciparum. They further suggest that malaria parasites employ an evolutionary divergent molecular complex to preserve telomere function. In summary, my results provide important new and detailed understanding of the molecular processes involved in genome maintenance, virulence gene expression and sexual conversion in P. falciparum, processes that are highly relevant for malaria pathogenesis, parasite viability and malaria transmission. I am confident that these findings have important implications for the development of intervention strategies targeting parasite propagation and transmission.

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