Short- and long-term risks of cardiovascular disease following radiotherapy in rectal cancer in four randomized controlled trials and a population-based register

Publication date: Available online 3 January 2018
Source:Radiotherapy and Oncology
Author(s): Lingjing Chen, Sandra Eloranta, Anna Martling, Ingrid Glimelius, Martin Neovius, Bengt Glimelius, Karin E. Smedby
AimA population-based cohort and four randomized trials enriched with long-term register data were used to clarify if radiotherapy in combination with rectal cancer surgery is associated with increased risks of cardiovascular disease (CVD).MethodsWe identified 14,901 rectal cancer patients diagnosed 1995–2009 in Swedish nationwide registers, of whom 9227 were treated with preoperative radiotherapy. Also, we investigated 2675 patients with rectal cancer previously randomized to preoperative radiotherapy or not followed by surgery in trials conducted 1980–1999. Risks of CVD overall and subtypes were estimated based on prospectively recorded hospital visits during relapse-free follow-up using multivariable Cox regression. Maximum follow-up was 18 and 33 years in the register and trials, respectively.ResultsWe found no association between preoperative radiotherapy and overall CVD risk in the register (Incidence Rate Ratio, IRR = 0.99, 95% confidence interval (CI) 0.92–1.06) or in the pooled trials (IRR = 1.07, 95% CI 0.93–1.24). We noted an increased risk of venous thromboembolism among irradiated patients in both cohorts (IRRregister = 1.41, 95% CI 1.15–2.72; IRRtrials = 1.41, 95% CI 0.97–2.04), that remained during the first 6 months following surgery among patients treated 2006–2009, after the introduction of antithrombotic treatment (IRR6 months = 2.30, 95% CI 1.01–5.21). However, the absolute rate difference of venous thromboembolism attributed to RT was low (10 cases per 1000 patients and year).DiscussionPreoperative radiotherapy did not affect rectal cancer patients' risk of CVD overall. Although an excess risk of short-term venous thromboembolism was noted, the small increase in absolute numbers does not call for general changes in routine prophylactic treatment, but might do so for patients already at high risk of venous thromboembolism.



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Concurrent chemoradiotherapy for bladder cancer: Practice patterns and outcomes in the general population

Publication date: Available online 3 January 2018
Source:Radiotherapy and Oncology
Author(s): Ketan Ghate, Kelly Brennan, Safiya Karim, D. Robert Siemens, William J. Mackillop, Christopher M. Booth
BackgroundClinical trials have shown that chemoradiotherapy (CRT) improves survival compared to radiation therapy (RT) alone in muscle-invasive bladder cancer. We describe uptake of CRT and comparative effectiveness in routine practice.MethodsElectronic treatment records were linked to the population-based Ontario Cancer Registry to identify all patients with bladder cancer treated with curative-intent RT in 1999–2013. Modified Poisson regression was used to analyze factors associated with use of CRT. Cox model and propensity score analyses were used to explore factors associated with cancer-specific (CSS) and overall survival (OS).Results1192 patients underwent RT during 1999–2013; median age was 79. Use of CRT increased over time: 36% (124/341) in 1999–2003, 38% (153/399) in 2004–2008, 48% (217/452) in 2009–2013 (p = 0.001). Drug details were available for 82% (402/493) of CRT cases; the most common regimens were single-agent Cisplatin (57%, 230/402), single-agent Carboplatin (31%, 125/402) and 5-FU/Mitomycin (4%, 17/402). Factors associated with CRT include younger age (p < 0.001), lower comorbidity (p = 0.001), and geographic region (range 14–89%, p < 0.001). Five year CSS and OS among CRT cases were 45% (95%CI 39–51%) and 35% (95%CI 30–40%). On adjusted analyses CRT was associated with superior survival compared to RT (CSS HR 0.70, 95%CI 0.59–0.84; OS HR 0.74, 95%CI 0.64–0.85); results were consistent on propensity score analysis. There was significant improvement in survival of all RT-treated cases (irrespective or chemotherapy delivery) in 2009–2013 compared to 1999–2003 (CSS HR 0.77, 95%CI 0.61–0.97; OS HR 0.82, 95%CI 0.69–0.98).ConclusionCRT is associated with superior survival compared to RT alone and its uptake corresponded to improved survival among all RT-treated cases in the general population. Uptake of CRT varies widely by geographic region.



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On the gamma spectrometry efficiency of reference materials and soil samples

Publication date: March 2018
Source:Journal of Environmental Radioactivity, Volume 183
Author(s): S. Mohammad Modarresi, S. Farhad Masoudi
The relative discrepancies between the gamma spectrometry efficiency of RGU, RGTh, RGK reference materials and some soil samples have been studied using a MCNP model of a real HPGe detector. It has been shown that, in a specified geometry, efficiencies differences depend on the sample elemental composition. The elemental compositions of RGU-1, RGTh-1 reference materials and a soil sample have been evaluated using X-Ray fluorescence (XRF) method and used in the MCNP simulation along with RGK-1 and six other soil samples with different elemental compositions to calculate their efficiencies in different gamma ray energies. To estimate the maximum relative efficiencies differences between soil samples and reference materials, five soil samples with higher attenuation properties were selected from a large data set of soils elemental compositions. The results show that the efficiency differences between soil samples and reference materials are almost ignorable for more than 100 KeV gamma energies. It strongly depends on the sample attenuation factor in the lower energies, so use of a self-attenuation correction is essential for radionuclide counting in low energies gamma rays. Results show about 8 percent discrepancy between RGU and two soil samples efficiencies in 63.2 KeV energy.



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Indoor radon regulation using tabulated values of temporal radon variation

Publication date: March 2018
Source:Journal of Environmental Radioactivity, Volume 183
Author(s): Andrey Tsapalov, Konstantin Kovler
Mass measurements of indoor radon concentrations have been conducted for about 30 years. In most of the countries, a national reference/action/limit level is adopted, limiting the annual average indoor radon (AAIR) concentration. However, until now, there is no single and generally accepted international protocol for determining the AAIR with a known confidence interval, based on measurements of different durations. Obviously, as the duration of measurements increases, the uncertainty of the AAIR estimation decreases. The lack of the information about the confidence interval of the determined AAIR level does not allow correct comparison with the radon reference level. This greatly complicates development of an effective indoor radon measurement protocol and strategy.The paper proposes a general principle of indoor radon regulation, based on the simple criteria widely used in metrology, and introduces a new parameter – coefficient of temporal radon variation KV(t) that depends on the measurement duration and determines the uncertainty of the AAIR. An algorithm for determining KV(t) based on the results of annual continuous radon monitoring in experimental rooms is proposed. Included are indoor radon activity concentrations and equilibrium equivalent concentration (EEC) of radon progeny. The monitoring was conducted in 10 selected experimental rooms located in 7 buildings, mainly in the Moscow region (Russia), from 2006 to 2013. The experimental and tabulated values of KV(t) and also the values of the coefficient of temporal EEC variation depending on the mode and duration of the measurements were obtained. The recommendations to improve the efficiency and reliability of indoor radon regulation are given. The importance of taking into account the geological factors is discussed. The representativity of the results of the study is estimated and the approach for their verification is proposed.



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Low Level Radiation and Health Conference 1985–2016

Publication date: Available online 3 January 2018
Source:Journal of Environmental Radioactivity
Author(s): Jill Sutcliffe




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ASNR 2018 Case of the Day competition

Radiopaedia.org and the American Society of Neuroradiology (ASNR)  are again collaborating on giving you all the opportunity to submit an adult brain case to ASNR 2018 Case of the Day. 

Each day during the  ASNR 56th Annual Meeting (June 2 - 7) in Vancouver, BC, Canada a case will be shown as the official Case of the Day. This has traditionally been 'invite only', but just like last year, this year one of the cases will be chosen from cases you submit to Radiopaedia.org. 

In addition to one ASNR 2018 case of the day winner, we will also be showcasing a number of the best submissions as our very own Radiopaedia.org 'cases of the day' on our home page and through social media. And, even better, you will be contributing to your personal case library and making Radiopaedia.org even better! 

Prizes

There are a number of prizes available: 

Winner

The winner gets two awesome prizes:

1. Standard Room for two (2) nights at the meeting venue at Fairmont Waterfront Hotel and including complimentary daily in-room WiFi and health club access (value of USD$545).
   
   The prize is courtesy of the American Society of Neuroradiology (ASNR). The reservation can be used at any point during the ASNR 56th Annual Meeting dates from Friday, June 1 through Thursday, June 7. If you are not planning to attend the conference, then that's ok. You will receive the prize either way, and you can, if you wish, transfer it.   
   
   Any questions, please contact, Ashley Boser, at ASNR office, 630-574-0220, Ext. 231 or email: aboser@asnr.org.
    
2. A 12-month all-access pass to Radiopaedia's online courses valued at USD$480.  

Runner-up

The Radiopaedia.org editorial team will be selecting a runner-up who will receive a 12-month all-access pass to Radiopaedia's online courses valued at USD$480.  

Submitting a case

To make your case eligible for the ASNR 2018 Case of the Day, simply:

1. upload an awesome Adult Brain Case (see below)
2. add the tag "ASNR2018" in the right-hand column of the case edit page

Please make sure that your case is fully fleshed out (see our case publishing guidelines) 

Submitting a case is easy, especially if you are using one of our case uploaders. If not, then you can do it the old-fashioned browser-based way. If you are not already familiar with how this works, this short video will help. 

Dates

Submissions close on February 28th 2018, and the winner will be chosen by ASNR committee in the following couple of weeks. The winner will then be contacted by email, so please make sure the email listed in your Radiopaedia.org profile is correct. 

Poster

The winner will then be asked to take a few choice images from their case and make a two-slide powerpoint poster (Question/Answer) which will be shown at the actual conference. This is not an onerous task, and the template will be provided to you. Here is an example. 

A physical poster will also be printed from your slides (by ASNR) and shown. This will be done for you, so if you are not attending, it is not a problem.  

Contact

If you have any questions, please write to general@radiopaedia.org.

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Concurrent chemoradiotherapy for bladder cancer: Practice patterns and outcomes in the general population

Clinical trials have shown that chemoradiotherapy (CRT) improves survival compared to radiation therapy (RT) alone in muscle-invasive bladder cancer. We describe uptake of CRT and comparative effectiveness in routine practice.

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Short- and long-term risks of cardiovascular disease following radiotherapy in rectal cancer in four randomized controlled trials and a population-based register

A population-based cohort and four randomized trials enriched with long-term register data were used to clarify if radiotherapy in combination with rectal cancer surgery is associated with increased risks of cardiovascular disease (CVD).

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A hybrid optimization strategy for registering images with large local deformations and intensity variations

Abstract

Purpose

To develop a method for intra-patient registration of pre- and post-contrast abdominal MR images with large local deformations and large intensity variations.

Method

A hybrid method is proposed to deal with this problem. It consists of two coupled techniques: (1) descriptor matching (DM) at the original resolution using a discrete optimization strategy to avoid getting trapped in a local minimum; (2) continuous optimization to refine the registration outcome based on autocorrelation of local image structure (ALOST). Our method—called DM-ALOST—has become insensitive to the local uptake of contrast agent by exploiting the mean phase and the phase congruency extracted from the multi-scale monogenic signal. The method was extensively tested on abdominal MR data of 30 patients with Crohn's disease.

Results

DM-ALOST produced significantly larger mean Dice coefficients than two state-of-the-art methods \(({p}<0.05)\) .

Conclusion

Both qualitative and quantitative tests demonstrated improved registration using the proposed method compared to the state-of-the-art. The DM-ALOST method facilitates measurement of corresponding features from different abdominal MR images, which can aid to assess certain diseases, particularly Crohn's disease.

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Cortical and Subcortical Morphometric and Iron Changes in Relapsing-Remitting Multiple Sclerosis and Their Association with White Matter T2 Lesion Load

Abstract

Introduction

This study was carried out to investigate the global and regional morphometric and iron changes in grey matter (GM) of multiple sclerosis (MS) patients and link them to the white matter (WM) lesions in a multimodal magnetic resonance imaging approach.

Material and Methods

The study involved 30 relapsing-remitting MS (RRMS) patients along with 30 age-matched healthy controls (HC) who were scanned on a 3T Siemens Trio system. The scanning protocol included a 3D, high resolution T1, T2, and T2*-weighted sequences. The T1-w images were used in FreeSurfer for cortical reconstruction and volumetric segmentation, while T2-w images were used to extract the WM T2 lesions; however, iron and magnetic susceptibility were calculated from the phase data of the T2*-w sequence. Surface-based analyses were performed in FreeSurfer to investigate the regional cortical morphometric changes and their correlations with the expanded disability status scale (EDSS), WM T2 lesions load, cortical iron deposition and magnetic susceptibility.

Results

Significant differences were detected between the RRMS patients and HC for all cortical and subcortical morphometric changes. The EDSS and T2 lesion load showed weak to moderate correlation with the reduced cortical morphometric measurements, increased cortical magnetic susceptibility and iron concentration. All deep grey matter (dGM) volumes showed a significant strong positive correlation with the cortical surface area and volume in RRMS patients and HC.

Conclusions

Grey matter is very much involved in the RRMS and cortical morphometric changes occur in a non-uniform pattern and are very likely to be associated with cortical iron deposition and magnetic susceptibility, dGM atrophy, WM T2 lesion load, and disability.

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Tertiary evaluation of the committed effective dose of emergency workers that responded to the Fukushima Daiichi NPP accident.

Related Articles

Tertiary evaluation of the committed effective dose of emergency workers that responded to the Fukushima Daiichi NPP accident.

J Occup Environ Hyg. 2017 Jun;14(6):D69-D79

Authors: Yasui S

Abstract
In January 2014, Tokyo Electric Power Company (TEPCO) learned that the committed effective dose (CED) for nine emergency workers at the Fukushima Daiichi Nuclear Power Plant accident had been assessed by a method other than the standard assessment methods, established by the Ministry of Health, Labour and Welfare (MHLW) in a secondary evaluation conducted in July 2013. The MHLW requested that the TEPCO and primary contractors review all CED data for 6,245 workers who engaged in emergency work in March and April 2011 except those previously reviewed in the 2013 secondary evaluation. This tertiary evaluation revealed that the recorded CED for 1,536 workers had more than 0.1 mSv discrepancy with the CED evaluated by the standard method. The MHLW requested that TEPCO and primary contractors revise CED data for 142 workers whose CED was 2 mSv or greater that required a CED revision of 1 mSv or greater. The average CED revision was 5.86 mSv. The revised effective dose ranged from 2.17-180.10 mSv. In addition, the number of workers whose CED exceeded 100 mSv increased by one. New issues addressed during the tertiary evaluation included the following: (a) setting of calibration coefficients to convert the CED value from whole body counters equipped with NaI scintillator (WBC(NaI)) to a CED value from WBCs with Ge semiconductor detector; (b) estimation methods for the cases where 131I was not detectable by WBC (NaI) and where 137Cs was not detectable but 134Cs was detected; (c) effects of stable iodine (KI) tablets to block the uptake of 131I by thyroid gland; and (d) complications in determining additional doses during stand-by in the seismically isolated building. To prevent the future use of non-uniform CED assessment methods in the dose assessment for workers, the MHLW issued administrative guidance documents to TEPCO and primary contractors on March 25, 2014.

PMID: 28165926 [PubMed - indexed for MEDLINE]

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Increased variability of watershed areas in patients with high-grade carotid stenosis

Abstract

Purpose

Watershed areas (WSAs) of the brain are most susceptible to acute hypoperfusion due to their peripheral location between vascular territories. Additionally, chronic WSA-related vascular processes underlie cognitive decline especially in patients with cerebral hemodynamic compromise. Despite of high relevance for both clinical diagnostics and research, individual in vivo WSA definition is fairly limited to date. Thus, this study proposes a standardized segmentation approach to delineate individual WSAs by use of time-to-peak (TTP) maps and investigates spatial variability of individual WSAs.

Methods

We defined individual watershed masks based on relative TTP increases in 30 healthy elderly persons and 28 patients with unilateral, high-grade carotid stenosis, being at risk for watershed-related hemodynamic impairment. Determined WSA location was confirmed by an arterial transit time atlas and individual super-selective arterial spin labeling. We compared spatial variability of WSA probability maps between groups and assessed TTP differences between hemispheres in individual and group-average watershed locations.

Results

Patients showed significantly higher spatial variability of WSAs than healthy controls. Perfusion on the side of the stenosis was delayed within individual watershed masks as compared to a watershed template derived from controls, being independent from the grade of the stenosis and collateralization status of the circle of Willis.

Conclusion

Results demonstrate feasibility of individual WSA delineation by TTP maps in healthy elderly and carotid stenosis patients. Data indicate necessity of individual segmentation approaches especially in patients with hemodynamic compromise to detect critical regions of impaired hemodynamics.

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Increased variability of watershed areas in patients with high-grade carotid stenosis

Abstract

Purpose

Watershed areas (WSAs) of the brain are most susceptible to acute hypoperfusion due to their peripheral location between vascular territories. Additionally, chronic WSA-related vascular processes underlie cognitive decline especially in patients with cerebral hemodynamic compromise. Despite of high relevance for both clinical diagnostics and research, individual in vivo WSA definition is fairly limited to date. Thus, this study proposes a standardized segmentation approach to delineate individual WSAs by use of time-to-peak (TTP) maps and investigates spatial variability of individual WSAs.

Methods

We defined individual watershed masks based on relative TTP increases in 30 healthy elderly persons and 28 patients with unilateral, high-grade carotid stenosis, being at risk for watershed-related hemodynamic impairment. Determined WSA location was confirmed by an arterial transit time atlas and individual super-selective arterial spin labeling. We compared spatial variability of WSA probability maps between groups and assessed TTP differences between hemispheres in individual and group-average watershed locations.

Results

Patients showed significantly higher spatial variability of WSAs than healthy controls. Perfusion on the side of the stenosis was delayed within individual watershed masks as compared to a watershed template derived from controls, being independent from the grade of the stenosis and collateralization status of the circle of Willis.

Conclusion

Results demonstrate feasibility of individual WSA delineation by TTP maps in healthy elderly and carotid stenosis patients. Data indicate necessity of individual segmentation approaches especially in patients with hemodynamic compromise to detect critical regions of impaired hemodynamics.

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Nonlinear deformation of tractography in ultrasound-guided low-grade gliomas resection

Abstract

Purpose

In brain tumor surgeries, maximum removal of cancerous tissue without compromising normal brain functions can improve the patient's survival rate and therapeutic benefits. To achieve this, diffusion MRI and intra-operative ultrasound (iUS) can be highly instrumental. While diffusion MRI allows the visualization of white matter tracts and helps define the resection plan to best preserve the eloquent areas, iUS can effectively track the brain shift after craniotomy that often renders the pre-surgical plan invalid, ensuring the accuracy and safety of the intervention. Unfortunately, brain shift correction using iUS and automatic registration has never been shown for brain tractography so far despite its rising significance in brain tumor resection.

Methods

We employed a correlation-ratio-based nonlinear registration algorithm to account for brain shift through MRI–iUS registration and used the recovered deformations to warp both the brain anatomy and tractography seen in pre-surgical plans. The overall technique was demonstrated retrospectively on four patients who underwent iUS-guided low-grade brain gliomas resection.

Results

Through qualitative and quantitative evaluations, the preoperative MRI and iUS scans were well realigned after nonlinear registration, and the deformed brain tumor volumes and white matter tracts showed large displacements away from the pre-surgical plans.

Conclusions

We are the first to demonstrate the technique to track nonlinear deformation of brain tractography using real clinical MRI and iUS data, and the results confirm the need for updating white matter tracts due to tissue shift during surgery.

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Assessment of alveolar bone marrow fat content using 15 T MRI.

Related Articles

Assessment of alveolar bone marrow fat content using 15 T MRI.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Nov 21;:

Authors: Cortes ARG, Cohen O, Zhao M, Aoki EM, Ribeiro RA, Abu Nada L, Costa C, Arita ES, Tamimi F, Ackerman JL

Abstract
OBJECTIVES: Bone marrow fat is inversely correlated with bone mineral density. The aim of this study is to present a method to quantify alveolar bone marrow fat content using a 15 T magnetic resonance imaging (MRI) scanner.
STUDY DESIGN: A 15 T MRI scanner with a 13-mm inner diameter loop-gap radiofrequency coil was used to scan seven 3-mm diameter alveolar bone biopsy specimens. A 3-D gradient-echo relaxation time (T1)-weighted pulse sequence was chosen to obtain images. All images were obtained with a voxel size (58 µm3) sufficient to resolve trabecular spaces. Automated volume of the bone marrow fat content and derived bone volume fraction (BV/TV) were calculated. Results were compared with actual BV/TV obtained from micro-computed tomography (CT) scans.
RESULTS: Mean fat tissue volume was 20.1 ± 11%. There was a significantly strong inverse correlation between fat tissue volume and BV/TV (r = -0.68; P = .045). Furthermore, there was a strong agreement between BV/TV derived from MRI and obtained with micro-CT (interclass correlation coefficient = 0.92; P = .001).
CONCLUSIONS: Bone marrow fat of small alveolar bone biopsy specimens can be quantified with sufficient spatial resolution using an ultra-high-field MRI scanner and a T1-weighted pulse sequence.

PMID: 29292160 [PubMed - as supplied by publisher]

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Crystallization of low saturated lipid blends of palm and canola oils with sorbitan monostearate and fully hydrogenated palm oil

Abstract

Several scientific investigations have focused on providing new strategies for supporting the development of low saturated and zero trans lipid materials, as healthier fat alternatives for food application. This work evaluated the consistency, crystallization behavior, microstructure and polymorphism of six blends composed of palm and canola oils at different concentrations (100:0, 80:20, 60:40, 40:60, 20:80 and 0:100, in w/w%) added with 5.0% of fully hydrogenated palm oil (FHPO) or with a mixture of 2.5% of FHPO and 2.5% of sorbitan monostearate (SMS). The results were compared with the non-structured blends (standard samples). Through microstructure images, the formation of a more homogeneous and denser packed crystal network was observed for samples added with both crystallization modifiers (FHPO/SMS) compared to the corresponding standard samples, after stabilization at 25 °C during 3 h. In particular, enhanced crystallization modifications were observed for the 40:60 blend, in which the crystal form β′ emerged after the addition of FHPO/SMS. Moreover, the 40:60 blend structured with FHPO/SMS showed increased consistency (from 30 to 658 g_F/cm²) and induced onset crystallization in a higher temperature (from 13.1 to 23.9 °C) compared with the non-structured one, due to the specific crystallization effects provided by both added structurants.

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The Incidence of Injury in Amateur Male Rugby Union: A Systematic Review and Meta-Analysis

Abstract

Background

Rugby union is a physically demanding, full-contact team sport that has gained worldwide popularity. The incidence of injury in rugby union has been widely reported in the literature. While comprehensive injury surveillance and prevention programmes have been implemented within the professional game, there is a need for similar strategies in the amateur game. Despite recent increases in the volume of research in rugby, there is little consensus regarding the true incidence rate of match and training injuries in senior amateur male rugby union players.

Objective

The aim of the current review was to systematically review the available evidence on the epidemiology of time-loss injuries in senior amateur male rugby union players and to subsequently conduct a meta-analysis of the findings.

Methods

A comprehensive search of the PubMed, Scopus, SportDiscus and Google Scholar electronic databases was performed using the following keywords; (‘rugby’ OR ‘rugby union’) AND (‘amateur’ OR ‘community’) AND (‘injur*’ OR ‘pain*’). Six articles regarding the incidence of injury in senior amateur male rugby union players, in both matches and training, were retrieved and included in the meta-analysis to determine the overall incidence rate of match injury, with descriptive analyses also provided for other reported variables.

Results

The overall incidence rate of match injuries within senior amateur rugby union players was 46.8/1000 player hours [95% confidence interval (CI) 34.4–59.2]. Contact events accounted for the majority of injuries, with the tackler more at risk than the player being tackled, and with respective incidence rates of 15.9/1000 player hours (95% CI 12.4–19.5) and 12.2/1000 player hours (95% CI 9.3–15.1).

Conclusion

This meta-analysis found that the incidence rate of injury in amateur rugby union players was lower than that in professional players, but higher than the incidences reported in adolescent and youth rugby players. By understanding the true incidence and nature of injuries in rugby, injury prevention strategies can best be implemented. Future prevention strategies may best be aimed towards the tackle area, specifically to the tackler, in order to minimize injury risk.

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health technology; +215 new citations

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

health technology

These pubmed results were generated on 2018/01/03

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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Frailty and quality of life among older people with and without a cancer diagnosis: Findings from TOPICS-MDS.

Related Articles

Frailty and quality of life among older people with and without a cancer diagnosis: Findings from TOPICS-MDS.

PLoS One. 2017;12(12):e0189648

Authors: Geessink N, Schoon Y, van Goor H, Olde Rikkert M, Melis R, TOPICS-MDS consortium

Abstract
BACKGROUND: The number of older cancer patients is rising. Especially in older people, treatment considerations should balance the impact of disease and treatment on quality of life (QOL) and survival. How a cancer diagnosis in older people interacts with concomitant frailty to impact on QOL is largely unknown. We aimed to determine the association between frailty and QOL among community-dwelling older people aged 65 years or above with and without a cancer diagnosis cross-sectionally and at 12 months follow-up.
METHODS: Data were derived from the TOPICS-MDS database. Frailty was quantified by a frailty index (FI). QOL was measured with the subjective Cantril's Self Anchoring Ladder (CSAL, range: 0-10) and the health-related EuroQol-5D (EQ-5D, range:-0.33-1.00) at baseline and after 12 months. To determine associations, linear mixed models were used.
RESULTS: 7493 older people (78.6±6.4 years, 58.4% female) were included. Dealing with a cancer diagnosis (n = 751) was associated with worse QOL both at baseline (CSAL:-0.25 (95%-CI:-0.36;-0.14), EQ-5D:-0.03 (95%-CI:-0.05;-0.02)) and at follow-up (CSAL:-0.13 (95%-CI:-0.24;-0.02), EQ-5D:-0.02 (95%-CI:-0.03;-0.00)). A ten percent increase in frailty was also associated with a decrease in QOL at baseline (CSAL:-0.35 (95%-CI:-0.38;-0.32), EQ-5D:-0.12 (95%-CI:-0.12;-0.11)) and follow-up (CSAL:-0.27 (95%-CI:-0.30;-0.24), EQ-5D:-0.07 (95%-CI:-0.07;-0.06)). When mutually adjusting for frailty and a cancer diagnosis, associations between a cancer diagnosis and QOL only remained significant for CSAL at baseline (-0.14 (95%-CI:-0.25;-0.03)), whereas associations between frailty and QOL remained significant for all QOL outcomes at baseline and follow-up. No statistical interactions between cancer and frailty in their combined impact on QOL were found.
CONCLUSIONS: Cancer diagnosis and frailty were associated with worse health-related and self-perceived QOL both at baseline and at follow-up. Differences in QOL between older people with and without a cancer diagnosis were explained to a large extent by differences in frailty levels. This stresses the importance to take into account frailty in routine oncologic care.

PMID: 29244837 [PubMed - indexed for MEDLINE]

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Factors influencing psychological well-being in patients with Parkinson's disease.

Related Articles

Factors influencing psychological well-being in patients with Parkinson's disease.

PLoS One. 2017;12(12):e0189682

Authors: Nicoletti A, Mostile G, Stocchi F, Abbruzzese G, Ceravolo R, Cortelli P, D'Amelio M, De Pandis MF, Fabbrini G, Pacchetti C, Pezzoli G, Tessitore A, Canesi M, Zappia M

Abstract
BACKGROUND: Both motor and non-motor symptoms could contribute to significant deterioration of psychological well-being in patients with Parkinson's disease (PD). However, its assessment has been only indirectly evaluated using tools based on health-related quality of life (HRQoL), such as the PDQ-39 scale.
OBJECTIVES: To evaluate psychological well-being in PD using a specific tool of assessment, the Psychological Well-being Scale (PWS), and its clinical correlates.
METHODS: This article reports data of patients' perception of health state, as measured by means of the PWS, from an epidemiological, cross-sectional study conducted in Italian PD patients (FORTE Study). We tested possible relationship between well-being and clinical characteristics including fatigue, depression, sleep disruption and HRQoL.
RESULTS: 272 patients completed the PWS questionnaire. Significant and clinically-relevant correlations were found between PWS total score and Parkinson's Fatigue Scale, Beck Depression Inventory, UPDRS Section I, PD Sleep Scale and PDQ-39 for HRQoL scores. Only clinically negligible correlations were found between PWS and motor scores.
CONCLUSIONS: Non-motor symptoms have a significant impact on psychological well-being in PD patients.

PMID: 29244834 [PubMed - indexed for MEDLINE]

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Development of the ThyCAT: A clinically useful computerized adaptive test to assess quality of life in thyroid cancer survivors.

Related Articles

Development of the ThyCAT: A clinically useful computerized adaptive test to assess quality of life in thyroid cancer survivors.

Surgery. 2018 Jan;163(1):137-142

Authors: Aschebrook-Kilfoy B, Ferguson BA, Angelos P, Kaplan EL, Grogan RH, Gibbons RD

Abstract
BACKGROUND: Current quality of life assessment tools for thyroid cancer survivors are not clinically useful due to the length of available questionnaires. Computerized adaptive tests are easily administered electronically and can achieve highly accurate and efficient results in minimal time. We aimed to develop a quality of life computerized adaptive tests (ThyCAT) for thyroid cancer survivors.
METHODS: A bifactor item response theory model was fit to questionnaire responses from 1,078 North American Thyroid Cancer Survivorship Study participants-a longitudinal cohort study of quality of life in thyroid cancer survivors. Tuning parameters were selected to maintain a correlation of r > 0.9 with the total item bank quality of life score obtained from the original North American Thyroid Cancer Survivorship Study questions, using a minimal number of adaptively administered ThyCAT items.
RESULTS: The ThyCAT assesses quality of life with strong correlation (r = 0.96) with the original 75 North American Thyroid Cancer Survivorship Study questions using an average of 9.94 questions (SD ± 3.03) administered in <2 minutes. There was no statistically significant difference in the number of ThyCAT questions required based on demographic or tumor characteristics.
CONCLUSION: The ThyCAT can be administered on a smartphone app in <10 questions, and <2 minutes, allowing efficient and accurate in or out of clinic identification of patients struggling with quality of life issues after thyroid cancer treatment.

PMID: 29128190 [PubMed - indexed for MEDLINE]

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Health-related quality of life in MEN1 patients compared with other chronic conditions and the United States general population.

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Health-related quality of life in MEN1 patients compared with other chronic conditions and the United States general population.

Surgery. 2018 Jan;163(1):205-211

Authors: Peipert BJ, Goswami S, Yount SE, Sturgeon C

Abstract
BACKGROUND: Health-related quality of life (HRQOL) in multiple endocrine neoplasia type-1 (MEN-1) is poorly described. HRQOL in MEN-1 was compared with other chronic conditions and the US general population.
METHODS: Adults aged ≥18 years recruited from an MEN-1 support group (n=153) completed the Patient-Reported Outcomes Measurement Information System (PROMIS) 29-item profile. MEN-1 scores were compared with PROMIS scores reported in peer-reviewed literature from back pain (n=218), cancer (n=310), congestive heart failure (CHF; n=60), chronic obstructive pulmonary disease (COPD; n=79), major depressive disorder (n=196), rheumatoid arthritis (RA; n=521), neuroendocrine tumors (NET; n=619), and primary hyperparathyroidism (PHPT; n=45) cohorts.
RESULTS: Patients with MEN-1 reported worse anxiety (mean=61.7), depression (57.9), fatigue (62.2), pain interference (55.4), sleep disturbance (58.0), physical functioning (44.4), and social functioning (44.7) compared to normative data (50, P < .05) and greater anxiety, depression, and fatigue than patients with back pain, cancer, COPD, RA, NETs, and PHPT (P < .001). MEN-1 respondents had greater pain interference (55.4) than those with cancer (51.9), NETs (52.3), and PHPT (38.4, P < .05). Physical functioning was higher in individuals with MEN-1 (44.4) than in those with back pain (37.5), CHF (34.8), COPD (38.0), and RA (40.7, P < .01).
CONCLUSION: This is the first study to describe HRQOL in a large sample of adults with MEN-1. MEN-1respondents reported worse HRQOL across PROMIS 29-item profile measure domains compared with the US general population and higher levels of anxiety, depression, and fatigue compared with many other chronic conditions.

PMID: 29128174 [PubMed - indexed for MEDLINE]

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Ethical Challenges in Biomarker-Driven Drug Development.

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Ethical Challenges in Biomarker-Driven Drug Development.

Clin Pharmacol Ther. 2018 Jan;103(1):23-25

Authors: Hey SP

Abstract
The increasing importance of biomarkers-as drivers of research and drug development activity, surrogate outcomes in clinical trials, and the centerpiece of precision medicine-raises many new ethical challenges. In what follows, I briefly review some of the major ethical challenges and debates already identified in the literature, and then describe a new ethical challenge that arises from the abstract nature of biomarker hypotheses.

PMID: 28944956 [PubMed - indexed for MEDLINE]

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A Journey in Public Health Ethics.

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A Journey in Public Health Ethics.

Perspect Biol Med. 2017;60(1):103-116

Authors: Kass NE

Abstract
While medical ethics has a long history, and research ethics guidance emerged more formally in the 1960s and 1970s, frameworks for public health ethics began to appear in the 1990s. The author's thinking about public health ethics evolved from consideration of some of the ethics and policy questions surfacing regularly in the HIV/AIDS epidemic. This essay discusses some of the shared commitments of public health and ethics, as well as how one might apply an ethics lens to public health programs, both generally and in the contexts of public health preparedness and obesity prevention.

PMID: 28890452 [PubMed - indexed for MEDLINE]

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History, Morals, and Medicine.

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History, Morals, and Medicine.

Perspect Biol Med. 2017;60(1):60-73

Authors: Moreno JD

Abstract
This essay provides a rational reconstruction of the author's genetically inscribed inclination to do normative ethics with an historical bent and offers some reflections on the value of historical thinking for bioethics.

PMID: 28890449 [PubMed - indexed for MEDLINE]

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My Time in Medicine.

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My Time in Medicine.

Perspect Biol Med. 2017;60(1):19-32

Authors: Fins JJ

Abstract
Through this autobiographical reflection on a life in medicine and bioethics, the author discovers that time is a unifying theme in his work. From his early writing on the regulation of house staff work hours and his abandonment of essentialism and the development of clinical pragmatism as a method of moral problem-solving to his scholarship on end-of-life care and disorders of consciousness, time has been a central heuristic in an effort to bridge ethical theory and clinical practice.

PMID: 28890446 [PubMed - indexed for MEDLINE]

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The Development of an Anthroposophic, Whole Medical System, Healthcare Program for Patients with Depressive Disorders.

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The Development of an Anthroposophic, Whole Medical System, Healthcare Program for Patients with Depressive Disorders.

J Altern Complement Med. 2017 Dec;23(12):941-948

Authors: Ponstein AS, Zwart CA, van Gerven M, Baars EW

Abstract
OBJECTIVES: The aim of the study was to develop a whole medical system healthcare program as an alternative for group-oriented guidelines and as a basis for future studies on safety and (cost) effects. Mild to moderately severe depressive disorders were chosen as an illustrative example.
DESIGN: Literature surveys, monodisciplinary expert interviews, and multidisciplinary panel discussions were employed to describe the whole medical system, its important elements, and the way the important elements are integrated in daily practice.
RESULTS: The treatment of depressive disorders consists of four separate treatment phases in which 10 specific treatment goals are identified. Different disciplines may contribute to each goal. This gives an opportunity for the individualization of care. Within each discipline multiple options per goal are identified which leads to additional possibilities to individualize care.
CONCLUSIONS: Individualized healthcare for patients with mild to moderately severe depressive disorders can be described in terms of treatment goals and treatment options to allow for personalization. The program may serve as the basis for future measurement of quality, cost effectiveness, and safety of provided care.

PMID: 28654315 [PubMed - indexed for MEDLINE]

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Effects of a T'ai Chi-Based Health Promotion Program on Metabolic Syndrome Markers, Health Behaviors, and Quality of Life in Middle-Aged Male Office Workers: A Randomized Trial.

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Effects of a T'ai Chi-Based Health Promotion Program on Metabolic Syndrome Markers, Health Behaviors, and Quality of Life in Middle-Aged Male Office Workers: A Randomized Trial.

J Altern Complement Med. 2017 Dec;23(12):949-956

Authors: Choi YS, Song R, Ku BJ

Abstract
OBJECTIVES: To determine the effects of a t'ai chi-applied worksite health promotion program on metabolic syndrome markers, health behaviors, and quality of life in middle-aged male office workers at a high risk of metabolic syndrome.
DESIGN: A prospective randomized controlled study.
SETTING: Health center of a government office building in Korea.
SUBJECTS: Forty-three male office workers with two or more metabolic syndrome markers.
INTERVENTIONS: The office workers were randomly assigned either to an experimental group that received t'ai chi combined with health education twice weekly for 12 weeks, or to a control group that received health education only.
OUTCOME MEASURES: Blood sampling for metabolic syndrome markers and structured questionnaires for health behaviors and quality of life.
RESULTS: The experimental group showed significant reductions in systolic (t = -3.103, p = 0.003) and diastolic (t = -2.159, p = 0.037) blood pressures and the triglyceride level (t = -2.451, p = 0.019) compared with the control group. Those in the experimental group also performed health behaviors more frequently (t = 4.047, p < 0.001) and reported a significantly better quality of life (t = 3.193, p = 0.003) than those in the control group.
CONCLUSION: The study findings show that t'ai chi was an effective adjunctive intervention in a worksite health promotion program for middle-aged office workers at a high risk of metabolic syndrome. Future studies should examine the long-term effects of t'ai chi-applied worksite health promotion programs in individuals with confirmed metabolic syndrome.

PMID: 28654312 [PubMed - indexed for MEDLINE]

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Patient-Centered Outcomes and Treatment Preferences Regarding Sexual Problems: A Qualitative Study Among Midlife Women.

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Patient-Centered Outcomes and Treatment Preferences Regarding Sexual Problems: A Qualitative Study Among Midlife Women.

J Sex Med. 2017 Aug;14(8):1011-1017

Authors: Thomas HN, Hamm M, Hess R, Borrero S, Thurston RC

Abstract
BACKGROUND: Sexual dysfunction is common in midlife women and can have a significant negative impact on quality of life. Although treatments exist, there is little research on which sexual function outcomes and treatments midlife women prefer.
AIM: To better understand the sexual function outcomes that were most important to sexually active women 45 to 60 years old and the types of treatments they would prefer from individual interviews and focus groups.
METHODS: Twenty individual interviews and three focus groups (N = 39) were led by a trained facilitator, audio recorded, and transcribed. Two investigators developed a codebook, and the primary investigator coded all data. A second investigator coded five randomly selected interviews to ensure intercoder reliability. Codes relating to outcomes and treatment preferences were examined to identify central themes.
RESULTS: The mean age was 52.8 years (range = 45-59). When asked what they would want a sexual dysfunction treatment to do, women sought solutions to specific sexual problems: low desire, vaginal pain and dryness, and decreased arousal or ability to achieve orgasm. However, when asked about the most important aspect of their sex life, most women indicated emotional outcomes, such as enhanced intimacy with their partner, were most important to them. Most women preferred behavioral over pharmaceutical treatments, citing concerns about side effects. These women felt that behavioral treatments might be better equipped to address physical and psychological aspects of sexual problems.
CLINICAL IMPLICATIONS: This study highlights the importance of considering not only physical but also emotional outcomes when evaluating and treating sexual dysfunction in midlife women. It also emphasizes the importance of developing behavioral treatments in addition to pharmaceutical treatments.
STRENGTHS AND LIMITATIONS: By using a qualitative approach, this study allowed women the time and space to speak their own words about their experiences with sexuality at midlife. In addition, different racial and ethnic groups and menopausal statuses were represented. Limitations include limited generalizability, as is true for most qualitative research. In addition, although most women did endorse sexual problems, we did not exclude women with no sexual complaints.
CONCLUSIONS: Midlife women value physical and emotional outcomes with regard to sexual function. Many midlife women in this sample expressed a preference for behavioral approaches over pharmaceutical approaches for the treatment of sexual dysfunction. Thomas HN, Hamm M, Hess R, et al. Patient-Centered Outcomes and Treatment Preferences Regarding Sexual Problems: A Qualitative Study Among Midlife Women. J Sex Med 2017;14:1011-1017.

PMID: 28647404 [PubMed - indexed for MEDLINE]

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Survival and quality of life in incident systemic sclerosis-related pulmonary arterial hypertension.

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Survival and quality of life in incident systemic sclerosis-related pulmonary arterial hypertension.

Arthritis Res Ther. 2017 Jun 02;19(1):122

Authors: Morrisroe K, Stevens W, Huq M, Prior D, Sahhar J, Ngian GS, Celermajer D, Zochling J, Proudman S, Nikpour M, Australian Scleroderma Interest Group (ASIG)

Abstract
BACKGROUND: Pulmonary arterial hypertension (PAH) is a leading cause of mortality in systemic sclerosis (SSc). We sought to determine survival, predictors of mortality, and health-related quality of life (HRQoL) related to PAH in a large SSc cohort with PAH.
METHODS: We studied consecutive SSc patients with newly diagnosed (incident) World Health Organization (WHO) Group 1 PAH enrolled in a prospective cohort between 2009 and 2015. Survival methods were used to determine age and sex-adjusted standardised mortality ratio (SMR) and years of life lost (YLL), and to identify predictors of mortality. HRQoL was measured using the Short form 36 (SF-36) instrument.
RESULTS: Among 132 SSc-PAH patients (112 female (85%); mean age 62 ± 11 years), 60 (45.5%) died, with a median (±IQR) survival time from PAH diagnosis of 4.0 (2.2-6.2) years. Median (±IQR) follow up from study enrolment was 3.8 (1.6-5.8) years. The SMR for patients with SSc-PAH was 5.8 (95% CI 4.3-7.8), with YLL of 15.2 years (95% CI 12.3-18.1). Combination PAH therapy had a survival advantage (p < 0.001) compared with monotherapy, as did anticoagulation compared with no anticoagulation (p < 0.003). Furthermore, combination PAH therapy together with anticoagulation had a survival benefit compared with monotherapy with or without anticoagulation and combination therapy without anticoagulation (hazard ratio 0.28, 95% CI 0.1-0.7). Older age at PAH diagnosis (p = 0.03), mild co-existent interstitial lung disease (ILD) (p = 0.01), worse WHO functional class (p = 0.03) and higher mean pulmonary arterial pressure at PAH diagnosis (p = 0.001), and digital ulcers (p = 0.01) were independent predictors of mortality.
CONCLUSIONS: Despite the significant benefits conferred by advanced PAH therapies suggested in this study, the median survival in SSc PAH remains short at only 4 years.

PMID: 28576149 [PubMed - indexed for MEDLINE]

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Round Window Application of an Active Middle Ear Implant: A Comparison With Hearing Aid Usage in Japan.

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Round Window Application of an Active Middle Ear Implant: A Comparison With Hearing Aid Usage in Japan.

Otol Neurotol. 2017 Jul;38(6):e145-e151

Authors: Iwasaki S, Usami SI, Takahashi H, Kanda Y, Tono T, Doi K, Kumakawa K, Gyo K, Naito Y, Kanzaki S, Yamanaka N, Kaga K

Abstract
OBJECTIVE: To report on the safety and efficacy of an investigational active middle ear implant (AMEI) in Japan, and to compare results to preoperative results with a hearing aid.
DESIGN: Prospective study conducted in Japan in which 23 Japanese-speaking adults suffering from conductive or mixed hearing loss received a VIBRANT SOUNDBRIDGE with implantation at the round window. Postoperative thresholds, speech perception results (word recognition scores, speech reception thresholds, signal-to-noise ratio [SNR]), and quality of life questionnaires at 20 weeks were compared with preoperative results with all patients receiving the same, best available hearing aid (HA).
RESULTS: Statistically significant improvements in postoperative AMEI-aided thresholds (1, 2, 4, and 8 kHz) and on the speech reception thresholds and word recognition scores tests, compared with preoperative HA-aided results, were observed. On the SNR, the subjects' mean values showed statistically significant improvement, with -5.7 dB SNR for the AMEI-aided mean and -2.1 dB SNR for the preoperative HA-assisted mean. The APHAB quality of life questionnaire also showed statistically significant improvement with the AMEI.
CONCLUSION: Results with the AMEI applied to the round window exceeded those of the best available hearing aid in speech perception as well as quality of life questionnaires. There were minimal adverse events or changes to patients' residual hearing.

PMID: 28481780 [PubMed - indexed for MEDLINE]

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[Evolutionary Concept Analysis of Spirituality].

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[Evolutionary Concept Analysis of Spirituality].

J Korean Acad Nurs. 2017 Apr;47(2):242-256

Authors: Ko IS, Choi SY, Kim JS

Abstract
PURPOSE: This study was done to clarify attributes, antecedents, and consequences of spirituality.
METHODS: Rodgers's evolutionary concept analysis was used to analyze fifty seven studies from the literature related to spirituality as it appears in systematic literature reviews of theology, medicine, counseling & psychology, social welfare, and nursing.
RESULTS: Spirituality was found to consist of two dimensions and eight attributes: 1) vertical dimension: 'intimacy and connectedness with God' and 'holy life and belief', 2) horizontal dimension: 'self-transcendence', 'meaning and purpose in life', 'self-integration', and 'self-creativity' in relationship with self, 'connectedness' and 'trust' in relationship with others·neighbors·nature. Antecedents of spirituality were socio-demographic, religious, psychological, and health related characteristics. Consequences of spirituality were positive and negative. Being positive included 'life centered on God' in vertical dimension, and among horizontal dimension 'joy', 'hope', 'wellness', 'inner peace', and 'self-actualization' in relationship with self, 'doing in love' and 'extended life toward neighbors and the world' in relationship with others·neighbors·nature. Being negative was defined as having 'guilt', 'inner conflict', 'loneliness', and 'spiritual distress'. Facilitators of spirituality were stressful life events and experiences.
CONCLUSION: Spirituality is a multidimensional concept. Unchangeable attributes of spirituality are 'connectedness with God', 'self-transcendence', 'meaning of life' and 'connectedness with others·nature'. Unchangeable consequences of spirituality are 'joy' and 'hope'. The findings suggest that the dimensional framework of spirituality can be used to assess the current spiritual state of patients. Based on these results, the development of a Korean version of the scale measuring spirituality is recommended.

PMID: 28470161 [PubMed - indexed for MEDLINE]

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Visual and health outcomes, measured with the activity inventory and the EQ-5D, in visual impairment.

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Visual and health outcomes, measured with the activity inventory and the EQ-5D, in visual impairment.

Acta Ophthalmol. 2017 Dec;95(8):e783-e791

Authors: Macedo AF, Ramos PL, Hernandez-Moreno L, Cima J, Baptista AMG, Marques AP, Massof R, Santana R

Abstract
PURPOSE: Generic instruments to assess health utilities can be used to express the burden of health problems in widely used indexes. That is in contrast with what can be obtained with condition-specific instruments, outcomes are very specific and difficult to compare across conditions. The purpose of this study was to assess health and visual outcomes and its determinants in patients with visual impairment (VI) using the EQ-5D-3L and the Activity Inventory (AI).
METHODS: Participants were recruited in different hospitals during the PCVIP-study. A total of 134 patients with acuity 0.30 logMAR or less in the better eye were interviewed. The AI includes 46 goals split between three objectives: social functioning, recreation and daily living, and was used to measure visual ability. The EQ-5D consists of five questions covering one domain each and was used to provide a measure of health states. Responses to each domain were combined to produce a single individual index.
RESULTS: The AI and the EQ-5D-3L showed enough discriminatory power between VI levels (p < 0.001), and their results were strongly correlated r(134) = 0.825, (p < 0.001). Explanatory factors for visual ability were level of VI in better eye, age and gender, R2  = 0.43, (p < 0.001). Explanatory factors for the EQ-5D-3L were level of VI in the better eye, comorbidities and gender, R2  = 0.36, (p < 0.001).
CONCLUSION: Our results showed that the EQ-5D-3L is useful when characterizing the burden of VI and to compute, when necessary, quality-adjusted-life-years (QALY) changes due to VI. However, it is important to consider that the EQ-5D-3L uses a coarse response scale, assesses a limited spectrum of domains and is influenced by comorbidities. This might limit its responsiveness to small changes in visual ability.

PMID: 28371261 [PubMed - indexed for MEDLINE]

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Relationship Between the Comprehensive Nutritional Index and the EORTC QLQ-H&N35 in Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiation Therapy.

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Relationship Between the Comprehensive Nutritional Index and the EORTC QLQ-H&N35 in Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiation Therapy.

Nutr Cancer. 2017 Apr;69(3):436-443

Authors: He Y, Chen L, Chen L, Hu W, Wang C, Tang L, Mai H, Li J, Wu L, Fan Y

Abstract
This study aimed to explore the relationship between the comprehensive nutritional index (CNI) and quality of life in nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiation therapy (IMRT). The nutritional index, which includes total lymphocyte count, hemoglobin and albumin levels, body mass index, and usual body weight percentage, was evaluated pre-treatment and post-treatment in patients who underwent IMRT. The quality of life of NPC patients was measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Cancer Module (EORTC QLQ-H&N35) at four time points: pre-treatment, post-treatment, and 3 and 6 mo after IMRT. A comprehensive nutritional model was used to assess the correlation with QLQ-H&N35. The nutritional index decreased significantly post-treatment. The CNI was associated with immunotherapy; the International Union Against Cancer (UICC) stage; concurrent chemotherapy; speech problems, trouble with social contact, feeling ill and having dental problems at pre-treatment; sexuality at 3 mos post-treatment; and sensory problems and xerostomia at 6 mo post-treatment (P < 0.05). The nutritional status and QLQ-H&N35 scores in NPC patients decreased during IMRT. Our study provides an alternative measure of the CNI to improve the QLQ-H&N35 evaluation system for patients with NPC.

PMID: 28287323 [PubMed - indexed for MEDLINE]

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Quality Indicators: Measurement and Predictors in Head and Neck Cancer Free Flap Patients.

Quality Indicators: Measurement and Predictors in Head and Neck Cancer Free Flap Patients.

Otolaryngol Head Neck Surg. 2017 Dec 01;:194599817742373

Authors: Eskander A, Kang SY, Tweel B, Sitapara J, Old M, Ozer E, Agrawal A, Carrau R, Rocco J, Teknos TN

Abstract
Objective To determine the predictors of length of stay (LOS), readmission within 30 days, and unplanned return to the operating room (OR) within 30 days in head and neck free flap patients. Study Design Case series with chart review. Setting Tertiary academic cancer hospital. Subjects and Methods All head and neck free flap patients at The Ohio State University (OSU, 2006-2012) were assessed. Multivariable logistic regression to assess the impact of patient factors, flap and wound factors, and intraoperative factors on the aforementioned quality metric outcomes. Results In total, 515 patients were identified, of whom 66% had oral cavity cancers, 33% had recurrent tumors, and 28% underwent primary radiotherapy. Of the patients, 31.5% had a LOS greater than 9 days, predicted by longer operative time, oral cavity and pharyngeal tumor sites, blood transfusion, diabetes mellitus, and any complication. A total of 12.6% of patients were readmitted within 30 days predicted by absent OSU preoperative assessment clinic attendance and any complication, and 14.8% of patients had an unplanned OR return predicted by advanced age. Conclusions When assessing quality metrics, adjustment for the complexity involved in managing patients with head and neck cancer with a high comorbidity index, clean contaminated wounds, and a high degree of primary radiotherapy is important. Patients seen in a preoperative assessment clinic had a lower risk of readmission postoperatively, and this should be recommended for all head and neck free flap patients. Quality improvement projects should focus on predictors and prevention of complications as this was the number one predictor of both increased length of stay and readmission.

PMID: 29293404 [PubMed - as supplied by publisher]

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Is Perineural Invasion of Head and Neck Squamous Cell Carcinomas Linked to Tobacco Consumption?

Is Perineural Invasion of Head and Neck Squamous Cell Carcinomas Linked to Tobacco Consumption?

Otolaryngol Head Neck Surg. 2017 Dec 01;:194599817750354

Authors: Baumeister P, Welz C, Jacobi C, Reiter M

Abstract
Perineural invasion (PNI) is an underrecognized path of cancer spread, and its causes and mechanisms are poorly understood. Recent research indicates a mutual attraction of neuronal and cancer cells, largely dependent on neurotrophic factors and their receptors. Interestingly, the release of neurotrophic factors occurs upon cigarette smoke/nicotine exposure in a dose-dependent manner, and serum levels correlate with current smoking, number of smoking years, and smoking severity. Among cell types capable of neurotrophic factors secretion are lung and oral fibroblasts. In our study of 178 patients with head and neck squamous cell carcinoma, tumors of current and former smokers showed PNI significantly more often than tumors of never smokers. Moreover, PNI was a marker for aggressive tumor growth. Surprisingly, PNI was more significant for survival than p16 status. Our study warrants further research on PNI in head and neck squamous cell carcinoma with special emphasis on the impact of tobacco consumption to identify suitable candidates for therapeutic interventions.

PMID: 29293403 [PubMed - as supplied by publisher]

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Salvage Surgery after Radiation Failure in T1/T2 Larynx Cancer: Outcomes following Total versus Conservation Surgery.

Salvage Surgery after Radiation Failure in T1/T2 Larynx Cancer: Outcomes following Total versus Conservation Surgery.

Otolaryngol Head Neck Surg. 2017 Dec 01;:194599817742596

Authors: Cheraghlou S, Kuo P, Mehra S, Yarbrough WG, Judson BL

Abstract
Objective After radiation failure for early T-stage larynx cancer, national guidelines recommend salvage surgery. Total laryngectomy and conservation laryngeal surgery with an open or endoscopic approach are both used. Beyond single-institution studies, there is a lack of evidence concerning the outcomes of these procedures. We aim to study whether treatment with conservation laryngeal surgery is associated with poorer outcomes than treatment with total laryngectomy as salvage surgery after radiation failure for T1/T2 larynx cancers. Study Design A retrospective study was conducted of adult squamous cell larynx cancer cases in the National Cancer Database diagnosed from 2004 to 2012. Setting Commission on Cancer cancer programs in the United States. Methods Demographic, facility, tumor, and survival variables were included in the analyses. Multivariate survival regressions as well as univariate Kaplan-Meier analyses were conducted. Results Slightly more than 7% of patients receiving radiotherapy for T1/T2 larynx cancers later received salvage surgery. Salvage with partial laryngectomy was not associated with diminished survival as compared with total laryngectomy. However, positive surgical margins were associated with worse outcomes (hazard ratio, 1.782; P = .001), and a larger percentage of patients receiving partial laryngectomy had positive margins than those receiving total laryngectomy. Facility characteristics were not associated with differences in salvage surgery type or outcomes. Conclusion In recognition of the inherent selection bias, patients who experienced recurrences after radiation for T1/T2 larynx cancer and underwent conservation salvage laryngeal surgery demonstrated clinical outcomes similar to those of patients undergoing salvage total laryngectomy. Increased rates of positive surgical margins were observed among patients undergoing salvage conservation surgery.

PMID: 29292665 [PubMed - as supplied by publisher]

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Economic Impact of Frozen Section for Thyroid Nodules with "Suspicious for Malignancy" Cytology.

Economic Impact of Frozen Section for Thyroid Nodules with "Suspicious for Malignancy" Cytology.

Otolaryngol Head Neck Surg. 2017 Dec 01;:194599817740328

Authors: Bollig CA, Gilley D, Lesko D, Jorgensen JB, Galloway TL, Zitsch RP, Dooley LM

Abstract
Objective To perform a cost analysis of the routine use of intraoperative frozen section (iFS) among patients undergoing a thyroid lobectomy with "suspicious for malignancy" (SUSP) cytology in the context of the 2015 American Thyroid Association guidelines. Study Design Case series with chart review; cost minimization analysis. Setting Academic. Subjects and Methods Records were reviewed for patients with SUSP cytology who underwent thyroid surgery between 2010 and 2015 in which iFS was utilized. The diagnostic test performance of iFS and the frequency of indicated completion/total thyroidectomies based on the 2015 guidelines were calculated. A cost minimization analysis was performed comparing lobectomy, with and without iFS, and the need for completion thyroidectomy according to costs estimated from 2014 data from Medicare, the Bureau of Labor Statistics, and the Nationwide Inpatient Sample. Results Sixty-five patients met inclusion criteria. The malignancy rate was 61.5%, 45% of which was identified intraoperatively. The specificity and positive predictive value were 100%. The negative predictive value and sensitivity were 83% and 95%, respectively. Completion/total thyroidectomy was indicated for 9% of patients; 83% of these individuals had findings on iFS that would have changed management intraoperatively. Application of the new guidelines would have resulted in a significant reduction in the frequency of conversion to a total thyroidectomy when compared with the actual management (26.1% vs 7.7%, P = .005). Performing routine iFS was the less costly scenario, resulting in a savings of $474 per case. Conclusion For patients with SUSP cytology undergoing lobectomy, routine use of iFS would result in decreased health care utilization.

PMID: 29292662 [PubMed - as supplied by publisher]

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Acceleration of Gas Reservoir Simulation Using Proper Orthogonal Decomposition

High-precision and high-speed reservoir simulation is important in engineering. Proper orthogonal decomposition (POD) is introduced to accelerate the reservoir simulation of gas flow in single-continuum porous media via establishing a reduced-order model by POD combined with Galerkin projection. Determination of the optimal mode number in the reduced-order model is discussed to ensure high-precision reconstruction with large acceleration. The typical POD model can achieve high precision for both ideal gas and real gas using only 10 POD modes. However, acceleration of computation can only be achieved for ideal gas. The obstacle of POD acceleration for real gas is that the computational time is mainly occupied by the equation of state (EOS). An approximation method is proposed to largely promote the computational speed of the POD model for real gas flow without decreasing the precision. The improved POD model shows much higher acceleration of computation with high precision for different reservoirs and different pressures. It is confirmed that the acceleration of the real gas reservoir simulation should use the approximation method instead of the computation of EOS.

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Cosmetics, Vol. 5, Pages 5: Coffee Silverskin: A Review on Potential Cosmetic Applications

Cosmetics, Vol. 5, Pages 5: Coffee Silverskin: A Review on Potential Cosmetic Applications

Cosmetics doi: 10.3390/cosmetics5010005

Authors: Sílvia Bessada Rita C. Alves M. P. P. Oliveira

Coffee silverskin, the major coffee-roasting by-product, is currently used as fuel and for soil fertilization. However, there are several studies reporting silverskin as a good source of bioactive compounds that can be extracted and further used by cosmetic industry. Its high antioxidant potential may be due to the synergistic interaction of chlorogenic acids (1–6%), caffeine (0.8–1.25%), and melanoidins (17–23%), among other antioxidant compounds. The bioactive compounds of silverskin can answer to the new fields of cosmetic industry on natural active ingredient resources that improve health skin appearance, counteract skin aging and related diseases, in an environmentally friendly approach. Skin aging is a complex process associated with oxidative metabolism and reactive oxygen species (ROS) generation. ROS production increase matrix metalloproteinases (MMPs), as well as pro-inflammatory mediators, resulting in consequent skin damage and aging. To counteract this process, cosmetic industry is looking for compounds able to increase MMP inhibitory activities, hyaluronidase inhibitory activity, expression of collagen and elastase inhibitory activity, as potential bioactive ingredients with anti-aging purposes. This review focuses on skin aging factors and the potential anti-aging, anti-inflammatory, antimicrobial, anti-cellulite and anti-hair loss activity, as well as protection against UV damage, of coffee silverskin and their bioactive compounds.

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FDA grants regular approval to cabozantinib for first-line treatment of advanced renal cell carcinoma

The Food and Drug Administration has granted regular approval to cabozantinib for treatment of patients with advanced renal cell carcinoma (RCC). The FDA previously approved cabozantinib in 2016 for treatment of patients with advanced RCC who have...

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Novel diabetes drugs sensitise cancer cells to chemotherapy agents

Scientists at Dana-Farber Cancer Institute have shown that experimental diabetes drugs can make cancer cells more vulnerable to traditional chemotherapy agents, and they say such combinations should be explored to potentially improve outcomes for cancer...

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State-of-the-art MRI technology bypasses need for biopsy

The most common type of tumour found in the kidney is generally quite small (less than 1.5 in). These tumours are usually found by accident when CAT scans are performed for other reasons and the serendipitous finding poses a problem for doctors. Are...

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Novel nanomedicine inhibits progression of pancreatic cancer in mice

A new Tel Aviv University study pinpoints the inverse correlation between a known oncogene -- a gene that promotes the development of cancer -- and the expression of an oncosuppressor microRNA as the reason for extended pancreatic cancer survival. The...

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Immune cells play key role in early breast cancer metastasis even before a tumour develops

Mount Sinai researchers have discovered that normal immune cells called macrophages, which reside in healthy breast tissue surrounding milk ducts, play a major role in helping early breast cancer cells leave the breast for other parts of the body,...

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Negative-pressure pulmonary oedema following choking on a rice ball

Description

A 74-year-old woman was brought to the emergency department by ambulance due to choking. Thirty minutes prior to presentation, the patient choked on a rice ball at lunch, and repeated banging on her back by family members led to successful dislodgement of a part of the object. The patient had a history of depression but no history of smoking.

On arrival, she was cyanotic and in respiratory distress. On physical examination, the patient was afebrile, with a heart rate of 112 beats per minute, blood pressure of 142/93 mm Hg, respiratory rate of 26 breaths per minute and oxygen saturation of 93% on 10 L/min via face mask. Her body mass index was 27 (64 kg for 1.53 m). Significant physical examination findings included inspiratory crackles in the right upper zone without wheezing, regular heart sounds without murmur or gallop, and no oedema.

A 12-lead ECG showed normal sinus rhythm with...

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Spontaneous rupture of uterine smooth muscle tumour presenting acute abdominal pain and haemoperitoneum

Uterine smooth muscle tumours are histologically categorised into benign leiomyoma, malignant leiomyosarcoma or smooth muscle tumours of uncertain malignant potentials (STUMPs).¹ Common symptoms of uterine tumours are hypermenorrhea, dysmenorrhea, lumbago or irregular genital bleeding. We experienced a case of uterine tumour with atypical clinical behaviour. A 40-year-old woman who had been diagnosed with leiomyoma presented with severe abdominal pain and intraperitoneal haemorrhage. By emergent surgery, we found that the uterine tumour had ruptured spontaneously. The pathological diagnosis was STUMPs. 14 months later, she underwent a second surgery for a tumour recurrence. Pathological diagnosis was leiomyosarcoma. 20 months later, she underwent a third surgery for a re-recurrent tumour. After the third surgery, massive fluid containing haemorrhage accumulated inside the tumour. Percutaneous drainage of intratumour fluid was successfully performed. Chemotherapy was also taken, but it ended without significant efficacy. 3 years after the first surgery, she died because of intestinal perforation and peritonitis.

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Conservative management of keratocystic odontogenic tumour in a young child with decompression and an intraoral appliance: 5-year follow-up

Keratocystic odontogenic tumour (KCOT) is considered one of the most aggressive odontogenic lesions presenting high recurrence rate which varies according to treatment modalities employed for management. The treatment rendered should have a lowest possible risk of recurrence and least morbidity while still eradicating the lesion. Although the radical treatment options like enucleation and en bloc resection are associated with lesser recurrences, these can lead to greater morbidity, especially in children with developing teeth and jaw bones, thus, emphasising need to consider more conservative treatment options like decompression and marsupialisation. The purpose of this article was to report the case of an 11-year-old male child with KCOT in the mandibular region associated with impacted premolar treated successfully with decompression and intraoral appliance. After 24 months of follow-up, the spontaneous eruption of premolar was noted with complete resolution of periapical radiolucency. No recurrence was noted even after 5-year follow-up.

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Peritonitis with Listeria monocytogenes in a patient on automated peritoneal dialysis

We present a case where Listeria monocytogenesserotype 1/2a was determined to be the causative agent of peritonitis in a patient on automated peritoneal dialysis. The patient, a 53-year-old Caucasian woman from the Faroe Islands was admitted to the National Hospital reporting of constant abdominal pain and a fever. Peritoneal cultures were positive for growth of L. monocytogenes. The patient was successfully treated with oral amoxicillin for 2 weeks and intraperitoneal vancomycin for 3 weeks. To date, the patient has not been readmitted due to peritonitis. The Faroese salmon was the suspected source of infection with L. monocytogenes.

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Secondary stone formation over a suture material after partial nephrectomy

We hereby present the treatment of renal pelvic and lower pole stones of sizes 2.74x1 cm and 1.38x0.92 cm, respectively, forming over a nidus of non-absorbable suture, in a 50-year-old female patient with a history of open partial nephrectomy done for renal angiomyolipoma around 10 years back. She was successfully treated with percutaneous nephrolithotomy technique under spinal anaesthesia. There was complete stone clearance, and she was discharged in stable condition within 40 hours of surgery without any stent. There is no case report showing the presence of suture material in the renal stone after partial nephrectomy. This case report highlights the fact that the non-absorbable suture material used during the open surgery especially for haemostasis can also act as nidus for future stone formation. This also suggests that percutaneous techniques can be considered to avoid repeat open surgery and the associated morbidity.

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Cardiac tamponade causing severe reversible hyponatraemia

Severe hyponatraemia in setting of cardiac tamponade is very rare and only few case reports have been reported so far. This case report highlights pericardial tamponade as a rare but easily treatable cause of severe hyponatraemia. Pertinent literature is also reviewed. A 70-year-old woman presented to the emergency department with altered mental status. She was tachycardic and hypotensive with cardiomegaly on a chest X-ray. Serum sodium was severely low at 109 mmol/L and was identified as the likely cause for her abnormal mentation. She was also in acute renal failure with serum creatinine of 4.1 mg/dL. A transthoracic echocardiogram was done that showed a large pericardial effusion with evidence of tamponade physiology. She underwent emergent pericardiocentesis with rapid improvement in clinical picture and blood pressure. Her serum sodium level rapidly improved and was normal in 48 hours.

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Compound heterozygous mutations with novel missense ABCA12 mutation in harlequin ichthyosis

Harlequin ichthyosis (HI) is the most severe form of autosomal recessive congenital ichthyosis, presenting at birth with distinctive facial features and thick, plate-like scales over the entire body. The abnormal skin barrier predisposes the patient to multiple complications, including dehydration and sepsis. Mortality rates of babies with HI have been greatly reduced since the introduction of systemic retinoid therapy. Mutations in ABCA12 have been found to lead to HI. Most of these mutations are truncation or deletion mutations in the conserved region of the protein, leading to severe loss of ABCA12 function. We report a case of HI caused by a compound heterozygous mutation (a known single nucleotide deletion and a novel single nucleotide substitution) in the ABCA12 gene.

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A case of IgG4oligoarthritis mimicking psoriatic arthritis

IgG₄-related disease (IgG₄-RD) is a rare but rapidly emerging immune-mediated fibroinflammatory condition that can affect almost any organ. It is typically associated with involvement of organs such as lymph nodes, submandibular glands, orbits, periaortic region and pancreas. However, IgG₄-RD presenting primarily as an inflammatory arthritis is much less recognised. We present a rare case of IgG₄-RD mimicking psoriatic arthritis. In spite of normal circulating IgG₄ plasma levels, a clinical index of suspicion was required to obtain a histopathological diagnosis. The patient’s aggressive arthritis disease did not initially respond to typical disease- modifying agents such as methotrexate. Instead, we report a dramatic response to B cell depletion with rituximab. It is important to emphasise this case as a rare presentation of a rare disease. IgG₄-RD is a rapidly emerging condition and the diagnosis should be considered when the alternatives do not seem to fit.

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Spontaneous right hepatic artery branch gallbladder fistula revealed by haemobilia and upper cataclysmic gastrointestinal bleeding

Spontaneous right hepatic artery branch gallbladder fistula is a rare condition. Our case reported a spontaneous fistula between the right branch of the hepatic artery and the gall bladder. It constitutes a rare cause of haemobilia. In fact, the most common aetiology of haemobilia is traumatic or iatrogenic secondary to hepatobiliary surgery or interventions. Diagnosis of vascular-biliary fistula is not easy. The gallbladder endoluminal clot can mimic a mass, as in our patient. Selective arterial angiography is helpful in identifying the source of gastrointestinal haemorrhage. It can demonstrate the presence of arteriobiliary fistula. The differential diagnosis is arterial pseudoaneurysm in the vicinity of the vessel. Mini-invasive treatment of this fistula constitutes the best treatment. We here report a case of haemobilia with upper cataclysmic gastrointestinal bleeding revealing a spontaneous fistula between the right branch of the hepatic artery and the gall bladder.

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Lemierres syndrome: a pain in the neck with far-reaching consequences

Lemierre’s syndrome is a potentially life-threatening consequence of oropharyngeal and ear infections and often results in critical care admission and even intubation. Due to the multisystem manifestation, multiple teams may initially be involved in the care, some of which may be unfamiliar with the features and usual clinical course. This report describes a case in a 36-year-old woman with the classic features of internal jugular vein thrombosis and septic emboli to the lungs secondary to an oropharyngeal infection. Treatment comprised antibiotic therapy, anticoagulation and fluid resuscitation, and was carried out in a high dependency unit setting. At follow-up 3 months after discharge, the patient was well with no residual symptoms off all treatment. During the events of this case, it became apparent that while ear, nose and throat and infectious diseases team members were relatively familiar with the condition, other departments including the critical care team were less so.

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Granulomatosis with polyangiitis: an unusual cause of acute liver injury

Granulomatosis with polyangiitis (GPA) causing liver injury is rare. Where liver biopsies have been taken findings are not always typical and diagnosis can be challenging. Here, we present a case of a 58-year-old male who on admission to hospital was found to have acute liver injury. Diagnosis of liver involvement in GPA is supported by liver histology and the resolution of hepatitis after commencement of immunosuppressive treatment.

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Severe FGF23-based hypophosphataemic osteomalacia due to ferric carboxymaltose administration

Ferric carboxymaltose (FCM) is a novel iron formulation increasingly prescribed due to its effectiveness and fast infusion time. FCM administration can cause an asymptomatic hypophosphataemia secondary to fibroblast growth factor 23 (FGF23) dysregulation. In patients with chronic iron needs, however, a severe, long-lasting hypophosphataemia can lead to osteomalacia with associated bone pain. Lack of awareness of this complication results in delayed time to diagnosis and significant morbidity. We report a case of a patient with Crohn’s disease and chronic iron-deficiency anaemia receiving multiple doses of FCM who developed severe hypophosphataemic osteomalacia with urinary phosphate loss and increased FGF23. FGF23 excess and osteomalacia resolved only months after FCM discontinuation and aggressive phosphate repletion. Potential mechanisms of FGF23 dysregulation are discussed, with the aim of raising awareness of this significant side effect for prescribers of chronic intravenous iron supplementation, and to help guide future studies to determine the safety of FCM in all patient populations.

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Non-surgical intervention for retroperitoneal lymphogenic and pulmonary metastases of a benign leiomyoma: treatment with ulipristal acetate

This case report describes a very rare coexistence of retroperitoneal lymphogenic and pulmonary metastases of a benign leiomyoma: benign metastasising leiomyoma (BML). Despite surgical treatment growth of multiple nodules in the lungs, omentum, mesenterium and retroperitoneum was observed by CT scan. We started off-label ulipristal acetate treatment with impressive results. The lesions on the CT scan disappeared, and the patient was asymptomatic after treatment.

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Cells, Vol. 7, Pages 3: Reagent Tracker Dyes Permit Quality Control for Verifying Plating Accuracy in ELISPOT Tests

Cells, Vol. 7, Pages 3: Reagent Tracker Dyes Permit Quality Control for Verifying Plating Accuracy in ELISPOT Tests

Cells doi: 10.3390/cells7010003

Authors: Alexander Lehmann Zoltan Megyesi Anna Przybyla Paul Lehmann

ELISPOT assays enable the detection of the frequency of antigen-specific T cells in the blood by measuring the secretion of cytokines, or combinations of cytokines, in response to antigenic challenges of a defined population of PBMC. As such, these assays are suited to establish the magnitude and quality of T cell immunity in infectious, allergic, autoimmune and transplant settings, as well as for measurements of anti-tumor immunity. The simplicity, robustness, cost-effectiveness and scalability of ELISPOT renders it suitable for regulated immune monitoring. In response to the regulatory requirements of clinical and pre-clinical immune monitoring trials, tamper-proof audit trails have been introduced to all steps of ELISPOT analysis: from capturing the raw images of assay wells and counting of spots, to all subsequent quality control steps involved in count verification. A major shortcoming of ELISPOT and other related cellular assays is presently the lack of audit trails for the wet laboratory part of the assay, in particular, the assurance that no pipetting errors have occurred during the plating of antigens and cells. Here, we introduce a dye-based reagent tracking platform that fills this gap, thereby increasing the transparency and documentation of ELISPOT test results.

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Neuropathology of autonomic dysfunction in synucleinopathies

Abstract

The synucleinopathies—Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure—result from distinct patterns of abnormal α-synuclein aggregation throughout the nervous system. Autonomic dysfunction in these disorders results from variable involvement of the central and peripheral autonomic networks. The major pathologic hallmark of Parkinson's disease and dementia with Lewy bodies is Lewy bodies and Lewy neurites; of multiple system atrophy, oligodendroglial cytoplasmic inclusions; and of pure autonomic failure, peripheral neuronal cytoplasmic inclusions. Clinical manifestations include orthostatic hypotension, thermoregulatory dysfunction, gastrointestinal dysmotility, and urogenital dysfunction with neurogenic bladder and sexual dysfunction. Strong evidence supports isolated idiopathic rapid eye movement sleep disorder as a significant risk factor for the eventual development of synucleinopathies with autonomic and/or motor involvement. In contrast, some neurologically normal elderly individuals have Lewy-related pathology. Future work may reveal protective or vulnerability factors that allow some patients to harbor Lewy pathology without overt autonomic dysfunction. © 2018 International Parkinson and Movement Disorder Society

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Selected health and lifestyle factors, cytosine-adenine-guanine status, and phenoconversion in Huntington's disease

ABSTRACT

Background

In Huntington's disease, 60% of the variance in onset age is not explained by the huntingtin gene mutation. Huntington's disease onset was earlier in caffeine users.

Objective

The objective of this study was to assess the relationship of lifestyle factors with motor phenoconversion among persons at risk for Huntington's disease.

Methods

The associations of motor phenoconversion and exposure to selected lifestyle and health factors were examined using Cox proportional hazards analyses adjusted for age, gender, and repeat length.

Results

Of 247 participants, 36 (14.6%) phenoconverted. Mean follow-up was 4.2 years. Greater caffeinated soda use was associated with an increased hazard of phenoconversion: moderate use hazard ratio 2.26 (95% confidence interval 0.59-8.71), high use hazard ratio 4.05 (95% confidence interval 1.18-13.96).

Conclusions

Huntington's disease onset was earlier among consumers of caffeinated soda, but not other caffeinated beverages. This finding may be spurious or not related to caffeine. © 2018 International Parkinson and Movement Disorder Society

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The effect of temperature on airborne filamentous fungi in the indoor and outdoor space of a hospital

Abstract

Fungi are one of the bioaerosols in indoor air of hospitals. They have adverse effects on staff and patients. The aim of this study was to investigate the effects of three incubation temperature on the density and composition of airborne fungi in an indoor and outdoor space of hospital. Sabouraud dextrose agar was used for culture the fungi. For improvement of aseptic properties, chloramphenicol was added to this medium. The density of airborne fungi was less than 282 CFU/m³. The highest density was detected in emergency room and the lowest of them was in neonatal intensive care unit (NICU) and operation room (OR). Results showed that fungi levels at 25 °C were higher than 37 and 15 °C (p = 0.006). In addition, ten different genera of fungi were identified in all departments. The predominant fungi were Fusarium spp., Penicillium spp., Paecilomyces spp., and Aspergillus niger. Moreover, the density and trend of distribution of Fusaruim spp. in the indoor space was directivity to outdoor space by ventilation system. The present study has provided that incubation temperature had effect on airborne fungi remarkably. We are suggested that more studies would be conducted on incubation temperature and other ambient factors on airborne fungi.

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