Παρασκευή, 26 Ιανουαρίου 2018

Dezidierte Knorpelbildgebung zur Detektion von Knorpelverletzungen und osteochondralen Läsionen

Zusammenfassung

Hintergrund

Osteochondrale Läsionen stellen einen Hauptrisikofaktor für die Entwicklung einer Arthrose am Sprunggelenk dar.

Ziel

Es sollen ein Überblick über therapierelevante klinische Bildgebungsverfahren zur Knorpelbildgebung an Fuß und Sprunggelenk gegeben und typische osteochondrale Verletzungen demonstriert werden.

Material und Methoden

Eine intensive Literaturrecherche wurde durchgeführt und mit persönlicher Erfahrung unterstrichen.

Ergebnisse

Die Knorpelbildgebung zur Detektion osteochondraler Läsionen an Fuß und Sprunggelenk bleibt eine Herausforderung. Dennoch können dezidierte morphologische und quantitative magnetresonanztomographische (MR-)Bildgebungsmethoden klinisch wichtige Informationen zur Verfügung stellen, die hilfreich bei Therapieentscheidungen z. B. hinsichtlich einer knorpelchirurgischen Maßnahme sind. Die Sensitivität der MR-Arthrographie (MR-A) und computertomographischen Arthrographie (CT-A) ist der nativen Magnetresonanztomographie (MRT) bezüglich der Detektion osteochondraler Läsionen überlegen. Im Bereich der kleineren Gelenke des Fußes werden vor allem fortgeschrittene degenerative Veränderungen mittels konventioneller Röntgendiagnostik detektiert; nur in ausgewählten Fällen spielt die MR- und CT-Diagnostik dieser kleineren Gelenken eine Rolle.

Diskussion

Während die dezidierte Knorpelbildgebung mit CT und MRT im Bereich der kleinen Fußgelenke eine geringere Rolle spielt, wird sie im Bereich des Sprunggelenks aufgrund der verfügbaren therapeutischen Optionen wie verschiedenen knorpelchirurgischen Verfahren immer wichtiger für die klinische Diagnostik.



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Delineation of two intracranial areas and the perpendicular intracranial width is sufficient for intracranial volume estimation

Abstract

Objectives

The aim of the present study is to determine if the delineation of one or two optimally chosen intracranial areas (ICA) is enough to achieve adequate estimates of intracranial volume (ICV) in magnetic resonance imaging.

Methods

The correlations of 62 fully delineated ICVs with four types of ICV estimates were calculated. The estimate types were: (1) a single midsagittal ICA, (2) single ICA multiplied by the intracranial width perpendicular to the ICA, (3) sum of two ICAs multiplied by the perpendicular intracranial width and (4) shape-preserving piecewise cubic interpolation using two ICAs. For methods 2–4, the fully delineated ICVs were randomly separated into an evaluation and a validation set of equal size. Method 1 was validated against all of the fully delineated ICVs.

Results

Estimates from method 1 had a Pearson correlation of 0.904 with fully delineated ICV. For method 2, the correlation was 0.986 when delineating the sagittal ICA at 31% of the sagittal intracranial width. For methods 3 and 4, the correlations were both 0.997 when delineating the sagittal ICAs at 17.5 and 64% and at 12 and 64% respectively.

Conclusions

Delineation of two specific intracranial areas is sufficient for intracranial volume estimation.

Main messages

• Delineation of two specific intracranial areas is sufficient for intracranial volume estimation.

• The estimates had a Pearson correlation of 0.997 with intracranial volume.

• The estimation should take no more than 5 min.



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Imaging of Spontaneous and Traumatic Cervical Artery Dissection

Abstract

Introduction

Cervical artery dissection (CAD) is an important etiology of ischemic stroke and early recognition is vital to protect patients from the major complication of cerebral embolization by administration of anticoagulants. The etiology of arterial dissections differ and can be either spontaneous or traumatic. Even though the historical gold standard is still catheter angiography, recent studies suggest a good performance of computed tomography angiography (CTA) for detection of CAD. We conducted this research to evaluate the variety and frequency of possible imaging signs of spontaneous and traumatic CAD and to guide neuroradiologists' decision making.

Methods

Retrospective review of the database of our multiple injured patients admitted to the Department of Trauma, Hand, and Reconstructive Surgery of the University Hospital Münster in Germany (a level 1 trauma center) for patients with traumatic CAD (tCAD) and of our stroke database (2008–2015) for patients with spontaneous CAD (sCAD) and CT/CTA on initial clinical work-up. All images were evaluated concerning specific and sensitive radiological features for dissection by two experienced neuroradiologists. Imaging features were compared between the two etiologies.

Results

This study included 145 patients (99 male, 46 female; 45 ± 18.8 years of age), consisting of 126 dissected arteries with a traumatic and 43 with spontaneous etiology. Intimal flaps were more frequently observed after traumatic etiology (58.1% tCADs, 6.9% sCADs; p < 0.001); additionally, multivessel dissections were much more frequent in trauma patients (3 sCADs, 21 tCADs) and only less than half (42%) of the patients with traumatic dissections showed cervical spine fractures.

Conclusion

Neuroradiologists should be aware that intimal flaps and multivessel dissections are more common after a traumatic etiology. In addition, it seems important to conduct a CTA in a trauma setting, even if no cervical spine fracture is detected.



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Bedeutung der Virchow-Robin-Räume

Zusammenfassung

Virchow-Robin-Räume (VRR) sind perivaskuläre, flüssigkeitsgefüllte Hohlräume um perforierende Arterien und Venen im Hirnparenchym. In der Regel sind sie bei gesunden Menschen etwa 5 mm im Durchmesser. Typische Lokalisationen sind Stammganglien, Mesencephalon sowie die weiße Substanz. Bildmorphologische Charakteristika der VRR sind runde oder tubuläre, glatt begrenzte, in den T2-gewichteten Sequenzen hyperintense Areale. VRR stellen eine physiologische Struktur im normalen Hirnparenchym dar. Es wird angenommen, dass sie mit interstitieller Flüssigkeit gefüllte Makrophagen beinhalten und eine wichtige Rolle für die Drainage der interstitiellen Flüssigkeit in Richtung zervikales Lymphsystem darstellen. Bei vielen Erkrankungen, wie z. B. der Alzheimer-Krankheit, zerebrovaskulären Erkrankungen oder Schädelhirntraumata, wird ein Zusammenhang mit VRR gesehen. Differenzialdiagnostisch müssen lakunäre Infarkte, zystische Raumforderungen, niedriggradige maligne Tumoren oder Arachnoidalzysten bedacht werden. In einzelnen Studien wurde ein Zusammenhang von gehäuft auftretenden erweiterten perivaskulären Räumen bei Patienten mit arterieller Hypertonie und bei Patienten mit CADASIL-Erkrankung festgestellt. Selten sind VRR so stark erweitert, dass es zu einer Kompression des Aquädukts oder der Foramina Monroi mit konsekutivem Hydrozephalus kommt.



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BTB/POZ domain-containing protein 7 is inversely associated with fibronectin expression in salivary adenoid cystic carcinoma.

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BTB/POZ domain-containing protein 7 is inversely associated with fibronectin expression in salivary adenoid cystic carcinoma.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Dec 28;:

Authors: Liu Y, Song J, Zhang J, Yang L, Liu Z, Wang X

Abstract
OBJECTIVE: This study aimed to investigate the relationship between BTB/POZ domain-containing protein 7 (BTBD7) and fibronectin (FN) expression in salivary adenoid cystic carcinoma (SACC) and the function of BTBD7 in proliferation, migration, and invasion of SACC cells.
STUDY DESIGN: The BTBD7 and FN expression in SACC and nontumor salivary tissues as well as SACC cells were characterized by immunohistochemistry and immunofluorescence. The effect of BTBD7 silencing on the proliferation, migration, and invasion of SACC-LM cells were determined by wound healing and transwell invasion assays.
RESULTS: The percentages of SACC with positive BTBD7 expression were significantly higher than those of SACC with FN expression. BTBD7 silencing significantly increased the relative levels of FN expression and inhibited the proliferation, migration, and invasion of SACC-LM cells.
CONCLUSIONS: The study data indicated that BTBD7 was inversely associated with FN expression in SACC. BTBD7 may inhibit FN expression, but it promotes the proliferation, migration, and invasion of SACC-LM cells. Hence, BTBD7 may be associated with metastasis and a new therapeutic target for intervention of SACC.

PMID: 29366608 [PubMed - as supplied by publisher]



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The role of a palliative care intervention in moderating the relationship between depression and survival among individuals with advanced cancer.

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The role of a palliative care intervention in moderating the relationship between depression and survival among individuals with advanced cancer.

Health Psychol. 2017 Dec;36(12):1140-1146

Authors: Prescott AT, Hull JG, Dionne-Odom JN, Tosteson TD, Lyons KD, Li Z, Li Z, Dragnev KH, Hegel MT, Steinhauser KE, Ahles TA, Bakitas MA

Abstract
OBJECTIVE: Randomized controlled trials (RCTs) of early palliative care interventions in advanced cancer have positively impacted patient survival, yet the mechanisms remain unknown. This secondary analysis of 2 RCTs assessed whether an early palliative care intervention moderates the relationship between depressive symptoms and survival.
METHOD: The relationships among mood, survival, and early palliative care intervention were studied among 529 advanced cancer patients who participated in 2 RCTs. The first (N = 322) compared intervention versus usual care. The second (N = 207) compared early versus delayed intervention (12 weeks after enrollment). The interventions included an in-person consultation, weekly nurse coach-facilitated phone sessions, and monthly follow-up. Mood was measured using the Center for Epidemiologic Studies-Depression (CES-D) scale. Cox proportional hazard analyses were used to examine the effects of baseline CES-D scores, the intervention, and their interaction on mortality risk while controlling for demographic variables, cancer site, and illness severity.
RESULTS: The combined sample was 56% male (M = 64.7 years). Higher baseline CES-D scores were significantly associated with greater mortality risk (hazard ratio [HR] = 1.042, 95% confidence interval [CI] [1.017, 1.067], p = .001). However, participants with higher CES-D scores who received the intervention had a lower mortality risk (HR = .963, CI [0.933, 0.993], p = .018) even when controlling for demographics, cancer site, and illness-related variables.
CONCLUSION: This study is the first to demonstrate that patients with advanced cancer who also have depressive symptoms benefit the most from early palliative care. Future research should be devoted to exploring the mechanisms responsible for these relationships. (PsycINFO Database Record

PMID: 29048177 [PubMed - indexed for MEDLINE]



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Validity of utility measures for women with pelvic organ prolapse.

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Validity of utility measures for women with pelvic organ prolapse.

Am J Obstet Gynecol. 2018 01;218(1):119.e1-119.e8

Authors: Harvie HS, Lee DD, Andy UU, Shea JA, Arya LA

Abstract
BACKGROUND: Pelvic organ prolapse is a common condition that frequently coexists with urinary and fecal incontinence. The impact of prolapse on quality of life is typically measured through condition-specific quality-of-life instruments. Utility preference scores are a standardized generic health-related quality-of-life measure that summarizes morbidity on a scale from 0 (death) to 1 (optimum health). Utility preference scores quantify disease severity and burden and are widely used in cost-effectiveness research. The validity of utility preference instruments in women with pelvic organ prolapse has not been established.
OBJECTIVE: The objective of this study was to evaluate the construct validity of generic quality-of-life instruments for measuring utility scores in women with pelvic organ prolapse. Our hypothesis was that women with multiple pelvic floor disorders would have worse (lower) utility scores than women with pelvic organ prolapse only and that women with all 3 pelvic floor disorders would have the worst (lowest) utility scores.
STUDY DESIGN: This was a prospective observational study of 286 women with pelvic floor disorders from a referral female pelvic medicine and reconstructive surgery practice. All women completed the following general health-related quality-of-life questionnaires: Health Utilities Index Mark 3, EuroQol, and Short Form 6D, as well as a visual analog scale. Pelvic floor symptom severity and condition-specific quality of life were measured using the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire, respectively. We measured the relationship between utility scores and condition-specific quality-of-life scores and compared utility scores among 4 groups of women: (1) pelvic organ prolapse only, (2) pelvic organ prolapse and stress urinary incontinence, (3) pelvic organ prolapse and urgency urinary incontinence, and (4) pelvic organ prolapse, urinary incontinence, and fecal incontinence.
RESULTS: Of 286 women enrolled, 191 (67%) had pelvic organ prolapse; mean age was 59 years and 73% were Caucasian. Among women with prolapse, 30 (16%) also had stress urinary incontinence, 39 (20%) had urgency urinary incontinence, and 42 (22%) had fecal incontinence. For the Health Utilities Index Mark 3, EuroQol, and Short Form 6D, the pattern in utility scores was noted to be lowest (worst) in the prolapse + urinary incontinence + fecal incontinence group (0.73-0.76), followed by the prolapse + urgency urinary incontinence group (0.77-0.85) and utility scores were the highest (best) for the prolapse only group (0.80-0.86). Utility scores from all generic instruments except the visual analog scale were significantly correlated with the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire total scores (r values -0.26 to -0.57), and prolapse, bladder, and bowel subscales (r values -0.16 to -0.50). Utility scores from all instruments except the visual analog scale were highly correlated with each other (r = 0.53-0.69, P < .0001).
CONCLUSION: The Health Utilities Index Mark 3, EuroQol, and Short Form 6D, but not the visual analog scale, provide valid measurements for utility scores in women with pelvic organ prolapse and associated pelvic floor disorders and could potentially be used for cost-effectiveness research.

PMID: 28988907 [PubMed - indexed for MEDLINE]



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The effect of glutamine and arginine-enriched nutritional support on quality of life in head and neck cancer patients treated with IMRT.

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The effect of glutamine and arginine-enriched nutritional support on quality of life in head and neck cancer patients treated with IMRT.

Clin Nutr ESPEN. 2016 Dec;16:30-35

Authors: Yuce Sari S, Yazici G, Yuce D, Karabulut E, Cengiz M, Ozyigit G

Abstract
BACKGROUND AND AIMS: Oral mucositis and esophagitis are common acute toxicities of radiotherapy (RT) for head and neck cancer (HNC). In order to decrease the rates of these toxicities, we compared quality of life in HNC patients that did and did not receive a glutamine and arginine-enriched solution (GAES) during RT.
METHODS: A total of 29 patients received intensity-modulated radiotherapy (IMRT); 15 used GAES b.i.d. during the treatment, and a matched cohort of 14 patients did not. Patients were administered the EORTC QLQ-C30, QLQ-H&N35 and QLQ-OES18 questionnaires on the 1st, 15th, and last days of IMRT.
RESULTS: The global health status, functional and symptom scale scores were similar in both groups on the 1st day of IMRT. On the 15th and last days, the scores of social functions (p = 0.01 and p = 0.012), pain (p = 0.002 and p = 0.002), appetite (p = 0.01 and p = 0.02), dry mouth (p = 0.001 and p = 0.03), sticky saliva (p = 0.003 and p = 0.04), trouble with taste (p = 0.001 and p = 0.03), trouble with social eating (p = 0.004 and p = 0.006), and swallowing problems (p = 0.002 and p = 0.046) were significantly worse in the control group.
CONCLUSIONS: Quality of life is negatively affected by IMRT; however, use of GAES may mediate this negative effect.

PMID: 28531452 [PubMed - indexed for MEDLINE]



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An Analysis of the Changes in Communication Techniques in the Italian Codes of Medical Deontology.

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An Analysis of the Changes in Communication Techniques in the Italian Codes of Medical Deontology.

Acta Biomed. 2017 Apr 28;88(1):33-38

Authors: Conti AA

Abstract
BACKGROUND AND AIM OF THE WORK: The code of deontology of the Italian National Federation of the Colleges of Physicians, Surgeons and Dentists (FNOMCeO) contains the principles and rules to which the professional medical practitioner must adhere. This work identifies and analyzes the medical-linguistic choices and the expressive techniques present in the different editions of the code, and evaluates their purpose and function, focusing on the first appearance and the subsequent frequency of key terms.
METHODS: Various aspects of the formal and expressive revisions of the eight editions of the Codes of Medical Deontology published after the Second World War (from 1947/48 to 2014) are here presented, starting from a brief comparison with the first edition of 1903. Formal characteristics, choices of medical terminology and the introduction of new concepts and communicative attitudes are here identified and evaluated.
RESULTS: This paper, in presenting a quantitative and epistemological analysis of variations, modifications and confirmations in the different editions of the Italian code of medical deontology over the last century, enucleates and demonstrates the dynamic paradigm of changing attitudes in the medical profession.
CONCLUSIONS: This analysis shows the evolution in medical-scientific communication as embodied in the Italian code of medical deontology. This code, in its adoption, changes and adaptations, as evidenced in its successive editions, bears witness to the expressions and attitudes pertinent to and characteristic of the deontological stance of the medical profession during the twentieth century.

PMID: 28467331 [PubMed - indexed for MEDLINE]



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Are lifetime affective disorders predictive of long-term outcome in severe adolescent anorexia nervosa?

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Are lifetime affective disorders predictive of long-term outcome in severe adolescent anorexia nervosa?

Eur Child Adolesc Psychiatry. 2017 Aug;26(8):969-978

Authors: Carrot B, Radon L, Hubert T, Vibert S, Duclos J, Curt F, Godart N

Abstract
Depression and anxiety are commonly associated with anorexia nervosa (AN) and contribute to difficulties in social integration, a negative factor for outcome in AN. The link between those disorders and AN has been poorly studied. Thus, our objective was to investigate (1) the link between outcome nine years after hospitalisation for AN and the occurrence of lifetime anxious or depressive comorbidities; (2) the prognostic value of these comorbidities on patient outcome; 181 female patients were hospitalised for AN (between 13 and 22 years old), and were re-evaluated for their psychological, dietary, physical and social outcomes, from 6 to 12 years after their hospitalisation. The link between anxious and depressive disorders (premorbid to AN and lifetime) and the outcome assessment criteria were tested through multivariate analyses; 63% of the participants had good or intermediate outcome, 83% had presented at least one anxiety or depression disorder in the course of their lives, half of them before the onset of AN. Premorbid obsessive compulsive disorders (OCD), BMI at admission, and premenarchal AN all contribute to poor prognosis. Social phobia and agoraphobia affect the subjects' quality of life and increase eating disorder symptoms. These results encourage a systematic assessment of, and care for, anxiety and depression comorbidities among female adolescent patients with a particular focus on premorbid OCD.

PMID: 28258321 [PubMed - indexed for MEDLINE]



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Advancing and Lengthening Genioplasty in Contouring of the Receding and Short Chin.

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Advancing and Lengthening Genioplasty in Contouring of the Receding and Short Chin.

J Craniofac Surg. 2017 Mar;28(2):314-317

Authors: Zhang C, Zhao L, Li CR, Shim YH, Cao D

Abstract
BACKGROUND: In East Asia, receding and short chin are common complaints of patients who do not have satisfied lower face. In most former studies, receding and short chin are considered and treated separately. But during the clinical work, the authors found that, in many patients, neither vertical elongation nor horizontal advancement of the chin is sufficient to achieve a harmonious result. In regards of this problem, the authors performed an advancing and lengthening genioplasty and the results were aesthetically satisfactory.
STUDY DESIGN: Twenty-six patients with receding and short chin were involved in this study. After presurgical computed tomography (CT) scan, advancing and lengthening genioplasty with/without other osteotomy operations were performed on all the patients. All patients underwent postoperative CT scan and had at least 3-month follow-up.
RESULT: All patients were satisfied with the final results. According to the postoperative CT images and 3-month follow-up, no severe complications occurred.
CONCLUSION: For patients with receding and short chin, advancing and lengthening genioplasty is a reliable therapy to obtain harmonious East Asian lower face.

PMID: 28045830 [PubMed - indexed for MEDLINE]



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Continuous Validity of Temporalis Muscle Flap in Reconstruction of Postablative Palatomaxillary Defects.

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Continuous Validity of Temporalis Muscle Flap in Reconstruction of Postablative Palatomaxillary Defects.

J Craniofac Surg. 2017 Mar;28(2):e130-e137

Authors: Hassanein AG

Abstract
INTRODUCTION: Postablative palatomaxillary defects (PAPMDs) represent a challenging reconstructive problem. Temporalis muscle flap (TMF) has been widely used for reconstruction of these defects with minimal morbidity and satisfactory outcome.
AIM OF THE STUDY: To presents the authors' experience in the reconstruction of PAPMDs with TMF and to evaluate the validity of TMF in the reconstruction of such defects.
METHODS: This prospective study was conducted between July 2011 and July 2016 on selected patients for primary reconstruction of PAPMDs with TMF. Temporalis muscle flaps were assessed during surgery and postoperatively. Patients were followed up to evaluate functional and esthetic outcomes and detect complications.
RESULTS: This study included 32 patients with mean age 48.3 years. The pathology was squamous cell carcinoma in 15 patients (46.9%). Twenty-one patients (65.6%) had type II maxillectomy. Mean time of flap harvesting was 43 minutes. Zygomatic arch osteotomy was done in 3 patients while Coronoid osteotomy in 4 patients. Postoperatively, flaps were viable in 31 patients (96.9%) with good healing of recipient site. Flap epithelization completed within 28 to 59 days. Follow-up period was 13 to 55 months. Satisfactory functional and esthetic outcomes were reported in most of patients with no recurrence. Transient temporal nerve palsy occurred in 2 patients, limited mouth opening in 5 patients. One patient had Transient diplopia with enopthalmos and hypophthalmos. Flap failure occurred in another patient.
CONCLUSIONS: Temporalis muscle flap is still a valid reliable and versatile reconstructive tool in palatomaxillary reconstruction after ablative surgery. It has a good cosmetic and functional outcomes and minimal morbidity.

PMID: 28033186 [PubMed - indexed for MEDLINE]



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Online purchasing creates opportunities to lower the life cycle carbon footprints of consumer products.

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Online purchasing creates opportunities to lower the life cycle carbon footprints of consumer products.

Proc Natl Acad Sci U S A. 2016 08 30;113(35):9780-5

Authors: Isley SC, Stern PC, Carmichael SP, Joseph KM, Arent DJ

Abstract
A major barrier to transitions to environmental sustainability is that consumers lack information about the full environmental footprints of their purchases. Sellers' incentives do not support reducing the footprints unless customers have such information and are willing to act on it. We explore the potential of modern information technology to lower this barrier by enabling firms to inform customers of products' environmental footprints at the point of purchase and easily offset consumers' contributions through bundled purchases of carbon offsets. Using online stated choice experiments, we evaluated the effectiveness of several inexpensive features that firms in four industries could implement with existing online user interfaces for consumers. These examples illustrate the potential for firms to lower their overall carbon footprints while improving customer satisfaction by lowering the "soft costs" to consumers of proenvironmental choices. Opportunities such as these likely exist wherever firms possess environmentally relevant data not accessible to consumers or when transaction costs make proenvironmental action difficult.

PMID: 27528670 [PubMed - indexed for MEDLINE]



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Sport activity in Charcot-Marie-Tooth disease: A case study of a Paralympic swimmer.

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Sport activity in Charcot-Marie-Tooth disease: A case study of a Paralympic swimmer.

Neuromuscul Disord. 2016 Sep;26(9):614-8

Authors: Vita G, La Foresta S, Russo M, Vita GL, Messina S, Lunetta C, Mazzeo A

Abstract
This study reports the positive physical, emotional and psychosocial changes induced by sport activity in a Paralympic swimmer with Charcot-Marie-Tooth (CMT) type 4A. When we compared evaluations before initiating sport activity with those after five years of competitive activity, we found: i) increased proximal muscles strength of upper limbs; ii) augmented ability to propel wheelchair independently; iii) improved quality of life; iv) reduced trait anxiety and striking improvement of depression; v) enhanced self-esteem. Longitudinal studies in large cohorts to evaluate the positive effects of sport activity are needed to support provision of evidence-based advice to patients and families.

PMID: 27460291 [PubMed - indexed for MEDLINE]



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Breast Cancer Survivorship: Why, What and When?

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Breast Cancer Survivorship: Why, What and When?

Ann Surg Oncol. 2016 Oct;23(10):3162-7

Authors: Gass J, Dupree B, Pruthi S, Radford D, Wapnir I, Antoszewska R, Curtis A, Johnson N

Abstract
Survivorship medicine is fairly new in the realm of oncology. As we broaden our focus from treatment and prevention to include survivorship there is substantial opportunity to enhance the care of the patient. Important in successful management of recovery after cancer treatment is managing the side effects of therapy and improving quality of life. This ranges from sexual dysfunction, depression to lymphedema. Guideline-based surveillance after treatment with clear communication of care plans to the patient and their providers, especially primary care, is paramount. Thoughtful pre-surgical treatment planning, which may include neoadjuvant approaches or consideration of fertility preservation, results in superior long-term patient outcomes. Understanding the importance of the teachable moment in effecting behavioral and lifestyle changes that reduce risk of recurrence is also an essential component of excellent cancer survivor patient care. We identified the following areas for focus as they represent the key areas for accreditation and patient driven needs. Development of survivorship plans, post treatment surveillance, sexuality and fertility preservation, lymphedema management and risk reduction lifestyle and behavioral changes.

PMID: 27431417 [PubMed - indexed for MEDLINE]



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Current Practices and Barriers to the Integration of Oncoplastic Breast Surgery: A Canadian Perspective.

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Current Practices and Barriers to the Integration of Oncoplastic Breast Surgery: A Canadian Perspective.

Ann Surg Oncol. 2016 Oct;23(10):3259-65

Authors: Maxwell J, Roberts A, Cil T, Somogyi R, Osman F

Abstract
BACKGROUND: Despite the safety and popularity of oncoplastic surgery, there is limited data examining utilization and barriers associated with its incorporation into practice. This study examines the use of oncoplastic techniques in breast conserving surgery and determines the barriers associated with their implementation.
METHODS: A 13-item survey was mailed to all registered general surgeons in Ontario, Canada. The survey assessed surgeon demographics, utilization of specific oncoplastic techniques, and perceived barriers.
RESULTS: A total of 234 survey responses were received, representing a response rate of 32.2 % (234 of 725). Of the respondents, 166 surgeons (70.9 %) reported a practice volume of at least 25 % breast surgery. Comparison was made between general surgeons performing oncoplastic breast surgery (N = 79) and those who did not use these techniques (N = 87). Surgeon gender, years in practice, fellowship training, and access to plastic surgery were similar across groups. Both groups rated the importance of breast cosmesis similarly. General surgeons with a practice volume involving >50 % breast surgery were more likely to use oncoplastic techniques (OR 8.82, p < .001) and involve plastic surgeons in breast conserving surgery (OR 2.21, p = .02). For surgeons not performing oncoplastic surgery, a lack of training and access to plastic surgeons were identified as significant barriers. For those using oncoplastic techniques, the absence of specific billing codes was identified as a limiting factor.
CONCLUSIONS: Lack of training, access to plastic surgeons, and absence of appropriate reimbursement for these cases are significant barriers to the adoption of oncoplastic techniques.

PMID: 27364502 [PubMed - indexed for MEDLINE]



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Outcomes After Oncoplastic Breast-Conserving Surgery in Breast Cancer Patients: A Systematic Literature Review.

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Outcomes After Oncoplastic Breast-Conserving Surgery in Breast Cancer Patients: A Systematic Literature Review.

Ann Surg Oncol. 2016 Oct;23(10):3247-58

Authors: De La Cruz L, Blankenship SA, Chatterjee A, Geha R, Nocera N, Czerniecki BJ, Tchou J, Fisher CS

Abstract
BACKGROUND: Surgeons have increasingly performed breast-conserving surgery (BCS) utilizing oncoplastic techniques in place of standard lumpectomy for early-stage breast cancer. We assess oncologic outcomes after oncoplastic BCS for T1-T2 breast cancer.
METHODS: A systematic literature review identified peer-reviewed articles in PubMed evaluating BCS with oncoplastic reconstruction. Selected studies reported on positive margin rate (PMR), re-excision rate (RR), conversion to mastectomy rate (CMR), overall survival (OS), disease-free survival (DFS), local recurrence (LR), distant recurrence (DR), complication rate, and/or cosmetic outcomes.
RESULTS: The search yielded 474 articles; 55 met the inclusion criteria and collectively evaluated 6011 patients with a mean age 54.6 years over a mean follow-up 50.5 months. T1 (43.8 %) and T2 (39.3 %) invasive ductal carcinoma were the most common tumor histopathologies. PMR, RR, and CMR were 10.8, 6.0, and 6.2 %, respectively, while OS, DFS, LR and DR were 95.0, 90.0, 3.2, and 8.7 %, respectively. Margin widths were heterogeneously defined in studies that included margin assessment. The PMR was not significantly different when positive margins were defined as tumor <10, <5, < 2, and <1 mm from ink margin, or tumor on ink (p = 0.162). Eleven studies reported specific margins for 1455 patients, of whom 143 (9.8 %) had positive margins, including 113 (7.8 %) with tumor on ink.
CONCLUSIONS: This study is the largest comprehensive literature review to date on oncoplastic BCS. Our systematic review reveals high rates of OS and DFS with low LR, DR, PMR, RR, CMR and complication rates, thereby confirming the oncologic safety of this procedure in patients with T1-T2 invasive breast cancer.

PMID: 27357177 [PubMed - indexed for MEDLINE]



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A Novel Treatment Schedule for Rapid Completion of Surgery and Radiation in Early-Stage Breast Cancer.

http:--production.springer.de-OnlineReso Related Articles

A Novel Treatment Schedule for Rapid Completion of Surgery and Radiation in Early-Stage Breast Cancer.

Ann Surg Oncol. 2016 Oct;23(10):3297-303

Authors: Hieken TJ, Mutter RW, Jakub JW, Boughey JC, Degnim AC, Sukov WR, Childs S, Corbin KS, Furutani KM, Whitaker TJ, Park SS

Abstract
BACKGROUND: Data support the use of accelerated partial-breast irradiation (APBI) for early-stage breast cancer. We initiated a prospective protocol for intraoperative APBI catheter placement using a multi-lumen strut-based device. We hypothesized that with intraoperative pathology assessment of margins and sentinel nodes, all locoregional treatment (surgery and APBI) could be completed within 10 days with acceptable complication rates and cosmesis.
METHODS: Eligible patients included women age 50 years or older with clinical T1 estrogen receptor positive (ER+) sentinel lymph node (SLN)-negative invasive ductal cancer or pure ductal carcinoma in situ. Patients were prospectively registered. Cosmesis was assessed using photographs graded independently by three investigators for patients with photos taken 6 months or longer after treatment.
RESULTS: From October 2012 to August 2015, we enrolled 123 patients; 110 (90 %) underwent intraoperative catheter placement, whereas 13 did not due to intraoperative pathology findings. 109 APBI patients (99 %) completed their prescribed radiotherapy within 5 days, and all their locoregional therapy within 9 days, whereas one patient with a delayed positive SLN received only boost radiotherapy via catheter followed by conventional whole breast radiation. The 30-day complication rate was 6 %. In 81 patients with at least one-year followup, complications occurred in 14 (17 %) (including infection in five patients and symptomatic seroma in five patients) and correlated with device size (p = 0.05) but not with tumor size or location. The local recurrence rate was 1.8 % (two patients). Scored cosmesis was excellent or good in 88 % and fair in 12 % of patients.
CONCLUSIONS: A protocol for intraoperative strut-based APBI catheter placement using careful patient selection and intraoperative pathology assessment can deliver efficient, effective treatment for early breast cancer.

PMID: 27334215 [PubMed - indexed for MEDLINE]



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Effects of neurostimulation for advanced Parkinson's disease patients on motor symptoms: A multiple-treatments meta-analysas of randomized controlled trials.

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Effects of neurostimulation for advanced Parkinson's disease patients on motor symptoms: A multiple-treatments meta-analysas of randomized controlled trials.

Sci Rep. 2016 05 04;6:25285

Authors: Xie CL, Shao B, Chen J, Zhou Y, Lin SY, Wang WW

Abstract
Deep brain stimulation (DBS) is the surgical procedure of choice for patients with advanced Parkinson disease (PD). We aim to evaluate the efficacy of GPi (globus pallidus internus), STN (subthalamic nucleus)-DBS and medical therapy for PD. We conducted a systematic review and multiple-treatments meta-analysis to investigate the efficacy of neurostimulation and medical therapy for PD patients. Sixteen eligible studies were included in this analysis. We pooled the whole data and found obvious difference between GPi-DBS versus medical therapy and STN-DBS versus medical therapy in terms of UPDRS scores (Unified Parkinson's Disease Rating Scale). Meanwhile, we found GPi-DBS had the similar efficacy on the UPDRS scores when compared with STN-DBS. What is more, quality of life, measured by PDQ-39 (Parkinson's disease Questionnaire) showed greater improvement after GPi-DBS than STN-DBS. Five studies showed STN-DBS was more effective for reduction in medication than GPi-DBS. Overall, either GPi-DBS or STN-DBS was an effective technique to control PD patients' symptoms and improved their functionality and quality of life. Meanwhile, the UPDRS scores measuring parkinsonian symptoms revealed no significant difference between GPi-DBS and STN-DBS. STN-DBS was more effective for reduction in medication than GPi-DBS. Alternatively, GPi-DBS was more effective for improving the PDQ-39 score than STN-DBS.

PMID: 27142183 [PubMed - indexed for MEDLINE]



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Bilateral muscular slips between superior and inferior rectus muscles: case report with discussion on classification of accessory rectus muscles within the orbit.

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Bilateral muscular slips between superior and inferior rectus muscles: case report with discussion on classification of accessory rectus muscles within the orbit.

Surg Radiol Anat. 2018 Jan 24;:

Authors: Haładaj R, Wysiadecki G, Polguj M, Topol M

Abstract
Accessory rectus muscles have rarely been reported as muscular 'bands' or 'slips' originating from the common tendinous ring (annulus of Zinn) and inserting in atypical location. This group of muscles is innervated by the inferior branch of the oculomotor nerve, lies on lateral side of the optic nerve and inserts in rectus muscles. Since there are only few descriptions of such unusual findings in the medical literature, the anatomical data on accessory rectus muscles is limited. Furthermore, existing reports vary in terms of studied objects (cadavers or living subjects), medical history (absence or presence of ocular movement disorders or eye movement abnormalities) and details of anatomical description. This report complements earlier publications and provides complete anatomical description of the accessory rectus muscle observed bilaterally during the dissection of a 68-year-old male cadaver with no eye movement abnormalities reported in the medical history. The accessory rectus muscle was divided into two 'slips' or 'heads'-superior and inferior-running in the sagittal plane (laterally to the optic nerve and the main trunk of the ophthalmic artery) and attached to the superior and inferior rectus muscles. Noticeable thickening of both superior and inferior rectus muscles at the insertion point of the accessory muscle heads was observed only in the sagittal plane. On both sides, the inferior head of the accessory rectus muscle was innervated by one of sub-branches derived from the inferior branch of the oculomotor nerve. No sub-branches to the superior head were macroscopically observed during the dissection. The classification, embryological background and clinical relevance of this variation have been discussed.

PMID: 29368252 [PubMed - as supplied by publisher]



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Imaging and anatomical features of ethmomaxillary sinus and its differentiation from surrounding air cells.

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Imaging and anatomical features of ethmomaxillary sinus and its differentiation from surrounding air cells.

Surg Radiol Anat. 2018 Jan 24;:

Authors: Liu J, Dai J, Wen X, Wang Y, Zhang Y, Wang N

Abstract
OBJECTIVE: The aim of this study was to investigate the imaging anatomical characteristics and clinical significance of the ethmomaxillary sinus (EMS).
METHODS: The study included a total of 280 ENT Outpatient Department patients with nasal symptoms whose paranasal sinus CT scans were analyzed from January 2012 to December 2016. The anatomical imaging characteristics of EMS were observed.
RESULTS: EMS was observed in 23 of 280 patients, with an incidence of 8.2%. Bilateral EMS appearance in 17 cases (73.9%) was significantly higher than that of unilateral EMS in 6 cases (26.1%) (P < 0.01). EMS occurs when there are anterior or anterior-inferior cells of the posterior ethmoidal sinus (PEs) extending toward the maxillary sinus (MS) and entering the MS through the maxillary hiatus rather than spreading from outside of the MS. EMS is surrounded by five walls, and the main position of EMS was invariably located in the posterior-superior corner of the MS and draining to the superior nasal meatus (SNM). EMS must be differentiated from SNM, sphenoid sinus, and retromaxillary pneumatization of PEs, because they may appear between the MS and the orbital floor.
CONCLUSION: EMS was not a rare variation that should be careful identification during endoscopic sinus surgery. Accurately confirming EMS is the key to completely opening and removing lesions in the MS and EMS.

PMID: 29368251 [PubMed - as supplied by publisher]



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Seitengang-IPMN: Resektion oder Beobachtung?



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Stellenwert der laparoskopischen Leberresektion im Vergleich mit laparoskopischer Radiofrequenzablation



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Laparoskopische Ileozökalresektion im Vergleich mit Infliximab bei Ileitis terminalis



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health technology; +200 new citations

200 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 2018/01/26

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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JFB, Vol. 9, Pages 14: Advances in Degradable Embolic Microspheres: A State of the Art Review

JFB, Vol. 9, Pages 14: Advances in Degradable Embolic Microspheres: A State of the Art Review

Journal of Functional Biomaterials doi: 10.3390/jfb9010014

Authors: Jensen Doucet Lauren Kiri Kathleen O’Connell Sharon Kehoe Robert Lewandowski David Liu Robert Abraham Daniel Boyd

Considerable efforts have been placed on the development of degradable microspheres for use in transarterial embolization indications. Using the guidance of the U.S. Food and Drug Administration (FDA) special controls document for the preclinical evaluation of vascular embolization devices, this review consolidates all relevant data pertaining to novel degradable microsphere technologies for bland embolization into a single reference. This review emphasizes intended use, chemical composition, degradative mechanisms, and pre-clinical safety, efficacy, and performance, while summarizing the key advantages and disadvantages for each degradable technology that is currently under development for transarterial embolization. This review is intended to provide an inclusive reference for clinicians that may facilitate an understanding of clinical and technical concepts related to this field of interventional radiology. For materials scientists, this review highlights innovative devices and current evaluation methodologies (i.e., preclinical models), and is designed to be instructive in the development of innovative/new technologies and evaluation methodologies.



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Temporal trends in the risk of second primary cancers among survivors of adult-onset cancers, 1980 through 2013: An Australian population-based study.

Temporal trends in the risk of second primary cancers among survivors of adult-onset cancers, 1980 through 2013: An Australian population-based study.

Cancer. 2018 Jan 25;:

Authors: Ye Y, Otahal P, Wills KE, Neil AL, Venn AJ

Abstract
BACKGROUND: The authors' systematic review indicated an increasing trend in the risk of second primary cancers (SPCs) from the 1980s to 2000 when considering studies from the United States and Australia. It is uncertain whether this trend has continued to increase since 2000.
METHODS: The current study was a population-based study of 51,802 individuals with adult-onset cancers identified in the Tasmanian Cancer Registry. Patients with a first cancer diagnosis made between 1980 and 2009 were followed up to December 2013. SPC risks were quantified using standardized incidence ratios (SIRs) and absolute excess risks (AERs). Trends in SPC risk were assessed using multivariable Poisson models.
RESULTS: With a median follow-up of 4.8 years (mean, 6.9 years), a total of 5339 SPCs were observed. The SIRs for any SPC increased from 0.98 (95% confidence interval, 0.90-1.07) after a first cancer diagnosis in 1980 through 1984 to 1.12 (95% confidence interval, 1.05-1.20) in 2005 through 2009. In multivariable Poisson models accounting for patient sex, age at the time of the first cancer diagnosis, follow-up interval, and first cancer type, the trend in SIRs increased significantly from 1980 through 2009 for all SPCs (P for trend <.001) and for specific SPCs of the head and neck, lung, digestive tract, and prostate (all P for trend <.05). From 2000 onward, the AER for specific SPCs after specific first cancers was highest for prostate cancer after first cancers of the urinary tract (AER, 54.3 per 10,000 person-years).
CONCLUSIONS: In Tasmania, the risk of SPCs among survivors of adult-onset cancers has increased with periods of first cancer diagnosis from 1980 through 2009. Increased cancer screening and improved medical imaging may have contributed to the greater risk in recent years. Cancer 2018. © 2018 American Cancer Society.

PMID: 29370456 [PubMed - as supplied by publisher]



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The role of MGMT polymorphisms rs12917 and rs11016879 in head and neck cancer risk and prognosis.

The role of MGMT polymorphisms rs12917 and rs11016879 in head and neck cancer risk and prognosis.

Acta Biochim Pol. 2018 Jan 25;:

Authors: Kiczmer P, Prawdzic Seńkowska A, Strzelczyk JK, Szydło B, Biernacki K, Osadnik T, Krakowczyk Ł, Ostrowska Z

Abstract
Head and neck squamous cell carcinoma (HNSCC) is one of the leading cancers by incidence worldwide. The risk of these cancers is strictly associated with alkylation factors present in tobacco smoke. The crucial role in preventing DNA alkylation is played by O6-methylguanine-DNA methyltransferase (MGMT). Dysfunction or lack of MGMT is associated with an increased risk of cancer. The aim of the study was to assess the influence of MGMT polymorphisms: rs12917 and rs11016879 on HNSCC risk and course. The study consisted of 69 HNSCC patients and 242 healthy individuals. Case samples were taken from resected tumour tissue. The control group comprised samples of epithelial cells collected from mucous membranes using swabs. DNA samples were genotyped by employing the 5' nuclease assay for allelic discrimination using TaqMan SNP Genotyping Assays. The significance between distributions of genotypes and alleles was tested using Pearson's χ2 test analysis. Our results indicated that the MGMT rs12917 TT genotype increases the risk of HNSCC. The MGMT rs11016879 AG genotype and A allele were associated with increased HNSCC risk. We noted higher risk of nodal metastasis in rs11016879 AA homozygotes. Mechanisms leading to MGMT enzymatic defect are unknown and hence further studies need to be carried out. Our data suggest that the examined polymorphisms may be considered as potential prognostic factors for HNSCC risk and outcome. Further studies are necessary to verify our results.

PMID: 29370316 [PubMed - as supplied by publisher]



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The histone demethylase LSD1 regulates inner ear progenitor differentiation through interactions with Pax2 and the NuRD repressor complex.

The histone demethylase LSD1 regulates inner ear progenitor differentiation through interactions with Pax2 and the NuRD repressor complex.

PLoS One. 2018;13(1):e0191689

Authors: Patel D, Shimomura A, Majumdar S, Holley MC, Hashino E

Abstract
The histone demethylase LSD1 plays a pivotal role in cellular differentiation, particularly in silencing lineage-specific genes. However, little is known about how LSD1 regulates neurosensory differentiation in the inner ear. Here we show that LSD1 interacts directly with the transcription factor Pax2 to form the NuRD co-repressor complex at the Pax2 target gene loci in a mouse otic neuronal progenitor cell line (VOT-N33). VOT-N33 cells expressing a Pax2-response element reporter were GFP-negative when untreated, but became GFP positive after forced differentiation or treatment with a potent LSD inhibitor. Pharmacological inhibition of LSD1 activity resulted in the enrichment of mono- and di-methylation of H3K4, upregulation of sensory neuronal genes and an increase in the number of sensory neurons in mouse inner ear organoids. Together, these results identify the LSD1/NuRD complex as a previously unrecognized modulator for Pax2-mediated neuronal differentiation in the inner ear.

PMID: 29370269 [PubMed - in process]



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Increased parietal circuit-breaker activity in delta frequency band and abnormal delta/theta band connectivity in salience network in hyperacusis subjects.

Increased parietal circuit-breaker activity in delta frequency band and abnormal delta/theta band connectivity in salience network in hyperacusis subjects.

PLoS One. 2018;13(1):e0191858

Authors: Han JJ, Jang JH, Ridder D, Vanneste S, Koo JW, Song JJ

Abstract
Recent studies have suggested that hyperacusis, an abnormal hypersensitivity to ordinary environmental sounds, may be characterized by certain resting-state cortical oscillatory patterns, even with no sound stimulus. However, previous studies are limited in that most studied subjects with other comorbidities that may have affected cortical activity. In this regard, to assess ongoing cortical oscillatory activity in idiopathic hyperacusis patients with no comorbidities, we compared differences in resting-state cortical oscillatory patterns between five idiopathic hyperacusis subjects and five normal controls. The hyperacusis group demonstrated significantly higher electrical activity in the right auditory-related cortex for the gamma frequency band and left superior parietal lobule (SPL) for the delta frequency band versus the control group. The hyperacusis group also showed significantly decreased functional connectivity between the left auditory cortex (AC) and left orbitofrontal cortex (OFC), between the left AC and left subgenual anterior cingulate cortex (sgACC) for the gamma band, and between the right insula and bilateral dorsal anterior cingulate cortex (dACC) and between the left AC and left sgACC for the theta band versus the control group. The higher electrical activity in the SPL may indicate a readiness of "circuit-breaker" activity to shift attention to forthcoming sound stimuli. Also, because of the disrupted salience network, consisting of the dACC and insula, abnormally increased salience to all sound stimuli may emerge, as a consequence of decreased top-down control of the AC by the dACC and dysfunctional emotional weight attached to auditory stimuli by the OFC. Taken together, abnormally enhanced attention and salience to forthcoming sound stimuli may render hyperacusis subjects hyperresponsive to non-noxious auditory stimuli.

PMID: 29370266 [PubMed - in process]



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Does ambient noise or hypobaric atmosphere influence olfactory and gustatory function?

Does ambient noise or hypobaric atmosphere influence olfactory and gustatory function?

PLoS One. 2018;13(1):e0190837

Authors: Rahne T, Köppke R, Nehring M, Plontke SK, Fischer HG

Abstract
Multidimensional food perception is based mainly on gustatory and olfactory function. Recent research has demonstrated that hypobaric pressure impairs gustatory function and that background noise or distracting auditory stimulation impairs olfactory function. Using a hypobaric chamber, the odor identification, discrimination, and thresholds as well as taste identification and threshold scores were measured in 16 healthy male volunteers under normal and hypobaric (6380 ft) conditions using clinically validated tests. In both conditions, background noise was either canceled out or replaced by white noise presentation (70 dB sound pressure level). Olfactory sensitivity for n-butanol and gustatory sensitivity were impaired in a hypobaric atmosphere. White noise did not influence the odor test results. White noise stimulation impaired sensitivity for sour and sweet but not for bitter or salty tastants. We conclude that hypobaric or noisy environments could impair gustatory and olfactory sensitivity selectively for particular tastants and odorants.

PMID: 29370217 [PubMed - in process]



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Free Flap Transfer for Head and Neck Reconstruction Using Local Anesthesia in Elderly Patients.

Free Flap Transfer for Head and Neck Reconstruction Using Local Anesthesia in Elderly Patients.

Ann Plast Surg. 2018 Jan 25;:

Authors: Hung WY, Tung CC, Fang WY, Kao WP, Lin SL, Poon Y, Chao WN

Abstract
BACKGROUND: The incidence of skin cancer appearing on the head and neck areas is higher in elderly patients. Although free flap reconstruction is the mainstay after tumor excision, it is challenging to complete in elderly patients, owing to the high risk of complications and/or mortality rates associated with the use of general anesthesia. In this study, we used only local anesthesia in free tissue reconstruction of the head and neck in five elderly patients.
MATERIALS AND METHODS: From 2013 to 2016, 5 elderly patients with high risk of general anesthesia underwent reconstruction with either anterolateral thigh free flaps or groin free flap under local anesthesia, after wide excision of malignant tumors at head and neck. For each patient, the following information was collected: age, gender, body weight, anesthesia agents, intravenous fluid, blood loss, site of lesion, flap size, operation time, complications, and follow-up time.
RESULTS: All flaps survived completely. The mean age of 5 patients (3 male patients and 2 female patients) was 84 years (range, 68-100 years), and mean flap size was 199.6 cm (range, 120-330 cm). The mean follow-up period was 26.6 months (range, 5-38 months). No complications were found.
CONCLUSIONS: With proper local anesthesia, successful head and neck reconstruction with free flap was possible, and patient prognosis was positive. There are numerous advantages, including: (1) a safer and inexpensive operation; (2) no complications from general anesthesia; (3) the fact that free flap transfer can be performed in elderly patients, even if they cannot tolerate general anesthesia; and (4) allowance of the performance of free tissue transferring in countries without adequate medical resources.

PMID: 29369912 [PubMed - as supplied by publisher]



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Postoperative Hematoma in Microvascular Reconstruction of the Head and Neck.

Postoperative Hematoma in Microvascular Reconstruction of the Head and Neck.

Ann Plast Surg. 2018 Jan 25;:

Authors: Chen YF, Wang TH, Chiu YH, Chang DH

Abstract
BACKGROUND: Free tissue transfer has become a safe and reliable means for repairing soft tissue and bony defects of the head and neck region. Although the success rate is high, the incidence of postoperative complications is common. One significant complication is postoperative hematoma formation. However, few published studies have addressed its incidence, etiology, or outcome. We performed a retrospective analysis to investigate this issue.
METHODS: A retrospective review was conducted of 293 consecutive microvascular free tissue transfers in the head and neck region in a single institute from January 2013 to December 2015. Patients with postoperative hematoma were identified, and demographic data, perioperative conditions, medications, and outcomes were evaluated by chart review.
RESULTS: A total of 34 patients (11.8%) had postoperative hematoma. Compared with the patients without hematoma, this group had a longer hospital stay (P = 0.06) and required more secondary procedures (P = 0.001). The use of nonsteroidal anti-inflammatory drugs (NSAIDs; P < 0.001) was associated with a higher incidence of hematoma formation. Among the 34 patients with hematoma, 16 (47.1%) had flap compromise and underwent emergent reexploration. The salvage rate was higher than that in the nonhematoma group (87.5% vs 59.3%, P = 0.086).
CONCLUSIONS: Postoperative hematoma after head and neck microvascular reconstruction is not a rare complication and may lead to poor outcome and more complications. The avoidance of NSAIDs preoperatively may prevent hematoma formation. Surgeons should be alert to this situation, and immediate return to the operative room for hematoma evacuation is necessary. Early intervention may contribute to a high salvage rate.

PMID: 29369911 [PubMed - as supplied by publisher]



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Intensive Care Unit Versus Ward Management After Anterolateral Thigh Flap Reconstruction After Oral Cancer Ablation.

Intensive Care Unit Versus Ward Management After Anterolateral Thigh Flap Reconstruction After Oral Cancer Ablation.

Ann Plast Surg. 2018 Jan 25;:

Authors: Chen WC, Hung KS, Chen SH, Shieh SJ, Lee JW, Hsiao JR, Lee YC

Abstract
BACKGROUND: Whether postoperative care in the intensive care unit (ICU) is a necessity for patients undergoing head and neck free flap reconstruction remains debatable. In August 2012, our institute initiated a policy to care for these patients in the ICU, opposed to the previous policy of care in the ward. Thus, we used this opportunity to compare outcomes between these 2 care approaches.
PATIENTS AND METHODS: Patients with oral cancer who underwent cancer ablation and immediate anterolateral thigh flap reconstruction from August 2010 to July 2014 were included in this retrospective study. Patients who simultaneously received an additional flap reconstruction were excluded. Before August 2012, these patients were routinely transferred to the ward for postoperative care (ward group, n = 179). Since August 2012, these patients have routinely been transferred to the ICU for postoperative care (ICU group, n = 138).
RESULTS: Both groups had comparable flap outcomes in terms of the rates of take-back, successful salvage, flap survival, and flap complication. Compared with the ward group, the ICU group showed an increased use of postoperative sedation (26.7% vs 6.8%, P = 0.000), a correspondingly longer use of mechanical ventilation (3.0 ± 2.7 days vs 0.4 ± 1.4 days, P = 0.000), and a higher incidence of sepsis (3.6% vs 0%, P = 0.015).
CONCLUSIONS: Postoperative care of patients who have undergone anterolateral thigh flap reconstruction after oral cancer ablation in the ward or ICU resulted in comparable flap outcomes. Risks and benefits between ward and ICU postoperative management in terms of nursing workloads, monitoring facilities, use of sedation and mechanical ventilation, and potential for sepsis should be taken into consideration when defining postoperative care settings in these patients.

PMID: 29369910 [PubMed - as supplied by publisher]



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Combined Use of Liposuction and Arthroscopic Shaving for Delayed Debulking of Free Flaps in Head and Neck Reconstruction.

Combined Use of Liposuction and Arthroscopic Shaving for Delayed Debulking of Free Flaps in Head and Neck Reconstruction.

Ann Plast Surg. 2018 Jan 25;:

Authors: Lai HT, Kuo PJ, Chang CH, Lai CS, Lin SD, Kuo YR

Abstract
BACKGROUND: Bulky appearance after free flap reconstruction in patients with head and neck cancer is common and requires revision to achieve improved final outcomes. Although different delayed debulking methods have been reported, the procedure can be technically difficult in patients with severe scaring after adjuvant radiotherapy. The present study proposes a combined method of liposuction and arthroscopic shaving for delayed contouring of free flaps in head and neck reconstruction.
METHODS: In this study, 12 patients with head and neck cancer who had bulky flaps after cancer ablation surgery and immediate free anterolateral thigh flap reconstruction were included. These patients underwent delayed debulking through the combined arthroscopic shaving and liposuction method at least 3 months after the initial reconstruction or the completion of adjuvant radiotherapy (if required). Age, sex, cancer stages, the presence or absence of adjuvant radiotherapy, the interval between the initial free flap reconstruction and the debulking procedure, complications, and subjective satisfaction ratings were recorded 1 and 6 months after the revision surgery.
RESULTS: All patients were men, with an average age of 56.3 years (43-69 years), and 9 (75%) patients underwent adjuvant radiotherapy. Partial flap loss was not observed in the study patients, and subjective satisfaction ratings improved after the debulking procedure.
CONCLUSIONS: The combined liposuction and arthroscopic shaving method can facilitate the debulking and contouring procedures in patients with head and neck cancer after free flap reconstruction. With appropriate timing, the combined procedure can be simple and safe, even in patients with severe scaring after adjuvant radiotherapy.

PMID: 29369909 [PubMed - as supplied by publisher]



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EphB4: A promising target for upper Aerodigestive malignancies.

EphB4: A promising target for upper Aerodigestive malignancies.

Biochim Biophys Acta. 2018 Jan 21;:

Authors: Salgia R, Kulkarni P, Gill PS

Abstract
The erythropoietin-producing hepatocellular carcinoma (Eph) receptors are the largest family of receptor tyrosine kinases (RTKs) that include two major subclasses, EphA and EphB. They form an important cell communication system with critical and diverse roles in a variety of biological processes during embryonic development. However, dysregulation of the Eph/ephrin interactions is implicated in cancer contributing to tumour growth, metastasis, and angiogenesis. Here, we focus on EphB4 and review recent developments in elucidating its role in upper aerodigestive malignancies to include lung cancer, head and neck cancer, and mesothelioma. In particular, we summarize information regarding EphB4 structure/function and role in disease pathobiology. We also review the data supporting EphB4 as a potential pharmacological and immunotherapy target and finally, progress in the development of new therapeutic strategies including small molecule inhibitors of its activity is discussed. The emerging picture suggests that EphB4 is a valuable and attractive therapeutic target for upper aerodigestive malignancies.

PMID: 29369779 [PubMed - as supplied by publisher]



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Evaluation of the accuracy and clinical practicality of a calculation system for patient positional displacement in carbon ion radiotherapy at five sites.

Evaluation of the accuracy and clinical practicality of a calculation system for patient positional displacement in carbon ion radiotherapy at five sites.

J Appl Clin Med Phys. 2018 Jan 25;:

Authors: Kubota Y, Hayashi H, Abe S, Souda S, Okada R, Ishii T, Tashiro M, Torikoshi M, Kanai T, Ohno T, Nakano T

Abstract
PURPOSE: We developed a system for calculating patient positional displacement between digital radiography images (DRs) and digitally reconstructed radiography images (DRRs) to reduce patient radiation exposure, minimize individual differences between radiological technologists in patient positioning, and decrease positioning time. The accuracy of this system at five sites was evaluated with clinical data from cancer patients. The dependence of calculation accuracy on the size of the region of interest (ROI) and initial position was evaluated for clinical use.
METHODS: For a preliminary verification, treatment planning and positioning data from eight setup patterns using a head and neck phantom were evaluated. Following this, data from 50 patients with prostate, lung, head and neck, liver, or pancreatic cancer (n = 10 each) were evaluated. Root mean square errors (RMSEs) between the results calculated by our system and the reference positions were assessed. The reference positions were manually determined by two radiological technologists to best-matching positions with orthogonal DRs and DRRs in six axial directions. The ROI size dependence was evaluated by comparing RMSEs for three different ROI sizes. Additionally, dependence on initial position parameters was evaluated by comparing RMSEs for four position patterns.
RESULTS: For the phantom study, the average (± standard deviation) translation error was 0.17 ± 0.05, rotation error was 0.17 ± 0.07, and ΔD was 0.14 ± 0.05. Using the optimal ROI size for each patient site, all cases of prostate, lung, and head and neck cancer with initial position parameters of 10 mm or under were acceptable in our tolerance. However, only four liver cancer cases and three pancreatic cancer cases were acceptable, because of low-reproducibility regions in the ROIs.
CONCLUSION: Our system has clinical practicality for prostate, lung, and head and neck cancer cases. Additionally, our findings suggest ROI size dependence in some cases.

PMID: 29369463 [PubMed - as supplied by publisher]



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Filaggrin gene mutations may influence the persistence of food allergies in Japanese primary school children.

Filaggrin gene mutations may influence the persistence of food allergies in Japanese primary school children.

Br J Dermatol. 2018 Jan 25;:

Authors: Kono M, Akiyama M, Inoue Y, Nomura T, Hata A, Okamoto Y, Takeichi T, Muro Y, McLean WHI, Shimizu H, Sugiura K, Suzuki Y, Shimojo N

Abstract
Mutations in FLG are the underlying cause of ichthyosis vulgaris and are an important predisposing factor for atopic dermatitis (AD).1 In 2011, FLG mutations were reported to increase the risk of peanut allergy2 , and they have been proven to increase the risk of other food sensitizations and allergies.3,4 In this study, we comprehensively screened 411 children in Japan for 10 Japanese-population-specific FLG mutations and suggested that FLG mutations influence the persistence of food allergies (FAs). This article is protected by copyright. All rights reserved.

PMID: 29369340 [PubMed - as supplied by publisher]



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Clinical application of MRI-respiratory gating technology in the evaluation of children with obstructive sleep apnea hypopnea syndrome.

Clinical application of MRI-respiratory gating technology in the evaluation of children with obstructive sleep apnea hypopnea syndrome.

Medicine (Baltimore). 2018 Jan;97(4):e9680

Authors: Zeng G, Teng Y, Zhu J, Zhu D, Yang B, Hu L, Chen M, Fu X

Abstract
The objective of the present study was to investigate the clinical application of magnetic resonance imaging (MRI)-respiratory gating technology for assessing illness severity in children with obstructive sleep apnea hypopnea syndrome (OSAHS).MRI-respiratory gating technology was used to scan the nasopharyngeal cavities of 51 children diagnosed with OSAHS during 6 respiratory phases. Correlations between the ratio of the area of the adenoid to the area of the nasopalatine pharyngeal cavity (Sa/Snp), with the main indexes of polysomnography (PSG), were analyzed. Receiver operator characteristic (ROC) curve and Kappa analysis were used to determine the diagnostic accuracy of Sa/Snp in pediatric OSAHS.The Sa/Snp was positively correlated with the apnea hypopnea index (AHI) (P < .001) and negatively correlated with the lowest oxygen saturation of blood during sleep (LaSO2) (P < .001). ROC analysis in the 6 respiratory phases showed that the area under the curve (AUC) of the Sa/Snp in the end-expiratory phase was the largest (0.992, P < .001), providing a threshold of 69.5% for the diagnosis of severe versus slight-moderate OSAHS in children. Consistency analysis with the AHI showed a diagnosis accordance rate of 96.0% in severe pediatric OSAHS and 96.2% in slight-moderate pediatric OSAHS (Kappa = 0.922, P < .001).Stenosis of the nasopalatine pharyngeal cavity in children with adenoidal hypertrophy was greatest at the end-expiration phase during sleep. The end-expiratory Sa/Snp obtained by a combination of MRI and respiratory gating technology has potential as an important imaging index for diagnosing and evaluating severity in pediatric OSAHS.

PMID: 29369187 [PubMed - in process]



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Targeted next-generation sequencing of malignant peripheral nerve sheath tumor of the pterygopalatine fossa with intracranial metastatic recurrence.

Targeted next-generation sequencing of malignant peripheral nerve sheath tumor of the pterygopalatine fossa with intracranial metastatic recurrence.

Medicine (Baltimore). 2018 Jan;97(4):e9636

Authors: Bao X, Kong X, Yang C, Wu H, Ma W, Wang R

Abstract
Malignant peripheral nerve sheath tumor (MPNST) is an uncommon neoplasm that rarely involves the head and neck region. Intracranial MPNSTs unrelated to cranial nerves are highly malignant tumors with poor overall survival, probably because of infiltrating growth into surrounding brain tissue. The pathogenesis of MPNST remains unclear. There are no conclusive explanations for the mechanisms underlying the initiation, progression, and metastasis of MPNST. In this paper, we describe a case of MPNST in the pterygopalatine fossa with intracranial metastatic recurrence and review related literatures. Meanwhile, targeted next-generation sequencing (NGS) revealed the presence of both a beta-catenin (CTNNB1) missense mutation p.Ser33Phe and a mediator complex subunit 12 (MED12) frameshift mutation p.Tyr1278fs in the recurrent intracranial tumor. Therapies that target CTNNB1 mutation, MED12 mutation, CTNNB1 activation, or Wnt pathway activation are worth future studying.

PMID: 29369179 [PubMed - in process]



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Free flaps for head and neck cancer in paediatric and neonatal patients.

Free flaps for head and neck cancer in paediatric and neonatal patients.

Curr Opin Otolaryngol Head Neck Surg. 2018 Jan 22;:

Authors: Elledge R, Parmar S

Abstract
PURPOSE OF REVIEW: To review recent literature on the subject of free tissue transfer options in paediatric head and neck surgery, with a particular emphasis on highlighting the advantages and disadvantages of different reconstructions in the paediatric patient.
RECENT FINDINGS: Free tissue transfer in paediatric patients is predictable and applicable for a wide range of congenital and acquired defects in the head and neck. The free fibula flap is a mainstay of mandibular reconstruction and allows excellent implant-supported prosthodontic rehabilitation and growth potential at the recipient site with little or no donor site morbidity. Other less commonly explored options include the deep circumflex iliac artery flap, scapula flap and medial femoral condyle flap. The gracilis mucle remains the mainstay for facial reanimation with other options including pectoralis minor, rectus abdominis, extensor digitorum brevis and latissimus dorsi. There are compelling arguments for centralization of services and creative strategies in postoperative rehabilitation (e.g. play therapy).
SUMMARY: Free flaps in paediatric patients are a viable option and may even have advantages relative to adults because of the absence of atherosclerosis, purported lower risk of vasospasm and proportionally larger vessel size. Transfer earlier in life maximizes functional potential and 'normalizes' treatment.

PMID: 29369088 [PubMed - as supplied by publisher]



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The Incidental Splenic Mass at CT: Does It Need Further Work-up? An Observational Study.

The Incidental Splenic Mass at CT: Does It Need Further Work-up? An Observational Study.

Radiology. 2018 Jan 24;:170293

Authors: Siewert B, Millo NZ, Sahi K, Sheiman RG, Brook OR, Sun MRM, Kane RA

Abstract
Purpose To evaluate whether an incidentally noted splenic mass at abdominal computed tomography (CT) requires further imaging work-up. Materials and Methods In this institutional review board-approved HIPAA-compliant retrospective study, a search of a CT database was performed for patients with splenic masses at CT examinations of the abdomen and chest from 2002 to 2008. Patients were divided into three groups: group 1, patients with a history of malignancy; group 2, patients with symptoms such as weight loss, fever, or pain related to the left upper quadrant and epigastrium; and group 3, patients with incidental findings. Patients' CT scans, follow-up examinations, and electronic medical records were reviewed. Final diagnoses of the causes of the masses were confirmed with imaging follow-up (83.9%), clinical follow-up (13.7%), and pathologic examination (2.4%). Results This study included 379 patients, 214 (56.5%) women and 165 (43.5%) men, with a mean age ± standard deviation of 59.3 years ± 15.3 (range, 21-97 years). There were 145 (38.3%) patients in the malignancy group, 29 (7.6%) patients in the symptomatic group, and 205 (54.1%) patients in the incidental group. The incidence of malignant splenic masses was 49 of 145 (33.8%) in the malignancy group, eight of 29 (27.6%) in the symptomatic group, and two of 205 (1.0%) in the incidental group (P < .0001). The incidental group consisted of new diagnoses of lymphoma in one (50%) patient and metastases from ovarian carcinoma in one (50%) patient. Malignant splenic masses in the incidental group were not indeterminate, because synchronous tumors in other organs were diagnostic of malignancy. Conclusion In an incidental splenic mass, the likelihood of malignancy is very low (1.0%). Therefore, follow-up of incidental splenic masses may not be indicated. © RSNA, 2018.

PMID: 29369753 [PubMed - as supplied by publisher]



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Fluorine MR Imaging Monitoring of Tumor Inflammation after High-Intensity Focused Ultrasound Ablation.

Fluorine MR Imaging Monitoring of Tumor Inflammation after High-Intensity Focused Ultrasound Ablation.

Radiology. 2018 Jan 24;:171603

Authors: Shin SH, Park SH, Kim SW, Kim M, Kim D

Abstract
Purpose To investigate whether high-intensity focused ultrasound (HIFU)-induced macrophage infiltration could be longitudinally monitored with fluorine 19 (19F) magnetic resonance (MR) imaging in a quantitative manner. Materials and Methods BALB/c mice were subcutaneously inoculated with 4T1 cells and were separated into three groups: untreated mice (control, n = 9), HIFU-treated mice (HIFU, n = 9), and HIFU- and clodronate-treated mice (HIFU+Clod, n = 9). Immediately after HIFU treatment, all mice were intravenously given perfluorocarbon (PFC) emulsion. MR imaging examinations were performed 2, 4, 7, 10, and 14 days after HIFU treatment. Two-way repeated measures analysis of variance was used to analyze the changes in 19F signal over time and differences between groups. Histologic examinations were performed to confirm in vivo data. Results Fluorine 19 signals were detected at the rims of tumors and the peripheries of ablated lesions. Mean 19F signal in tumors was significantly higher in HIFU-treated mice than in control mice up to day 4 (0.82 ± 0.26 vs 0.42 ± 0.17, P < .001). Fluorine 19 signals were higher in the HIFU+Clod group than in the control group from day 4 (0.82 ± 0.23, P < .001) to day 14 (0.55 ± 0.16 vs 0.28 ± 0.06, P < .05). Histologic examination revealed macrophage infiltration around ablated lesions. Immunofluorescence staining confirmed PFC labeling of macrophages. Conclusion Fluorine 19 MR imaging can longitudinally capture and quantify HIFU-induced macrophage infiltration in preclinical tumor models. © RSNA, 2018 Online supplemental material is available for this article.

PMID: 29369752 [PubMed - as supplied by publisher]



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Extent of BOLD Vascular Dysregulation Is Greater in Diffuse Gliomas without Isocitrate Dehydrogenase 1 R132H Mutation.

Extent of BOLD Vascular Dysregulation Is Greater in Diffuse Gliomas without Isocitrate Dehydrogenase 1 R132H Mutation.

Radiology. 2018 Jan 24;:170790

Authors: Englander ZK, Horenstein CI, Bowden SG, Chow DS, Otten ML, Lignelli A, Bruce JN, Canoll P, Grinband J

Abstract
Purpose To determine the effect that R132H mutation status of diffuse glioma has on extent of vascular dysregulation and extent of residual blood oxygen level-dependent (BOLD) abnormality after surgical resection. Materials and Methods This study was an institutional review board-approved retrospective analysis of an institutional database of patients, and informed consent was waived. From 2010 to 2017, 39 treatment-naïve patients with diffuse glioma underwent preoperative echo-planar imaging and BOLD functional magnetic resonance imaging. BOLD vascular dysregulation maps were made by identifying voxels with time series similar to tumor and dissimilar to healthy brain. The spatial overlap between tumor and vascular dysregulation was characterized by using the Dice coefficient, and areas of BOLD abnormality outside the tumor margins were quantified as BOLD-only fraction (BOF). Linear regression was used to assess effects of R132H status on the Dice coefficient, BOF, and residual BOLD abnormality after surgical resection. Results When compared with R132H wild-type (R132H-) gliomas, R132H-mutated (R132H+) gliomas showed greater spatial overlap between BOLD abnormality and tumor (mean Dice coefficient, 0.659 ± 0.02 [standard error] for R132H+ and 0.327 ± 0.04 for R132H-; P < .001), less BOLD abnormality beyond the tumor margin (mean BOF, 0.255 ± 0.03 for R132H+ and 0.728 ± 0.04 for R132H-; P < .001), and less postoperative BOLD abnormality (residual fraction, 0.046 ± 0.0047 for R132H+ and 0.397 ± 0.045 for R132H-; P < .001). Receiver operating characteristic curve analysis showed high sensitivity and specificity in the discrimination of R132H+ tumors from R132H- tumors with calculation of both Dice coefficient and BOF (area under the receiver operating characteristic curve, 0.967 and 0.977, respectively). Conclusion R132H mutation status is an important variable affecting the extent of tumor-associated vascular dysregulation and the residual vascular dysregulation after surgical resection. © RSNA, 2018 Online supplemental material is available for this article.

PMID: 29369751 [PubMed - as supplied by publisher]



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Targeting the CACNA1A IRES as a Treatment for Spinocerebellar Ataxia Type 6

Abstract

We have discovered that the P/Q-type voltage-gated Ca2+ channel (VGCC) gene, CACNA1A, encodes both the α1A (Cav2.1) subunit and a newly recognized transcription factor, α1ACT, by means of a novel internal ribosomal entry site (IRES) within the α1A C-terminal coding region. α1ACT, when mutated with an expansion of the polyglutamine tract in the C-terminus, gives rise to spinocerebellar ataxia type 6 (SCA6). Because silencing of the entire CACNA1A gene would result in the loss of the essential Cav2.1 channel, the IRES controlling α1ACT expression is an excellent target for selective silencing of α1ACT as a therapeutic intervention for SCA6. We performed a high-throughput screen of FDA-approved small molecules using a dual luciferase reporter system and identified ten hits able to selectively inhibit the IRES. We identified four main candidates that showed selective suppression of α1ACT relative to α1A in HEK cells expressing a native CACNA1A vector. We previously pursued another avenue of molecular intervention through miRNA silencing. We studied three human miRNAs (miRNA-711, -3191-5p, -4786) that would potentially bind to sequences within the CACNA1A IRES region, based on an miRNA prediction program. Only miRNA-3191-5p was found to selectively inhibit the translation of α1ACT in cells. We developed a hyperacute model of SCA6 in mice by injecting a pathogenic form of the IRES-mediated α1ACT (AAV9-α1ACTQ33). Finally, we tested the effectiveness of the miRNA therapy by co-expressing either control miRNA or miRNA-3191-5p and found that miRNA-3191-5p decreased the levels of α1ACTQ33 and prevented the hyperacute disease in mice. These studies provide the proof of principle that a therapy directed at selectively preventing α1ACT expression could be used to treat SCA6.



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Study provides first systematic survey of metabolites across tumour types

In an advance reminiscent of the earliest maps of genomic mutations in cancer, investigators at Dana-Farber Cancer Institute and Memorial Sloan Kettering Cancer Center have completed the first systematic survey of the products of biochemical reactions...

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Altered intrinsic brain activity and memory performance improvement in patients with end-stage renal disease during a single dialysis session

Abstract

Memory deficits are considered to have a great influence on self-management, dietary restriction and therapeutic regimen for end-stage renal disease (ESRD) patients with dialysis treatment. This study was aim to investigate the spontaneous brain activity and its relationship with memory performance in ESRD patients before dialysis (T1) and after 24 h (T2) during a single dialysis session. 23 ESRD patients and 25 matched healthy controls (HCs) were scanned using functional magnetic resonance imaging (fMRI) at T1, and all patients were also scanned at T2. Amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) methods were used to evaluate the spontaneous brain activity between two groups. The Auditory Verbal Learning Test-Huashan version (AVLT-H) was performed to assess memory function. Compared with HCs, ESRD group showed a significant decreases in the immediate recall total score (IR-S), short-term delayed recall score (SR-S), and long-term delayed recall score (LR-S) at T1. IR-S, SR-S, LR-S and recognition score (REC-S) were significantly increased at T2. Compared with HCs at T1, ESRD patients showed that the lower mean ALFF (mALFF) values were mainly located in dorsolateral prefrontal cortex (DLPFC), medial frontal gyrus, and precuneus. Higher ReHo in the bilateral inferior temporal gyrus and left hippocampus and lower ReHo in the right precentral gyrus, anterior cingulate cortex were found at T1 too. The mALFF values of the DLPFC and precuneus were significantly increased during a dialysis session, while no significantly difference of ReHo region was found. Furthermore, the increased mALFF values of the DLPFC were significantly positively correlated with the improvement in the IR-S. Our results indicated that increased regional spontaneous activity of the DLPFC may reflect memory performance improvement after a single dialysis treatment, which may provide insight into the effect of hemodialysis on spontaneous brain function during a single dialysis session.



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Physical activity mitigates adverse effect of metabolic syndrome on vessels and brain

Abstract

Metabolic syndrome (MetS) adversely affects the vasculature and cerebral white matter (CWM) integrity. Arterial stiffening has been associated with diminished CWM integrity. Physical activity (PA) can ameliorate components of MetS and subsequently affect arterial stiffening and CWM integrity. Our aim was to determine the role of PA on mitigating the adverse influence of MetS on arterial stiffness and CWM integrity. In a cross-sectional study design, sixty-six middle-aged adults (40–62 years) composed of 18 sedentary MetS (Sed MetS), 21 physically active MetS (Active MetS), and 27 healthy individuals absent of MetS risk factors were studied. Carotid artery stiffness was assessed via simultaneous ultrasound and tonometry. CWM integrity was measured using diffusion tensor imaging (DTI) through metrics of fractional anisotropy (FA) and mean diffusivity (MD). Carotid β-stiffness index in Active MetS was lower than Sed MetS but was not different from Healthy controls (6.6 ± 1.5, 7.7 ± 2.1, and 5.6 ± 1.6 au, p = 0.001). CWM integrity was significantly greater in Active MetS subjects compared to Sed MetS subjects but statistically equal to Healthy controls in the anterior limb of the internal capsule, and splenium of the corpus callosum, uncinate fasciculus, and superior corona radiata (all p < 0.05). Middle-aged individuals with MetS who habitually perform PA demonstrated lower arterial stiffness and more favorable CWM integrity than their sedentary peers, indicating that PA may be effective in mitigating the adverse effects of MetS on the vasculature and brain at midlife.



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Missing motoric manipulations: rethinking the imaging of the ventral striatum and dopamine in human reward

Abstract

Human neuroimaging studies of natural rewards and drugs of abuse frequently assay the brain’s response to stimuli that, through Pavlovian learning, have come to be associated with a drug’s rewarding properties. This might be characterized as a ‘sensorial’ view of the brain’s reward system, insofar as the paradigms are designed to elicit responses to a reward’s (drug’s) sight, aroma, or flavor. A different field of research nevertheless suggests that the mesolimbic dopamine system may also be critically involved in the motor behaviors provoked by such stimuli. This brief review and commentary surveys some of the preclinical data supporting this more “efferent” (motoric) view of the brain’s reward system, and discusses what such findings might mean for how human brain imaging studies of natural rewards and drugs of abuse are designed.



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Joseph Connors speaks to ecancer at #ASH17 @ASH_hematology about the improvements in treating Hodgkin #Lymphoma.… https://t.co/dKg0aWwrip

Joseph Connors speaks to ecancer at #ASH17 @ASH_hematology about the improvements in treating Hodgkin #Lymphoma.… https://t.co/dKg0aWwrip

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Röntgen-Phasenkontrast

Zusammenfassung

Vor mehr als 100 Jahren entdeckte Max von Laue in München, dass Röntgenstrahlung nicht nur als Röntgenquanten im Teilchenbild interpretiert werden kann, sondern ebenso einen Wellencharakter aufweist. Diese Eigenschaft wird mittlerweile auch schon lange in der Grundlagenforschung eingesetzt (z. B. in der Kristallographie zur Strukturbestimmung von Proteinen), hatte bisher jedoch keine Anwendung in der medizinischen Bildgebung. In den letzten 10 Jahren allerdings konnten in der vorklinischen Forschung sehr große technologische Fortschritte erzielt werden, die eine Nutzung dieses Wellencharakters von Röntgenlicht auch für die medizinische Bildgebung möglich machen. Diese neuartigen Radiographie-Verfahren, die sog. Phasenkontrast- und Dunkelfeldbildgebung, bergen ein großes Potenzial für eine deutliche Verbesserung der Röntgenbildgebung und somit auch der Diagnose von wichtigen Krankheiten. Dieser Artikel zeigt die Grundprinzipien dieser neuen Verfahren auf, fasst exemplarisch die bereits erreichten vorklinischen Forschungsergebnisse an verschiedenen Organen zusammen und zeigt das Potenzial für die zukünftige klinische Nutzung in Radiographie und Computertomographie auf.



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