One-Year Follow-up Study Detects Myocardial Changes with Cardiovascular Magnetic Resonance Tagging in Active Rheumatoid Arthritis

Publication date: Available online 1 December 2017
Source:Academic Radiology
Author(s): Lauri Lehmonen, Aino-Maija Vuorinen, Riitta Koivuniemi, Marjatta Leirisalo-Repo, Miia Holmström, Sari Kivistö, Touko Kaasalainen
Rationale and ObjectivesTo evaluate the effects of 1 year of medical treatment on myocardial function in active rheumatoid arthritis (RA).Materials and MethodsThirty-nine female patients with RA without any known cardiovascular disease underwent a cardiovascular magnetic resonance (CMR) examination before and after 1 year of antirheumatic treatment. The population comprised untreated active early RA (ERA) and chronic RA patients, who were grouped accordingly. The CMR protocol included volumetric determinations, late gadolinium enhancement imaging, myocardial tagging, and native T1 mapping. DAS28-CRP disease activity scores were calculated before and after the treatment.ResultsResults are reported as median (quartile 1–quartile 3). Time to peak diastolic filling rate improved in ERA (495 [443–561] ms vs 441 [340–518] ms, P = .018). Peak diastolic mean mid short-axis circumferential strain rate of all six segments was improved (82 [74–91] %/s vs 91 [77–100] %/s, P = .05), particularly in the anterior segment (82 [63–98] %/s vs 86 [77–109] %/s, P = .013). DAS28-CRP decreased in ERA (3.8 [3.2–4.1] vs 1.6 [1.4–2.2], P < .001). In chronic RA, no statistically significant improvement was detected.ConclusionsEarly treatment of active RA is important, as myocardial function detected with CMR tagging improved in ERA in parallel with decreasing inflammatory activity.



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Bone Marrow Involvement in Malignant Lymphoma

Publication date: Available online 1 December 2017
Source:Academic Radiology
Author(s): Ulrika Asenbaum, Richard Nolz, Georgios Karanikas, Julia Furtner, Ramona Woitek, Ingrid Simonitsch-Klupp, Markus Raderer, Marius E. Mayerhoefer
Rationale and ObjectivesThis study aimed to determine the diagnostic utility of standardized uptake values (SUV) and apparent diffusion coefficients (ADC) for assessment of focal and diffuse bone marrow involvement in patients with malignant lymphoma.Materials and MethodsSixty treatment-naive patients (28 males; mean age 51.2 ± 16.7 years) with histologically proven lymphoma, who underwent fludeoxyglucose (¹⁸F) positron emission tomography-computed tomography ([F18]-FDG-PET/CT) and whole-body diffusion-weighted imaging (WB-DWI) within 7 days, and also routine bone marrow biopsy, were included in this institutional review board-approved, retrospective study. The maximum SUV (SUVmax) on [F18]-FDG-PET/CT, and the mean ADC (ADCmean, ×10⁻³ mm²/s) on whole-body-DWI, were extracted from focal lesions, or, in their absence, from the thoracic (Th8) and lumbar vertebral bodies (L4), the sacral bone (S1), and the iliac crest. Lesion-to-liver-ratios (SUVmax-ratio) were calculated. Pearson correlation coefficients were used to assess the correlation between SUVmax-ratios and ADCmean values.ResultsBone marrow involvement was observed in 16 of 60 patients (8 of 16 with diffuse infiltration). The SUVmax-ratio cutoff value was 95.25% for focal and 70.2% for diffuse bone marrow involvement (sensitivity/specificity of 87.5%/86.4% and 100%/43.2%, respectively). The ADCmean cutoff value was 0.498 for focal and 0.401 for diffuse bone marrow involvement (sensitivity/specificity of 100%/90.9% and 87.5%/56.8%, respectively). No significant correlations were found between SUVmax-ratios and ADCmean values in the different groups.ConclusionWith the liver as reference tissue, quantitative [F18]-FDG-PET/CT may be useful to differentiate bone marrow involvement from normal bone marrow in patients with lymphoma, even though the specificity for diffuse marrow involvement is rather low. Quantitative DWI can be used only to distinguish focal bone marrow lesions from normal bone marrow.



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Interpreting Change in Quantitative Imaging Biomarkers

Publication date: Available online 1 December 2017
Source:Academic Radiology
Author(s): Nancy A. Obuchowski
Rationale and ObjectivesQuantitative imaging biomarkers (QIBs) are becoming increasingly adopted into clinical practice to monitor changes in patients' conditions. The repeatability coefficient (RC) is the clinical cut-point used to discern between changes in a biomarker's measurements due to measurement error and changes that exceed measurement error, thus indicating real change in the patient. Imaging biomarkers have characteristics that make them difficult for estimating the repeatability coefficient, including nonconstant error, non-Gaussian distributions, and measurement error that must be estimated from small studies.MethodsWe conducted a Monte Carlo simulation study to investigate how well three statistical methods for estimating the repeatability coefficient perform under five settings common for QIBs.ResultsWhen the measurement error is constant and replicates are normally distributed, all of the statistical methods perform well. When the measurement error is proportional to the true value, approaches that use the log transformation or coefficient of variation perform similarly. For other common settings, none of the methods for estimating the repeatability coefficient perform adequately.ConclusionMany of the common approaches to estimating the repeatability coefficient perform well for only limited scenarios. The optimal approach depends strongly on the pattern of the within-subject variability; thus, a precision profile is critical in evaluating the technical performance of QIBs. Asymmetric bounds for detecting regression vs progression can be implemented and should be used when clinically appropriate.



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Screening Mammography Utilization and Medicare Beneficiaries' Perceptions of Their Primary Care Physicians

Publication date: Available online 1 December 2017
Source:Academic Radiology
Author(s): Andrew B. Rosenkrantz, Margaret M. Fleming, Linda Moy, James S. Babb, Richard Duszak
Rationale and ObjectivesTo assess associations between screening mammography utilization and Medicare beneficiaries' relationships with, and impressions of, their primary care physicians.Materials and MethodsUsing the Medicare Current Beneficiary Survey Access to Care Public Use File, we retrospectively studied responses from a national random cross section of Medicare beneficiaries surveyed in 2013 regarding perceptions of their primary care physicians and their screening mammography utilization. Statistical analysis accounted for subject weighting factors to estimate national screening utilization.ResultsAmong 7492 female Medicare beneficiaries, 62.0% (95% confidence interval 59.8%–64.2%) underwent screening mammography. Utilization was higher for beneficiaries having (vs. not) a regular medical practice or clinic (63.2% vs. 34.6%) and a usual physician (63.8% vs. 50.3%). Utilization was higher for beneficiaries very satisfied (vs. very dissatisfied) with the overall quality of care they received (66.0% vs. 35.8%), their ease of getting to a doctor (67.7% vs. 43.2%), and their physician's concerns for their health (65.7% vs. 53.4%), as well as for beneficiaries strongly agreeing (vs. strongly disagreeing) that their physician is competent (66.0% vs. 54.1%), understands what is wrong (66.3% vs. 47.1%), answers all questions (67.0% vs. 46.7%), and fosters confidence (66.0% vs. 50.6%). Independent predictors of screening mammography utilization (P < .05) were satisfaction with quality of care, having a regular practice or clinic, and satisfaction with ease of getting to their physician.ConclusionsScreening mammography utilization is higher among Medicare beneficiaries with established primary physician relationships, particularly when those relationships are favorable. To optimize screening mammography utilization, breast imagers are encouraged to support initiatives to enhance high-quality primary care relationships.



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Epidemiology of Hepatic Steatosis at a Tertiary Care Center

Publication date: Available online 2 December 2017
Source:Academic Radiology
Author(s): Tyler J. Fraum, Daniel R. Ludwig, Scott Kilian, William A. Curtis, Thomas K. Pilgram, Claude B. Sirlin, Kathryn J. Fowler
Rationale and ObjectivesLittle is known about the frequency and risk factors of hepatic steatosis in the tertiary care setting. Such knowledge is essential to clinicians making decisions about testing for this condition. Thus, our aim was to describe the epidemiology of hepatic steatosis, as captured by magnetic resonance imaging (MRI), at a tertiary care center.Materials and MethodsA near-consecutive cohort of 1006 adult patients underwent standard-of-care liver MRIs. Images were retrospectively processed to derive proton density fat fraction (PDFF) maps. Data from three spatially distinct regions of interest (ROIs) were aggregated to derive overall hepatic PDFF values. Demographic, anthropometric, clinical, and laboratory variables were included in a multivariate analysis to determine predictors of hepatic steatosis grades (based on established PDFF cutoffs). Hepatic steatosis grades derived from single vs aggregated ROIs were compared.ResultsHepatic steatosis was observed in 25% of patients (19% grade 1; 3% grade 2; 3% grade 3). Controlling for all other variables, the odds of hepatic steatosis increased by 7%–9% (P < .001) for each whole point increase in body mass index (BMI), whereas elevated serum bilirubin was associated with lower odds of hepatic steatosis (P = .002). Race, diabetes mellitus, dyslipidemia, and metabolic syndrome were not independently predictive of hepatic steatosis when controlling for other variables (eg, BMI). Employing single ROIs (rather than three aggregated ROIs) resulted in incorrect steatosis grading in up to 8.0% of patients.ConclusionMany adult patients undergoing liver MRI at a tertiary care center have hepatic steatosis, with larger BMIs as the only independent predictor of higher grades. This information can be used by clinicians at such centers to make evidence-based decisions about when to test for hepatic steatosis in their patients.



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Fragmentation level determines mitochondrial damage response and subsequently the fate of cancer cells exposed to carbon ions

Although mitochondria are known to play an important role in radiation-induced cellular damage response, the mechanisms of how radiation elicits mitochondrial responses are largely unknown.

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Clinical evaluation of atlas and deep learning based automatic contouring for lung cancer

Contouring of organs at risk (OARs) is an important but time consuming part of radiotherapy treatment planning. The aim of this study was to investigate whether using institutional created software-generated contouring will save time if used as a starting point for manual OAR contouring for lung cancer patients.

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Interobserver variability in the delineation of the primary lung cancer and lymph nodes on different four-dimensional computed tomography reconstructions

The study compared interobserver variation in the delineation of the primary tumour (GTVp) and lymph nodes (GTVln) between three different 4DCT reconstruction types; Maximum Intensity Projection (MIP), Mid-Ventilation (Mid-V) and Mid-Position (Mid-P).

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The distribution of tritium in aquatic environments, Lithuania

Publication date: Available online 1 December 2017
Source:Journal of Environmental Radioactivity
Author(s): Olga Jefanova, Jonas Mažeika, Rimantas Petrošius, Žana Skuratovič
The aim of this study is to investigate mobile radionuclide tritium (³H or T) activity dynamics in aquatic environments related to Ignalina NPP (INPP) site and water bodies located in remote areas unaffected by the INPP. The ³H excess in the INPP environment was analyzed and compared to the variable ³H background level over the period of operation of the INPP (end of 1983 – end of 2009) and during the initial stage of decommissioning (2010–2017). ³H in the INPP vicinity has been studied in the water of artificial channels related to operation of the INPP and site drainage, in natural surface water bodies and, at a smaller scale, in unconfined groundwater. This study presents an extensive ³H data set extending back to 1980, i.e. before INPP operation started. To assess the contribution of global sources to ³H dynamics, monthly precipitation was also studied, along with water from the Baltic Sea, Curonian Lagoon and Nemunas River were studied as well, all three of these located in the Lithuanian maritime zone. The ³H activity concentration in water was measured using liquid scintillation counting (LSC) techniques (direct counting and counting after enrichment). During the period of INPP operation, ³H from liquid effluent could be clearly observed in discharge channels, occurring in rather low diluted conditions, as well as in Lake Druksiai, the cooling basin, at an even more diluted level. The highest ³H activity concentration in Lake Druksiai was observed in 2003 and reached 201.3 ± 1.3 TU at a time when ³H activity concentrations in background water bodies was 9.2 ± 3.5 TU. After the closure of the INPP, the ³H liquid effluent rate reduced by approximately two orders of magnitude (from 10¹² Bq in 1991 to 10¹⁰ Bq in 2016) and when decommissioning activity commenced then the ³H activity concentration fell to that approaching the background level (19–27 TU) that can still be observed in industrial discharge and rainwater drainage channels. ³H as a result of leakage from the INPP can be observed in groundwater only in direct proximity to the INPP site near the radioactive waste storage zone.



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Identifying radon priority areas and dwellings with radon exceedances in Bulgaria using stored CD/DVDs

Publication date: Available online 1 December 2017
Source:Journal of Environmental Radioactivity
Author(s): D. Pressyanov, I. Dimitrova, K. Mitev, S. Georgiev, D. Dimitrov
The implementation of the 2013/59/EURATOM directive in the part related to radon exposure imposes challenges for radon measurement methodology and radon survey design. Among them is the need to have estimates (preferably direct) of the annual average radon concentrations, which can be directly compared to the recommended reference levels. On this basis, the surveys should make possible the identification of dwellings with indoor radon above the reference levels and "radon priority areas" where significant proportion of the dwellings falls in this category. The performance of the CD/DVD method for radon measurements as a tool to address these issues is presented. A recent large scale field study based on the CD/DVD method that was carried out in the suburb area of Sofia, Bulgaria is described. Part of the studied area was affected in the past by the uranium mining and milling industry. In total 462 disks (CDs and DVDs) taken from 335 private dwellings from 10 districts in the region were analyzed. The results revealed the large heterogeneity in radon distribution in the area, with the percentage of dwellings with a ²²²Rn level above 300 Bq m⁻³ ranking from about 7% to 74%. The district of Yana, for which this percent was 74, was identified as the area of highest radon priority in the region. The paper also discusses how prompt identification of dwellings with radon above the reference level by CD/DVDs can be incorporated within an integrated approach to the radon problem. Within this approach the radon hazard is identified shortly after the stakeholder's decision to test, which allows fast solution of the problem without waiting the long (and usually demotivating) one-year period needed for direct results by the commonly used prospective methods.



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Head and neck Merkel cell carcinoma: a retrospective case series and critical literature review with emphasis on treatment and prognosis

Publication date: Available online 2 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Ioannis Papadiochos, Anna Patrikidou, Aikaterini Patsatsi, Doxa Mangoudi, Henri Thuau, Konstantinos Vahtsevanos
ObjectiveMerkel cell carcinoma (MCC) is a rare cutaneous malignancy with a high recurrence and mortality rates. More than half of MCCs occur in the head and neck region. This paper aims to present a retrospective case series study of primary MCCs of the head and neck treated in our department over 12 years.Study DesignSix patients were identified, and their characteristics, treatment modalities, and outcomes are reported. A critical review of the current literature is also included to provide up-to-date information on MCCs with special emphasis on treatment modalities and disease prognosis.ResultsManagement of head and neck MCCs requires early and accurate diagnosis and includes surgery, radiotherapy, and/or combination chemotherapy. Accurate cervical nodal staging is of paramount importance before establishing the definite treatment plan.ConclusionsThe results of both our case series and literature data review indicate that elective management of regional lymph nodes is recommended instead of an observation approach for patients with no identifiable disease in the lymph nodes (cN0). Because the majority of MCCs arise in the head and neck region, oral and maxillofacial surgeons are likely be the first professionals who will encounter this disease and should therefore be aware of the current diagnostic and treatment modalities.



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Expression of ADAMTS2 and ADAMTS5 in the salivary gland of rats after radioiodine therapy.

Expression of ADAMTS2 and ADAMTS5 in the salivary gland of rats after radioiodine therapy.

Nucl Med Commun. 2017 Nov 29;:

Authors: Sadic M, Demirel K, Halacli SO, Karakok E, Koca G, Ekinci O, Demircan K, Korkmaz M

Abstract
OBJECTIVE: The aim of this study was to investigate the presence of ADAMTS2 and ADAMTS5 in the salivary gland (SG) of rats after high-dose radioiodine therapy.
METHODS: A total of 36 male Wistar albino rats were used for this study. Thirty-six male rats were divided randomly into six groups: control and five radioactive iodine (RAI) treatment groups of six rats each. All animals were killed. The evaluation of biodistribution and histopathological studies were carried out on the SGs removed. Real-time PCR and immunohistochemical analysis were carried out to determine mRNA and protein expression levels of ADAMTS genes. Differences between the groups were evaluated statistically.
RESULTS: In RAI-treated groups, ADAMTS2 and ADAMTS5 gene expression was observed to increase, whereas there was no mRNA or protein expression in the control group. There were statistically significant increases in the mRNA expression of ADAMTS2 (all RAI-administered groups in parathyroid gland and at 4, 24, and 48 h in submandibular gland) and ADAMTS5 (all RAI-administered groups, except on the 30th day in the parathyroid gland and all RAI groups in submandibular gland). Through immunohistochemical analysis, the staining pattern in the extracellular source was also observed in the overexpressed ADAMTS2 and ADAMTS5 groups. Nuclear coarsening and partial focal subnuclei vacuolization were determined in all RAI-administered groups with histopathological examinations.
CONCLUSION: An increase in the mRNA expression levels of ADAMTS2 and ADAMTS5 genes was detected in the RAI-administered groups. These results suggested that ADAMTS2 and ADAMTS5 genes might play a role in radiation exposure and radioiodine-induced SG changes.

PMID: 29194287 [PubMed - as supplied by publisher]

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The Untold Toll of the Opioid Crisis on Intensive Care Units in the United States.

The Untold Toll of the Opioid Crisis on Intensive Care Units in the United States.

Ann Am Thorac Soc. 2017 Dec;14(12):1763-1765

Authors: Mehta AB, Weinstein Z, Walkey AJ

PMID: 29192818 [PubMed - in process]

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The PPARα-dependent rodent liver tumor response is not relevant to humans: addressing misconceptions

Abstract

A number of industrial chemicals and therapeutic agents cause liver tumors in rats and mice by activating the nuclear receptor peroxisome proliferator-activated receptor α (PPARα). The molecular and cellular events by which PPARα activators induce rodent hepatocarcinogenesis have been extensively studied elucidating a number of consistent mechanistic changes linked to the increased incidence of liver neoplasms. The weight of evidence relevant to the hypothesized mode of action (MOA) for PPARα activator-induced rodent hepatocarcinogenesis is summarized here. Chemical-specific and mechanistic data support concordance of temporal and dose–response relationships for the key events associated with many PPARα activators. The key events (KE) identified in the MOA are PPARα activation (KE1), alteration in cell growth pathways (KE2), perturbation of hepatocyte growth and survival (KE3), and selective clonal expansion of preneoplastic foci cells (KE4), which leads to the apical event—increases in hepatocellular adenomas and carcinomas (KE5). In addition, a number of concurrent molecular and cellular events have been classified as modulating factors, because they potentially alter the ability of PPARα activators to increase rodent liver cancer while not being key events themselves. These modulating factors include increases in oxidative stress and activation of NF-kB. PPARα activators are unlikely to induce liver tumors in humans due to biological differences in the response of KEs downstream of PPARα activation. This conclusion is based on minimal or no effects observed on cell growth pathways and hepatocellular proliferation in human primary hepatocytes and absence of alteration in growth pathways, hepatocyte proliferation, and tumors in the livers of species (hamsters, guinea pigs and cynomolgus monkeys) that are more appropriate human surrogates than mice and rats at overlapping dose levels. Despite this overwhelming body of evidence and almost universal acceptance of the PPARα MOA and lack of human relevance, several reviews have selectively focused on specific studies that, as discussed, contradict the consensus opinion and suggest uncertainty. In the present review, we systematically address these most germane suggested weaknesses of the PPARα MOA.

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Search Engine Optimization: An Analysis of Rhinoplasty Web sites.

Search Engine Optimization: An Analysis of Rhinoplasty Web sites.

Facial Plast Surg. 2017 Dec;33(6):665-669

Authors: Rayess HM, Gupta A, Nissan M, Carron MA, Zuliani GF

PMID: 29195249 [PubMed - in process]

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Role of Camouflage in Management of Facial Trauma Deformities.

Role of Camouflage in Management of Facial Trauma Deformities.

Facial Plast Surg. 2017 Dec;33(6):643-652

Authors: Chin OY, Tollefson TT

PMID: 29195246 [PubMed - in process]

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Repair of the Malpositioned Lower Lid.

Repair of the Malpositioned Lower Lid.

Facial Plast Surg. 2017 Dec;33(6):598-605

Authors: Chan D, Sokoya M, Ducic Y

PMID: 29195240 [PubMed - in process]

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In-Continuity Neck Dissection: Long-Term Oncological Outcomes in Squamous Cell Carcinoma of the Buccal Mucosa.

In-Continuity Neck Dissection: Long-Term Oncological Outcomes in Squamous Cell Carcinoma of the Buccal Mucosa.

J Oral Maxillofac Surg. 2017 Nov 11;:

Authors: Xie L, Zhang Y, Huang W, Chen J, Yu J, Zhou X

Abstract
PURPOSE: To introduce in-continuity neck dissection (ND) in squamous cell carcinoma of the buccal mucosa (BMSCC) and to determine its impact on the oncologic outcomes of these patients.
MATERIALS AND METHODS: A retrospective review of patients treated for BMSCC from 2006 through 2016 was performed. Kaplan-Meier analysis and log-rank test were used to evaluate local control, regional control (RC), distant metastasis (DM), and disease-specific survival (DSS) of in-continuity ND versus discontinuous ND in 220 previously untreated patients with BMSCC, followed by a multivariate Cox regression that included all relevant variables.
RESULTS: Fifty-three patients received discontinuous ND and 167 patients received in-continuity ND. The 2 groups were comparable. Univariate Kaplan-Meier analysis showed that 5-year DSS rates for the discontinuous ND and in-continuity ND groups were 38 and 62% (P = .023), respectively. The 5-year RC rate for the in-continuity ND group (81%) was significantly better (P = .004) than for the discontinuous ND group (54%). At Cox regression analysis, in-continuity ND meaningfully contributed to a higher RC rate and subsequently better DSS.
CONCLUSION: Compared with discontinuous ND, in-continuity ND predicted favorable oncologic outcomes in patients with BMSCC. In-continuity ND could be a practical approach in the surgical management of BMSCC.

PMID: 29195080 [PubMed - as supplied by publisher]

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Hemorrhage following transoral robotic surgery (TORS).

Hemorrhage following transoral robotic surgery (TORS).

Clin Otolaryngol. 2017 Dec 01;:

Authors: Hay A, Migliacci J, Karassawa Zanoni D, Boyle JO, Singh B, Wong RJ, Patel SG, Ganly I

Abstract
BACKGROUND: To report our experience of postoperative hemorrhage in patients following transoral robotic surgery (TORS).
METHODS: Data was collected on patients having TORS. Postoperative hemorrhage within 30 days was graded using the Mayo clinic grading system.
RESULTS: TORS operations were performed on 122 patients. There were 23 bleeding events classified as minor to severe following 19 operations (16%). Hemorrhage requiring a return to the operating room occurred after 7 operations (6%). The odds of an emergent hemorrhage was 5.19 times greater in patients that had a staged neck dissection after TORS (p= 0.05). The odds of a postoperative bleeding event were 2.6 times greater in patients receiving a larger resection (p=0.107). There were no hemorrhage events in the 36 patients who received a synchronous neck dissection with transcervical ligation of the external carotid artery.
CONCLUSIONS: Surgical intervention for TORS hemorrhage occurred in 6% patients. No haemorrhage occurred in patients who had ligation of the external carotid artery. This article is protected by copyright. All rights reserved.

PMID: 29194991 [PubMed - as supplied by publisher]

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The effect of adjuvant radiotherapy on radial forearm free flap volume after soft palate reconstruction in 13 patients.

The effect of adjuvant radiotherapy on radial forearm free flap volume after soft palate reconstruction in 13 patients.

Clin Otolaryngol. 2017 Dec 01;:

Authors: Haymerle G, Enzenhofer E, Lechner W, Stock M, Schratter-Sehn A, Vyskocil E, Bachtiary B, Selzer E, Erovic BM

Abstract
Treatment options for squamous cell carcinoma of the soft palate include surgical resection followed by radiotherapy or primary radiotherapy. In most cases sufficient resection margins require reconstruction of the defect with free flaps. The most common flaps used in oropharyngeal carcinoma are the radial forearm free flap and the anterolateral thigh and latissimus dorsi free flap. According to the magnitude of the resection defect, surgeons estimate the size and volume of soft tissue transfer needed for an optimal esthetic and in particular functional outcome. This article is protected by copyright. All rights reserved.

PMID: 29194976 [PubMed - as supplied by publisher]

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Cognitive and Behavioral Consequences of Sleep Disordered Breathing in Children.

Cognitive and Behavioral Consequences of Sleep Disordered Breathing in Children.

Med Sci (Basel). 2017 Dec 01;5(4):

Authors: Trosman I, Trosman SJ

Abstract
There is now a plethora of evidence that children with sleep disordered breathing (SDB) show deficits in neurocognitive performance, behavioral impairments, and school performance. The following review will focus on the neurobehavioral impacts of SDB, pediatric sleep investigation challenges, potential mechanisms of behavioral and cognitive deficits in children with SDB, and the impact of SDB treatment.

PMID: 29194375 [PubMed]

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Desmoplastic Melanoma of the Periorbital Region.

Desmoplastic Melanoma of the Periorbital Region.

Ophthal Plast Reconstr Surg. 2017 Nov 27;:

Authors: Thakar S, Kandl T, Sagiv O, Tripathy D, Tetzlaff MT, Kapur S, Myers J, Hwu WJ, Esmaeli B, Jaber BMY

Abstract
Desmoplastic melanoma (DM) is a rare subtype of melanoma and an even smaller proportion of periocular melanomas. Here, the authors report 2 cases of DM in the periocular region. Staged according to the American Joint Committee on Cancer (AJCC) eighth edition classification, patient 1 presented with a stage IIIC (pT4apN1cM0) DM in the left lateral canthus with upper and lower eyelid and patient 2 presented with a stage IIIB (T4aN1bM0) DM in the left brow and supraorbital region with a parotid lymph node metastasis. In both patients, the lesions were amelanotic, with inflammatory appearance, and had been noted for several years before the correct diagnosis was made. In both patients, wide excision led to large surgical defects, and perineural invasion prompted adjuvant radiation therapy postoperatively. Patient 2 was treated with an immune checkpoint inhibitor for his parotid metastasis. Ophthalmologists should be aware of DM, its neurotrophic nature, and potential to metastasize with locally advanced lesions.

PMID: 29194286 [PubMed - as supplied by publisher]

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Preoperative Exposure of Sigmoid Sinus Trajectory in Posterolateral Cranial Base Approaches Using a New Landmark Through a Neurosurgical Perspective.

Preoperative Exposure of Sigmoid Sinus Trajectory in Posterolateral Cranial Base Approaches Using a New Landmark Through a Neurosurgical Perspective.

J Craniofac Surg. 2017 Nov 20;:

Authors: Doğan I, Özgüral O, Eroğlu Ü, Al-Beyati ESM, Kilinç CM, Cömert A, Uğur HÇ

Abstract
The location of burr holes in posterolateral cranial base approaches should be appropriate to provide an adequate operative field, and surgical freedom is crucial for bone window opening. The aim of this study was to search for more convenient and easily detectable landmarks in comparison with current landmarks in posterolateral cranial base surgery. Twenty 3-dimensional reconstructed head and neck computed tomography angiography images (group 1) and 20 cadaver heads (group 2) were evaluated. An imaginary line connecting the angle of the mandible and the mastoid tip was extended upward. A second line passing through the lateral edge of the zygomatic arch was also extended posteriorly. The authors examined if the first line met with the sigmoid sinus throughout its course and determined the location of the intersection point of these 2 lines relative to the sigmoid-transverse sinus junction. The intersection point did not correspond to the sinus region in 3 images from group 1 and 4 specimens from group 2. The matching of the mandibula-mastoid line trajectory with the sigmoid sinus course was unacceptable in 4 images and 5 cadavers. For venous anatomy preservation and anatomic skull base fossa orientation during posterolateral cranial base approaches, upward extension of the mandibula-mastoid line can be a proper landmark for surgical planning in this region. The authors' proposed superficial anatomical line and intersection point over the skull could be used as a reliable indicator for the external projection of the sigmoid sinus and an appropriate initial burr-hole location.

PMID: 29194275 [PubMed - as supplied by publisher]

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Success Rate of Tympanic Membrane Closure in the Elderly Compared to Younger Adults.

Success Rate of Tympanic Membrane Closure in the Elderly Compared to Younger Adults.

Otol Neurotol. 2017 Nov 30;:

Authors: Jolink C, Zwemstra MR, de Wolf MJF, Ebbens FA, van Spronsen E

Abstract
OBJECTIVE: To assess the effectiveness and safety of tympanoplasty in elderly patients and the effect of frailty on the results.
STUDY DESIGN: Retrospective chart review.
SETTING: Tertiary referral center.
PATIENTS: Thirty-one ears in 30 patients aged 65 years and older were included and matched with 31 controls, based on the type of surgery, of a pool of 133 patients aged 35 to 55 years.
INTERVENTION: Therapeutic.
MAIN OUTCOME MEASURE: Success was defined as tympanic membrane closure and resolution of presenting complaints. Complications were assessed. Frailty was defined by assessing multimorbidity and polypharmacy. Fisher's exact test was used to compare success and complication rates between the age groups. Linear logistic regression analysis using generalized linear models was performed on success and complication rate.
RESULTS: Success rates in both the groups were 84%. Complication rate in the elderly group was 16% versus 6% in the control group. This difference was not statistically significant in the Fisher's exact test. In the generalized linear model analysis age group, multimorbidity and polypharmacy had no significant influence on both success and complication rate.
CONCLUSION: There was no difference in success and complication rate in elderly undergoing tympanoplasty compared with younger adults. Having multimorbidity or polypharmacy did not correlate with failure of the tympanic membrane closure or a higher complication rate.

PMID: 29194226 [PubMed - as supplied by publisher]

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Hearing Outcomes After Stereotactic Radiosurgery for Jugular Paraganglioma.

Hearing Outcomes After Stereotactic Radiosurgery for Jugular Paraganglioma.

Otol Neurotol. 2017 Nov 30;:

Authors: Patel NS, Link MJ, Driscoll CLW, Pollock BE, Lohse CM, Carlson ML

Abstract
OBJECTIVE: To describe audiometric outcomes following stereotactic radiosurgery (SRS) for jugular paraganglioma (JP).
STUDY DESIGN: Retrospective review.
SETTING: Tertiary referral center.
PATIENTS: Patients with pretreatment serviceable hearing (American Academy of Otolaryngology-Head and Neck Surgery [AAO-HNS] Class A or B) and serial post-SRS audiometric follow-up who underwent Gamma Knife SRS for JP between 1990 and 2017.
INTERVENTION(S): Gamma Knife SRS.
MAIN OUTCOME MEASURES: Progression to nonserviceable hearing; correlation between baseline hearing and treatment parameters with audiometric outcomes.
RESULTS: Of 85 patients with JP who underwent SRS during the study period, 35 (66% female, median age 53) had pretreatment serviceable hearing and serial post-treatment audiometry available for review. Median tumor volume at the time of treatment was 7,080 mm, median cochlear point dose was 5.8 Gy (interquartile range [IQR] 4.1 to 7.3 Gy), and median marginal and maximum tumor doses were 16 and 32 Gy, respectively.After a median follow-up of 37 months (IQR 16 to 77 mo), the median change in pure-tone average and speech discrimination score in the treated ear was -1.2 dB HL/yr (IQR -4.5 to 0.3) and 0%/yr (IQR 0-3.5%), compared with 0.07 dB HL/yr (IQR -0.03 to 0.12) and 0 %/yr (IQR 0 to 0%) in the contralateral untreated ear. Seven patients developed nonserviceable hearing (AAO-HNS Class C or D) at a median of 13.2 months following SRS (IQR 4.8 to 24 mo). Among those who maintained serviceable hearing, median audiometric follow-up was 42 months (IQR 18 to 77 mo). The Kaplan-Meier estimated rates of serviceable hearing at 1, 3, and 5 years following SRS were 91%, 80%, and 80%, respectively. Sixty percent of patients with pulsatile tinnitus who underwent SRS experienced varying levels of symptomatic improvement following treatment.
CONCLUSION: The short- and intermediate-term risk of progression to nonserviceable hearing following SRS for JP is low. Data regarding the impact of cochlear dose from the vestibular schwannoma literature should not be freely applied to JP, since the impact of SRS parameters on hearing preservation seems to be less significant.

PMID: 29194225 [PubMed - as supplied by publisher]

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A Population Based Analysis of Melanoma of the External Ear.

A Population Based Analysis of Melanoma of the External Ear.

Otol Neurotol. 2017 Nov 30;:

Authors: Patel TD, Chin OY, Baredes S, Eloy JA, Ying YM

Abstract
OBJECTIVE: Malignant melanoma accounts for nearly 75% of all skin cancer deaths, and the incidence is on the rise in the United States. External ear melanoma (EEM) is rare, and there is little long-term data regarding the clinical behavior of this melanoma site. This study analyzes the demographic, clinicopathologic, and survival characteristics of EEM.
METHODS: The SEER database was queried for EEM cases from 1973 to 2012 (8,982 cases). Data analyzed included patient demographics, incidence trends, and survival outcomes.
RESULTS: External ear melanoma occurred most frequently in the sixth and seventh decades of life. Mean age at diagnosis was 65.5 (±16.8) years. However, the incidence of EEM in adolescents and young adults (ages 15-39 yr) has increased by 111.9% from 1973 to 2012. There was a strong male predilection with a male-to-female ratio of 6.40:1. The most common histologic subtype was malignant melanoma, NOS (46.8%), followed by superficial spreading melanoma (21.4%), and lentigo maligna melanoma (17.9%). The majority of cases were localized at the time of presentation (88.0%), with rare distant metastasis (1.9%). The most common treatment modality was surgery alone (97.6%), followed by surgery with radiotherapy (2.3%). Ten-year disease-specific survival was better among those treated with surgery alone (90.7%), than those treated with surgery with radiotherapy (37.1%) (p < 0.0001). Increasing Breslow's thickness and presence of an ulcerating lesion were both associated with poorer survival (p < 0.0001).
CONCLUSION: This study represents the largest cohort of EEM. It has an excellent survival outcome with surgery being the treatment of choice.

PMID: 29194224 [PubMed - as supplied by publisher]

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Ollier Disease of the Lateral Skull Base.

Ollier Disease of the Lateral Skull Base.

Otol Neurotol. 2017 Nov 29;:

Authors: Fridirici ZC, Petrusek JJ, Thorpe EJ, Leonetti JP

PMID: 29194213 [PubMed - as supplied by publisher]

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Publishing Trends in Otology and Neurotology.

Publishing Trends in Otology and Neurotology.

Otol Neurotol. 2017 Nov 29;:

Authors: Boerner R, Hatch JL, Harruff E, Nguyen SA, Rizk HG, Meyer TA, Lambert PR, McRackan TR

Abstract
OBJECTIVES: 1) Describe publishing trends for otologic/neurotologic disorders over a 35-year span. 2) Compare trends in publishing with disease prevalence. 3) Evaluate changes in topic and journal specific ranking scores over time.
METHODS: PubMed searches were performed on 35 otologic/neurotologic disorders using medical subject headings (MeSH) terms from 1980 to 2015. Searches were limited in scope to the English language. A Mann-Kendall trend analysis evaluated changes in publication frequency as a discrete variable while correcting for total number of articles published per year. Scopus was used to identify SCImago Country and Journal Rank (SJR) indicator scores and weighted-averages used to calculate changes over time.
RESULTS: The total number of publications on the 35 topics increased from 853 in 1980 to a peak of 3,068 in 2013. Otitis media (τ = -0.799, p < 0.001) and Menière's disease (τ = -0.724, p < 0.001) showed strong decreasing publication trends. Temporal bone encephaloceles (τ = 0.743, p < 0.001) and cochlear implants (τ = 0.740, p < 0.001) showed strong increasing publication trends. Rapid rise in publications on superior canal dehiscence and vestibular migraine illustrate novel diagnoses. The weighted-average SJR score increased from 0.816 in 2000 to 1.160 in 2015 (p < 0.001).
CONCLUSION: This study displays trends in the literature over the past 35 years that are often inconsistent with common disorders seen by otologists/neurotologists. Certain diagnoses that are currently being researched less commonly continue to impact patients with the same regularity. Quality of otologic/neurotologic literature has become more reputable with regards to SJR scores.

PMID: 29194211 [PubMed - as supplied by publisher]

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Giant cell tumor of temporomandibular joint presenting as a parotid tumor: Challenges in the accurate subclassification of giant cell tumors in an unusual location.

Giant cell tumor of temporomandibular joint presenting as a parotid tumor: Challenges in the accurate subclassification of giant cell tumors in an unusual location.

Diagn Cytopathol. 2017 Nov 30;:

Authors: Ren R, Mueller S, Kraft AO, Powers CN

Abstract
Fine needle aspiration is frequently used as the initial diagnostic procedure in the work-up of head and neck lesions, including soft tissue masses and salivary gland neoplasms. Giant cell tumors (GCTs), both osseous and extraosseous, are benign tumors that occur, albeit rarely, in the head and neck region. Extraosseous GCTs may be further classified based on their tissue of origin and specific anatomic location. Regardless of location, giant cell tumors are morphologically similar and share cytologic and histologic diagnostic criteria. Evaluation of imaging is therefore essential to the correct classification of these tumors. Accurate diagnosis is crucial since the clinical behavior and treatment is significantly different among the subtypes of GCTs. The case presented herein illustrates the diagnostic dilemma between two uncommon entities in an unusual site: GCT of parotid gland and tenosynovial GCT.

PMID: 29193882 [PubMed - as supplied by publisher]

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Olfactory loss in chronic rhinosinusitis is associated with neuronal activation of c-Jun N-terminal kinase.

Olfactory loss in chronic rhinosinusitis is associated with neuronal activation of c-Jun N-terminal kinase.

Int Forum Allergy Rhinol. 2017 Nov 28;:

Authors: Victores AJ, Chen M, Smith A, Lane AP

Abstract
BACKGROUND: Olfactory inflammation in chronic rhinosinusitis (CRS) is associated with cytokines that may result in the death of olfactory sensory neurons. The principal signaling molecules involved in the apoptotic pathway are c-Jun N-terminal kinases (JNK). Although the JNK pathway has emerged as a key player in programmed cell death in neuroinflammation, its specific role in CRS-associated olfactory loss has not been thoroughly investigated.
METHODS: JNK activation was studied in human tissue samples from 9 control and 11 CRS patients by immunohistochemical staining for phosphorylated c-Jun. A mouse model of inducible olfactory cytokine expression was used to experimentally control inflammation and assess JNK activation over time.
RESULTS: In patients with CRS, activation of c-Jun is significantly increased relative to non-CRS control subjects, and there is an associated loss of sensory neurons. In the olfactory inflammation mouse model, prolonged induction of inflammation results in elevation of c-Jun expression and neuronal apoptosis.
CONCLUSION: Activation of neuronal JNK is a feature of chronic olfactory inflammation that is associated with neuronal apoptosis. Given that inhibition of JNK activity is neuroprotective in other settings, antagonism of this pathway may have therapeutic potential in the management of inflammatory olfactory loss or other disorders linked to olfactory neuronal apoptosis.

PMID: 29193850 [PubMed - as supplied by publisher]

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TRAF6 regulates tumour metastasis through EMT and CSC phenotypes in head and neck squamous cell carcinoma.

TRAF6 regulates tumour metastasis through EMT and CSC phenotypes in head and neck squamous cell carcinoma.

J Cell Mol Med. 2017 Nov 29;:

Authors: Chen L, Li YC, Wu L, Yu GT, Zhang WF, Huang CF, Sun ZJ

Abstract
Epithelial-mesenchymal transition (EMT) is associated with metastasis formation, generation and maintenance of cancer stem cells (CSCs). However, the regulatory mechanisms of CSCs have not been clarified. This study aims to investigate the role of TNF receptor-associated factor 6 (TRAF6) on EMT and CSC regulation in squamous cell carcinoma of head and neck (SCCHN). We found TRAF6 was overexpressed in human SCCHN tissues, and high TRAF6 expression was associated with lymphatic metastasis and resulted in poor prognosis in patients with SCCHN. In addition, elevated TRAF6 expression was observed in several HNSCC cell lines, and wound healing and transwell assay results showed that TRAF6 knockdown inhibited the migration and invasion ability of the SCCHN cells. Moreover, the expression of Vimentin, Slug and N-cadherin was down-regulated and that of E-cadherin was elevated after TRAF6 knockdown but decreased by transforming growth factor beta 1 (TGF-β1) and CAL27 similar to mesenchymal cells formed after TGF-β1 induction. In addition, the expression levels of CD44, ALDH1, KLF4 and SOX2 were inhibited after TRAF6 knockdown, and the anchor-dependent colony formation number and sphere number were remarkably reduced. Flow cytometry showed TRAF6 knockdown reduced ALDH1-positive cancer stem cells. We also demonstrated that TRAF6 is closely associated with EMT process and cancer stem cells using a Tgfbr1/Pten 2cKO mice SCCHN model and human SCCHN tissue microarray. Our findings indicate that TRAF6 plays a role in EMT phenotypes, the generation and maintenance of CSCs in SCCHN, suggesting that TRAF6 is a potential therapeutic target for SCCHN.

PMID: 29193723 [PubMed - as supplied by publisher]

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Platelet-Facilitated Photothermal Therapy of Head and Neck Squamous Cell Carcinoma.

Platelet-Facilitated Photothermal Therapy of Head and Neck Squamous Cell Carcinoma.

Angew Chem Int Ed Engl. 2017 Nov 29;:

Authors: Rao L, Bu LL, Ma L, Wang W, Liu H, Wan D, Liu JF, Li A, Guo SS, Zhang L, Zhang WF, Zhao XZ, Sun ZJ, Liu W

Abstract
Here, we present a platelet-facilitated photothermal tumor therapy (PLT-PTT) strategy, in which PLTs act as carriers for targeted delivery of photothermal agents to tumor tissues and enhance the PTT effect. Gold nanorods (AuNRs) were first loaded into PLTs by electroporation and the resulting AuNR-loaded PLTs (PLT-AuNRs) inherited long blood circulation and cancer targeting characteristics from PLTs and good photothermal property from AuNRs. Using a gene-knockout mouse model, we demonstrate that the administration of PLT-AuNRs and localizing laser irradiation could effectively inhibit the growth of head and neck squamous cell carcinoma (HNSCC). In addition, we found that the PTT treatment augmented PLT-AuNRs targeting to the tumor sites and in turn, improved the PTT effects in a feedback manner, demonstrating the unique self-reinforcing characteristic of PLT-PTT in cancer therapy.

PMID: 29193651 [PubMed - as supplied by publisher]

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Superiorly based facial artery musculomucosal flap: A versatile pedicled flap.

Superiorly based facial artery musculomucosal flap: A versatile pedicled flap.

Head Neck. 2017 Nov 29;:

Authors: Berania I, Lavigne F, Rahal A, Ayad T

Abstract
BACKGROUND: The superiorly based facial artery musculomucosal (FAMM) flap is pedicled on the angular artery. This flap offers a well-vascularized mucosal surface allowing closure of medium size defects, most frequently within the oral cavity and intranasal region.
METHODS: We describe a superiorly based harvest of the FAMM flap, which may be used for closure of multiple head and neck surgical defects. An operative technique video is provided, which can be viewed online.
RESULTS: Our results demonstrate a fast and relatively straightforward harvest technique of the FAMM flap. This intraoral flap is a useful reconstructive tool, which also has the advantage to leave no visible external scars.
CONCLUSION: The superiorly pedicled FAMM flap is a versatile and effective technique that may be integrated in the algorithm for reconstruction of head and neck defects.

PMID: 29193596 [PubMed - as supplied by publisher]

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Norcantharidin induce apoptosis in human nasopharyngeal carcinoma through caspase and mitochondrial pathway.

Norcantharidin induce apoptosis in human nasopharyngeal carcinoma through caspase and mitochondrial pathway.

Environ Toxicol. 2017 Nov 29;:

Authors: Chen AW, Tseng YS, Lin CC, Hsi YT, Lo YS, Chuang YC, Lin SH, Yu CY, Hsieh MJ, Chen MK

Abstract
While Nasopharyngeal carcinoma (NPC) is uncommon in western countries, it is endemic in Southeast Asia and Southern China. Previous study of norcantharidin (NCTD), isolated from blister beetles, has proved its anticancer effect on various tumors. However, the effect of NCTD in NPC has never been studied. The purpose of this study is to inspect the suppression activity of NCTD on NPC, along with the underlying mechanism. NPC cell line NPC-BM was treated with NCTD. NCTD remarkably inhibited proliferation and induce apoptosis in NPC-BM cell. Activation of caspase-3, -8, -9 was observed through western blotting. The expression of antiapoptotic protein Bcl-XL was significantly reduced, but expression of proapoptotic protein Bak was increased after treatment of NCTD. The cytotoxic effect of NCTD on NPC-BM cell is mainly due to apoptosis, mediated by caspase and mitochondrial pathway. These results suggested that NCTD could be a potential anticancer agent for NPC.

PMID: 29193574 [PubMed - as supplied by publisher]

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Lymphographic-Like Technique for the Treatment of Microcystic Lymphatic Malformation Components of <3 mm.

Lymphographic-Like Technique for the Treatment of Microcystic Lymphatic Malformation Components of <3 mm.

AJNR Am J Neuroradiol. 2017 Nov 30;:

Authors: Da Ros V, Iacobucci M, Puccinelli F, Spelle L, Saliou G

Abstract
BACKGROUND AND PURPOSE: The treatment of microcystic lymphatic malformations remains challenging. Our aim was to describe the lymphographic-like technique, a new technique of slow bleomycin infusion for the treatment of microcyst components of <3 mm, performed at our institution.
MATERIALS AND METHODS: A retrospective analysis of a prospectively collected lymphatic malformation data base was performed. Patients with at least 1 microcystic lymphatic malformation component demonstrated on MR imaging treated by lymphographic-like technique bleomycin infusion were included in the study. Patient interviews and MR imaging were performed to assess subjective and objective (microcystic lymphatic malformation size decrease of >30%) clinical improvement, respectively. Patients were reviewed 3 months after each sclerotherapy session. Lymphographic-like technique safety and efficacy were assessed.
RESULTS: Between January 2012 and July 2016, sixteen patients (5 males, 11 females; mean age, 15 years; range, 1-47 years) underwent the bleomycin lymphographic-like technique for microcystic lymphatic malformations. Sixty sclerotherapy sessions were performed, with a mean of 4 sessions per patient (range, 1-8 sessions) and a mean follow-up of 26 months (range, 5-58 months). We observed no major and 3 minor complications: 1 eyelid infection, 1 case of severe postprocedural nausea and vomiting, and 1 case of skin discoloration. One patient was lost to follow-up. Overall MR imaging objective improvement was observed in 5/16 (31%) patients; overall improvement of clinical symptoms was obtained in 93% of treated patients.
CONCLUSIONS: The bleomycin lymphographic-like technique for microcystic lymphatic malformations is safe and feasible with objective improvement in about one-third of patients. MR signal intensity changes after the lymphographic-like technique are associated with subjective improvement of the patient's symptoms.

PMID: 29191875 [PubMed - as supplied by publisher]

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CT Attenuation Analysis of Carotid Intraplaque Hemorrhage.

CT Attenuation Analysis of Carotid Intraplaque Hemorrhage.

AJNR Am J Neuroradiol. 2017 Nov 30;:

Authors: Saba L, Francone M, Bassareo PP, Lai L, Sanfilippo R, Montisci R, Suri JS, De Cecco CN, Faa G

Abstract
BACKGROUND AND PURPOSE: Intraplaque hemorrhage is considered a leading parameter of carotid plaque vulnerability. Our purpose was to assess the CT characteristics of intraplaque hemorrhage with histopathologic correlation to identify features that allow for confirming or ruling out the intraplaque hemorrhage.
MATERIALS AND METHODS: This retrospective study included 91 patients (67 men; median age, 65 ± 7 years; age range, 41-83 years) who underwent CT angiography and carotid endarterectomy from March 2010 to May 2013. Histopathologic analysis was performed for the tissue characterization and identification of intraplaque hemorrhage. Two observers assessed the plaque's attenuation values by using an ROI (≥ 1 and ≤2 mm2). Receiver operating characteristic curve, Mann-Whitney, and Wilcoxon analyses were performed.
RESULTS: A total of 169 slices were assessed (59 intraplaque hemorrhage, 63 lipid-rich necrotic core, and 47 fibrous); the average values of the intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue were 17.475 Hounsfield units (HU) and 18.407 HU, 39.476 HU and 48.048 HU, and 91.66 HU and 93.128 HU, respectively, before and after the administration of contrast medium. The Mann-Whitney test showed a statistically significant difference of HU values both in basal and after the administration of contrast material phase. Receiver operating characteristic analysis showed a statistical association between intraplaque hemorrhage and low HU values, and a threshold of 25 HU demonstrated the presence of intraplaque hemorrhage with a sensitivity and specificity of 93.22% and 92.73%, respectively. The Wilcoxon test showed that the attenuation of the plaque before and after administration of contrast material is different (intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue had P values of .006, .0001, and .018, respectively).
CONCLUSIONS: The results of this preliminary study suggest that CT can be used to identify the presence of intraplaque hemorrhage according to the attenuation. A threshold of 25 HU in the volume acquired after the administration of contrast medium is associated with an optimal sensitivity and specificity. Special care should be given to the correct identification of the ROI.

PMID: 29191874 [PubMed - as supplied by publisher]

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Time for a Time Window Extension: Insights from Late Presenters in the ESCAPE Trial.

Time for a Time Window Extension: Insights from Late Presenters in the ESCAPE Trial.

AJNR Am J Neuroradiol. 2017 Nov 30;:

Authors: Evans JW, Graham BR, Pordeli P, Al-Ajlan FS, Willinsky R, Montanera WJ, Rempel JL, Shuaib A, Brennan P, Williams D, Roy D, Poppe AY, Jovin TG, Devlin T, Baxter BW, Krings T, Silver FL, Frei DF, Fanale C, Tampieri D, Teitelbaum J, Iancu D, Shankar J, Barber PA, Demchuk AM, Goyal M, Hill MD, Menon BK, ESCAPE Trial Investigators

Abstract
BACKGROUND AND PURPOSE: The safety and efficacy of endovascular therapy for large-artery stroke in the extended time window is not yet well-established. We performed a subgroup analysis on subjects enrolled within an extended time window in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) trial.
MATERIALS AND METHODS: Fifty-nine of 315 subjects (33 in the intervention group and 26 in the control group) were randomized in the ESCAPE trial between 5.5 and 12 hours after last seen healthy (likely to have groin puncture administered 6 hours after that). Treatment effect sizes for all relevant outcomes (90-day mRS shift, mRS 0-2, mRS 0-1, and 24-hour NIHSS scores and intracerebral hemorrhage) were reported using unadjusted and adjusted analyses.
RESULTS: There was no evidence of treatment heterogeneity between subjects in the early and late windows. Treatment effect favoring intervention was seen across all clinical outcomes in the extended time window (absolute risk difference of 19.3% for mRS 0-2 at 90 days). There were more asymptomatic intracerebral hemorrhage events within the intervention arm (48.5% versus 11.5%, P = .004) but no difference in symptomatic intracerebral hemorrhage.
CONCLUSIONS: Patients with an extended time window could potentially benefit from endovascular treatment. Ongoing randomized controlled trials using imaging to identify late presenters with favorable brain physiology will help cement the paradigm of using time windows to select the population for acute imaging and imaging to select individual patients for therapy.

PMID: 29191873 [PubMed - as supplied by publisher]

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Influences for Gender Disparity in Academic Neuroradiology.

Influences for Gender Disparity in Academic Neuroradiology.

AJNR Am J Neuroradiol. 2017 Nov 30;:

Authors: Ahmadi M, Khurshid K, Sanelli PC, Jalalkhan S, Chahal T, Norbash A, Nicolaou S, Castillo M, Khosa F

Abstract
BACKGROUND AND PURPOSE: There has been extensive interest in promoting gender equality within radiology, a predominately male field. In this study, our aim was to quantify gender representation in neuroradiology faculty rankings and determine any related factors that may contribute to any such disparity.
MATERIALS AND METHODS: We evaluated the academic and administrative faculty members of neuroradiology divisions for all on-line listed programs in the US and Canada. After excluding programs that did not fulfill our selection criteria, we generated a short list of 85 US and 8 Canadian programs. We found 465 faculty members who met the inclusion criteria for our study. We used Elsevier's SCOPUS for gathering the data pertaining to the publications, H-index, citations, and tenure of the productivity of each faculty member.
RESULTS: Gender disparity was insignificant when analyzing academic ranks. There are more men working in neuroimaging relative to women (χ2 = 0.46; P = .79). However, gender disparity was highly significant for leadership positions in neuroradiology (χ2 = 6.76; P = .009). The median H-index was higher among male faculty members (17.5) versus female faculty members (9). Female faculty members have odds of 0.84 compared with male faculty members of having a higher H-index, adjusting for publications, citations, academic ranks, leadership ranks, and interaction between gender and publications and gender and citations (9).
CONCLUSIONS: Neuroradiology faculty members follow the same male predominance seen in many other specialties of medicine. In this study, issues such as mentoring, role models, opportunities to engage in leadership/research activities, funding opportunities, and mindfulness regarding research productivity are explored.

PMID: 29191872 [PubMed - as supplied by publisher]

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MR Imaging Characteristics Associate with Tumor-Associated Macrophages in Glioblastoma and Provide an Improved Signature for Survival Prognostication.

MR Imaging Characteristics Associate with Tumor-Associated Macrophages in Glioblastoma and Provide an Improved Signature for Survival Prognostication.

AJNR Am J Neuroradiol. 2017 Nov 30;:

Authors: Zhou J, Reddy MV, Wilson BKJ, Blair DA, Taha A, Frampton CM, Eiholzer RA, Gan PYC, Ziad F, Thotathil Z, Kirs S, Hung NA, Royds JA, Slatter TL

Abstract
BACKGROUND AND PURPOSE: In glioblastoma, tumor-associated macrophages have tumor-promoting properties. This study determined whether routine MR imaging features could predict molecular subtypes of glioblastoma that differ in the content of tumor-associated macrophages.
MATERIALS AND METHODS: Seven internally derived MR imaging features were assessed in 180 patients, and 25 features from the Visually AcceSAble Rembrandt Images feature set were assessed in 164 patients. Glioblastomas were divided into subtypes based on the telomere maintenance mechanism: alternative lengthening of telomeres positive (ALT+) and negative (ALT-) and the content of tumor-associated macrophages (with [M+] or without [M-] a high content of macrophages). The 3 most frequent subtypes (ALT+/M-, ALT-/M+, and ALT-/M-) were correlated with MR imaging features and clinical parameters. The fourth group (ALT+/M+) did not have enough cases for correlation with MR imaging features.
RESULTS: Tumors with a regular margin and those lacking a fungating margin, an expansive T1/FLAIR ratio, and reduced ependymal extension were more frequent in the subgroup of ALT+/M- (P < .05). Radiologic necrosis, lack of cystic component (by both criteria), and extensive peritumoral edema were more frequent in ALT-/M+ tumors (P < .05). Multivariate testing with a Cox regression analysis found the cystic imaging feature was additive to tumor subtype, and O6-methylguanine methyltransferase (MGMT) status to predict improved patient survival (P < .05).
CONCLUSIONS: Glioblastomas with tumor-associated macrophages are associated with routine MR imaging features consistent with these tumors being more aggressive. Inclusion of cystic change with molecular subtypes and MGMT status provided a better estimate of survival.

PMID: 29191871 [PubMed - as supplied by publisher]

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Reproducibility of Deep Gray Matter Atrophy Rate Measurement in a Large Multicenter Dataset.

Reproducibility of Deep Gray Matter Atrophy Rate Measurement in a Large Multicenter Dataset.

AJNR Am J Neuroradiol. 2017 Nov 30;:

Authors: Meijerman A, Amiri H, Steenwijk MD, Jonker MA, van Schijndel RA, Cover KS, Vrenken H, Alzheimer's Disease Neuroimaging Initiative

Abstract
BACKGROUND AND PURPOSE: Precise in vivo measurement of deep GM volume change is a highly demanded prerequisite for an adequate evaluation of disease progression and new treatments. However, quantitative data on the reproducibility of deep GM structure volumetry are not yet available. In this paper we aim to investigate this reproducibility using a large multicenter dataset.
MATERIALS AND METHODS: We have assessed the reproducibility of 2 automated segmentation software packages (FreeSurfer and the FMRIB Integrated Registration and Segmentation Tool) by quantifying the volume changes of deep GM structures by using back-to-back MR imaging scans from the Alzheimer Disease Neuroimaging Initiative's multicenter dataset. Five hundred sixty-two subjects with scans at baseline and 1 year were included. Reproducibility was investigated in the bilateral caudate nucleus, putamen, amygdala, globus pallidus, and thalamus by carrying out descriptives as well as multilevel and variance component analysis.
RESULTS: Median absolute back-to-back differences varied between GM structures, ranging from 59.6-156.4 μL for volume change, and 1.26%-8.63% for percentage volume change. FreeSurfer had a better performance for the outcome of longitudinal volume change for the bilateral amygdala, putamen, left caudate nucleus (P < .005), and right thalamus (P < .001). For longitudinal percentage volume change, Freesurfer performed better for the left amygdala, bilateral caudate nucleus, and left putamen (P < .001). Smaller limits of agreement were found for FreeSurfer for both outcomes for all GM structures except the globus pallidus. Our results showed that back-to-back differences in 1-year percentage volume change were approximately 1.5-3.5 times larger than the mean measured 1-year volume change of those structures.
CONCLUSIONS: Longitudinal deep GM atrophy measures should be interpreted with caution. Furthermore, deep GM atrophy measurement techniques require substantially improved reproducibility, specifically when aiming for personalized medicine.

PMID: 29191870 [PubMed - as supplied by publisher]

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John Nash and the Organization of Stroke Care.

John Nash and the Organization of Stroke Care.

AJNR Am J Neuroradiol. 2017 Nov 30;:

Authors: Goyal M, Wilson AT, Mayank D, Kamal N, Robinson DH, Turkel-Parrella D, Hirsch JA

Abstract
The concept of Nash equilibrium, developed by John Forbes Nash Jr, states that an equilibrium in noncooperative games is reached when each player takes the best action for himself or herself, taking into account the actions of the other players. We apply this concept to the provision of endovascular thrombectomy in the treatment of acute ischemic stroke and suggest that collaboration among hospitals in a health care jurisdiction could result in practices such as shared call pools for neurointervention teams, leading to better patient care through streamlined systems.

PMID: 29191869 [PubMed - as supplied by publisher]

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Alphabet Soup: Sagittal Balance Correction Osteotomies of the Spine-What Radiologists Should Know.

Alphabet Soup: Sagittal Balance Correction Osteotomies of the Spine-What Radiologists Should Know.

AJNR Am J Neuroradiol. 2017 Nov 30;:

Authors: Takahashi T, Kainth D, Marette S, Polly D

Abstract
Global sagittal malalignment has been demonstrated to have correlation with clinical symptoms and is a key component to be restored in adult spinal deformity. In this article, various types of sagittal balance-correction osteotomies are reviewed primarily on the basis of the 3 most commonly used procedures: Smith-Petersen osteotomy, pedicle subtraction osteotomy, and vertebral column resection. Familiarity with the expected imaging appearance and commonly encountered complications seen on postoperative imaging studies following correction osteotomies is crucial for accurate image interpretation.

PMID: 29191868 [PubMed - as supplied by publisher]

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Viruses, Vol. 9, Pages 369: An Opportunistic Pathogen Afforded Ample Opportunities: Middle East Respiratory Syndrome Coronavirus

Viruses, Vol. 9, Pages 369: An Opportunistic Pathogen Afforded Ample Opportunities: Middle East Respiratory Syndrome Coronavirus

Viruses doi: 10.3390/v9120369

Authors: Ian Mackay Katherine Arden

The human coronaviruses (CoV) include HCoV-229E, HCoV-OC43, HCoV-NL63, and HCoV-HKU1, some of which have been known for decades. The severe acute respiratory syndrome (SARS) CoV briefly emerged into the human population but was controlled. In 2012, another novel severely human pathogenic CoV—the Middle East Respiratory Syndrome (MERS)-CoV—was identified in the Kingdom of Saudi Arabia; 80% of over 2000 human cases have been recorded over five years. Targeted research remains key to developing control strategies for MERS-CoV, a cause of mild illness in its camel reservoir. A new therapeutic toolbox being developed in response to MERS is also teaching us more about how CoVs cause disease. Travel-related cases continue to challenge the world’s surveillance and response capabilities, and more data are needed to understand unexplained primary transmission. Signs of genetic change have been recorded, but it remains unclear whether there is any impact on clinical disease. How camels came to carry the virus remains academic to the control of MERS. To date, human-to-human transmission has been inefficient, but virus surveillance, characterisation, and reporting are key to responding to any future change. MERS-CoV is not currently a pandemic threat; it is spread mainly with the aid of human habit and error.

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Evaluating the Quality of Life of Glaucoma Patients Using the State-Trait Anxiety Inventory.

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Evaluating the Quality of Life of Glaucoma Patients Using the State-Trait Anxiety Inventory.

J Glaucoma. 2017 Nov;26(11):1025-1029

Authors: Otori Y, Takahashi G, Urashima M, Kuwayama Y, Quality of Life Improvement Committee

Abstract
PURPOSE: To evaluate anxiety felt by glaucoma patients.
PATIENTS AND METHODS: In total, 472 glaucoma patients responded to a questionnaire on anxiety, subjective symptoms, and vision-related quality of life (VR-QOL) associated with glaucoma. Anxiety was evaluated using the State-Trait Anxiety Inventory (STAI), state anxiety (STAI-State) subscale along with our novel questionnaire, assessing visual function and subjective symptoms, specialized for glaucoma. VR-QOL was evaluated using 5 subitems from the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). Adherence to ophthalmic antiglaucoma agents was confirmed. As indexes of visual function, corrected visual acuity (measured by eye chart), mean deviation (MD) score (measured with static perimetry), and 4 thresholds at the center of vision were determined. Stages were classified according to the Aulhorn Classification. From the STAI-State scores, the prevalence of anxiety in glaucoma patients was evaluated. We analyzed the correlation between the STAI-State and VFQ-25, anxiety, subjective symptoms, adherence, and visual function indexes.
RESULTS: In total, 78% of glaucoma patients experienced at least an intermediate level of anxiety. The STAI-State correlated significantly with anxiety and subjective symptoms as measured by our novel questionnaire, particularly for questions "current anxiety about loss of vision" and "current anxiety in life" (r=0.468 and 0.500; both P<0.0001). However, STAI-State correlated weakly with VFQ-25, and not at all with visual function indexes and adherence.
CONCLUSIONS: Many glaucoma patients feel anxiety. The STAI-State is correlated with the VR-QOL and anxiety in glaucoma patients, making it useful for understanding the anxiety present in glaucoma patients.

PMID: 28858160 [PubMed - indexed for MEDLINE]

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How is disease severity associated with quality of life in psoriasis patients? Evidence from a longitudinal population-based study in Sweden.

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How is disease severity associated with quality of life in psoriasis patients? Evidence from a longitudinal population-based study in Sweden.

Health Qual Life Outcomes. 2017 Jul 28;15(1):151

Authors: Geale K, Henriksson M, Schmitt-Egenolf M

Abstract
BACKGROUND: Assessing the impact of disease severity on generic quality of life (QOL) is a critical step in outcomes research and in the development of decision-analytic models structured around health states defined by clinical measures. While data from routine clinical practice found in healthcare registers are increasingly used for research, more attention should be paid to understanding the relationship between clinical measures of disease severity and QOL. The purpose of this work was therefore to investigate this relationship in psoriasis using a population-based dataset.
METHODS: Severity was measured by the Psoriasis Area and Severity Index (PASI), which combines severity of erythema, induration, and desquamation into a single value ranging from 0 to 72. The generic EQ-5D-3L utility instrument, under the UK tariff, was used to measure QOL. The association between PASI and EQ-5D-3L was estimated using a population-based dataset of 2674 patients with moderate to severe psoriasis enrolled over ten years in the Swedish psoriasis register (PsoReg). Given the repeated measurement of patients in the register data, a longitudinal fixed-effects model was employed to control for unobserved patient-level heterogeneity.
RESULTS: Marginal changes in PASI are associated with a non-linear response in EQ-5D-3L: Moving from PASI 10 to 9 (1 to 0) is associated with an increase of 0.0135 (0.0174) in EQ-5D-3L. Furthermore, unobserved patient-level heterogeneity appears to be an important source of confounding when estimating the relationship between QOL and PASI.
CONCLUSIONS: Using register data to estimate the impact of disease severity on QOL while controlling for unobserved patient-level heterogeneity shows that PASI appears to have a larger impact on QOL than previously estimated. Routine collection of generic QOL data in registers should be encouraged to enable similar applications in other disease areas.
TRIAL REGISTRATION: Not applicable.

PMID: 28754116 [PubMed - indexed for MEDLINE]

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Self-Determination Theory and Risk Behavior in a Collectivistic Society: Preventing Reckless Driving in Urban Nepal.

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Self-Determination Theory and Risk Behavior in a Collectivistic Society: Preventing Reckless Driving in Urban Nepal.

J Health Commun. 2017 Aug;22(8):672-681

Authors: Ranjit YS, Snyder LB, Hamilton MA, Rimal RN

Abstract
Traffic road accidents are one of the leading causes of mortality in Nepal and around the world. Drivers in Nepal are not adequately educated about road safety rules. Road conditions are chaotic as traffic regulations are also not strictly enforced. Public safety campaigns may be able to alter drivers' attitudes and behaviors; however, little is known about which persuasive strategies may be most effective. Drawing on self-determination theory and the Health Belief Model, the current study used a post-only experimental design to test the impact of a short video message. The video included collective vs. individual appeals, and messages emphasizing one's ability to make the right choice (autonomy support) vs. directive language. Participants were Nepali college students (mean age 20, N = 199). Using structural equation modeling, the study found that directive messages rather than autonomy support influenced an individual seeing value in the recommended behavior (identified regulation), which in turn influenced perceived susceptibility, perceived severity, and behavioral intention. The study also proposed a behavior change model by incorporating the stage of identification with the message upon exposure. This model aims to expand the model proposed by the Health Belief Model, to include a stage of value identification before cues to action influence perception of threat. Further implications are discussed.

PMID: 28753075 [PubMed - indexed for MEDLINE]

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Use of Nandrolone Decanoate in Treatment of Pure Red Cell Aplasia Secondary to Diclofenac Administration: A Case Report.

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Use of Nandrolone Decanoate in Treatment of Pure Red Cell Aplasia Secondary to Diclofenac Administration: A Case Report.

Top Companion Anim Med. 2017 Mar;32(1):44-47

Authors: de Marchi PN, Sueur Vieira ANL, Antunes Ribeiro JF, Geraldes SS, Rodrigues Ramos PR, Melchert A, Guimarães-Okamoto PTC

Abstract
Pure red cell aplasia (PRCA) is a disorder that leads to a nonregenerative anemia that results from erythroid precursors failing to reach maturity in the bone marrow, whereas the numbers of mature myeloid and megakaryocytic cells remain normal. PRCA can be induced by autoimmune processes, infections, drugs, toxins, and radiation, and is diagnosed by a bone marrow cytology examination after excluding the most common causes of nonregenerative anemia. Immunosuppressive therapies are used to treat PRCA, and usually involve the use of glucocorticoids, cyclosporin, or azathioprine. Alternatively, although little studied in veterinary medicine, drugs which stimulate bone marrow (e.g., nandrolone decanoate) have been mentioned as possible therapeutic agents. A case of PRCA that presented at the Veterinary Teaching Hospital of the Faculty of Veterinary Medicine and Animal Science (UNESP)-Botucatu, Brazil showed a good therapeutic response to weekly administration of nandrolone decanoate. Therefore, it was concluded that bone marrow stimulants might improve the quality of life of PRCA patients, provided they are used with caution and under close clinical supervision.

PMID: 28750791 [PubMed - indexed for MEDLINE]

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Acute Brain Failure: Pathophysiology, Diagnosis, Management, and Sequelae of Delirium.

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Acute Brain Failure: Pathophysiology, Diagnosis, Management, and Sequelae of Delirium.

Crit Care Clin. 2017 Jul;33(3):461-519

Authors: Maldonado JR

Abstract
Delirium is the most common psychiatric syndrome found in the general hospital setting, with an incidence as high as 87% in the acute care setting. Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances. The development of delirium is associated with increased morbidity, mortality, cost of care, hospital-acquired complications, placement in specialized intermediate and long-term care facilities, slower rate of recovery, poor functional and cognitive recovery, decreased quality of life, and prolonged hospital stays. This article discusses the epidemiology, known etiological factors, presentation and characteristics, prevention, management, and impact of delirium.

PMID: 28601132 [PubMed - indexed for MEDLINE]

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Challenges in Opening and Enrolling Patients in Clinical Trials.

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Challenges in Opening and Enrolling Patients in Clinical Trials.

Am Soc Clin Oncol Educ Book. 2017;37:139-143

Authors: Vose JM, Chuk MK, Giles F

Abstract
Clinical trials are key elements of the processes that account for many of the recent advances in cancer care, including decreased mortality rates and increased survivorship; better supportive care; and improved understanding of cancer risk, prevention, and screening. This research also has led to the validation of numerous exciting new types of cancer treatments, such as molecularly targeted therapies and immunotherapies. Clinical trials, however, are becoming more and more challenging to conduct. Research programs must comply with legal and regulatory requirements that can be inefficient and costly to implement and often are variably interpreted by institutions and sponsors and sponsors' representatives, including contract research organizations. Some of these requirements are essential to protect the safety of trial participants, to promote the scientific integrity of research, or to ensure that trial conduct is efficient and adequately resourced. Such requirements are important to preserve. However, some requirements do not fulfill any of these goals and, in fact, hinder research and slow patient access to safe and effective treatments. This article discusses some of the identified issues that are slowing the process of cancer clinical trials, such as conservatively interpreted guidelines by pharmaceutical companies and contract research organizations; overprotective language for contracts; and patient protections by health systems and universities. The article also discusses possible solutions to these problems that are slowing down the cancer therapies that patients need.

PMID: 28561725 [PubMed - indexed for MEDLINE]

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Disorders of sex development (DSD): Clinical service delivery in the United States.

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Disorders of sex development (DSD): Clinical service delivery in the United States.

Am J Med Genet C Semin Med Genet. 2017 Jun;175(2):268-278

Authors: Rolston AM, Gardner M, van Leeuwen K, Mohnach L, Keegan C, Délot E, Vilain E, Sandberg DE, members of the DSD-TRN Advocacy, Advisory Network Accord Alliance

Abstract
Following the principles of care recommended in the 2006 Consensus Statement on Disorders of Sex Development (DSD), along with input from representatives of peer support and advocacy groups, this study surveyed DSD clinical management practices at healthcare facilities in the United States. DSD are congenital conditions in which development of chromosomal, gonadal, or anatomic sex is atypical. Facilities providing care for patients with DSD were targeted for participation. Specialty providers completed a survey with questions in six broad categories: Institution Information, Nomenclature and Care Guidelines, Interdisciplinary Services, Staff and Community Education, DSD Management, and Research. Twenty-two of 36 targeted sites (61%) participated. Differences were observed between sites with regard to what conditions were considered to be DSD. All sites reported some degree of involvement of pediatric urology and/or surgery and pediatric endocrinology in the care of DSD patients. Gynecology and neonatology were most frequently not represented. Wide variation was observed across sites in continuing education standards, obtaining informed consent for clinical procedures, and in specific clinical management practices. This survey is the first to assess DSD clinical management practices in the United States. The findings establish a baseline of current practices against which providers delivering care to these patients and their families can benchmark their efforts. Such surveys also provide a practical framework for collaboration in identifying opportunities for change that enhance health and quality of life outcomes for patients and families affected by DSD.

PMID: 28557237 [PubMed - indexed for MEDLINE]

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Perceived social support and its impact on depression and health-related quality of life: a comparison between cancer patients and general population.

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Perceived social support and its impact on depression and health-related quality of life: a comparison between cancer patients and general population.

Jpn J Clin Oncol. 2017 Aug 01;47(8):728-734

Authors: Yoo H, Shin DW, Jeong A, Kim SY, Yang HK, Kim JS, Lee JE, Oh JH, Park EC, Park K, Park JH

Abstract
Objective: It is well known that cancer patients' perception of social support is associated with their depressive symptoms and health-related quality of life. However, there have been little studies that compared the variates of cancer patients with the general population. We sought to compare differences in the level of perceived social support and the impact of perceived social support on depressive symptoms and health-related quality of life between cancer survivors and the general population.
Methods: Data were collected from 1818 cancer patients treated at the National Cancer Center and regional cancer centers in South Korea. The control group of the general population was composed of 2000 individuals without cancer from community.
Results: Cancer patients reported significantly higher level of perceived social support than the general population, while they reported lower health-related quality of life and were more susceptible to depression. The positive associations of higher perceived social support with lower depressive symptoms, as well as with higher health-related quality of life, were stronger among cancer patients than among the general population.
Conclusions: The interaction effect suggests that the impact of social support would be stronger among cancer patients than the general public. Thus, it would be beneficial to pay attention to providing social support to cancer patients, particularly to those who are more vulnerable. Furthermore, investigation of the most effective and efficient methods to deliver social support interventions would be worthwhile.

PMID: 28531292 [PubMed - indexed for MEDLINE]

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Mobile App for Treatment of Stress Urinary Incontinence: A Cost-Effectiveness Analysis.

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Mobile App for Treatment of Stress Urinary Incontinence: A Cost-Effectiveness Analysis.

J Med Internet Res. 2017 May 08;19(5):e154

Authors: Sjöström M, Lindholm L, Samuelsson E

Abstract
BACKGROUND: Mobile apps can increase access to care, facilitate self-management, and improve adherence to treatment. Stress urinary incontinence (SUI) affects 10-35% of women and, currently, an app with instructions for pelvic floor muscle training (PFMT) is available as first-line treatment. A previous randomized controlled study demonstrated that the app benefitted symptom severity and quality of life (QoL); in this study we investigate the cost-effectiveness of the app.
OBJECTIVE: The objective of this study was to evaluate the health economy of the app for treating SUI.
METHODS: This deterministic cost-utility analysis, with a 1-year societal perspective, compared the app treatment with no treatment. Health economic data were collected alongside a randomized controlled trial performed in Sweden from March 2013 to October 2014. This study included 123 community-dwelling women participants of 18 years and above, with stress urinary incontinence ≥1 time per week. Participants were self-assessed with validated questionnaires and 2-day leakage diaries, and then randomized to 3 months of treatment (app group, n=62) or no treatment (controls, n=61). The app focused on pelvic floor muscle training, prescribed 3 times daily. We continuously registered treatment delivery costs. Data were collected on each participant's training time, incontinence aids, and laundry at baseline and at a 3-month follow-up. We measured quality of life with the International Consultation on Incontinence Modular Questionnaire on Lower Urinary Tract Symptoms and Quality of Life, and calculated the quality-adjusted life years (QALYs) gained. Data from the 3-month follow-up were extrapolated to 1 year for the calculations. Our main outcome was the incremental cost-effectiveness ratios compared between app and control groups. One-way and multiway sensitivity analyses were performed.
RESULTS: The mean age of participants was 44.7 years (SD 9.4). Annual costs were €547.0 for the app group and €482.4 for the control group. Annual gains in quality-adjusted life years for app and control groups were 0.0101 and 0.0016, respectively. Compared with controls, the extra cost per quality-adjusted life year for the app group ranged from -€2425.7 to €14,870.6, which indicated greater gains in quality-adjusted life years at similar or slightly higher cost.
CONCLUSIONS: The app for treating stress urinary incontinence is a new, cost-effective, first-line treatment with potential for increasing access to care in a sustainable way for this patient group.

PMID: 28483745 [PubMed - indexed for MEDLINE]

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Evaluation of Pollen Apps Forecasts: The Need for Quality Control in an eHealth Service.

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Evaluation of Pollen Apps Forecasts: The Need for Quality Control in an eHealth Service.

J Med Internet Res. 2017 May 08;19(5):e152

Authors: Bastl K, Berger U, Kmenta M

Abstract
BACKGROUND: Pollen forecasts are highly valuable for allergen avoidance and thus raising the quality of life of persons concerned by pollen allergies. They are considered as valuable free services for the public. Careful scientific evaluation of pollen forecasts in terms of accurateness and reliability has not been available till date.
OBJECTIVE: The aim of this study was to analyze 9 mobile apps, which deliver pollen information and pollen forecasts, with a focus on their accurateness regarding the prediction of the pollen load in the grass pollen season 2016 to assess their usefulness for pollen allergy sufferers.
METHODS: The following number of apps was evaluated for each location: 3 apps for Vienna (Austria), 4 apps for Berlin (Germany), and 1 app each for Basel (Switzerland) and London (United Kingdom). All mobile apps were freely available. Today's grass pollen forecast was compared throughout the defined grass pollen season at each respective location with measured grass pollen concentrations. Hit rates were calculated for the exact performance and for a tolerance in a range of ±2 and ±4 pollen per cubic meter.
RESULTS: In general, for most apps, hit rates score around 50% (6 apps). It was found that 1 app showed better results, whereas 3 apps performed less well. Hit rates increased when calculated with tolerances for most apps. In contrast, the forecast for the "readiness to flower" for grasses was performed at a sufficiently accurate level, although only two apps provided such a forecast. The last of those forecasts coincided with the first moderate grass pollen load on the predicted day or 3 days after and performed even from about a month before well within the range of 3 days. Advertisement was present in 3 of the 9 analyzed apps, whereas an imprint mentioning institutions with experience in pollen forecasting was present in only three other apps.
CONCLUSIONS: The quality of pollen forecasts is in need of improvement, and quality control for pollen forecasts is recommended to avoid potential harm to pollen allergy sufferers due to inadequate forecasts. The inclusion of information on reliability of provided forecasts and a similar handling regarding probabilistic weather forecasts should be considered.

PMID: 28483740 [PubMed - indexed for MEDLINE]

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Intranasal oxytocin enhances intrinsic corticostriatal functional connectivity in women.

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Intranasal oxytocin enhances intrinsic corticostriatal functional connectivity in women.

Transl Psychiatry. 2017 Apr 18;7(4):e1099

Authors: Bethlehem RAI, Lombardo MV, Lai MC, Auyeung B, Crockford SK, Deakin J, Soubramanian S, Sule A, Kundu P, Voon V, Baron-Cohen S

Abstract
Oxytocin may influence various human behaviors and the connectivity across subcortical and cortical networks. Previous oxytocin studies are male biased and often constrained by task-based inferences. Here, we investigate the impact of oxytocin on resting-state connectivity between subcortical and cortical networks in women. We collected resting-state functional magnetic resonance imaging (fMRI) data on 26 typically developing women 40 min following intranasal oxytocin administration using a double-blind placebo-controlled crossover design. Independent components analysis (ICA) was applied to examine connectivity between networks. An independent analysis of oxytocin receptor (OXTR) gene expression in human subcortical and cortical areas was carried out to determine plausibility of direct oxytocin effects on OXTR. In women, OXTR was highly expressed in striatal and other subcortical regions, but showed modest expression in cortical areas. Oxytocin increased connectivity between corticostriatal circuitry typically involved in reward, emotion, social communication, language and pain processing. This effect was 1.39 standard deviations above the null effect of no difference between oxytocin and placebo. This oxytocin-related effect on corticostriatal connectivity covaried with autistic traits, such that oxytocin-related increase in connectivity was stronger in individuals with higher autistic traits. In sum, oxytocin strengthened corticostriatal connectivity in women, particularly with cortical networks that are involved in social-communicative, motivational and affective processes. This effect may be important for future work on neurological and psychiatric conditions (for example, autism), particularly through highlighting how oxytocin may operate differently for subsets of individuals.

PMID: 28418398 [PubMed - indexed for MEDLINE]

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