Registration Accuracy of CT/MRI Fusion for Localisation of Deep Brain Stimulation Electrode Position: An Imaging Study and Systematic Review

Background: Postoperative imaging is essential for verifying electrode location in patients undergoing deep brain stimulation (DBS). MRI offers better visualisation of brain targets, but concerns about adverse events have limited its use. Preoperative stereotactic MRI fused with a postoperative stereotactic CT, demonstrating the electrode position, is now widely used. Objectives: The aims of this study were to: (1) evaluate the accuracy of image registration using Neuroinspire, and (2) undertake a systematic review of the literature on CT/MRI fusion techniques to ascertain the accuracy of other software packages. Methods: Twenty patients who underwent bilateral subthalamic nucleus DBS for Parkinson's disease were selected. The postoperative CT was registered and fused with the preoperative MRI using Neuroinspire. The position of each electrode tip was determined in stereotactic coordinates both in the (unfused) postoperative CT and the fused CT/MRI. The difference in tip position was used to evaluate the registration accuracy. Results: The mean error ± SD of CT/MRI fusion using Neuroinspire was 0.25 ± 0.15, 0.33 ± 0.26 and 0.46 ± 0.55 mm in lateral, anteroposterior and vertical axes. A systematic review suggested that CT/MRI registration with Neuroinspire is more accurate than that achieved with other tested CT/MRI fusion algorithms. Conclusion: CT/MRI fusion for localisation of electrode placement offers an accurate, reliable and safe modality for assessing electrode location.
Stereotact Funct Neurosurg 2016;94:159-163

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I festivalmedisinens tjeneste

Få tenker på legeyrket som sesongarbeid, men når andre tar ferie er det en gruppe leger som bare skifter beite.

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Behandling av gassembolier

– Helsedirektoratet har nylig utgitt et notat om gassembolier vi mener er mangelfullt, skriver kommentarforfattere.

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Festa della Musica 2016, il 21 giugno Special Stage all'Istituto dei Tumori

Special Stage all'INT in occasione della Festa della Musica 2016
Blocco "E" 7mo piano - Sala attesa Trapianto di Fegato
Martedì 21 giugno 2016 - Ore 16:00 - 18:00
Fondazione IRCCS Istituto Nazionale dei Tumori
Via G. Venezian, 1 - 20133 Milano

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IJMS, Vol. 17, Pages 957: Aquaporins in Urinary Extracellular Vesicles (Exosomes)

Since the successful characterization of urinary extracellular vesicles (uEVs) by Knepper’s group in 2004, these vesicles have been a focus of intense basic and translational research worldwide, with the aim of developing novel biomarkers and therapeutics for renal disease. Along with these studies, there is growing evidence that aquaporins (AQPs), water channel proteins, in uEVs have the potential to be diagnostically useful. In this review, we highlight current knowledge of AQPs in uEVs from their discovery to clinical application.

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IJMS, Vol. 17, Pages 960: Pediatric Tuberculosis in Italian Children: Epidemiological and Clinical Data from the Italian Register of Pediatric Tuberculosis

Tuberculosis (TB) is one of the leading causes of death worldwide. Over the last decades, TB has also emerged in the pediatric population. Epidemiologic data of childhood TB are still limited and there is an urgent need of more data on very large cohorts. A multicenter study was conducted in 27 pediatric hospitals, pediatric wards, and public health centers in Italy using a standardized form, covering the period of time between 1 January 2010 and 31 December 2012. Children with active TB, latent TB, and those recently exposed to TB or recently adopted/immigrated from a high TB incidence country were enrolled. Overall, 4234 children were included; 554 (13.1%) children had active TB, 594 (14.0%) latent TB and 3086 (72.9%) were uninfected. Among children with active TB, 481 (86.8%) patients had pulmonary TB. The treatment of active TB cases was known for 96.4% (n = 534) of the cases. Overall, 210 (39.3%) out of these 534 children were treated with three and 216 (40.4%) with four first-line drugs. Second-line drugs where used in 87 (16.3%) children with active TB. Drug-resistant strains of Mycobacterium tuberculosis were reported in 39 (7%) children. Improving the surveillance of childhood TB is important for public health care workers and pediatricians. A non-negligible proportion of children had drug-resistant TB and was treated with second-line drugs, most of which are off-label in the pediatric age. Future efforts should concentrate on improving active surveillance, diagnostic tools, and the availability of antitubercular pediatric formulations, also in low-endemic countries.

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IJMS, Vol. 17, Pages 938: Genome-Wide Discriminatory Information Patterns of Cytosine DNA Methylation

Cytosine DNA methylation (CDM) is a highly abundant, heritable but reversible chemical modification to the genome. Herein, a machine learning approach was applied to analyze the accumulation of epigenetic marks in methylomes of 152 ecotypes and 85 silencing mutants of Arabidopsis thaliana. In an information-thermodynamics framework, two measurements were used: (1) the amount of information gained/lost with the CDM changes I R and (2) the uncertainty of not observing a SNP L C R . We hypothesize that epigenetic marks are chromosomal footprints accounting for different ontogenetic and phylogenetic histories of individual populations. A machine learning approach is proposed to verify this hypothesis. Results support the hypothesis by the existence of discriminatory information (DI) patterns of CDM able to discriminate between individuals and between individual subpopulations. The statistical analyses revealed a strong association between the topologies of the structured population of Arabidopsis ecotypes based on I R and on LCR, respectively. A statistical-physical relationship between I R and L C R was also found. Results to date imply that the genome-wide distribution of CDM changes is not only part of the biological signal created by the methylation regulatory machinery, but ensures the stability of the DNA molecule, preserving the integrity of the genetic message under continuous stress from thermal fluctuations in the cell environment.

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IJMS, Vol. 17, Pages 962: The Potential for Microalgae as Bioreactors to Produce Pharmaceuticals

As photosynthetic organisms, microalgae can efficiently convert solar energy into biomass. Microalgae are currently used as an important source of valuable natural biologically active molecules, such as carotenoids, chlorophyll, long-chain polyunsaturated fatty acids, phycobiliproteins, carotenoids and enzymes. Significant advances have been achieved in microalgae biotechnology over the last decade, and the use of microalgae as bioreactors for expressing recombinant proteins is receiving increased interest. Compared with the bioreactor systems that are currently in use, microalgae may be an attractive alternative for the production of pharmaceuticals, recombinant proteins and other valuable products. Products synthesized via the genetic engineering of microalgae include vaccines, antibodies, enzymes, blood-clotting factors, immune regulators, growth factors, hormones, and other valuable products, such as the anticancer agent Taxol. In this paper, we briefly compare the currently used bioreactor systems, summarize the progress in genetic engineering of microalgae, and discuss the potential for microalgae as bioreactors to produce pharmaceuticals.

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Aspirin may increase survival after colon cancer

It is well known that aspirin has analgesic and fever-reducing properties. However, this drug may also increase the likelihood of surviving colon cancer. Kjetil Taskén, professor at the Faculty of Medicine, is one of the authors of a study that has...

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Innovative device allows 3-D imaging of the breast with less radiation

Preliminary tests have demonstrated that a new device may enable existing breast cancer imagers to provide up to six times better contrast of tumours in the breast, while maintaining the same or better image quality and halving the radiation dose to...

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Cancer-preventing protein finds its own way in our DNA

Geneticists from KU Leuven, Belgium, have shown that tumour protein TP53 knows exactly where to bind to our DNA to prevent cancer, according to new research published in Genome Research. Once bound to this specific DNA sequence, the protein can activate...

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Extent of resection associated with likelihood of survival in glioblastoma

The extent of resection in patients with glioblastoma, an aggressive and often fatal brain tumour, was associated with the likelihood of survival and disease progression, according to a new study published online by JAMA Oncology. Glioblastoma multiforme...

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Combined radiotherapy and immunotherapy improve efficacy in a murine lung cancer model

Radiation therapy is commonly used to reduce tumour size and improve symptoms of non-small cell lung cancer. While initially beneficial, many patients will eventually relapse with metastatic tumours. Last year, two immunotherapies that improve...

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Network per la diagnosi e cura dei tumori testa collo da hpv - NapoliToday

NapoliToday

Network per la diagnosi e cura dei tumori testa collo da hpv NapoliToday Negli ultimi anni, si è registrato un notevole aumento di un particolare gruppo di tumori di testa collo, localizzati nell'orofaringe, causati da papillomavirus (HPV) ad alto rischio. Attraverso una rete multidisciplinare di esperti, al Policlinico ...

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Feedback: Straight to the stars on a heterosexual space ark

Plus how to make your sweat smell of maple syrup, a unit of sexism, Americans want DNA labels, Captain Cook on the dancefloor, new primary colours and more

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An extraordinary stringent and sensitive light-switchable gene expression system for bacterial cells

An extraordinary stringent and sensitive light-switchable gene expression system for bacterial cells

Cell Research advance online publication, June 17 2016. doi:10.1038/cr.2016.74

Authors: Xianjun Chen, Renmei Liu, Zhengcai Ma, Xiaopei Xu, Haoqian Zhang, Jianhe Xu, Qi Ouyang & Yi Yang

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Mea6 controls VLDL transport through the coordinated regulation of COPII assembly

Mea6 controls VLDL transport through the coordinated regulation of COPII assembly

Cell Research advance online publication, June 17 2016. doi:10.1038/cr.2016.75

Authors: Yaqing Wang, Liang Liu, Hongsheng Zhang, Junwan Fan, Feng Zhang, Mei Yu, Lei Shi, Lin Yang, Sin Man Lam, Huimin Wang, Xiaowei Chen, Yingchun Wang, Fei Gao, Guanghou Shui & Zhiheng Xu

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DGKζ Downregulation Enhances Osteoclast Differentiation and Bone Resorption Activity Under Inflammatory Conditions

Abstract

Bone homeostasis is maintained by a balance between resorption of the bone matrix and its replacement by new bone. Osteoclasts play a crucially important role in bone metabolism. They are responsible for bone resorption under pathophysiological conditions. Differentiation of these cells, which are derived from bone marrow cells, depends on receptor activator of NF-κB ligand (RANKL). RANKL-induced osteoclastogenesis is regulated by the phosphoinositide (PI) signaling pathway, in which diacylglycerol (DG) serves as a second messenger in signal transduction. In this study, we examined the functional implications of DG kinase (DGK), an enzyme family responsible for DG metabolism, for osteoclast differentiation and activity. Of DGKs, DGKζ is most abundantly expressed in osteoclast precursors such as bone marrow-derived monocytes/macrophages. During osteoclast differentiation from precursor cells, DGKζ is downregulated at the protein level. In this regard, we found that DGKζ deletion enhances osteoclast differentiation and bone resorption activity under inflammatory conditions in an animal model of osteolysis. Furthermore, DGKζ deficiency upregulates RANKL expression in response to TNFα stimulation. Collectively, results suggest that DGKζ is silent under normal conditions, but it serves as a negative regulator in osteoclast function under inflammatory conditions. Downregulation of DGKζ might be one factor predisposing a person to osteolytic bone destruction in pathological conditions. This article is protected by copyright. All rights reserved

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CD19 CAR T-cells are effective for treating advanced lymphoma in combination with low dose chemotherapy: https://t.co/Ulz44u5dbh #EHA2016

CD19 CAR T-cells are effective for treating advanced lymphoma in combination with low dose chemotherapy: https://t.co/Ulz44u5dbh #EHA2016

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Interleukin-31 receptor and pruritus associated with primary localized cutaneous amyloidosis: reply from the authors

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5 reasons you absolutely must eat jamuns this summer - India Today

India Today

5 reasons you absolutely must eat jamuns this summer India Today Do you also check for a purple patch on your tongue after eating a handful of jamuns? Of course you do! ... They contain several nutrients and vitamins that help fight various diseases like cancer, diabetes, infections and liver problems. But that's ...

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Thirty-Day Hospital Revisit Rates and Factors Associated With Revisits in Patients Undergoing Septorhinoplasty.

Thirty-Day Hospital Revisit Rates and Factors Associated With Revisits in Patients Undergoing Septorhinoplasty.

JAMA Facial Plast Surg. 2016 Jun 16;

Authors: Spataro E, Branham GH, Kallogjeri D, Piccirillo JF, Desai SC

Abstract
Importance: Estimates of the 30-day hospital revisit rate following septorhinoplasty and the risk factors associated with revisits are unknown in the current literature. Surgical 30-day readmission rates are important to establish, as they are increasingly used as a quality care metric and can incur future financial penalties from third-party payers and government agencies.
Objective: To determine the rate of 30-day hospital revisits following septorhinoplasty and the risk factors associated with revisits.
Design, Setting, and Participants: A retrospective cohort analysis was conducted of 175 842 patients undergoing septorhinoplasty between January 1, 2005, and December 31, 2009, using data from the Healthcare Cost and Utilization Project state inpatient database, state ambulatory surgery database, and state emergency department database from California, Florida, and New York. Information on revisits for these patients was collected from the 3 databases between January 1, 2005, and December 31, 2012. Data analysis was conducted from September 1, 2014, to May 1, 2015.
Main Outcomes and Measures: Hospital revisits within 30 days after an index septorhinoplasty and the primary diagnosis at the time of the revisit were the main outcome measures. The revisit rate was calculated within subgroups of patients based on different demographic and clinical characteristics. A multivariable model was then used to determine independent risk factors for the occurrence of a hospital revisit within 30 days of the septorhinoplasty procedure.
Results: In total, 11 456 of 175 842 patients (6.5%) who underwent septorhinoplasty procedures revisited the hospital within 30 days of the procedure. Most of these revisits (6353 [55.5%]) were to the emergency department. The most common primary diagnosis was bleeding or epistaxis, occurring in 2150 patients (1.2%). Multivariable logistic regression showed that patients aged 41 to 65 years (adjusted odds ratio [aOR], 1.09; 99% CI, 1.02-1.16) or older than 65 years (aOR, 1.23; 99% CI, 1.06-1.43) had an increased revisit rate, as did black patients (aOR, 1.39; 99% CI, 1.16-1.66); those with Medicare (aOR, 1.55; 99% CI, 1.32-1.81) and Medicaid (aOR, 1.63; 99% CI, 1.33-2.01); those with diagnoses of autoimmune disorders or immunodeficiency (aOR, 2.69; 99% CI, 1.20-6.03), coagulopathy (aOR, 2.06; 99% CI, 1.33-3.20), anxiety (aOR, 1.79; 99% CI, 1.55-2.07), and alcohol use (aOR, 1.70; 99% CI, 1.35-2.14); and those who had a conchal cartilage graft (aOR, 2.01; 99% CI, 1.29-3.14).
Conclusions and Relevance: The study results suggest that patients with more medical comorbidities and lower socioeconomic status most commonly returned to the emergency department for surgical complications, such as bleeding or epistaxis, in the 30-day period after the procedure. These data provide valuable preoperative counseling information for patients and physicians. In addition, this study provides data to third-party payers or government agencies in which postprocedure readmissions in the 30-day period are used as a quality care metric affecting reimbursements and financial penalties.
Level of Evidence: 3.

PMID: 27311117 [PubMed - as supplied by publisher]

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Association of Eyelid Position and Facial Nerve Palsy With Unresolved Weakness.

Association of Eyelid Position and Facial Nerve Palsy With Unresolved Weakness.

JAMA Facial Plast Surg. 2016 Jun 16;

Authors: Sinha KR, Rootman DB, Azizzadeh B, Goldberg RA

Abstract
Importance: Understanding the prevalence and clinical features of eyelid malpositions in facial nerve palsy (FNP) may inform proper management of patients with FNP and supplement our knowledge of eyelid physiology.
Objective: To describe eyelid malposition in FNP.
Design, Setting, and Participants: In this retrospective cohort study, patients with FNP seen at the Center for Advanced Facial Plastic Surgery and Jules Stein Eye Institute between January 1, 1999, and June 1, 2014, were reviewed for study inclusion. Data collection was performed between June 1, 2014, to August 1, 2014, and data analysis was performed between June 15, 2014, to September 1, 2015. The distances from the center of the pupil to the upper eyelid margin (marginal reflex distance 1 [MRD1]) and to the lower eyelid margin (marginal reflex distance 2 [MRD2]) were measured on photographs of patients in the primary position and with full smile. Eyelid asymmetry, retraction, ptosis, synkinesis, and severity and duration of FNP were assessed. Eligible participants were adults with FNP at a private tertiary care clinic with primary position photographs. Exclusion criteria included prior history of procedures or medical conditions that could alter eyelid position.
Results: The 52 included patients were predominantly female (38 [73%]), with a mean (SD) age of 44.1 (13.8) years. Of this group, 34 patients (65%) were white, 8 (15%) were Asian, 8 (15%) were Hispanic, and 2 (4%) were African American. Retraction (MRD1, >5.0 mm) was present in 8 patients (15%), 3 of whom had eyelid asymmetry (MRD1, >1.0 mm). Overall, total asymmetry of greater than 1.0 mm was present in 14 patients (27%), with the FNP side higher in 12 (23%). Compared with those without asymmetry, patients with eyelid asymmetry were significantly more likely to have contralateral ptosis (42% vs 2.5%, P < .001) but did not have a significantly shorter duration of FNP (12.3 months vs 13.8 months, P = .82). Ptosis was noted in 4 patients and was also unrelated to duration of FNP (9.6 months in patients with ptosis vs 13.6 months in those without, P = .60). Synkinesis was found in 24 patients (46%), but none had concomitant ptosis. Severe FNP (House-Brackmann score, ≥4) was present in 28 patients (54%), and these patients were 20 times more likely to have asymmetry greater than 1.0 mm, often with the FNP side higher.
Conclusions and Relevance: Upper eyelid asymmetry is common in FNP. In most of the patients in this study, the FNP side was higher without demonstrating retraction, and the contralateral side was ptotic. Thus, contralateral ptosis surgery may benefit these patients. Furthermore, patients with severe facial weakness were more likely to have eyelid asymmetry, suggesting that the ability of the eyelid position maintenance system to adapt to weakness of eyelid protractors may be limited by the severity of this weakness.
Level of Evidence: 3.

PMID: 27311069 [PubMed - as supplied by publisher]

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Prognostic role of platelet-lymphocyte ratio in colorectal cancer: A systematic review and meta-analysis.

Prognostic role of platelet-lymphocyte ratio in colorectal cancer: A systematic review and meta-analysis.

Medicine (Baltimore). 2016 Jun;95(24):e3837

Authors: Tan D, Fu Y, Su Q, Wang H

Abstract
Many studies have been reported that platelet-lymphocyte ratio (PLR) may be associated with the prognosis of colorectal cancer (CRC), but the results are inconsistent. Current opinion on the prognostic role of the PLR in CRC is inconsistent and inconclusive. Therefore, we conduct a meta-analysis that combines these studies and to identify the prognostic value of PLR in patients with CRC. Data were retrieved from PubMed, EMBASE, Cochrane Library, and Web of Science databases that came from inception through January 2016. We extracted data from the characteristics of each study and analyzed the relationship between PLR and overall survival (OS), disease-free survival (DFS), or other prognosis in patients with CRC by using the hazard ratio (HR) and 95% confidence intervals (95% CIs). Of the 256 identified studies, 15 studies were included and a total of 3991 patients were included. In a meta-analysis, patients with an elevated PLR had a significantly lower OS (pooled HR, 1.53; 95% CI, 1.24-1.89; P ≤ 0.001), DFS (pooled HR, 1.68; 95% CI, 1.07-2.62; P = 0.023). Even after sensitivity analyses and trim and fill method, high PLR remains significantly predictive poorer OS, but not DFS. In addition, our meta-analysis indicated that increased PLR is also significantly associated with the poor tumor differentiation [odds ratio (OR) 2.12; 95% CI, 1.45-3.08, P < 0.001)], the propensity toward depth of infiltration (OR 1.69; 95% CI, 1.20-2.39, P = 0.003), and recurrence in patients with CRC (HR, 2.71; 95% CI, 1.31-5.60, P = 0.005). This meta-analysis suggested that a high peripheral blood PLR can be used as a predictor of OS connected with clinicopathological parameters in patients with CRC, not DFS. These ratios may thus contribute to inform more personalized treatment decisions and predict treatment outcomes.

PMID: 27310960 [PubMed - as supplied by publisher]

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Anesthetic Management During Emergency Surgical Ligation for Carotid Blowout Syndrome.

Anesthetic Management During Emergency Surgical Ligation for Carotid Blowout Syndrome.

A A Case Rep. 2016 Jun 15;

Authors: Klein Nulent CG, de Graaff HJ, Ketelaars R, Sewnaik A, Maissan IM

Abstract
A 44-year-old man presented to our emergency department with a pharyngeal hemorrhage, 6 weeks after a total laryngectomy and extensive neck dissection. Immediate surgical intervention was necessary to stop massive arterial hemorrhage from the pharynx. The head and neck surgeon successfully ligated the common carotid artery during this procedure. We describe the anesthetic strategy and the thromboelastometry (ROTEM®)-guided massive transfusion protocol.

PMID: 27310900 [PubMed - as supplied by publisher]

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Association Between Facial Nerve Monitoring With Postoperative Facial Paralysis in Parotidectomy.

Association Between Facial Nerve Monitoring With Postoperative Facial Paralysis in Parotidectomy.

JAMA Otolaryngol Head Neck Surg. 2016 Jun 16;

Authors: Savvas E, Hillmann S, Weiss D, Koopmann M, Rudack C, Alberty J

Abstract
Importance: Electrophysiologic facial nerve monitoring is becoming an established intraoperative aid to assist the surgeon in facial nerve trunk or branch location and dissection. Limited studies have addressed the postoperative outcomes of parotid surgery with and without monitoring.
Objective: To examine the influence of intraoperative facial nerve monitoring on postoperative facial nerve function and procedure duration in parotid surgery.
Design, Setting, and Participants: An 8-year retrospective review of parotidectomies performed at the Department of Otorhinolaryngology-Head and Neck Surgery, University of Münster. The study analyzed 120 patients undergoing parotidectomy without monitoring from January 1, 1988, to December 31, 1991, and 147 patients undergoing parotidectomy with monitoring from January 1, 2003, to December 31, 2006. The patients were further subdivided in partial parotidectomy (PP) (n = 222) and total parotidectomy (TP) (n = 45) groups. An evaluation of operative time was performed to test the hypothesis of shorter duration of surgery with facial nerve monitoring. Final follow-up was completed on December 31, 2008, and data were analyzed from June 1 to December 31, 2013.
Main Outcomes and Measures: Comparison of the incidence of facial nerve dysfunction and operative time between the PP and TP subgroups with and without monitoring.
Results: A total of 267 patients (127 men [47.6%] and 140 women [52.4%]; mean [SD] age, 51.3 [17.6] years; range, 3-90 years) were included in the analysis. A significant reduction in postoperative facial nerve dysfunction with the use of nerve monitoring could be seen in the PP group (46 of 99 without monitoring [46.5%] vs 18 of 123 with monitoring [14.6%]; P = .001). A similar finding was evident in the TP group when comparing moderate and severe nerve dysfunction (9 of 21 without monitoring [42.9%] vs 2 of 24 with monitoring [8.3%]; P = .01). The mean (SD) operative time in the PP subgroup without nerve monitoring was 115.3 (37.8) minutes; with nerve monitoring, 110.1 (33.6) minutes. The mean (SD) operative time in the TP subgroup without nerve monitoring was 134.5 (50.4) minutes; with nerve monitoring, 158.3 (56.3) minutes. There was no statistical difference between these groups.
Conclusions and Relevance: Facial nerve monitoring in primary parotid surgery for benign and malignant disease does not necessarily reduce the operative time, but the rate of transient postoperative facial nerve dysfunction or the grade of palsy is reduced.

PMID: 27310887 [PubMed - as supplied by publisher]

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Anterior lateral thigh osteomyocutaneous free flap reconstruction in the head and neck: The anterolateral thigh osteomyocutaneous femur bone flap.

Anterior lateral thigh osteomyocutaneous free flap reconstruction in the head and neck: The anterolateral thigh osteomyocutaneous femur bone flap.

Head Neck. 2016 Jun 16;

Authors: Brody RM, Pandey NC, Bur AM, O'Malley BW, Rassekh CH, Weinstein GS, Chalian AA, Newman JG, Cannady SB

Abstract
BACKGROUND: The anterolateral thigh (ALT) free flap is one of the most commonly used donor sites in head and neck reconstruction, however, it is not typically considered when an osseous component is needed.
METHODS: Soft tissue harvests, cadaveric study, and retrospective analysis of a series of 10 patients undergoing angiography were performed to assess vascular supply to the femoral cortex. In 6 patients, corticocancellous split-femur was incorporated into the ALT to reconstruct bony defects of the head and neck.
RESULTS: There is a consistent blood supply to the femur from the lateral femoral circumflex artery both intraoperatively and on angiography. No fractures or orthopedic injuries have been seen to date. None of the patients had complications of bone harvest, such as deep vein thrombosis or pulmonary embolism.
CONCLUSION: The ALT osteomyocutaneous (ALTO) flap has consistent vascular anatomy to the femoral cortex. This flap provides additional corticocancellous bone and overlying vastus intermedius muscle for the reconstruction of complex craniofacial defects. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27310816 [PubMed - as supplied by publisher]

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Comparison of cartilage graft and fascia in type 1 tympanoplasty: systematic review and meta-analysis.

Comparison of cartilage graft and fascia in type 1 tympanoplasty: systematic review and meta-analysis.

Acta Otolaryngol. 2016 Jun 16;:1-6

Authors: Yang T, Wu X, Peng X, Zhang Y, Xie S, Sun H

Abstract
CONCLUSIONS: Tympanoplasty using cartilage grafts has a better graft take rate than that using temporalis fascia grafts. There are no significant differences between cartilage grafts and temporalis fascia grafts for hearing outcomes. Contrary to the sliced cartilage sub-group, full-thickness cartilage grafts generate better hearing outcomes than temporalis fascia grafts.
OBJECTIVE: Tympanic membrane perforation can cause middle ear relapsing infection and lead to hearing damage. Various techniques have been applied in order to reconstruct the tympanic membrane. Recently, cartilage grafts and temporalis fascia grafts have been widely used for tympanic membrane closure. A systemic review and meta-analysis was carried out based on published retrospective trials that investigated the efficacy of cartilage grafts and temporalis fascia grafts in type 1 tympanoplasty. Both graft take rates and mean AIR-BONE-GAP gains were analyzed.
METHODS: Cochrane Library, PubMed, and Embase were systematically searched. After a scientific investigation, we extracted the relevant data following our selection criteria. Odds ratio (OR) of graft take rates and mean difference (MD) of AIR-BONE-GAP gains were calculated within 95% confidence intervals.
RESULTS: Eight eligible articles with 915 patients were reviewed. The pooled OR for graft take rate was 3.11 (95% CI =1.94-5.00; p = 0.43) and the difference between the two groups was significant, which means that the cartilage grafts group got a better graft take rate than the temporalis fascia grafts group. The pooled MD for mean AIR-BONE-GAP gain was 1.92 (95% CI = -0.12-3.95; p < 0.000 01) and the difference was not significant. However, in the full thickness cartilage grafts sub-group, the pooled MD for mean AIR-BONE-GAP gains was 2.56 (95% CI =1.02-4.10; p = 0.14) and the difference was significant, which means that the full thickness cartilage grafts sub-group got a better hearing outcome than the temporalis fascia grafts group. On the contrary, the pooled MD of sliced cartilage grafts sub-group was 0.12 (95% CI = -0.44-0.69; p = 0.61) and there was no significant difference between the sliced cartilage grafts and temporalis fascia group.

PMID: 27310768 [PubMed - as supplied by publisher]

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In situ cultured preantral follicles is a useful model to evaluate the effect of anticancer drugs on caprine folliculogenesis

ABSTRACT

Despite the increase in the incidence of cancer, the number of women who survive cancer treatment is growing. However, one of the principal results of chemotherapy is premature ovarian failure (POF). The aim of this study was to use the in situ culture preantral follicles as an in vitro model to evaluate the toxicity of two anticancer drugs, doxorubicin (DXR) and paclitaxel (PTX), on the integrity and development of ovarian follicles. Fragments of the ovarian cortex of goats were cultured in vitro for 1 or 7 days in α-MEM⁺ supplemented with different concentrations of DXR (0.003, 0.03, or 0.3 µg/mL) and PTX (0.001, 0.01, or 0.1 µg/mL). Analyses were performed before and after culture to evaluate tissue integrity by classical histology, apoptosis by TUNEL assay, DNA laddering kit and the detection of activated caspase 3, and DNA damage by the immune detection of phosphorylated histone H2A.x (H2AXph139). Both DXR and PTX reduced the number of morphologically normal primordial and developing follicles. Positive staining for TUNEL and active caspase 3 was detected in all the samples (P < 0.05). Therefore, we propose the in situ culture of caprine preantral follicles as a useful experimental model for assessing the toxic effects of the chemotherapeutic agents on ovarian folliculogenesis. Microsc. Res. Tech, 2016. © 2016 Wiley Periodicals, Inc.

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Effect of Ca addition on the microstructure and mechanical properties of as-cast Mg–Sm alloys

This study investigated the effect of Ca addition on the microstructure and mechanical properties of as-cast Mg–4Sm alloys. The addition of 1.0 wt% Ca led to a significant grain refinement of Mg–4.0Sm alloys owing to the formation of rod-like Mg2Ca phases that acted as active nucleates for the Mg matrix. The as-cast Mg–4.0Sm–1.0Ca alloy showed the smallest grain size at 45 μm. Furthermore, the Mg–4.0Sm–1.0Ca alloy exhibited greater hardness, higher tensile strength, and higher yield tensile strength and elongation than the other two alloys with different Ca contents. These results were attributed to the grain refinement and precipitation strengthening of the Mg2Ca and Mg41Sm5 phases. Microsc. Res. Tech., 2016. © 2016 Wiley Periodicals, Inc.

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Scar formation in mice deafened with kanamycin and furosemide

ABSTRACT

In mammals, hair cell loss is irreversible and leads to hearing loss. To develop and test the functioning of different strategies aiming at hair cell regeneration, animal models of sensorineural hearing loss are essential. Although cochleae of these animals should lack hair cells, supporting cells should be preserved forming an environment for the regenerated hair cells. In this study, we investigated how ototoxic treatment with kanamycin and furosemide changes the structure of cochlear sensory epithelium in mice. The study also compared different tissue preparation protocols for scanning electron microscopy (SEM). Cochleae were collected from deafened and nondeafened mice and further processed for plastic mid modiolar sections and SEM. For comparing SEM protocols, cochleae from nondeafened mice were processed using three protocols: osmium–thiocarbohydrazide–osmium (OTO), tannic acid–arginine–osmium, and the conventional method with gold-coating. The OTO method demonstrated optimal cochlear tissue preservation. Histological investigation of cochleae of deafened mice revealed that the supporting cells enlarged and ultimately replaced the lost hair cells forming types 1 and 2 phalangeal scars in a base towards apex gradient. The type 3 epithelial scar, flattened epithelium, has not been seen in analysed cochleae. The study concluded that mice deafened with kanamycin and furosemide formed scars containing supporting cells, which renders this mouse model suitable for testing various hair cell regeneration approaches. Microsc. Res. Tech, 2016. © 2016 Wiley Periodicals, Inc.

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Biotinylated vanadium and chromium sulfide nanoparticles as probes for colocalization of membrane proteins

ABSTRACT

We report the microemulsion synthesis of vanadium and chromium sulfide nanoparticles (NPs) and their biological application as nanoprobes for colocalization of membrane proteins. Spherical V₂S₃ and Cr₂S₃ NPs were prepared in reverse microemulsion droplets, as nanoreactors, obtained by the surfactant sodium bis(2-ethylhexyl) sulfosuccinate (AOT) in nonpolar organic phase (heptane). Electron microscopic data indicated that the size distribution of the nanoparticles was uniform with an average diameter between 3 ÷ 5 nm. The prepared hydrophobic nanocrystals were transferred in aqueous phase by surface cap exchange of AOT with biotin-dihydrolipoic ligands. This substitution allows the nanoparticles solubility in aqueous solutions and confer their bioactivity. In addition, we report the conjugation procedure between α-Lipoic acid (LA) and biotin (abbreviated as biotin-LA). The biotin-LA structure was characterized by 1D and 2D NMR spectroscopy. The biotinylated vanadium and chromium sulfide nanoparticles were tested as probes for colocalization of glutamate receptors on sodium-dodecyl-sulfate-digested replica prepared from rat hippocampus. The method suggests their high labeling efficiency for study of membrane biological macromolecules. Microsc. Res. Tech., 2016. © 2016 Wiley Periodicals, Inc.

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Per rectal endoscopic myotomy (PREM) for the treatment of adult Hirschsprung's disease - First human case (with video).

Per rectal endoscopic myotomy (PREM) for the treatment of adult Hirschsprung's disease - First human case (with video).

Dig Endosc. 2016 Jun 15;

Authors: Bapaye A, Wagholikar G, Jog S, Kothurkar A, Purandare S, Dubale N, Pujari R, Mahadik M, Vyas V, Bapaye J

Abstract
Hirschsprung's disease (HD) is a congenital disorder characterized by absence of intrinsic ganglion cells in submucosal (SM) and myenteric plexuses of the hindgut; and presents with constipation, intestinal obstruction and / or megacolon. HD commonly involves the rectosigmoid region (short segment HD) although shorter and longer variants of the disease are described. Standard treatment involves pull-through surgery for short segment HD or posterior anorectal myotomy (PARM) in selected ultra-short segment candidates. Third space endoscopy has evolved during the last few years. Peroral endoscopic myotomy (POEM) and peroral pyloromyotomy (G-POEM or POEP) are described for treatment of achalasia cardia and refractory gastroparesis respectively. Using the same philosophy of muscle / sphincter disruption for spastic bowel segments, per-rectal endoscopic myotomy (PREM) could be considered as a treatment option for short segment HD. A 24-years male patient presented with refractory constipation since childhood and habituated to high dose laxative combinations. Diagnosis was confirmed as adult short segment HD by barium enema, colonoscopic deep suction mucosal biopsies and anorectal manometry (HRM). Histopathology confirmed aganglionosis in the distal 15 cm. By implementing principles of third space endoscopy, per-rectal endoscopic myotomy (PREM) 20 cm in length was successfully performed. At twenty-four weeks follow up; patient reports significant relief of constipation and associated symptoms. Sigmoidoscopy, HRM and barium enema confirm improved rectal distensibility and reduced rectal pressures. This case report describes the first human experience of per-rectal endoscopic myotomy (PREM) for successful treatment of adult short segment HD.

PMID: 27307403 [PubMed - as supplied by publisher]

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Interpreting risk as evidence of causality: lessons learned from a legal case to determine medical malpractice.

Interpreting risk as evidence of causality: lessons learned from a legal case to determine medical malpractice.

J Eval Clin Pract. 2016 Jun 15;

Authors: Mercuri M, Baigrie BS

Abstract
Translating risk estimates derived from epidemiologic study into evidence of causality for a particular patient is problematic. The difficulty of this process is not unique to the medical context; rather, courts are also challenged with the task of using risk estimates to infer evidence of cause in particular cases. Thus, an examination of how this is done in a legal context might provide insight into when and how it is appropriate to use risk information as evidence of cause in a medical context. A careful study of the case of Goodman v. Viljoen, a medical malpractice suit litigated in the Ontario Superior Court of Justice in 2011, reveals different approaches to how risk information is used as or might be considered a substitute for evidence of causation, and the pitfalls associated with these approaches. Achieving statistical thresholds, specifically minimizing the probability of falsely rejecting the null hypothesis, and exceeding a relative risk of 2, plays a significant role in establishing causality of the particular in the legal setting. However, providing a reasonable explanation or establishing "biological plausibility" of the causal association also seems important, and (to some) may even take precedent over statistical thresholds for a given context.

PMID: 27305892 [PubMed - as supplied by publisher]

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Water--Our Most Precious Resource.

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Water--Our Most Precious Resource.

WMJ. 2016 Apr;115(2):61

Authors: Mazza JJ

PMID: 27197336 [PubMed - indexed for MEDLINE]

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Response: Scientific misconduct encountered by APAME journals: insight?

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Response: Scientific misconduct encountered by APAME journals: insight?

Malays J Pathol. 2016 Apr;38(1):73

Authors: Looi LM, Wong LX, Koh CC

PMID: 27126670 [PubMed - indexed for MEDLINE]

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Government wants 'honest' nurses to be treated more leniently.

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Government wants 'honest' nurses to be treated more leniently.

Nurs Manag (Harrow). 2016 Apr;23(1):6

Authors:

PMID: 27032260 [PubMed - indexed for MEDLINE]

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Promoting organisational justice in medicine and health science research and practice.

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Promoting organisational justice in medicine and health science research and practice.

BMJ. 2016;352:i1048

Authors: MacLachlan M

PMID: 26908037 [PubMed - indexed for MEDLINE]

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Global Health Governance and Global Power: A Critical Commentary on the Lancet-University of Oslo Commission Report.

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Global Health Governance and Global Power: A Critical Commentary on the Lancet-University of Oslo Commission Report.

Int J Health Serv. 2016;46(2):346-65

Authors: Gill S, Benatar S

Abstract
The Lancet-University of Oslo Commission Report on Global Governance for Health provides an insightful analysis of the global health inequalities that result from transnational activities consequent on what the authors call contemporary "global social norms." Our critique is that the analysis and suggested reforms to prevailing institutions and practices are confined within the perspective of the dominant-although unsustainable and inequitable-market-oriented, neoliberal development model of global capitalism. Consequently, the report both elides critical discussion of many key forms of material and political power under conditions of neoliberal development and governance that shape the nature and priorities of the global governance for health, and fails to point to the extent of changes required to sustainably improve global health. We propose that an alternative concept of progress-one grounded in history, political economy, and ecologically responsible health ethics-is sorely needed to better address challenges of global health governance in the new millennium. This might be premised on global solidarity and the "development of sustainability." We argue that the prevailing market civilization model that lies at the heart of global capitalism is being, and will further need to be, contested to avoid contradictions and dislocations associated with the commodification and privatization of health.

PMID: 26883181 [PubMed - indexed for MEDLINE]

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[Cost and effectiveness analysis of treatments for benign prostatic hyperplasia].

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[Cost and effectiveness analysis of treatments for benign prostatic hyperplasia].

Zhonghua Yi Xue Za Zhi. 2016 Jan 26;96(4):289-92

Authors: Zhong C, Wen W, Xia S

Abstract
OBJECTIVE: To compare the costs and effectiveness of treatments for benign prostatic hyperplasia (BPH), including pharmaceuticals (finasteride, tamsulosin, combined therapy), transurethral 2 micron laser resection of the prostate and transurethral resection of the prostate (TURP).
METHODS: Since July 2007 to June 2009, a total of 790 patients with BPH were prospectively collected in this study, including 390 outpatients with pharmaceuticals who were randomly classified into 3 groups of finasteride, tamsulosin and combined therapy, 140 inpatients with transurethral 2 micron laser resection of the prostate and 260 inpatients with TURP. The costs and effectiveness of each group were compared.
RESULTS: Prostate volume of finasteride group was decreased after three months of medication, of tamsulosin group no change, of combined therapy group was decreased after one month of medication. Maximum flow rate (MFR) of three groups was higher after one month of medication. International prostate symptom score (IPSS) and quality of life (QOL) score were decreased after one month of medication and further decreased 3 months, 6 months after the medicine, the difference was statistically significant. The effective rate of three pharmaceutical groups after 6 months of treatment was 84%, 89% and 89%, respectively. The cost of operative group was lower than 5-year cost of pharmaceutical group.
CONCLUSIONS: Tamsulosin combined with finasteride is the better pharmaceutical option for BPH patients and the transurethral 2 micron laser resection of the prostate, the cost of which is lower than pharmaceuticals, is a safe and effective surgery.

PMID: 26879791 [PubMed - indexed for MEDLINE]

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Chancellor's psychiatrist brother is struck off medical register.

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Chancellor's psychiatrist brother is struck off medical register.

BMJ. 2016;352:i900

Authors: Dyer C

PMID: 26873224 [PubMed - indexed for MEDLINE]

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Nobel official resigns in wake of storm over Italian surgeon.

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Nobel official resigns in wake of storm over Italian surgeon.

BMJ. 2016;352:i837

Authors: Hawkes N

PMID: 26872776 [PubMed - indexed for MEDLINE]

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Poor governance in the award of honours and degrees in British medicine: an extreme example of a systemic problem.

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Poor governance in the award of honours and degrees in British medicine: an extreme example of a systemic problem.

BMJ. 2016;352:h6952

Authors: Wilmshurst P

PMID: 26838121 [PubMed - indexed for MEDLINE]

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The National Disability Insurance Scheme: a time for real change in Australia.

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The National Disability Insurance Scheme: a time for real change in Australia.

Dev Med Child Neurol. 2016 Feb;58 Suppl 2:66-70

Authors: Reddihough DS, Meehan E, Stott NS, Delacy MJ, Australian Cerebral Palsy Register Group

Abstract
In Australia, the supports and services for persons with disabilities have long been underfunded and fragmented. Often, individuals did not receive the services they needed, but rather the services they were entitled to based on how or when they acquired their disability. As a result, there was an increasing reliance on ageing carers, a lack of permanent and respite accommodation, and reduced employment and educational opportunities. Individuals with disabilities and their families were often isolated and financially disadvantaged. In March 2013, legislation was passed in Australia to establish a National Disability Insurance Scheme, a radical new way of funding disability services. No longer would funding be directed to agencies, but rather to individuals who would make their own plan and select their preferred services and service providers, giving them more control over the services and supports they receive. The hope is that this change from a welfare-driven to an insurance-based model will improve equity of service delivery, levels of participation, and overall quality of life among Australians with disabilities and their families.

PMID: 26782069 [PubMed - indexed for MEDLINE]

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PRO-cision Medicine: Personalizing Patient Care Using Patient-Reported Outcomes.

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PRO-cision Medicine: Personalizing Patient Care Using Patient-Reported Outcomes.

J Clin Oncol. 2016 Feb 20;34(6):527-9

Authors: Jensen RE, Snyder CF

PMID: 26644538 [PubMed - indexed for MEDLINE]

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Workplace Violence and Job Performance among Community Healthcare Workers in China: The Mediator Role of Quality of Life.

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Workplace Violence and Job Performance among Community Healthcare Workers in China: The Mediator Role of Quality of Life.

Int J Environ Res Public Health. 2015 Nov;12(11):14872-86

Authors: Lin WQ, Wu J, Yuan LX, Zhang SC, Jing MJ, Zhang HS, Luo JL, Lei YX, Wang PX

Abstract
OBJECTIVE: To explore the impact of workplace violence on job performance and quality of life of community healthcare workers in China, especially the relationship of these three variables.
METHODS: From December 2013 to April 2014, a total of 1404 healthcare workers were recruited by using the random cluster sampling method from Community Health Centers in Guangzhou and Shenzhen. The workplace violence scale, the job performance scale and the quality of life scale (SF-36) were self-administered. The structural equation model constructed by Amos 17.0 was employed to assess the relationship among these variables.
RESULTS: Our study found that 51.64% of the respondents had an experience of workplace violence. It was found that both job performance and quality of life had a negative correlation with workplace violence. A positive association was identified between job performance and quality of life. The path analysis showed the total effect (β = -0.243) of workplace violence on job performance consisted of a direct effect (β = -0.113) and an indirect effect (β = -0.130), which was mediated by quality of life.
CONCLUSIONS: Workplace violence among community healthcare workers is prevalent in China. The workplace violence had negative effects on the job performance and quality of life of CHCs' workers. The study suggests that improvement in the quality of life may lead to an effective reduction of the damages in job performance caused by workplace violence.

PMID: 26610538 [PubMed - indexed for MEDLINE]

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Vitamin D supplementation to prevent depression and poor physical function in older adults: Study protocol of the D-Vitaal study, a randomized placebo-controlled clinical trial.

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Vitamin D supplementation to prevent depression and poor physical function in older adults: Study protocol of the D-Vitaal study, a randomized placebo-controlled clinical trial.

BMC Geriatr. 2015;15:151

Authors: de Koning EJ, van Schoor NM, Penninx BW, Elders PJ, Heijboer AC, Smit JH, Bet PM, van Tulder MW, den Heijer M, van Marwijk HW, Lips P

Abstract
BACKGROUND: Depressive symptoms and decreased physical functioning are interrelated conditions and common in older persons, causing significant individual and societal burden. Evidence suggests that vitamin D supplementation may be beneficial for both mental and physical functioning. However, previous randomized controlled trials have yielded inconsistent results and often had suboptimal designs. This study examines the effect of vitamin D supplementation on both depressive symptoms and physical functioning in a high-risk population of older persons with low vitamin D status.
METHODS/DESIGN: The D-Vitaal study is a randomized, double-blind, placebo-controlled trial investigating the effects of a daily dose of 1200 IU vitamin D3 versus placebo for one year on depressive symptoms and physical functioning (primary outcomes) in older adults. Participants (N = 155, age 60-80 years) were recruited from the general population. Eligibility criteria included the presence of depressive symptoms, ≥1 functional limitation and serum 25-hydroxyvitamin D levels between 15 and 50/70 nmol/L (depending on season). Secondary outcomes include incidence of major depressive disorder, anxiety symptoms, health-related quality of life, cognitive function and cost-effectiveness of the intervention.
DISCUSSION: With this study, we aim to elucidate the effects of vitamin D supplementation on depressive symptoms and physical functioning in older persons who are at high risk of developing more substantial mental and physical problems. If effective, vitamin D supplementation can be a preventive intervention strategy that is easy to implement in the primary care setting.
TRIAL REGISTRATION: Netherlands Trial Register NTR3845. Registered 6 February 2013.

PMID: 26585952 [PubMed - indexed for MEDLINE]

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Quality of care in European home care programs using the second generation interRAI Home Care Quality Indicators (HCQIs).

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Quality of care in European home care programs using the second generation interRAI Home Care Quality Indicators (HCQIs).

BMC Geriatr. 2015;15:148

Authors: Foebel AD, van Hout HP, van der Roest HG, Topinkova E, Garms-Homolova V, Frijters D, Finne-Soveri H, Jónsson PV, Hirdes JP, Bernabei R, Onder G

Abstract
BACKGROUND: Evaluating the quality of care provided to older individuals is a key step to ensure that needs are being met and to target interventions to improve care. To this aim, interRAI's second-generation home care quality indicators (HCQIs) were developed in 2013. This study assesses the quality of home care services in six European countries using these HCQIs as well as the two derived summary scales.
METHODS: Data for this study were derived from the Aged in Home Care (AdHOC) study - a cohort study that examined different models of community care in European countries. The current study selected a sub-sample of the AdHOC cohort from six countries whose follow-up data were complete (Czech Republic, Denmark, Finland, Germany, Italy and the Netherlands). Data were collected from the interRAI Home Care instrument (RAI-HC) between 2000 and 2002. The 23 HCQIs of interest were determined according to previously established methodology, including risk adjustment. Two summary measures, the Clinical Balance Scale and Independence Quality Scale were also determined using established methodology.
RESULTS: A total of 1,354 individuals from the AdHOC study were included in these analyses. Of the 23 HCQIs that were measured, the highest proportion of individuals experienced declines in Instrumental Activities of Daily Living (IADLs) (48.4 %). Of the clinical quality indicators, mood decline was the most prevalent (30.0 %), while no flu vaccination and being alone and distressed were the most prevalent procedural and social quality indicators, respectively (33.4 and 12.8 %). Scores on the two summary scales varied by country, but were concentrated around the median mark.
CONCLUSIONS: The interRAI HCQIs can be used to determine the quality of home care services in Europe and identify areas for improvement. Our results suggest functional declines may prove the most beneficial targets for interventions.

PMID: 26572734 [PubMed - indexed for MEDLINE]

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The historical origins of the safe haven status of the Swiss franc

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Impact of Advance Notice Periods on the Performance Persistence of Hedge Funds

This paper examines the impact of the advance notice period on hedge fund performance persistence in investors’ portfolios. As investors in hedge funds face several trading restrictions related to the funds’ common investment terms and conditions, it is hypothesized that the advance notice period generates illiquidity for investors and impairs their ability to benefit from performance persistence in hedge funds. Using a sample of 4,788 hedge funds over a period from 1994 to 2008 and contingency table based standard methodology for returns and Sharpe ratios, the results suggest that accounting for individual funds’ advance notice periods has a negative impact on the performance persistence of hedge funds. The proportion of significantly persistent funds declines when incorporating the advance notice period, especially for short time horizons. Furthermore, a considerable part of hedge fund performance persistence is related to asset class-specific terms and conditions, reducing the amount of short-term performance persistence in practice.

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