Τετάρτη, 14 Φεβρουαρίου 2018

Medication-related osteonecrosis of the jaw (MRONJ): an update on the Memorial Sloan Kettering Cancer Center (MSKCC) experience and the role of pre-medication dental evaluation in the prevention of MRONJ

Publication date: Available online 14 February 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Adepitan A. Owosho, See Toh Yoong Liang, Adi Z. Sax, Kant Wu, SaeHee K. Yom, Joseph M. Huryn, Cherry L. Estilo
Objective.We aim to investigate the relationship between type of antiresorptive medication and MRONJ onset and the role of pre-medication dental evaluation (PMDE) in the prevention of MRONJ.Study Design.Our database of MRONJ patients was reviewed. Kruskal-Wallis test was used to analyze the onset dose of the three frequent medication types associated with MRONJ. To evaluate the role of PMDE in the prevention of MRONJ, all patients on anti-resorptive and/or anti-angiogenic medications (A/A) seen in the Dental Service of MSKCC during a 10-year period were sub-classified into two groups. Group I, patients seen for PMDE before the commencement of A/A and Group II, patients seen after prior exposure to A/A. Fischer's exact test was used to compare the incidence of MRONJ in both groups.Results.Patients on denosumab developed MRONJ earlier compared to zoledronate and pamidronate (p=0.003). Group I had a significantly reduced incidence of MRONJ (0.9%) compared to Group II (10.5%) (p<0.0001). Dentoalveolar trauma as a precipitating factor between Groups I and II was not statistically significant.Conclusions.Denosumab was associated with an earlier occurrence of MRONJ compared to zoledronate and pamidronate. The role of PMDE may be an effective preventive strategy in reducing the incidence of MRONJ.



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A chronic oral ulcerative eruption

Publication date: Available online 13 February 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Isabel Schausltz Pereira Faustino, Diego Tetzner Fernandes, Alan Roger dos Santos-Silva, Pablo Agustin Vargas, Marcio Ajudarte Lopes




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Uptake and distribution of organo-iodine in deep-sea corals

Publication date: Available online 13 February 2018
Source:Journal of Environmental Radioactivity
Author(s): Nancy G. Prouty, E. Brendan Roark, Leslye M. Mohon, Ching-Chih Chang
Understanding iodine concentration, transport, and bioavailability is essential in evaluating iodine's impact to the environment and its effectiveness as an environmental biogeotracer. While iodine and its radionuclides have proven to be important tracers in geologic and biologic studies, little is known about transport of this element to the deep sea and subsequent uptake in deep-sea coral habitats. Results presented here on deep-sea black coral iodine speciation and iodine isotope variability provides key information on iodine behavior in natural and anthropogenic environments, and its geochemical pathway in the Gulf of Mexico. Organo-iodine is the dominant iodine species in the black corals, demonstrating that binding of iodine to organic matter plays an important role in the transport and transfer of iodine to the deep-sea corals. The identification of growth bands captured in high-resolution scanning electron images (SEM) with synchronous peaks in iodine variability suggest that riverine delivery of terrestrial-derived organo-iodine is the most plausible explanation to account for annual periodicity in the deep-sea coral geochemistry. Whereas previous studies have suggested the presence of annual growth rings in deep-sea corals, this present study provides a mechanism to explain the formation of annual growth bands. Furthermore, deep-sea coral ages based on iodine peak counts agree well with those ages derived from radiocarbon (14C) measurements. These results hold promise for developing chronologies independent of 14C dating, which is an essential component in constraining reservoir ages and using radiocarbon as a tracer of ocean circulation. Furthermore, the presence of enriched 129I/127I ratios during the most recent period of skeleton growth is linked to nuclear weapons testing during the 1960s. The sensitivity of the coral skeleton to record changes in surface water 129I composition provides further evidence that iodine composition and isotope variability captured in proteinaceous deep-sea corals is a promising geochronometer as well as an emerging tracer for continental material flux.



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Detecting the leakage source of a reservoir using isotopes

Publication date: Available online 13 February 2018
Source:Journal of Environmental Radioactivity
Author(s): Peng Yi, Jing Yang, Yongdong Wang, Vincent de Paul Mugwanezal, Li Chen, Ala Aldahan
A good monitoring method is vital for understanding the sources of a water reservoir leakage and planning for effective restoring. Here we present a combination of several tracers (222Rn, oxygen and hydrogen isotopes, anions and temperature) for identification of water leakage sources in the Pushihe pumped storage power station which is in the Liaoning province, China. The results show an average 222Rn activity of 6843 Bq/m3 in the leakage water, 3034 Bq/m3 in the reservoir water, and 41,759 Bq/m3 in the groundwater. Considering that 222Rn activity in surface water is typically less than 5000 Bq/m3, the low level average 222Rn activity in the leakage water suggests the reservoir water as the main source of water. Results of the oxygen and hydrogen isotopes show comparable ranges and values in the reservoir and the leakage water samples. However, important contribution of the groundwater (up to 36%) was present in some samples from the bottom and upper parts of the underground powerhouse, while the leakage water from some other parts indicate the reservoir water as the dominant source. The isotopic finding suggests that the reservoir water is the main source of the leakage water which is confirmed by the analysis of anions (nitrate, sulfate, and chloride) in the water samples. The combination of these tracer methods for studying dam water leakage improves the accuracy of identifying the source of leaks and provide a scientific reference for engineering solutions to ensure the dam safety.



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Accuracy evaluation of a 3D-printed individual template for needle guidance in head and neck brachytherapy.

https:--academic.oup.com-images-oup_pubm https:--www.ncbi.nlm.nih.gov-corehtml-pm Related Articles

Accuracy evaluation of a 3D-printed individual template for needle guidance in head and neck brachytherapy.

J Radiat Res. 2016 Nov;57(6):662-667

Authors: Huang MW, Zhang JG, Zheng L, Liu SM, Yu GY

Abstract
To transfer the preplan for the head and neck brachytherapy to the clinical implantation procedure, a preplan-based 3D-printed individual template for needle insertion guidance had previously been designed and used. The accuracy of needle insertion using this kind template was assessed in vivo In the study, 25 patients with head and neck tumors were implanted with 125I radioactive seeds under the guidance of the 3D-printed individual template. Patients were divided into four groups based on the site of needle insertion: the parotid and masseter region group (nine patients); the maxillary and paranasal region group (eight patients); the submandibular and upper neck area group (five patients); and the retromandibular region group (six patients). The distance and angular deviations between the preplanned and placed needles were compared, and the complications and time required for needle insertion were assessed. The mean entrance point distance deviation for all 619 needles was 1.18 ± 0.81 mm, varying from 0.857 ± 0.545 to 1.930 ± 0.843 mm at different sites. The mean angular deviation was 2.08 ± 1.07 degrees, varying from 1.85 ± 0.93 to 2.73 ± 1.18 degrees at different sites. All needles were manually inserted to their preplanned positions in a single attempt, and the mean time to insert one needle was 7.5 s. No anatomical complications related to inaccurately placed implants were observed. Using the 3D-printed individual template for the implantation of 125I radioactive seeds in the head and neck region can accurately transfer a CT-based preplan to the brachytherapy needle insertion procedure. Moreover, the addition of individual template guidance can reduce the time required for implantation and minimize the damage to normal tissues.

PMID: 27422928 [PubMed - indexed for MEDLINE]



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What Patients Want to Know about Imaging Examinations: A Multiinstitutional U.S. Survey in Adult and Pediatric Teaching Hospitals on Patient Preferences for Receiving Information before Radiologic Examinations.

What Patients Want to Know about Imaging Examinations: A Multiinstitutional U.S. Survey in Adult and Pediatric Teaching Hospitals on Patient Preferences for Receiving Information before Radiologic Examinations.

Radiology. 2018 Feb 13;:170592

Authors: Pahade JK, Trout AT, Zhang B, Bhambhvani P, Muse VV, Delaney LR, Zucker EJ, Pandharipande PV, Brink JA, Goske MJ

Abstract
Purpose To identify what information patients and parents or caregivers found useful before an imaging examination, from whom they preferred to receive information, and how those preferences related to patient-specific variables including demographics and prior radiologic examinations. Materials and Methods A 24-item survey was distributed at three pediatric and three adult hospitals between January and May 2015. The χ2 or Fisher exact test (categorical variables) and one-way analysis of variance or two-sample t test (continuous variables) were used for comparisons. Multivariate logistic regression was used to determine associations between responses and demographics. Results Of 1742 surveys, 1542 (89%) were returned (381 partial, 1161 completed). Mean respondent age was 46.2 years ± 16.8 (standard deviation), with respondents more frequently female (1025 of 1506, 68%) and Caucasian (1132 of 1504, 75%). Overall, 78% (1117 of 1438) reported receiving information about their examination most commonly from the ordering provider (824 of 1292, 64%), who was also the most preferred source (1005 of 1388, 72%). Scheduled magnetic resonance (MR) imaging or nuclear medicine examinations (P < .001 vs other examination types) and increasing education (P = .008) were associated with higher rates of receiving information. Half of respondents (757 of 1452, 52%) sought information themselves. The highest importance scores for pre-examination information (Likert scale ≥4) was most frequently assigned to information on examination preparation and least frequently assigned to whether an alternative radiation-free examination could be used (74% vs 54%; P < .001). Conclusion Delivery of pre-examination information for radiologic examinations is suboptimal, with half of all patients and caregivers seeking information on their own. Ordering providers are the predominant and preferred source of examination-related information, with respondents placing highest importance on information related to examination preparation. © RSNA, 2018 Online supplemental material is available for this article.

PMID: 29436946 [PubMed - as supplied by publisher]



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Characteristics of Follicular Variant Papillary Thyroid Carcinoma in a Pediatric Cohort.

Characteristics of Follicular Variant Papillary Thyroid Carcinoma in a Pediatric Cohort.

J Clin Endocrinol Metab. 2018 Feb 08;:

Authors: Samuels SL, Surrey LF, Hawkes CP, Amberge M, Mostoufi-Moab S, Langer JE, Adzick NS, Kazahaya K, Bhatti T, Baloch Z, LiVolsi VA, Bauer AJ

Abstract
Context: In adults, non-invasive follicular variant papillary thyroid carcinoma (FVPTC) is considered low risk for metastasis and persistent/recurrent disease.
Objective: The goal of this study was to assess the clinical, sonographic, and histopathological features of FVPTC in a pediatric cohort.
Design: A retrospective review of subjects < 19 years of age with papillary thyroid carcinoma (PTC) who underwent thyroidectomy between January 2010 and July 2015.
Setting: Multidisciplinary, academic referral center.
Patients: Patients with FVPTC, defined as a tumor ≥1.0 cm in largest dimension with predominant follicular growth, complete lack of well-formed papillae, and nuclear features of PTC.
Main Outcome Measure: Tumor size and location, presence of a tumor capsule, capsule and vascular invasion, lymph node and distant metastasis.
Results: Eighteen patients with FVPTC were identified from a case cohort of 110 patients with PTC. On histopathology, 13 (72%) had unifocal nodules and 14 (78%) were completely encapsulated. Capsule invasion was frequent (9/14; 64%) and vascular invasion was found in one third of patients (6/18; 33%). No lymph node metastases were found in the 13 (72%) patients who had a central neck lymph node dissection. One patient with vascular invasion had distant metastases.
Conclusion: When strictly defined, FVPTC in pediatric patients has a low risk for bilateral disease and metastasis. Prospective studies are needed to confirm whether lobectomy with surveillance is sufficient to achieve remission in pediatric patients with low risk FVPTC.

PMID: 29438531 [PubMed - as supplied by publisher]



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Transient Anosmia Induces Depressive-like and Anxiolytic-like Behavior and Reduces Amygdalar Corticotropin-Releasing Hormone in a ZnSO4-induced Mouse Model.

Transient Anosmia Induces Depressive-like and Anxiolytic-like Behavior and Reduces Amygdalar Corticotropin-Releasing Hormone in a ZnSO4-induced Mouse Model.

Chem Senses. 2018 Feb 09;:

Authors: Ahn S, Choi M, Kim H, Yang E, Mahmood U, Kang SI, Shin HW, Kim DW, Kim HS

Abstract
Olfactory loss is known to affect both mood and quality of life. Transient anosmia was induced in mice to study the resulting changes in mood, behavior, and on a molecular level. Transient anosmia was induced by a single intranasal instillation of ZnSO4 in BALB/c mice. Hematoxylin and eosin (HE) staining, and potato chip finding test were performed to confirm olfactory loss. Tail suspension, forced swim, and splash tests were performed to evaluate depression-related behavior; while the open field, and elevated plus maze tests were used to evaluate anxiety-related behavior. The mRNA levels of amygdalar corticotropin releasing hormone (CRH) and hypothalamic glucocorticoid receptor (GR) were quantified using real-time PCR to confirm relevant molecular change. Olfactory loss was confirmed 1-2.5 weeks after induction, and this loss was subsequently reversed over time. The results of the behavioral tests indicated increased depression-like and reduced anxiety-like behavior at week 1. Accordingly, PCR data identified decreased amygdalar CRH expression at week 1. These results suggest that transient anosmia induces both depressive and anxiolytic behavior as a result of decreased amygdalar CRH in a mouse model of anosmia.

PMID: 29438489 [PubMed - as supplied by publisher]



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Evaluation of the 8th TNM classification on p16-positive oropharyngeal squamous cell carcinomas in the Netherlands, and the importance of additional HPV DNA-testing.

Evaluation of the 8th TNM classification on p16-positive oropharyngeal squamous cell carcinomas in the Netherlands, and the importance of additional HPV DNA-testing.

Ann Oncol. 2018 Feb 09;:

Authors: Nauta IH, Rietbergen MM, van Bokhoven AAJD, Bloemena E, Witte BI, Heideman DAM, Baatenburg de Jong RJ, Brakenhoff RH, Leemans CR

Abstract
Background: Oropharyngeal squamous cell carcinomas (OPSCCs) are traditionally caused by smoking and excessive alcohol consumption. However, in the last decades high-risk human papillomavirus (HR-HPV) infections play an increasingly important role in tumorigenesis. HPV-driven OPSCCs are known to have a more favorable prognosis, which has led to important and marked changes in the recently released TNM-8. In this edition, OPSCCs are divided based on p16-immunostaining, with p16-overexpression as surrogate marker for the presence of HPV. The aims of this study are to evaluate TNM-8 on a Dutch consecutive cohort of patients with p16-positive OPSCC and to determine the relevance of additional HPV DNA-testing.
Patients and methods: All OPSCC patients without distant metastases at diagnosis and treated with curative intent at VU University Medical Center (2000-2015) and Erasmus Medical Center (2000-2006) were included (N = 1,204). HPV-status was established by p16-immunostaining followed by HPV DNA-PCR on the p16-immunopositive cases. We compared TNM-7 and TNM-8 using the Harrell's C index.
Results: In total, 388 of 1,204 (32.2%) patients were p16-immunopositive. In these patients, TNM-8 had a markedly better predictive prognostic power than TNM-7 (Harrell's C index 0.63 versus 0.53). Of the 388 p16-positive OPSCCs, 48 tumors (12.4%) were HPV DNA-negative. This subgroup had distinct demographic, clinical and morphologic characteristics and showed a significantly worse five-year overall survival compared to the HPV DNA-positive tumors (P < 0.001).
Conclusions: TNM-8 has a better predictive prognostic power than TNM-7 in patients with p16-positive OPSCC. However, within p16-positive OPSCCs there is an HPV DNA-negative subgroup with distinct features and a worse overall survival, indicating the importance to perform additional HPV DNA-testing when predicting prognosis and particularly for selecting patients for de-intensified treatment regimens.

PMID: 29438466 [PubMed - as supplied by publisher]



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Vestibular schwannomas: Accuracy of tumor volume estimated by ice cream cone formula using thin-sliced MR images.

Vestibular schwannomas: Accuracy of tumor volume estimated by ice cream cone formula using thin-sliced MR images.

PLoS One. 2018;13(2):e0192411

Authors: Ho HH, Li YH, Lee JC, Wang CW, Yu YL, Hueng DY, Ma HI, Hsu HH, Juan CJ

Abstract
PURPOSE: We estimated the volume of vestibular schwannomas by an ice cream cone formula using thin-sliced magnetic resonance images (MRI) and compared the estimation accuracy among different estimating formulas and between different models.
METHODS: The study was approved by a local institutional review board. A total of 100 patients with vestibular schwannomas examined by MRI between January 2011 and November 2015 were enrolled retrospectively. Informed consent was waived. Volumes of vestibular schwannomas were estimated by cuboidal, ellipsoidal, and spherical formulas based on a one-component model, and cuboidal, ellipsoidal, Linskey's, and ice cream cone formulas based on a two-component model. The estimated volumes were compared to the volumes measured by planimetry. Intraobserver reproducibility and interobserver agreement was tested. Estimation error, including absolute percentage error (APE) and percentage error (PE), was calculated. Statistical analysis included intraclass correlation coefficient (ICC), linear regression analysis, one-way analysis of variance, and paired t-tests with P < 0.05 considered statistically significant.
RESULTS: Overall tumor size was 4.80 ± 6.8 mL (mean ±standard deviation). All ICCs were no less than 0.992, suggestive of high intraobserver reproducibility and high interobserver agreement. Cuboidal formulas significantly overestimated the tumor volume by a factor of 1.9 to 2.4 (P ≤ 0.001). The one-component ellipsoidal and spherical formulas overestimated the tumor volume with an APE of 20.3% and 29.2%, respectively. The two-component ice cream cone method, and ellipsoidal and Linskey's formulas significantly reduced the APE to 11.0%, 10.1%, and 12.5%, respectively (all P < 0.001).
CONCLUSION: The ice cream cone method and other two-component formulas including the ellipsoidal and Linskey's formulas allow for estimation of vestibular schwannoma volume more accurately than all one-component formulas.

PMID: 29438424 [PubMed - in process]



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Antitumor effect of the Newcastle disease viral hemagglutinin-neuraminidase gene is expressed through an oncolytic adenovirus effect in osteosarcoma cells.

Antitumor effect of the Newcastle disease viral hemagglutinin-neuraminidase gene is expressed through an oncolytic adenovirus effect in osteosarcoma cells.

Anticancer Drugs. 2018 Mar;29(3):197-207

Authors: Chen S, Zhang Q, Xu D, Li Y, Fan Y, Li W, Yin X, Zhang Y, Liu J, Li X, Sun L, Jin N

Abstract
Newcastle disease virus (NDV) can specifically kill cancer cells and has less toxicity to normal cells. The hemagglutinin-neuraminidase (HN) protein is an important structural protein in NDV pathogenesis and has been postulated as a promising candidate for antitumor therapy. The aim of this study was to investigate the anticancer potential of recombinant adenovirus Ad-HN-PEG3p-E1a. An MTS assay was performed to determine viral proliferation after viral infection, the data showed that the proliferation ability of osteosarcoma cells decreased, whereas there was no significant change in normal hepatic cells. DAPI and Annexin V experiments showed that osteosarcoma cells were killed because of apoptosis, active oxygen content, and augmented mitochondrial membrane potential loss. Caspase Activity Assay Kits were used to detect the caspase-3 activities of the treated OS-732 for increased expression. Western blot analysis showed that cytochrome C increased significantly and apoptosis of the virus was confirmed in tumor cells. In-vivo experiments show that NDV has an inhibitory effect on tumor growth. The recombinant adenovirus, which is composed of a HN protein and progressive increment promoter PEG3p, could inhibit the growth of OS-732 and promote the apoptosis of tumor cells. However, there was no clear relationship with normal cell (L02) apoptosis.

PMID: 29438228 [PubMed - in process]



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Seasonal Variation of Epistaxis in Germany.

Seasonal Variation of Epistaxis in Germany.

J Craniofac Surg. 2018 Feb 12;:

Authors: Seidel DU, Sesterhenn AM, Kostev K

Abstract
AIM: The goal of the present study was to analyze the seasonal variation of epistaxis in ear, nose, and throat (ENT) practices in Germany in 2016.
METHODS: The present study sample included patients who received a first epistaxis diagnosis from physicians in 114 ENT practices in Germany between January 2016 and December 2016. The number of epistaxis patients per practice was calculated for each month. A logistic regression model, adjusted for age and sex, was used to calculate the association between epistaxis diagnosis and the month.
RESULTS: The authors found a total of 15,523 patients with epistaxis in 114 ENT practices. Of these patients, 55.9% were men and the mean age was 47.8 ± 27.6 years. The highest number of epistaxis patients was found in February (14.89 patients per practice) and the lowest in August (7.22 patients per practice). The age- and sex-adjusted risk of epistaxis was significantly higher in the months of February (OR = 1.32), March (OR = 1.37), April (OR = 1.34), May (OR = 1.35), and December (OR = 1.33) compared with August.
CONCLUSIONS: The presentation of patients with epistaxis at German ENT practices shows a marked seasonal variation with a low in the summer, an increase in fall and winter, and a peak in February, March, and April.

PMID: 29438211 [PubMed - as supplied by publisher]



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Hemangioma of the Hard Palate in an Elderly Patient as a Life-Threatening Surgical Emergency.

Hemangioma of the Hard Palate in an Elderly Patient as a Life-Threatening Surgical Emergency.

J Craniofac Surg. 2018 Feb 12;:

Authors: Uluyol S

Abstract
Hemangiomas of the head and neck are common benign tumors usually in childhood. They are rarely seen in hard palate. The authors present a geriatric patient with abundant hemorrhage due to a capillary hemangioma of the hard palate. Management and treatment approaches of this rare, urgent, and life-threatening situation is discussed.

PMID: 29438210 [PubMed - as supplied by publisher]



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Endoscopic Modified Medial Maxillectomy for Fungal Ball of the Hypoplastic Maxillary Sinus With Bony Hypertrophy.

Endoscopic Modified Medial Maxillectomy for Fungal Ball of the Hypoplastic Maxillary Sinus With Bony Hypertrophy.

J Craniofac Surg. 2018 Feb 12;:

Authors: Nomura K, Ikushima H, Ozawa D, Shimizu Y, Arakawa K, Suzuki J, Hidaka H, Katori Y, Ohyama K

Abstract
Sinus fungal ball is defined as noninvasive chronic rhino-sinusitis with a clump of mold in the paranasal sinuses, typically affecting the maxillary sinus. Fairly good outcomes of endoscopic surgery have been reported where the ball is removed through the antrostomy. However, the affected sinus tends to have a smaller cavity and thicker bony walls. As such, it is often challenging to maintain a window size that is sufficient to control possible recurrence. The endoscopic modified medial maxillectomy procedure was applied to a 61-year old and a 70-year old female patient with maxillary sinus fungal ball. Using this method, we created a much larger inferior meatal antrostomy without difficulty. The window provided us with an endoscopic view of the whole sinus and complete eradication of the lesion. Endoscopic modified medial maxillectomy is useful as a surgical procedure for maxillary sinus fungal ball and should be considered for better outcomes.

PMID: 29438202 [PubMed - as supplied by publisher]



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INSM1 is a Sensitive and Specific Marker of Neuroendocrine Differentiation in Head and Neck Tumors.

INSM1 is a Sensitive and Specific Marker of Neuroendocrine Differentiation in Head and Neck Tumors.

Am J Surg Pathol. 2018 Feb 12;:

Authors: Rooper LM, Bishop JA, Westra WH

Abstract
The head and neck is the site of a wide and sometimes bewildering array of neuroendocrine (NE) tumors. Although recognition of NE differentiation may be necessary for appropriate tumor classification and treatment, traditional NE markers such as synaptophysin, chromogranin, and CD56 are not always sufficiently sensitive or specific to make this distinction. Insulinoma-associated protein 1 (INSM1) is a novel transcription factor that has recently demonstrated excellent sensitivity and specificity for NE differentiation in various anatomic sites, but has not yet been extensively evaluated in tumors of the head and neck. We performed INSM1 immunohistochemistry on NE tumors (n=97) and non-NE tumors (n=626) across all histologic grades and anatomic subsites of the head and neck. INSM1 was positive in all types of head and neck NE tumors evaluated here (99.0% sensitivity), including middle ear adenoma, pituitary adenoma, paraganglioma, medullary thyroid carcinoma, olfactory neuroblastoma, small cell carcinoma, large cell NE carcinoma, and sinonasal teratocarcinosarcoma. Notably, it was positive in the vast majority of high-grade NE malignancies (95.8% sensitivity). INSM1 also was negative in almost all non-NE tumors (97.6% specificity) with the highest rates of reactivity in alveolar rhabdomyosarcoma and SWI/SNF related, matrix associated, actin dependent regulator of chromatin, subfamily B, member 1 (SMARCB1)-deficient sinonasal carcinoma. These findings confirm that INSM1 may be used as a standalone first-line marker of NE differentiation for tumors of the head and neck.

PMID: 29438167 [PubMed - as supplied by publisher]



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Lymphangitis carcinomatosa of a cutaneous squamous cell carcinoma.

Lymphangitis carcinomatosa of a cutaneous squamous cell carcinoma.

BMJ Case Rep. 2018 Feb 08;2018:

Authors: van Kester MS, Genders RE, Quint KD

PMID: 29437807 [PubMed - in process]



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Nasopharyngeal angiofibroma in a 32-year-old man.

Nasopharyngeal angiofibroma in a 32-year-old man.

BMJ Case Rep. 2018 Feb 08;2018:

Authors: McGarey PO, David AP, Payne SC

Abstract
Nasopharyngeal angiofibroma (NA) is a benign, highly vascularised tumour of the nasopharynx, which typically occurs in young males aged 14-25 years. We report an interesting case of an NA arising de novo in a 32-year-old male. He was referred to our facility for severe nasal haemorrhage after biopsy of a left nasopharyngeal mass. In the operating room, extensive bleeding was noted, and an endoscopic medial maxillectomy was performed, and the left internal maxillary artery was ligated allowing for near total resection of the lesion. The pathological specimen confirmed the diagnosis of NA. To our knowledge, this is one of the oldest patients presenting with a de novo NA, in his fourth decade of life, confirming that this diagnosis must be considered in all those with large nasopharyngeal masses.

PMID: 29437803 [PubMed - in process]



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Vertebro-vertebral fistula presenting as a pulsatile tinnitus.

Vertebro-vertebral fistula presenting as a pulsatile tinnitus.

BMJ Case Rep. 2018 Feb 05;2018:

Authors: Breda MS, Amorim J, Rocha J, Dias L

Abstract
Tinnitus is the perception of sound in the absence of a corresponding external acoustic stimulus, resulting in an estimated prevalence of 10% to 15% in adults. Tinnitus may be classified as pulsatile (PT) or continuous (non-PT), and may be subjective (heard only by the patient) or objective (also audible to the examiner). PT is usually related to vascular causes and is pulse synchronous (coinciding with the patient's heartbeat). PT is much less common affecting approximately 4% of patients with tinnitus, but unlike non-PT, usually has a specific identifiable cause. We present a case of a man without previous otological disease or head trauma, with a left-ear subjective PT. MR angiography detected a left vertebro-vertebral arteriovenous fistula, which was treated by endovascular embolisation with important symptomatic relief.

PMID: 29437736 [PubMed - in process]



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Temporal bone neoplasia: a rare entity.

Temporal bone neoplasia: a rare entity.

BMJ Case Rep. 2018 Feb 07;2018:

Authors: Breda MS, Menezes AS, Miranda DA, Rocha J

PMID: 29437713 [PubMed - in process]



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Opioid Stewardship in Otolaryngology: State of the Art Review.

Opioid Stewardship in Otolaryngology: State of the Art Review.

Otolaryngol Head Neck Surg. 2018 Feb 01;:194599818757999

Authors: Cramer JD, Wisler B, Gouveia ACJ

Abstract
Objective The United States is facing an epidemic of opioid addiction. Deaths from opioid overdose have quadrupled in the past 15 years and now surpass annual deaths during the height of the human immunodeficiency virus epidemic. There is a link between opioid prescriptions after surgery, opioid misuse, opioid diversion, and use of other drugs of abuse. As surgeons, otolaryngologists contribute to this crisis. Our objective is to outline the risk of abuse from opioids in the management of acute postoperative pain in otolaryngology-head and neck surgery (OHNS) and strategies to avoid misuse. Data Sources PubMed/MEDLINE. Review Methods We conducted a review of the literature on the rate of opioid abuse after surgery, methods of safe opioid use, and strategies to minimize the dangers of opioids. Conclusions Otolaryngologists have a responsibility to treat pain. This begins preoperatively by discussing perioperative pain control and developing a personalized pain control plan. Patients should be aware that opioids carry significant risks of adverse events and abuse. Perioperative use of multimodal nonopioid agents enables pain control and avoidance of opioids in many otolaryngologic cases. When this approach is inadequate, opioids should be used in short duration under close surveillance. Institutional standards for opioid prescribing after common procedures can minimize misuse. Implications for Practice Otolaryngologists need to acknowledge the potential harm that opioids cause. It is essential that we evaluate our practices to ensure that opioids are used responsibly. Furthermore, opioid stewardship should become a priority in otolaryngology.

PMID: 29437536 [PubMed - as supplied by publisher]



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Tracheotomy for Difficult Airway Foreign Bodies in Children.

Tracheotomy for Difficult Airway Foreign Bodies in Children.

Otolaryngol Head Neck Surg. 2018 Feb 01;:194599818758995

Authors: Samra S, Schroeder JW, Valika T, Billings KR

PMID: 29437526 [PubMed - as supplied by publisher]



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Recurrent rearrangements of the PLAG1 and HMGA2 genes in lacrimal gland pleomorphic adenoma and carcinoma ex pleomorphic adenoma.

Recurrent rearrangements of the PLAG1 and HMGA2 genes in lacrimal gland pleomorphic adenoma and carcinoma ex pleomorphic adenoma.

Acta Ophthalmol. 2018 Feb 13;:

Authors: Andreasen S, von Holstein SL, Homøe P, Heegaard S

Abstract
PURPOSE: Lacrimal gland tumours constitute a wide spectrum of neoplastic lesions that are histologically similar to tumours of the salivary gland. In the salivary gland, pleomorphic adenoma (PA) is frequently characterized by recurrent chromosomal rearrangements of the PLAG1 and HMGA2 genes, a genetic feature retained in carcinoma ex pleomorphic adenoma (ca-ex-PA) that makes it possible to distinguish ca-ex-PA from de novo carcinomas. However, whether PLAG1 and HMGA2 gene rearrangements are found in lacrimal gland PA and ca-ex-PA is not known.
METHODS: Twenty-one lacrimal gland PAs and four ca-ex-PAs were retrospectively reviewed and subjected to break-apart fluorescence in situ hybridization (FISH) for rearrangements of the PLAG1 gene. Cases without PLAG1 abnormalities were subjected to HMGA2 break-apart FISH. Immunohistochemical staining for PLAG1 and HMGA2 protein was performed and correlated with gene status.
RESULTS: Sixteen of 21 PAs showed rearrangement of PLAG1 and were all positive for PLAG1 protein. Two of the remaining five PAs showed rearrangement of HMGA2 and were the only cases positive for HMGA2 with immunohistochemistry. The three FISH-negative PAs expressed PLAG1 protein. All four ca-ex-PAs showed rearrangement of PLAG1 and expressed PLAG1 protein. None of the de novo carcinomas showed rearrangement of either of the two genes or expression of the two proteins.
CONCLUSION: Rearrangement of PLAG1 and HMGA2 and expression of the corresponding proteins are frequent and specific findings in lacrimal gland PA and ca-ex-PA. The mechanism for PLAG1 overexpression in FISH-negative PAs is yet to be clarified.

PMID: 29437290 [PubMed - as supplied by publisher]



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Evaluation of Leptomeningeal Contrast Enhancement Using Pre-and Postcontrast Subtraction 3D-FLAIR Imaging in Multiple Sclerosis.

Evaluation of Leptomeningeal Contrast Enhancement Using Pre-and Postcontrast Subtraction 3D-FLAIR Imaging in Multiple Sclerosis.

AJNR Am J Neuroradiol. 2018 Feb 08;:

Authors: Zivadinov R, Ramasamy DP, Hagemeier J, Kolb C, Bergsland N, Schweser F, Dwyer MG, Weinstock-Guttman B, Hojnacki D

Abstract
BACKGROUND AND PURPOSE: Leptomeningeal contrast enhancement is found in patients with multiple sclerosis, though reported rates have varied. The use of 3D-fluid-attenuated inversion recovery pre- and postcontrast subtraction imaging may more accurately determine the frequency of leptomeningeal contrast enhancement. The purpose of this study was to investigate the frequency of leptomeningeal contrast enhancement using the pre- and postcontrast subtraction approach and to evaluate 3 different methods of assessing the presence of leptomeningeal contrast enhancement.
MATERIALS AND METHODS: We enrolled 258 consecutive patients with MS (212 with relapsing-remitting MS, 32 with secondary-progressive MS, and 14 with clinically isolated syndrome) who underwent both pre- and 10-minute postcontrast 3D-FLAIR sequences after a single dose of gadolinium injection on 3T MR imaging. The analysis included leptomeningeal contrast-enhancement evaluation on 3D-FLAIR postcontrast images in native space (method A), on pre- and postcontrast 3D-FLAIR images in native space (method B), and on pre-/postcontrast 3D-FLAIR coregistered and subtracted images (method C, used as the criterion standard).
RESULTS: In total, 51 (19.7%) patients with MS showed the presence of leptomeningeal contrast enhancement using method A; 39 (15.1%), using method B; and 39 (15.1%), using method C (P = .002). Compared with method C as the criterion standard, method A showed 89.8% sensitivity and 92.7% specificity, while method B showed 84.6% sensitivity and 97.3% specificity (P < .001) at the patient level. Reproducibility was the highest using method C (κ agreement, r = 088, P < .001). The mean time to analyze the 3D-FLAIR images was significantly lower with method C compared with methods A and B (P < .001).
CONCLUSIONS: 3D-FLAIR postcontrast imaging offers a sensitive method for detecting leptomeningeal contrast enhancement in patients with MS. However, the use of subtraction imaging helped avoid false-positive cases, decreased reading time, and increased the accuracy of leptomeningeal contrast-enhancement foci detection in a clinical routine.

PMID: 29439125 [PubMed - as supplied by publisher]



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Dual-Energy CT in Hemorrhagic Progression of Cerebral Contusion: Overestimation of Hematoma Volumes on Standard 120-kV Images and Rectification with Virtual High-Energy Monochromatic Images after Contrast-Enhanced Whole-Body Imaging.

Dual-Energy CT in Hemorrhagic Progression of Cerebral Contusion: Overestimation of Hematoma Volumes on Standard 120-kV Images and Rectification with Virtual High-Energy Monochromatic Images after Contrast-Enhanced Whole-Body Imaging.

AJNR Am J Neuroradiol. 2018 Feb 08;:

Authors: Bodanapally UK, Shanmuganathan K, Issa G, Dreizin D, Guang L, Sudini K, Fleiter TR

Abstract
BACKGROUND AND PURPOSE: In patients with hemorrhagic contusions, hematoma volumes are overestimated on follow-up standard 120-kV images obtained after contrast-enhanced whole-body CT. We aimed to retrospectively determine hemorrhagic progression of contusion rates on 120-kV and 190-keV images derived from dual-energy CT and the magnitude of hematoma volume overestimation.
MATERIALS AND METHODS: We retrospectively analyzed admission and follow-up CT studies in 40 patients with hemorrhagic contusions. After annotating the contusions, we measured volumes from admission and follow-up 120-kV and 190-keV images using semiautomated 3D segmentation. Bland-Altman analysis was used for hematoma volume comparison.
RESULTS: On 120-kV images, hemorrhagic progression of contusions was detected in 24 of the 40 patients, while only 17 patients had hemorrhagic progression of contusions on 190-keV images (P = .008). Hematoma volumes were systematically overestimated on follow-up 120-kV images (9.68 versus 8 mm3; mean difference, 1.68 mm3; standard error, 0.37; P < .001) compared with 190-keV images. There was no significant difference in volumes between admission 120-kV and 190-keV images. Mean and median percentages of overestimation were 29% (95% CI, 18-39) and 22% (quartile 3 - quartile 1 = 36.8), respectively.
CONCLUSIONS: The 120-kV images, which are comparable with single-energy CT images, significantly overestimated the hematoma volumes, hence the rate of hemorrhagic progression of contusions, after contrast-enhanced whole-body CT. Hence, follow-up of hemorrhagic contusions should be performed on dual-energy CT, and 190-keV images should be used for the assessment of hematoma volumes.

PMID: 29439124 [PubMed - as supplied by publisher]



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Endovascular Thrombectomy in Wake-Up Stroke and Stroke with Unknown Symptom Onset.

Endovascular Thrombectomy in Wake-Up Stroke and Stroke with Unknown Symptom Onset.

AJNR Am J Neuroradiol. 2018 Feb 08;:

Authors: Bücke P, Pérez MA, Hellstern V, AlMatter M, Bäzner H, Henkes H

Abstract
BACKGROUND AND PURPOSE: Mechanical thrombectomy in acute ischemic stroke within 6 hours of symptom onset is effective and safe. However, in many patients, information on the beginning of symptoms is not available. Patients can be divided into those with wake-up stroke and daytime-unwitnessed stroke. Evidence on outcome and complications after mechanical thrombectomy in wake-up stroke and daytime-unwitnessed stroke is rare. A potential beneficial effect of mechanical thrombectomy in selected patients with wake-up stroke or daytime-unwitnessed stroke is suspected.
MATERIALS AND METHODS: We analyzed 1073 patients with anterior circulation stroke undergoing mechanical thrombectomy between 2010 and 2016. Patients with wake-up stroke and daytime-unwitnessed stroke were compared with controls receiving mechanical thrombectomy as the standard of care. We assessed good functional outcome (mRS ≤ 2 at 3 months), mortality rates, and frequencies of symptomatic intracranial hemorrhage. Subgroup analyses tried to detect influences of patient selection via further imaging modalities (MR imaging, CTP; wake-up stroke [advanced], daytime-unwitnessed stroke [advanced]) on outcome and safety.
RESULTS: There was no significant difference in good functional outcome between patients with wake-up stroke and controls (35.9% versus 38.3%, P = .625). Outcome in patients with daytime-unwitnessed stroke was inferior compared with controls (27.3%, P = .007). Groups did not differ in all-cause mortality at day 90 (P = .224) and the rate of symptomatic intracranial hemorrhage (P = .292). Advanced imaging improved the frequency of good functional outcome (non-wake-up stroke [advanced] versus wake-up stroke [advanced]: OR, 2.92; 95% CI, 1.32-6.45; non-daytime-unwitnessed stroke [advanced] versus daytime-unwitnessed stroke [advanced]: OR, 2.09; 95% CI, 1.03-4.25) with an additional reduction in all-cause mortality (non-daytime-unwitnessed stroke [advanced] versus daytime-unwitnessed stroke [advanced]: OR, 0.42; 95% CI, 0.20-0.88).
CONCLUSIONS: Mechanical thrombectomy in selected patients with wake-up stroke allows a good functional outcome comparable with that of controls. Outcome after mechanical thrombectomy in daytime-unwitnessed stroke seems to be inferior compared with that in controls. Advanced imaging modalities may increase the frequency of good functional outcome in both patients with wake-up stroke and daytime-unwitnessed stroke.

PMID: 29439123 [PubMed - as supplied by publisher]



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Iron-Insensitive Quantitative Assessment of Subcortical Gray Matter Demyelination in Multiple Sclerosis Using the Macromolecular Proton Fraction.

Iron-Insensitive Quantitative Assessment of Subcortical Gray Matter Demyelination in Multiple Sclerosis Using the Macromolecular Proton Fraction.

AJNR Am J Neuroradiol. 2018 Feb 08;:

Authors: Yarnykh VL, Krutenkova EP, Aitmagambetova G, Repovic P, Mayadev A, Qian P, Jung Henson LK, Gangadharan B, Bowen JD

Abstract
BACKGROUND AND PURPOSE: Fast macromolecular proton fraction mapping is a recent quantitative MR imaging method for myelin assessment. The objectives of this study were to evaluate the macromolecular proton fraction as a measure of demyelination in subcortical GM structures in multiple sclerosis and assess a potential relationship between demyelination and excess iron deposition using the macromolecular proton fraction and T2* mapping.
MATERIALS AND METHODS: Macromolecular proton fraction and T2* maps were obtained from 12 healthy controls, 18 patients with relapsing-remitting MS, and 12 patients with secondary-progressive MS using 3T MR imaging. Parameter values in the caudate nucleus, globus pallidus, putamen, substantia nigra, and thalamus were compared between groups and correlated to clinical data.
RESULTS: The macromolecular proton fraction in all subcortical structures and T2* in the globus pallidus, putamen, and caudate nucleus demonstrated a significant monotonic decrease from controls to patients with relapsing-remitting MS and from those with relapsing-remitting MS to patients with secondary-progressive MS. The macromolecular proton fraction in all subcortical structures significantly correlated with the Expanded Disability Status Scale and MS Functional Composite scores with absolute Pearson correlation coefficient (r) values in a range of 0.4-0.6. Significant correlations (r = -0.4 to -0.6) were also identified between the macromolecular proton fraction and the 9-Hole Peg Test, indicating a potential relationship with nigrostriatal pathway damage. Among T2* values, weak significant correlations with clinical variables were found only in the putamen. The macromolecular proton fraction did not correlate with T2* in any of the studied anatomic structures.
CONCLUSIONS: The macromolecular proton fraction provides an iron-insensitive measure of demyelination. Myelin loss in subcortical GM structures in MS is unrelated to excess iron deposition. Subcortical GM demyelination is more closely associated with the disease phenotype and disability than iron overload.

PMID: 29439122 [PubMed - as supplied by publisher]



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Brain Imaging in Cases with Positive Serology for Dengue with Neurologic Symptoms: A Clinicoradiologic Correlation.

Brain Imaging in Cases with Positive Serology for Dengue with Neurologic Symptoms: A Clinicoradiologic Correlation.

AJNR Am J Neuroradiol. 2018 Feb 08;:

Authors: Vanjare HA, Mannam P, Mishra AK, Karuppusami R, Carey RAB, Abraham AM, Rose W, Iyyadurai R, Mani S

Abstract
BACKGROUND AND PURPOSE: Dengue is a common arboviral disease, which uncommonly involves the brain. There has been a recent surge in dengue cases and dengue-related deaths in tropical countries. The aim of this study was to describe brain imaging findings in patients with dengue infection having neurologic symptoms.
MATERIALS AND METHODS: Thirty-five patients with positive serology for dengue with CNS symptoms undergoing imaging of the brain were included in the study. Clinical, laboratory, and imaging parameters were assessed and correlated to poor outcome.
RESULTS: A Glasgow Coma Scale score of ≤12 at presentation, clinical classification of severe-type dengue, and the presence of acute renal failure were associated with poor outcome. Imaging parameters associated with poor outcome were involvement of the thalami and cerebellar peduncles and the presence of diffusion restriction and hemorrhagic foci in the brain parenchyma.
CONCLUSIONS: Although not specific, dengue infection has imaging findings that can be used to narrow down the differential list and help in prognostication.

PMID: 29439121 [PubMed - as supplied by publisher]



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Improved Visualization of Cortical Lesions in Multiple Sclerosis Using 7T MP2RAGE.

Improved Visualization of Cortical Lesions in Multiple Sclerosis Using 7T MP2RAGE.

AJNR Am J Neuroradiol. 2018 Feb 08;:

Authors: Beck ES, Sati P, Sethi V, Kober T, Dewey B, Bhargava P, Nair G, Cortese IC, Reich DS

Abstract
BACKGROUND AND PURPOSE: Cortical lesions are common and often extensive in multiple sclerosis but are difficult to visualize by MRI, leaving important questions about their clinical implications and response to therapy unanswered. Our aim was to determine whether cortical lesions are better visualized using magnetization prepared 2 rapid acquisition gradient echoes (MP2RAGE) than T2*-weighted imaging on 7T MR imaging.
MATERIALS AND METHODS: Brain MR imaging using T1-weighted MP2RAGE at 500-μm isotropic resolution, T2*-weighted gradient-echo, and T2*-weighted segmented echo-planar imaging sequences were collected for 13 patients with MS and 5 age-matched neurologically healthy controls on a 7T research system. One MS case underwent postmortem MR imaging including gradient-echo and MP2RAGE sequences, after which cortical lesions seen on MR imaging were assessed with immunohistochemistry.
RESULTS: MP2RAGE detected 203 cortical lesions (median, 16 lesions/case; interquartile range, 15), compared to 92 with T2*gradient-echo (median, 7; interquartile range, 8; P < .001) and 81 with T2*EPI (median, 7; interquartile range, 5; P < .001). This increase in lesion number detected on MP2RAGE versus T2* was observed for juxtacortical, leukocortical, and intracortical lesions. Forty-three percent of all cortical lesions were identified only on MP2RAGE. White matter lesion volume correlated with total juxtacortical (r = 0.86, P < .001) and leukocortical lesion volume (r = 0.70, P < .01) but not intracortical lesion volume, suggesting that pathophysiology may differ by lesion type. Of 4 suspected lesions seen on postmortem imaging, 3 were found to be true cortical lesions while 1 represented postmortem tissue damage.
CONCLUSIONS: A combination of MP2RAGE and T2*-weighted imaging at 7T improved detection of cortical lesions and should enable longitudinal studies to elucidate their spatiotemporal dynamics and clinical implications.

PMID: 29439120 [PubMed - as supplied by publisher]



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"Otolaryngol Head Neck Surg"[jour]; +17 new citations

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

"Otolaryngol Head Neck Surg"[jour]

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Reactive Oxygen Species: Involvement in T Cell Signaling and Metabolism

Publication date: Available online 13 February 2018
Source:Trends in Immunology
Author(s): Davide G. Franchina, Catherine Dostert, Dirk Brenner
T cells are a central component of defenses against pathogens and tumors. Their effector functions are sustained by specific metabolic changes that occur upon activation, and these have been the focus of renewed interest. Energy production inevitably generates unwanted products, namely reactive oxygen species (ROS), which have long been known to trigger cell death. However, there is now evidence that ROS also act as intracellular signaling molecules both in steady-state and upon antigen recognition. The levels and localization of ROS contribute to the redox modeling of effector proteins and transcription factors, influencing the outcome of the T cell response. We discuss here how ROS can directly fine-tune metabolism and effector functions of T cells.



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Orchestration of NLRP3 Inflammasome Activation by Ion Fluxes

Publication date: Available online 13 February 2018
Source:Trends in Immunology
Author(s): Tao Gong, Yanqing Yang, Tengchuan Jin, Wei Jiang, Rongbin Zhou
The assembly of the NLRP3 inflammasome can promote the release of IL-1β/IL-18 and initiate pyroptosis. Accordingly, the dysregulation of NLRP3 inflammasome activation is involved in a variety of human diseases, including gout, diabetes, and Alzheimer’s disease. NLRP3 can sense a variety of structurally unrelated pathogen-associated molecular patterns (PAMPs) or danger-associated molecular patterns (DAMPs) to trigger inflammation, but the unifying mechanism of NLRP3 activation is still poorly understood. Increasing evidence suggests that intracellular ions, such as K+, Ca2+, and Cl, have a significant role in NLRP3 inflammasome activation. Here, we review the current knowledge about the role of ionic fluxes in NLRP3 inflammasome activation and discuss how disturbances in intracellular ionic levels orchestrate different signaling events upstream of NLRP3.



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Symposium review: Lactococcus lactis from nondairy sources: Their genetic and metabolic diversity and potential applications in cheese

Publication date: Available online 13 February 2018
Source:Journal of Dairy Science
Author(s): Olivia McAuliffe
The widespread dissemination of species of the lactic acid bacteria (LAB) group in different environments testifies to their extraordinary niche adaptability. Members of the LAB are present on grass and other plant material, in dairy products, on human skin, and in the gastrointestinal and reproductive tracts. The selective pressure imparted by these specific environments is a key driver in the genomic diversity observed between strains of the same species deriving from distinct habitats. Strains that are exploited in the dairy industry for the production of fermented dairy products are often referred to as “domesticated” strains. These strains, which initially may have occupied a nondairy niche, have become specialized for growth in the milk environment. In fact, comparative genome analysis of multiple LAB species and strains has revealed a central trend in LAB evolution: the loss of ancestral genes and metabolic simplification toward adaptation to nutritionally rich environments. In contrast, “environmental” strains, or those from raw milk, plants, and animals, exhibit diverse metabolic capabilities and lifestyle characteristics compared with their domesticated counterparts. Because of the limited number of established dairy strains used in fermented food production today, demand is increasing for novel strains, with concerted efforts to mine the microbiota of natural environments for strains of technological interest. Many studies have concentrated on uncovering the genomic and metabolic potential of these organisms, facilitating comparative genome analysis of strains from diverse environments and providing insight into the natural diversity of the LAB, a group of organisms that is at the core of the dairy industry. The natural biodiversity that exists in these environments may be exploited in dairy fermentations to expand flavor profiles, to produce natural “clean label” ingredients, or to develop safer products.



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Early-life events associated with first-lactation performance in pasture-based dairy herds

Publication date: Available online 13 February 2018
Source:Journal of Dairy Science
Author(s): G.M. Chuck, P.D. Mansell, M.A. Stevenson, M.M. Izzo
This was a prospective cohort study to determine how events from birth until first calving affect performance during the first lactation in pasture-based dairy herds in Victoria, Australia. Events during the preweaning (0–84 d), prepubertal (85–473 d), and postpubertal (474–804 d) periods were recorded in 6 herds, and their association with first-lactation 100-d and 250-d total milk, fat, and protein yields was quantified. Predictors of first-lactation performance included passive transfer status as a calf; season of birth; age of dam; the presence or absence of dystocia at the time of the heifer's birth; the presence or absence of preweaning diarrhea; preweaning, prepubertal, and postpubertal average daily weight gain; age at first calving; the presence or absence of periparturient disease at first calving; sex of the first-born calf; the presence or absence of a stillborn calf at the first calving; and requirement of assistance at the first calving. Lactation performance was quantified using cumulative 100-d and 250-d milk, fat, and protein yields estimated from herd recording. A multivariable linear regression model was developed for each outcome: cumulative 100-d milk, fat, and protein yield and cumulative 250-d milk, fat, and protein yield. Heifers that experienced dystocia at the time of their birth produced 7.6 kg [95% confidence interval (CI): 1.8–13.3] less fat and 4.8 kg (95% CI: 0.6–8.9) less protein at 100 d in milk in the first lactation compared with heifers that were delivered without dystocia. Heifers born in the summer and autumn produced 20 L (95% CI: 0.8–40) more milk and 20 kg (95% CI: 5.9–33) more protein at 250 d in milk in the first lactation compared with heifers born in the spring. For 100 g/d increases in prepubertal average daily gain, heifers produced an additional 182 L (95% CI: 149–216) of milk, 4.1 kg (95% CI: 2.8–5.5) of fat, and 4.0 kg (95% CI 3.1–5.0) of protein at 100 d in milk and an additional 345 L (95% CI 264–425) of milk, 6.1 kg (95% CI 3.2–9.0) of fat, and 7.5 kg (95% CI 5.3–9.7) of protein at 250 d in milk. Postpubertal average daily gain was positively associated with 100-d milk yield and 250-d milk yield and protein production. We conclude that of all the growth periods assessed in this study, events that occurred during the prepubertal period (85–473 d of age) had the greatest effect on first-lactation performance.



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Magic Angle in Cardiac CT

Publication date: Available online 13 February 2018
Source:Academic Radiology
Author(s): Sebastian D. Reinartz, Christiane K. Kuhl, Kerstin Fehrenbacher, Andreas Napp
Rationale and ObjectiveTo identify the influence of various parameters for reducing artifacts in computed tomography (CT) of commonly used pacemakers or implantable cardioverter-defibrillator (ICD) lead tips.Materials and MethodsThis ex vivo phantom study compared two CT techniques (Dual-Energy CT [DECT] vs. Dual-Source CT [DSCT]), as well as the influence of incremental alterations of current-time product and pacemaker lead-tip angle with respect to the gantry plane. Four pacemaker leads and one ICD lead were evaluated. The images were assessed visually on a five-point Likert scale (1 = artifact free to 5 = massive artifacts). Likert values 1–3 represent clinically relevant, diagnostic image quality.Results344 of 400 total images were rated with diagnostic image quality. The DECT and dual-source DSCT technique each scored 86% diagnostic image quality. Statistically, DECT images showed significantly improved image quality (P < .05). Concerning the current-time product, no statistically significant change was found. Regarding lead-tip positioning, an angle of ≤70° yielded 100% diagnostic image quality. Pacemaker and ICD leads were assessed to have statistically significant differences.ConclusionsSurprisingly, the lead-tip angle of 70° has been established as the key angle under which diagnostic image quality is always ensured, regardless of the imaging technique. Thus, we call 70° the "Magic angle" in CT pacemaker imaging.



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Fat Necrosis of the Breast

Publication date: Available online 13 February 2018
Source:Academic Radiology
Author(s): Hebatallah Hassan Mamdouh Hassan, Amr Magdi El Abd, Amany Abdel Bary, Nagy N.N. Naguib
Rationale and ObjectivesThis study aims to describe the magnetic resonance imaging (MRI) features of fat necrosis on magnetic resonance mammography, which may downstage a suspicious lesion to a merely benign finding.Materials and MethodsThis prospective study included 82 female patients (mean age 50 years) who were diagnosed to have suspicious lesions by mammography, ultrasonography or both. All patients underwent MRI including diffusion-weighted imaging and spectroscopy. Image postprocessing and analysis included signal intensity, enhancement characteristics, diffusion restriction, and spectroscopic analysis. All patients underwent histopathological analysis for confirmation. Sensitivity, specificity, positive predictive value (PPV), and negative (NPV) predictive value were calculated.ResultsTo label a lesion as fat necrosis on MRI analysis, presence of fat signal in a lesion revealed sensitivity of 98.04%, specificity of 100%, PPV of 100%, and NPP of 96.88%, whereas nonenhancement of the lesion itself revealed sensitivity of 96.08%, specificity of 100%, PPV of 100%, and NPP of 93.94%. However, adding both the nonrestriction on diffusion analysis and the lack of tCholine at 3.22 ppm increased the sensitivity and specificity to 100%, as well as PPV of 100% for fat necrosis and hence a NPV for malignancy of 100%.ConclusionsMRI proved to be of value in differentiating fat necrosis from malignancy based on the molecular composition of fat necrosis, clearly depicted by MRI without the need for invasive confirmation by biopsy.



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Utility of Clinical Parameters and Multiparametric MRI as Predictive Factors for Differentiating Uterine Sarcoma From Atypical Leiomyoma

Publication date: Available online 13 February 2018
Source:Academic Radiology
Author(s): Qiu Bi, Zhibo Xiao, Fajin Lv, Yao Liu, Chunxia Zou, Yiqing Shen
ObjectivesThe objective of this study was to find clinical parameters and qualitative and quantitative magnetic resonance imaging (MRI) features for differentiating uterine sarcoma from atypical leiomyoma (ALM) preoperatively and to calculate predictive values for uterine sarcoma.Materials and MethodsData from 60 patients with uterine sarcoma and 88 patients with ALM confirmed by surgery and pathology were collected. Clinical parameters, qualitative MRI features, diffusion-weighted imaging with apparent diffusion coefficient values, and quantitative parameters of dynamic contrast-enhanced MRI of these two tumor types were compared. Predictive values for uterine sarcoma were calculated using multivariable logistic regression.ResultsPatient clinical manifestations, tumor locations, margins, T2-weighted imaging signals, mean apparent diffusion coefficient values, minimum apparent diffusion coefficient values, and time-signal intensity curves of solid tumor components were obvious significant parameters for distinguishing between uterine sarcoma and ALM (all P < .001). Abnormal vaginal bleeding, tumors located mainly in the uterine cavity, ill-defined tumor margins, and mean apparent diffusion coefficient values of <1.272 × 10−3 mm2/s were significant preoperative predictors of uterine sarcoma. When the overall scores of these four predictors were greater than or equal to 7 points, the sensitivity, the specificity, the accuracy, and the positive and negative predictive values were 88.9%, 99.9%, 95.7%, 97.0%, and 95.1%, respectively.ConclusionsThe use of clinical parameters and multiparametric MRI as predictive factors was beneficial for diagnosing uterine sarcoma preoperatively. These findings could be helpful for guiding treatment decisions.



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IJMS, Vol. 19, Pages 574: Bioactive Films Containing Alginate-Pectin Composite Microbeads with Lactococcus lactis subsp. lactis: Physicochemical Characterization and Antilisterial Activity

IJMS, Vol. 19, Pages 574: Bioactive Films Containing Alginate-Pectin Composite Microbeads with Lactococcus lactis subsp. lactis: Physicochemical Characterization and Antilisterial Activity

International Journal of Molecular Sciences doi: 10.3390/ijms19020574

Authors: Mariam Bekhit Elmira Arab-Tehrany Cyril Kahn Franck Cleymand Solenne Fleutot Stephane Desobry Laura Sánchez-González

Novel bioactive films were developed from the incorporation of Lactococcus lactis into polysaccharide films. Two different biopolymers were tested: cellulose derivative (hydroxylpropylmethylcellulose (HPMC)) and corn starch. Lactic acid bacteria (LAB) free or previously encapsulated in alginate-pectin composite hydrogel microbeads were added directly to the film forming solution and films were obtained by casting. In order to study the impact of the incorporation of the protective culture into the biopolymer matrix, the water vapour permeability, oxygen permeability, optical and mechanical properties of the dry films were evaluated. Furthermore, the antimicrobial effect of bioactive films against Listeria monocytogenes was studied in synthetic medium. Results showed that the addition of LAB or alginate-pectin microbeads modified slightly films optical properties. In comparison with HPMC films, starch matrix proves to be more sensitive to the addition of bacterial cells or beads. Indeed, mechanical resistance of corn starch films was lower but barrier properties were improved, certainly related to the possible establishment of interactions between alginate-pectin beads and starch. HPMC and starch films containing encapsulated bioactive culture showed a complete inhibition of listerial growth during the first five days of storage at 5 °C and a reduction of 5 logs after 12 days.



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Sam Guglani: Life, mortality, and poetry

bmj;360/feb14_6/k550/FAF1faDuncan SmithBiographySam Guglani is a consultant oncologist in Cheltenham, where he specialises in lung and brain cancers and chairs the hospital’s ethics committee. He is...
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GP inspections: are sanctions holding back improvement in poor areas?

GP partners working in England’s deprived areas who have had negative feedback after inspections by the health and social services regulator have told The BMJ how they were left feeling demoralised,...
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Practices in poor areas are more likely to face CQC sanctions

General practices in England’s more deprived areas are nearly three times as likely as those in affluent areas to face sanctions from the health services regulator, a BMJ investigation has...
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CDC tightens controls on scientists’ communication with news media

The requirement for all information to be vetted could undermine scientific openness, reports Peter DoshiQuestions have been raised about top-down efforts to constrain scientists at the Centers for...
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Appointment day—the tip of an iceberg

To you, my appointment might just be another slot in a hectic day. My perspective is different. As a person with long term conditions, my one hospital appointment a year with a consultant is an...
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