Gadolinium leakage into ocular structures in Stroke: New Update

In a study published in Neurology Emi Hitomi et al  prompted by the unexpected finding of gadolinium leakage into ocular structures (GLOS) in acute stroke patients,   authors studied the frequency and nature of this finding in 167 patients. 

Authors found  gadolinium leakage into ocular structures (GLOS) to be common in patients with acute stroke; delayed GLOS was a marker for chronic vascular disease. 

The mechanism for acute GLOS remains uncertain but may be a remote effect of acute cerebral injury on the blood–ocular barrier.

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Evidence-Based Review Of Pharmacotherapy For Acute Agitation. Part 2: Safety

Publication date: Available online 9 February 2018
Source:The Journal of Emergency Medicine
Author(s): Leslie S. Zun
BackgroundThe management of acute agitation in the emergency department often requires the administration of rapid-acting antipsychotic agents. However, there are few comparative studies and little guidance regarding the risks associated with use of such drugs in the acute setting.ObjectiveThis structured evidence-based review compared the safety of antipsychotic pharmacotherapies for acute agitation using data from randomized controlled trials identified by a literature search of the PubMed database.ResultsBased on findings from 34 blinded, randomized controlled trials, common acute adverse effects of second-generation antipsychotics and haloperidol were headache, dizziness, insomnia, and somnolence. There were some differences in incidence of extrapyramidal symptoms (EPS), degree of sedation, and acute QTc prolongations between agents.ConclusionsThe results of this review demonstrate the improved safety (particularly regarding EPS and over-sedation) of certain newer-generation antipsychotic agents compared with haloperidol and benzodiazepines for the treatment of acutely agitated patients. The risk of prolonged QT interval and torsade de pointes needs to be considered with haloperidol and some of the second-generation antipsychotics.



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Use of meta-analyses and joint analyses to select variants in whole genome sequences for genomic evaluation: An application in milk production of French dairy cattle breeds

Publication date: Available online 7 February 2018
Source:Journal of Dairy Science
Author(s): M. Teissier, M.P. Sanchez, M. Boussaha, A. Barbat, C. Hoze, C. Robert-Granie, P. Croiseau
As a result of the 1000 Bull Genome Project, it has become possible to impute millions of variants, with many of these potentially causative for traits of interest, for thousands of animals that have been genotyped with medium-density chips. This enormous source of data opens up very interesting possibilities for the inclusion of these variants in genomic evaluations. However, for computational reasons, it is not possible to include all variants in genomic evaluation procedures. One potential approach could be to select the most relevant variants based on the results of genome-wide association studies (GWAS); however, the identification of causative mutations is still difficult with this method, partly because of weak imputation accuracy for rare variants. To address this problem, this study assesses the ability of different approaches based on multi-breed GWAS (joint and meta-analyses) to identify single-nucleotide polymorphisms (SNP) for use in genomic evaluation in the 3 main French dairy cattle breeds. A total of 6,262 Holstein bulls, 2,434 Montbéliarde bulls, and 2,175 Normande bulls with daughter yield deviations for 5 milk production traits were imputed for 27 million variants. Within-breed and joint (including all 3 breeds) GWAS were performed and 3 models of meta-analysis were tested: fixed effect, random effect, and Z-score. Comparison of the results of within- and multi-breed GWAS showed that most of the quantitative trait loci identified using within-breed approaches were also found with multi-breed methods. However, the most significant variants identified in each region differed depending on the method used. To determine which approach highlighted the most predictive SNP for each trait, we used a marker-assisted best unbiased linear prediction model to evaluate lists of SNP generated by the different GWAS methods; each list contained between 25 and 2,000 candidate variants per trait, which were identified using a single within- or multi-breed GWAS approach. Among all the multi-breed methods tested in this study, variant selection based on meta-analysis (fixed effect) resulted in the most-accurate genomic evaluation (+1 to +3 points compared with other multi-breed approaches). However, the accuracies of genomic evaluation were always better when variants were selected using the results of within-breed GWAS. As has generally been found in studies of quantitative trait loci, these results suggest that part of the genetic variance of milk production traits is breed specific in Holstein, Montbéliarde, and Normande cattle.



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An Overview of the Emerging Interface Between Cardiac Metabolism, Redox Biology and the Circadian Clock

Publication date: Available online 10 February 2018
Source:Free Radical Biology and Medicine
Author(s): Rodrigo A. Peliciari-Garcia, Victor Darley-Usmar, Martin E. Young
At various biological levels, mammals must integrate with 24-hr rhythms in their environment. Daily fluctuations in stimuli/stressors of cardiac metabolism and oxidation-reduction (redox) status have been reported over the course of the day. It is therefore not surprising that the heart exhibits dramatic oscillations in various cellular processes over the course of the day, including transcription, translation, ion homeostasis, metabolism, and redox signaling. This temporal partitioning of cardiac processes is governed by a complex interplay between intracellular (e.g., circadian clocks) and extracellular (e.g., neurohumoral factors) influences, thus ensuring appropriate responses to daily stimuli/stresses. The purpose of the current article is to review knowledge regarding control of metabolism and redox biology in the heart over the course of the day, and to highlight whether disruption of these daily rhythms contribute towards cardiac dysfunction observed in various disease states.

Graphical abstract

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Mitochondrial protein S-nitrosation protects against ischemia reperfusion-induced denervation at neuromuscular junction in skeletal muscle

Publication date: Available online 9 February 2018
Source:Free Radical Biology and Medicine
Author(s): Rebecca J. Wilson, Joshua C. Drake, Di Cui, Bevan M. Lewellen, Carleigh C. Fisher, Mei Zhang, David F. Kashatus, Lisa A. Palmer, Michael P. Murphy, Zhen Yan
Deterioration of neuromuscular junction (NMJ) integrity and function is causal to muscle atrophy and frailty, ultimately hindering quality of life and increasing the risk of death. In particular, NMJ is vulnerable to ischemia reperfusion (IR) injury when blood flow is restricted followed by restoration. However, little is known about the underlying mechanism(s) and hence the lack of effective interventions. New evidence suggests that mitochondrial oxidative stress plays a causal role in IR injury, which can be precluded by enhancing mitochondrial protein S-nitrosation (SNO). To elucidate the role of IR and mitochondrial protein SNO in skeletal muscle, we utilized a clinically relevant model and showed that IR resulted in significant muscle and motor nerve injuries with evidence of elevated muscle creatine kinase in the serum, denervation at NMJ, myofiber degeneration and regeneration, as well as muscle atrophy. Interestingly, we observed that neuromuscular transmission improved prior to muscle recovery, suggesting the importance of the motor nerve in muscle functional recovery. Injection of a mitochondria-targeted S-nitrosation enhancing agent, MitoSNO, into ischemic muscle prior to reperfusion reduced mitochondrial oxidative stress in the motor nerve and NMJ, attenuated denervation at NMJ, and resulted in accelerated functional recovery of the muscle. These findings demonstrate that enhancing mitochondrial protein SNO protects against IR-induced denervation at NMJ in skeletal muscle and accelerates functional regeneration. This could be an efficacious intervention for protecting neuromuscular injury under the condition of IR and other related pathological conditions.

Graphical abstract

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An ulcer on the ventral tip of tongue

Publication date: Available online 9 February 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Hélder Antônio Rebelo Pontes, Lucas Lacerda de Souza, Anderson Mauricio Paiva e Costa, Andreia Aparecida da Silva, Fábio Luiz Neves Gonçalves, Felipe Paiva Fonseca, Flávia Sirotheau Correa Pontes




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Manage the consequences of febrile neutropenia, including preventive measures: https://t.co/wyuKRnBezv https://t.co/klujRbsly0

Manage the consequences of febrile neutropenia, including preventive measures: https://t.co/wyuKRnBezv https://t.co/klujRbsly0

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FBW7 is associated with prognosis, inhibits malignancies and enhances temozolomide sensitivity in glioblastoma cells

Abstract

F-box and WD repeat domain-containing 7(FBW7) is a SCF-type E3 ubiquitin ligase targeting a multitude of oncoproteins for degradation. Acting as one of the most important tumor suppressor it is frequently inactivated in various tumors. In this study we aimed to evaluate the relationship of FBW7 with glioma pathology and prognosis, and examine its effect in glioma malignancies and temozolomide(TMZ)-based therapy. Clinical tissues and TCGA database analysis revealed FBW7 expression was correlated inversely with glioma histology and positively with patient survival time. Lentivirus transfection- induced FBW7 overexpression significantly suppressed proliferation, invasion and migration of U251 and U373 cells whereas knockdown of FBW7 by targeted shRNA promoted proliferation, invasion and migration of glioma cells. Most importantly, the expression level of FBW7 was found to affect 50% inhibition concentration(IC50) of U251 and the TMZ resistant variant. Combining TMZ with FBW7 overexpression notably increased the cytotoxicity than TMZ treatment alone, which was conversely attenuated by FBW7 knockdown. Moreover, flow cytometry(FC) analysis showed either overexpression of FBW7, TMZ or the combination increased proportion of G2/M arrest and apoptotic rate whereas FBW7 inhibition reduced G2/M arrest and apoptosis in U251 cells. Finally, mechanistic study found FBW7 overexpression downregulated Aurora B, Mcl1 and Notch1 levels in a time-dependent pattern and this expressional suppression was independent of TMZ. These findings collectively demonstrate the critical role of FBW7 as a prognostic factor and a potential target to overcome chemoresistance of glioblastoma.

This article is protected by copyright. All rights reserved.

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Comprehensive review of genetic factors contributing to head and neck squamous cell carcinoma development in low-risk, nontraditional patients

Abstract

Background

The past 2 decades have seen an increased incidence of head and neck squamous cell carcinoma (HNSCC) in a nontraditional, low-risk patient population (ie, ≤45 years of age, no substance use history), owing to a combination of human papillomavirus (HPV) infection and individual genetic variation.

Methods

Articles positing genetic variants as contributing factors in HNSCC incidence in low-risk, nontraditional patients were identified using a PubMed search, reviewed in detail, and concisely summarized herein.

Results

Recent data suggest that common polymorphisms in DNA repair enzymes, cell-cycle control proteins, apoptotic pathway members, and Fanconi anemia-associated genes likely modulate susceptibility to HNSCC development in low-risk, nontraditional patients.

Conclusion

At present, there is a lack of robust, comprehensive data on genetic drivers of oncogenesis in low-risk patients and a clear need for further research on genetic alterations underlying the rising incidence of HNSCC in low-risk, nontraditional patients.

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Hepatic heterogeneity and attenuation on contrast-enhanced CT in patients with the hypovolemic shock complex: Objective classification using a contemporary cohort

Publication date: Available online 10 February 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Benjamin Wildman-Tobriner, Michael S. Enslow, Rendon C. Nelson
ObjectiveWhen objectively measured on computed tomography (CT), does either hepatic heterogeneity or overall liver attenuation predict the presence of shock?MethodsThis retrospective study included 73 patients (mean age 33 years) with the hypoperfusion shock complex (HSC) on CT (cases) and 100 patients (mean age 43 years) with negative trauma CT scans (controls). Liver heterogeneity was calculated by using consistently sized regions of interest (ROIs) to measure the 2 highest and 2 lowest areas of hepatic density (in Hounsfield units [HU]). The difference between the means of the 2 highest and 2 lowest ROIs was considered the heterogeneity. Attenuation was calculated using the mean of 3 randomly placed ROIs. Both heterogeneity and attenuation were then compared between cases and controls.ResultsMedian hepatic heterogeneity was 16.8 HU (IQR 10.7–23.4) for the HSC group and 9.0 HU (IQR 7.0–10.4) for the controls (p<0.001). The area under the curve was 0.79, and a threshold of 30 HU yielded a specificity of 100%. Median hepatic attenuation was not significantly different between the HSC and control groups, with an area under the curve of 0.56.ConclusionsIncreased hepatic heterogeneity may represent an objective marker of the HSC that performs similarly to other established signs. By comparison, overall hepatic hypoattenuation is a poor indicator of the HSC.



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Nonlinear regression improves accuracy of characterization of multiplexed mass spectrometric assays [Research]

The need for assay characterization is ubiquitous in quantitative mass spectrometry-based proteomics. Among many assay characteristics, the limit of blank (LOB) and limit of detection (LOD) are two particularly useful figures of merit. LOB and LOD are determined by repeatedly quantifying the observed intensities of peptides in samples with known peptide concentrations, and deriving an intensity versus concentration response curve. Most commonly, a weighted linear or logistic curve is fit to the intensity-concentration response, and LOB and LOD are estimated from the fit. Here we argue that these methods inaccurately characterize assays where observed intensities level off at low concentrations, which is a common situation in multiplexed systems. This manuscript illustrates the deficiencies of these methods, and proposes an alternative approach based on non-linear regression that overcomes these inaccuracies. We evaluated the performance of the proposed method using computer simulations, and using eleven experimental datasets acquired in Data-Independent Acquisition (DIA), Parallel Reaction Monitoring (PRM), and Selected Reaction Monitoring (SRM) mode. When the intensity levels off at low concentrations, the non-linear model changes the estimates of LOB/LOD upwards, in some datasets by 20-40%. In absence of a low concentration intensity leveling off, the estimates of LOB/LOD obtained with non-linear statistical modeling were identical to those of weighted linear regression. We implemented the non-linear regression approach in the open-source R-based software MSstats, and advocate its general use for characterization of mass spectrometry-based assays.

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Doxorubicin-induced DNA damage causes extensive ubiquitination of ribosomal proteins associated with a decrease in protein translation [Research]

Protein post-translational modifications (PTMs) play a central role in the DNA damage response. In particular, protein phosphorylation and ubiquitination have been shown to be essential in the signalling cascade that coordinates break repair with cell cycle progression. Here, we performed whole-cell quantitative proteomics to identify global changes in protein ubiquitination that are induced by DNA double-strand breaks. In total, we quantified more than 9400 ubiquitin sites and found that the relative abundance of approximately 10% of these sites was altered in response to DNA double-strand breaks. Interestingly, a large proportion of ribosomal proteins, including those from the 40S as well as the 60S subunit, were ubiquitinated in response to DNA damage. In parallel, we discovered that DNA damage leads to the inhibition of ribosome function. Taken together, these data uncover the ribosome as a major target of the DNA damage response.

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Global Identification of SUMO Substrates Reveals Crosstalk between SUMOylation and Phosphorylation Promotes Cell Migration [Research]

Proteomics studies have revealed that SUMOylation is widely used posttranslational modification (PTM) in eukaryotes. However, how SUMO E1/2/3 complexes use different SUMO isoforms and recognize substrates remains largely unknown.  Using a human proteome microarray-based activity screen, we identified over 2,500 proteins that undergo SUMO E3-dependent SUMOylation.  We next constructed a SUMO isoform- and E3 ligase-dependent enzyme-substrate relationship network. Protein kinases were significantly enriched among SUMOylation substrates, suggesting crosstalk between tyrosine phosphorylation and SUMOylation. Cell-based analyses of tyrosine kinase, PYK2, revealed that SUMOylation at four lysine residues promoted PYK2 autophosphorylation at Tyrsine402, which in turn enhanced its interaction with SRC and full activation of the SRC-PYK2 complex. SUMOylation on WT but not the 4KR mutant of PYK2 further elevated phosphorylation of the downstream components in the focal adhesion pathway, such as paxillin and Erk1/2, leading to significantly enhanced cell migration during wound healing.  These studies illustrate how our SUMO E3 ligase-substrate network can be used to explore crosstalk between SUMOylation and other PTMs in many biological processes.

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IJMS, Vol. 19, Pages 538: Comparative Membrane-Associated Proteomics of Three Different Immune Reactions in Potato

IJMS, Vol. 19, Pages 538: Comparative Membrane-Associated Proteomics of Three Different Immune Reactions in Potato

International Journal of Molecular Sciences doi: 10.3390/ijms19020538

Authors: Dharani Burra Marit Lenman Fredrik Levander Svante Resjö Erik Andreasson

Plants have evolved different types of immune reactions but large-scale proteomics about these processes are lacking, especially in the case of agriculturally important crop pathosystems. We have established a system for investigating PAMP-triggered immunity (PTI) and two different effector-triggered immunity (ETI; triggered by Avr2 or IpiO) responses in potato. The ETI responses are triggered by molecules from the agriculturally important Phytophthora infestans interaction. To perform large-scale membrane protein-based comparison of these responses, we established a method to extract proteins from subcellular compartments in leaves. In the membrane fractions that were subjected to quantitative proteomics analysis, we found that most proteins regulated during PTI were also regulated in the same way in ETI. Proteins related to photosynthesis had lower abundance, while proteins related to oxidative and biotic stress, as well as those related to general antimicrobial defense and cell wall degradation, were found to be higher in abundance. On the other hand, we identified a few proteins—for instance, an ABC transporter-like protein—that were only found in the PTI reaction. Furthermore, we also identified proteins that were regulated only in ETI interactions. These included proteins related to GTP binding and heterotrimeric G-protein signaling, as well as those related to phospholipase signaling.

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A novel NMR-based assay to measure circulating concentrations of branched-chain amino acids: Elevation in subjects with type 2 diabetes mellitus and association with carotid intima media thickness

Publication date: Available online 9 February 2018
Source:Clinical Biochemistry
Author(s): Justyna Wolak-Dinsmore, Eke G. Gruppen, Irina Shalaurova, Steven P. Matyus, Russell P. Grant, Ray Gegen, Stephan J.L. Bakker, James D. Otvos, Margery A. Connelly, Robin P.F. Dullaart
ObjectivesPlasma branched-chain amino acid (BCAA) levels, measured on nuclear magnetic resonance (NMR) metabolomics research platforms or by mass spectrometry, have been shown to be associated with type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). We developed a new test for quantification of BCAA on a clinical NMR analyzer and used this test to determine the clinical correlates of BCAA in 2 independent cohorts.Design and methodsThe performance of the NMR-based BCAA assay was evaluated. A method comparison study was performed with mass spectrometry (LC-MS/MS). Plasma BCAA were measured in the Insulin Resistance Atherosclerosis Study (IRAS, n = 1209; 376 T2DM subjects) and in a Groningen cohort (n = 123; 67 T2DM subjects). In addition, carotid intima media thickness (cIMT) was measured successfully in 119 subjects from the Groningen cohort.ResultsNMR-based BCAA assay results were linear over a range of concentrations. Coefficients of variation for inter- and intra-assay precision ranged from 1.8–6.0, 1.7–5.4, 4.4–9.1, and 8.8–21.3%, for total BCAA, valine, leucine, and isoleucine, respectively. BCAA quantified from the same samples using NMR and LC-MS/MS were highly correlated (R² = 0.97, 0.95 and 0.90 for valine, leucine and isoleucine). In both cohorts total and individual BCAA were elevated in T2DM (P = 0.01 to ≤0.001). Moreover, cIMT was associated with BCAA independent of age, sex, T2DM and metabolic syndrome (MetS) categorization or alternatively of individual MetS components.ConclusionsBCAA levels, measured by NMR in the clinical laboratory, are elevated in T2DM and may be associated with cIMT, a proxy of subclinical atherosclerosis.



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Paper spray mass spectrometry for the direct, semi-quantitative measurement of fentanyl and norfentanyl in complex matrices

Publication date: Available online 9 February 2018
Source:Clinical Biochemistry
Author(s): Gregory W. Vandergrift, Arden J. Hessels, Jan Palaty, Erik T. Krogh, Chris G. Gill
BackgroundFentanyl is a potent, synthetic opioid at the centre of an international health crisis that has seen thousands of fatal overdoses. Most analytical methods focus on the detection of fentanyl in blood and/or urine (i.e., post-drug use). Harm reduction (including pre-screening before drug use) may be an effective strategy against fentanyl overdoses.MethodPaper spray-mass spectrometry (PS-MS) is an inexpensive, direct sampling strategy where a small volume of sample (<10 μL) is spotted onto a piece of paper that is then wetted and connected to high voltage. Ions are emitted from the paper and enter a mass spectrometer for sensitive and selective semi-quantitation using labeled internal standards.ResultsWe present the use of PS-MS for the direct measurement of fentanyl and norfentanyl using a custom PS interface, demonstrating that paper tip position and quality can significantly affect quantitative results. Furthermore, we observe comparable calibrations for fentanyl and norfentanyl (0.5 to 600 ng/mL) across a variety of complex matrices (methanol, diluted urine, analgesic slurry). Detection limits for fentanyl are as low as 0.049 ng/mL (0.4 pg total material) in methanol, and 0.66 ng/mL (5.3 pg total material) spiked in an analgesic slurry (illicit substance simulation). PS-MS was compared with liquid chromatography-MS for the analyses of real urine samples, with satisfactory results.ConclusionPS-MS shows potential as a sensitive and selective direct measurement strategy for use in fentanyl harm reduction strategies, and may also be used for pre-screening in advance of or in combination with more conventional (i.e., chromatographic) analyses.

Graphical abstract

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Cervico-shoulder dystonia following lateral medullary infarction: a case report and review of the literature

Secondary cervical dystonia is induced by organic brain lesions involving the basal ganglia, thalamus, cerebellum, and brain stem. It is extremely rare to see cervical dystonia induced by a medullary lesion.

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health technology; +243 new citations

243 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 2018/02/10

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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Life lessons: The tiny neuro-gadgets rebuilding our bodies

Nature's designs are helping to build amazing new devices that link to the body and each other, reveals a fascinating book called Bioinspired Devices

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IJMS, Vol. 19, Pages 537: Chondrogenic Differentiation of Defined Equine Mesenchymal Stem Cells Derived from Umbilical Cord Blood for Use in Cartilage Repair Therapy

IJMS, Vol. 19, Pages 537: Chondrogenic Differentiation of Defined Equine Mesenchymal Stem Cells Derived from Umbilical Cord Blood for Use in Cartilage Repair Therapy

International Journal of Molecular Sciences doi: 10.3390/ijms19020537

Authors: Mélanie Desancé Romain Contentin Lélia Bertoni Tangni Gomez-Leduc Thomas Branly Sandrine Jacquet Jean-Marc Betsch Agnès Batho Florence Legendre Fabrice Audigié Philippe Galéra Magali Demoor

Cartilage engineering is a new strategy for the treatment of cartilage damage due to osteoarthritis or trauma in humans. Racehorses are exposed to the same type of cartilage damage and the anatomical, cellular, and biochemical properties of their cartilage are comparable to those of human cartilage, making the horse an excellent model for the development of cartilage engineering. Human mesenchymal stem cells (MSCs) differentiated into chondrocytes with chondrogenic factors in a biomaterial appears to be a promising therapeutic approach for direct implantation and cartilage repair. Here, we characterized equine umbilical cord blood-derived MSCs (eUCB-MSCs) and evaluated their potential for chondrocyte differentiation for use in cartilage repair therapy. Our results show that isolated eUCB-MSCs had high proliferative capacity and differentiated easily into osteoblasts and chondrocytes, but not into adipocytes. A three-dimensional (3D) culture approach with the chondrogenic factors BMP-2 and TGF-β1 potentiated chondrogenic differentiation with a significant increase in cartilage-specific markers at the mRNA level (Col2a1, Acan, Snorc) and the protein level (type II and IIB collagen) without an increase in hypertrophic chondrocyte markers (Col10a1 and Mmp13) in normoxia and in hypoxia. However, these chondrogenic factors caused an increase in type I collagen, which can be reduced using small interfering RNA targeting Col1a2. This study provides robust data on MSCs characterization and demonstrates that eUCB-MSCs have a great potential for cartilage tissue engineering.

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A False Positive I-131 Metastatic Survey Caused by Radioactive Iodine Uptake by a Benign Thymic Cyst.

A False Positive I-131 Metastatic Survey Caused by Radioactive Iodine Uptake by a Benign Thymic Cyst.

Case Rep Endocrinol. 2017;2017:6469015

Authors: Singh AK, Bodolan AA, Gilbert MP

Abstract
Thyroid carcinoma is the most common endocrine malignancy in the United States with increasing incidence and diagnosis but stable mortality. Differentiated thyroid cancer rarely presents with distant metastases and is associated with a low risk of morbidity and mortality. Despite this, current protocols recommend remnant ablation with radioactive iodine and evaluation for local and distant metastasis in some patients with higher risk disease. There are several case reports of false positive results of metastatic surveys that are either normal physiologic variants or other pathological findings. Most false positive findings are associated with tissue that has physiologic increased uptake of I-131, such as breast tissue or lung tissue; pathological findings such as thymic cysts are also known to have increased uptake. Our case describes a rare finding of a thymic cyst found on a false positive I-131 metastatic survey. The patient was taken for surgical excision and the final pathology was a benign thymic cyst. Given that pulmonary metastases of differentiated thyroid cancer are rare, thymic cysts, though also rare, must be part of the differential diagnosis for false positive findings on an I-131 survey.

PMID: 29423324 [PubMed]

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Viruses, Vol. 10, Pages 76: RNA Dependent RNA Polymerases: Insights from Structure, Function and Evolution

Viruses, Vol. 10, Pages 76: RNA Dependent RNA Polymerases: Insights from Structure, Function and Evolution

Viruses doi: 10.3390/v10020076

Authors: Sangita Venkataraman Burra Prasad Ramasamy Selvarajan

RNA dependent RNA polymerase (RdRp) is one of the most versatile enzymes of RNA viruses that is indispensable for replicating the genome as well as for carrying out transcription. The core structural features of RdRps are conserved, despite the divergence in their sequences. The structure of RdRp resembles that of a cupped right hand and consists of fingers, palm and thumb subdomains. The catalysis involves the participation of conserved aspartates and divalent metal ions. Complexes of RdRps with substrates, inhibitors and metal ions provide a comprehensive view of their functional mechanism and offer valuable insights regarding the development of antivirals. In this article, we provide an overview of the structural aspects of RdRps and their complexes from the Group III, IV and V viruses and their structure-based phylogeny.

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Life lessons: The tiny neuro-gadgets rebuilding our bodies

Nature's designs are helping to build amazing new devices that link to the body and each other, reveals a fascinating book called Bioinspired Devices

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A local strain of Paprika mild mottle virus breaks L 3 resistance in peppers and is accelerated in Tomato brown rugose fruit virus -infected Tm - 2 2 -resistant tomatoes

Abstract

During October 2014, unfamiliar mild mosaic and mottling symptoms were identified on leaves of pepper (Capsicum chinense cv. Habanero) seedlings grown in the Arava valley in Israel 2–3 weeks post planting. Symptomatic plants were tested positive by ELISA using laboratory-produced antisera for tobamovirus species. Typical tobamovirus rod-shaped morphology was observed by transmission electron microscopy (TEM) analysis of purified virion preparation that was used for mechanical inoculation of laboratory test plants for the completion of Koch’s postulates. The complete viral genome was sequenced from small interfering RNA purified from symptomatic pepper leaves and fruits by next-generation sequencing (NGS) using Illumina MiSeq platform. The contigs generated by the assembly covered 80% of the viral genome. RT-PCR amplification and Sanger sequencing were employed in order to validate the sequence generated by NGS technology. The nucleotide sequence of the complete viral genome was 99% identical to the complete genome of Paprika mild mottle virus isolate from Japan (PaMMV-J), and the deduced amino acid sequence was 99% identical to PaMMV-J protein. Amplicons from seed RNA showed 100% identity to the viral isolate from the collected symptomatic pepper plants. Partial host range analysis revealed a slow development of systemic infection in inoculated tomato plants (Lycopersicon esculentum). Interestingly, double inoculation of susceptible wild-type tomato plants and Tm-2²-resistant tomato plants with the PaMMV-IL and Tomato brown rugose fruit virus (ToBRFV) resulted in accelerated viral expression in the plants.

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health technology; +243 new citations

243 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 2018/02/10

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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Correction: Study protocol for a randomised controlled trial: harmonising optimal strategy for treatment of coronary artery stenosis -- coronary intervention with next-generation drug-eluting stent platforms and abbreviated dual antiplatelet therapy (HOST-IDEA) trial

Kim C, Han J, Yang H, et al. Study protocol for a randomised controlled trial: harmonising optimal strategy for treatment of coronary artery stenosis — coronary intervention with next-generation drug-eluting stent platforms and abbreviated dual antiplatelet therapy (HOST-IDEA) trial. BMJ Open 2017;7:e016617. doi: 10.1136/bmjopen-2017-016617

The author name ‘Kyu-Rock Han’ should be spelled ‘Kyoo-Rok Han’.

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Does assistive technology contribute to social inclusion for people with intellectual disability? A systematic review protocol

Introduction

The aim of this review is to answer the following question: Does assistive technology contribute to social inclusion for people with intellectual disability? Previous research on assistive technology has focused on socioeconomic impacts such as education, employment and access to healthcare by people with intellectual disability. There is a need to consolidate evidence on the interaction between intellectual disability, assistive technology, community living and social inclusion.

Methods and analysis

The review will consider studies from all settings: geographical, socioeconomic and care (institutional and community care), published in English. Studies reported in other languages with abstracts in English will be included if they can be translated using Google Translate, otherwise such studies will be included in the appendix. The review will include both qualitative and quantitative studies. The intervention in this review refers to the use of assistive technology to promote community participation or interpersonal relationships (social inclusion) for people with intellectual disability. The outcomes will be behavioural and social benefits of using assistive technology by people with intellectual disability. Enhanced interpersonal relationships and community participation by people with intellectual disability. Data analysis will be in two phases. The first phase will involve analysis of individual study designs separately. The second phase will be narrative/thematic synthesis of all study groups.

Ethics

The review will not create any ethical or safety concerns.

Dissemination

At least one peer-reviewed article in a leading journal such as the BMJ is planned. The findings will also be disseminated through a seminar session involving internal audience at Trinity College Dublin and within the Assistive Technologies for people with Intellectual Disability and Autism research programme.

PROSPERO registration number

CRD42017065447; Pre-results.

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Severity and management of postabortion complications among women in Zimbabwe, 2016: a cross-sectional study

Objectives

Abortion complications cause significant morbidity and mortality. We aimed to assess the severity and factors associated with abortion complications (induced or spontaneous), and the management of postabortion care (PAC) in Zimbabwe.

Design

Prospective, facility-based 28 day survey among women seeking PAC and their providers.

Setting

127 facilities in Zimbabwe with the capacity to provide PAC, including all central and provincial hospitals, and a sample of primary health centres (30%), district/general/mission hospitals (52%), private (77%) and non-governmental organisation (NGO) (68%) facilities.

Participants

1002 women presenting with abortion complications during the study period.

Main outcome measures

Severity of abortion complications and associated factors, delays in care seeking, and clinical management of complications.

Results

Overall, 59% of women had complications classified as mild, 19% as moderate, 19% as severe, 3% as near miss and 0.2% died. A median of 47 hours elapsed between experiencing complication and receiving treatment; many delays were due to a lack of finances. Women who were rural, younger, not in union, less educated, at later gestational ages or who had more children were significantly more likely to have higher severity complications. Most women were treated by doctors (91%). The main management procedure used was dilatation and curettage/dilatation and evacuation (75%), while 12% had manual vacuum aspiration (MVA) or electrical vacuum aspiration and 11% were managed with misoprostol. At discharge, providers reported that 43% of women received modern contraception.

Conclusion

Zimbabwean women experience considerable abortion-related morbidity, particularly young, rural or less educated women. Abortion-related morbidity and concomitant mortality could be reduced in Zimbabwe by liberalising the abortion law, providing PAC in primary health centres, and training nurses to use medical evacuation with misoprostol and MVA. Regular in-service training on PAC guidelines with follow-up audits are needed to ensure compliance and availability of equipment, supplies and trained staff.

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Outcomes comparison of different surgical strategies for the management of severe aortic valve stenosis: study protocol of a prospective multicentre European registry (E-AVR registry)

Introduction

Traditional and transcatheter surgical treatments of severe aortic valve stenosis (SAVS) are increasing in parallel with the improved life expectancy. Recent randomised controlled trials (RCTs) reported comparable or non-inferior mortality with transcatheter treatments compared with traditional surgery. However, RCTs have the limitation of being a mirror of the predefined inclusion/exclusion criteria, without reflecting the ‘real clinical world’. Technological improvements have recently allowed the development of minimally invasive surgical accesses and the use of sutureless valves, but their impact on the clinical scenario is difficult to assess because of the monocentric design of published studies and limited sample size. A prospective multicentre registry including all patients referred for a surgical treatment of SAVS (traditional, through full sternotomy; minimally invasive; or transcatheter; with both ‘sutured’ and ‘sutureless’ valves) will provide a ‘real-world’ picture of available results of current surgical options and will help to clarify the ‘grey zones’ of current guidelines.

Methods and analysis

European Aortic Valve Registry is a prospective observational open registry designed to collect all data from patients admitted for SAVS, with or without coronary artery disease, in 16 cardiac surgery centres located in six countries (France, Germany, Italy, Spain, Switzerland and UK). Patients will be enrolled over a 2-year period and followed up for a minimum of 5 years to a maximum of 10 years after enrolment. Outcome definitions are concordant with Valve Academic Research Consortium-2 criteria and established guidelines. Primary outcome is 5-year all-cause mortality. Secondary outcomes aim at establishing ‘early’ 30-day all-cause and cardiovascular mortality, as well as major morbidity, and ‘late’ cardiovascular mortality, major morbidity, structural and non-structural valve complications, quality of life and echocardiographic results.

Ethics and dissemination

The study protocol is approved by local ethics committees. Any formal presentation or publication of data will be considered as a joint publication by the participating physician(s) and will follow the recommendations of the International Committee of Medical Journal Editors for authorship.

Trial registration number

NCT03143361; Pre-results.

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Protocol for validation of the 4AT, a rapid screening tool for delirium: a multicentre prospective diagnostic test accuracy study

Introduction

Delirium is a severe neuropsychiatric syndrome of rapid onset, commonly precipitated by acute illness. It is common in older people in the emergency department (ED) and acute hospital, but greatly under-recognised in these and other settings. Delirium and other forms of cognitive impairment, particularly dementia, commonly coexist. There is a need for a rapid delirium screening tool that can be administered by a range of professional-level healthcare staff to patients with sensory or functional impairments in a busy clinical environment, which also incorporates general cognitive assessment. We developed the 4 ’A’s Test (4AT) for this purpose. This study’s primary objective is to validate the 4AT against a reference standard. Secondary objectives include (1) comparing the 4AT with another widely used test (the Confusion Assessment Method (CAM)); (2) determining if the 4AT is sensitive to general cognitive impairment; (3) assessing if 4AT scores predict outcomes, including (4) a health economic analysis.

Methods and analysis

900 patients aged 70 or over in EDs or acute general medical wards will be recruited in three sites (Edinburgh, Bradford and Sheffield) over 18 months. Each patient will undergo a reference standard delirium assessment and will be randomised to assessment with either the 4AT or the CAM. At 12 weeks, outcomes (length of stay, institutionalisation and mortality) and resource utilisation will be collected by a questionnaire and via the electronic patient record.

Ethics and dissemination

Ethical approval was granted in Scotland and England. The study involves administering tests commonly used in clinical practice. The main ethical issues are the essential recruitment of people without capacity. Dissemination is planned via publication in high impact journals, presentation at conferences, social media and the website www.the4AT.com.

Trial registration number

ISRCTN53388093; Pre-results.

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Adaptive design clinical trials: a review of the literature and ClinicalTrials.gov

Objectives

This review investigates characteristics of implemented adaptive design clinical trials and provides examples of regulatory experience with such trials.

Design

Review of adaptive design clinical trials in EMBASE, PubMed, Cochrane Registry of Controlled Clinical Trials, Web of Science and ClinicalTrials.gov. Phase I and seamless Phase I/II trials were excluded. Variables extracted from trials included basic study characteristics, adaptive design features, size and use of independent data monitoring committees (DMCs) and blinded interim analyses. We also examined use of the adaptive trials in new drug submissions to the Food and Drug Administration (FDA) and European Medicines Agency (EMA) and recorded regulators’ experiences with adaptive designs.

Results

142 studies met inclusion criteria. There has been a recent growth in publicly reported use of adaptive designs among researchers around the world. The most frequently appearing types of adaptations were seamless Phase II/III (57%), group sequential (21%), biomarker adaptive (20%), and adaptive dose-finding designs (16%). About one-third (32%) of trials reported an independent DMC, while 6% reported blinded interim analysis. We found that 9% of adaptive trials were used for FDA product approval consideration, and 12% were used for EMA product approval consideration. International regulators had mixed experiences with adaptive trials. Many product applications with adaptive trials had extensive correspondence between drug sponsors and regulators regarding the adaptive designs, in some cases with regulators requiring revisions or alterations to research designs.

Conclusions

Wider use of adaptive designs will necessitate new drug application sponsors to engage with regulatory scientists during planning and conduct of the trials. Investigators need to more consistently report protections intended to preserve confidentiality and minimise potential operational bias during interim analysis.

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Correction: Bluebelle study (phase A): a mixed-methods feasibility study to inform an RCT of surgical wound dressing strategies

The Bluebelle Study Group, the Severn and Peninsula Audit and Research Collaborative for Surgeons, and the West Midlands Research Collaborative. Bluebelle study (phase A): a mixed-methods feasibility study to inform an RCT of surgical wound dressing strategies. BMJ Open 2016;6:e012635. doi: 10.1136/bmjopen-2016-012635

The study group for this research agreed a collaborative authorship policy, as stated in the title of the manuscript. The author byline should have read:

Rooshenas L, The Bluebelle Study Group, the Severn and Peninsula Audit and Research Collaborative for Surgeons, and the West Midlands Research Collaborative.

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Association between social health insurance and choice of hospitals among internal migrants in China: a national cross-sectional study

Objectives

There is a tendency to pursue higher-level hospitalisation services in China, especially for internal migrants. This study aims to investigate the choices of hospitalisation services among internal migrants, and evaluate the association between social health insurance and hospitalisation choices.

Methods

Data were from a 2014 nationally representative cross-sectional sample of internal migrants aged 15–59 years in China. Descriptive analyses were used to perform the distribution of healthcare facility levels for hospitalisation services, and multinomial logistic regression was applied to examine the association between social health insurance and hospitalisation choices.

Results

Of the 6121 inpatient care users, only 11.50% chose the primary healthcare facilities for hospitalisation services, 44.91% chose the secondary hospitals and 43.59% preferred the tertiary hospitals. The choices presented large regional variations across the country. Compared with the uninsured, social health insurance had no statistically significant effect on patient choices of healthcare facility levels among internal migrants in China, whereas socioeconomic status was positively associated with the choices.

Conclusions

Social health insurance had little influence on the hospital choice among the internal migrants. Thus, social health insurance should be consolidated and portable to enhance the proper incentive of health insurance on healthcare seeking behaviours.

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Interventions to increase access to or uptake of physical health screening in people with severe mental illness: a realist review

Objectives

To identify and evaluate interventions aimed at increasing uptake of, or access to, physical health screening by adults with severe mental illness; to examine why interventions might work.

Design

Realist review.

Setting

Primary, secondary and tertiary care.

Results

A systematic search identified 1448 studies, of which 22 met the inclusion criteria. Studies were from Australia (n=3), Canada (n=1), Hong Kong (n=1), UK (n=11) and USA (n=6). The studies focused on breast cancer screening, infection preventive services and metabolic syndrome (MS) screening by targeting MS-related risk factors. The interventions could be divided into those focusing on (1) health service delivery changes (12 studies), using quality improvement, randomised controlled trial, cluster randomised feasibility trial, retrospective audit, cross-sectional study and satisfaction survey designs and (2) tests of tools designed to facilitate screening (10 studies) using consecutive case series, quality improvement, retrospective evaluation and pre–post audit study designs. All studies reported improved uptake of screening, or that patients had received screening they would not have had without the intervention. No estimation of overall effect size was possible due to heterogeneity in study design and quality. The following factors may contribute to intervention success: staff and stakeholder involvement in screening, staff flexibility when taking physical measurements (eg, using adapted equipment), strong links with primary care and having a pharmacist on the ward.

Conclusions

A range of interventions may be effective, but better quality research is needed to determine any effect size. Researchers should consider how interventions may work when designing and testing them in order to target better the specific needs of this population in the most appropriate setting. Behaviour-change interventions to reduce identified barriers of patient and health professional resistance to screening this population are required. Resource constraints, clarity over professional roles and better coordination with primary care need to be addressed.

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Is socioeconomic segregation of the poor associated with higher premature mortality under the age of 60? A cross-sectional analysis of survey data in major Indian cities

Objectives

Although urbanisation is generally associated with poverty reduction in low-income and middle-income countries, it also results in increased socioeconomic segregation of the poor. Cities with higher levels of socioeconomic segregation tend to have higher mortality rates, although the evidence is based on ecological associations. The paper examines whether socioeconomic segregation of the poor is associated with higher under-60 years (‘premature’) mortality risk in Indian cities and whether this association is confounded by contextual and compositional sociodemographic and socioeconomic factors.

Setting and participants

A population representative sample of over one million from 39 427 households living in 1876 urban wards within 59 Indian districts (cities) from the third (2008) District Level Household Survey (DLHS-3).

Primary outcome and other measures

The outcome was any death under the age of 60 reported by households in the preceding 4years of the DLHS-3. Socioeconomic segregation, estimated at the district (city) level, was measured using an isolation index of the poor and the index of dissimilarity.

Results

Poor households living in cities where the poor were more isolated had higher probabilities of premature mortality than poor households living in cities where the poor were less isolated. In contrast, it did not matter whether rich households lived in more or less socioeconomically segregated cities. A 1 SD increase in the isolation index was associated with an absolute increase of 1.1% in the probability of premature mortality for the poorest households.

Conclusion

Increasing segregation of the poor may result in higher premature mortality. As low-income and middle-income countries become increasingly urbanised, there is a risk that this may lead to increased segregation of the poor as well as increased premature mortality.

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Sequelae of multidrug-resistant tuberculosis: protocol for a systematic review and meta-analysis

Introduction

The sequelae of multidrug-resistant tuberculosis (MDR-TB) are poorly understood and inconsistently reported. We will aim to assess the existing evidence for the clinical, psychological, social and economic sequelae of MDR-TB and to assess the health-related quality of life in patients with MDR-TB.

Methods and analysis

We will perform a systematic review and meta-analysis of published studies reporting sequelae of MDR-TB. We will search PubMed, SCOPUS, ProQuest, Web of Science and PsychINFO databases up to 5 September 2017. MDR-TB sequelae will include any clinical, psychological, social and economic effects as well as health-related quality of life that occur after MDR-TB treatment or illness. Two researchers will screen the titles and abstracts of all citations identified in our search, extract data, and assess the scientific quality using standardised formats. Providing there is appropriate comparability in the studies, we will use a random-effects meta-analysis model to produce pooled estimates of MDR-TB sequelae from the included studies. We will stratify the analyses based on treatment regimen, comorbidities (such as HIV status and diabetes mellitus), previous TB treatment history and study setting.

Ethics and dissemination

As this study will be based on published data, ethical approval is not required. The final report will be disseminated through publication in a peer-reviewed scientific journal and will also be presented at relevant conferences.

PROSPERO registration number

CRD42017073182.

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Risk factors and between-hospital variation of caesarean section in Denmark: a cohort study

Objectives

The aim of this study was to estimate the effects of risk factors on elective and emergency caesarean section (CS) and to estimate the between-hospital variation of risk-adjusted CS proportions.

Design

Historical registry-based cohort study.

Settings and participants

The study was based on all singleton deliveries in hospital units in Denmark from January 2009 to December 2012. A total of 226 612 births by 198 590 mothers in 29 maternity units were included.

Primary and secondary outcome measures

We estimated (1) OR of elective and emergency CS adjusted for several risk factors, for example, body mass index, parity, age and size of maternity unit and (2) risk-adjusted proportions of elective and emergency CS to evaluate between-hospital variation.

Results

The CS proportion was stable at 20%–21%, but showed wide variation between units, even in adjusted models. Large units performed significantly more elective CSs than smaller units, and the risk of emergency CS was significantly reduced compared with smaller units. Many of the included risk factors were found to influence the risk of CS. The most important risk factors were breech presentation and previous CS. Four units performed more CSs and one unit fewer CSs than expected.

Conclusion

The main risk factors for elective CS were breech presentation and previous CS; for emergency CS they were breech presentation and cephalopelvic disproportion. The proportions of CS were stable during the study period. We found variation in risk-adjusted CS between hospitals in Denmark. Although exhaustive models were applied, the results indicated the presence of systematic variation between hospital units, which was unexpected in a small, well-regulated country such as Denmark.

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Standard echocardiography versus handheld echocardiography for the detection of subclinical rheumatic heart disease: protocol for a systematic review

Introduction

Rheumatic heart disease (RHD) is a preventable and treatable chronic condition which persists in many developing countries largely affecting impoverished populations. Handheld echocardiography presents an opportunity to address the need for more cost-effective methods of diagnosing RHD in developing countries, where the disease continues to carry high rates of morbidity and mortality. Preliminary studies have demonstrated moderate sensitivity as well as high specificity and diagnostic odds for detecting RHD in asymptomatic patients. We describe a protocol for a systematic review on the diagnostic performance of handheld echocardiography compared to standard echocardiography using the 2012 World Heart Federation criteria for diagnosing subclinical RHD.

Methods and analysis

Electronic databases including PubMed, Scopus, Web of Science and EBSCOhost as well as reference lists and citations of relevant articles will be searched from 2012 to date using a predefined strategy incorporating a combination of Medical Subject Heading terms and keywords. The methodological validity and quality of studies deemed eligible for inclusion will be assessed against review specific Quality Assessment of Diagnostic Accuracy Studies 2 criteria and information on metrics of diagnostic accuracy and demographics extracted. Forest plots of sensitivity and specificity as well as scatter plots in receiver operating characteristic (ROC) space will be used to investigate heterogeneity. If possible, a meta-analysis will be conducted to produce summary results of sensitivity and specificity using the Hierarchical Summary ROC method. In addition, a sensitivity analysis will be conducted to investigate the effect of studies with a high risk of bias.

Ethics and dissemination

Ethics approval is not required for this systematic review of previously published literature. The planned review will provide a summary of the diagnostic accuracy of handheld echocardiography. Results may feed into evidence-based guidelines and should the findings of this review warrant a change in clinical practice, a summary report will be disseminated among leading clinicians and healthcare professionals in the field.

PROSPERO registration number

CRD42016051261.

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Multicentre study on capsular closure versus non-capsular closure during hip arthroscopy in Danish patients with femoroacetabular impingement (FAI): protocol for a randomised controlled trial

Introduction

Hip arthroscopy has become a standard procedure in the treatment of hip joint pain not related to osteoarthritis or dysplasia in the young and active patient. There has been increasing focus on the contribution of the hip capsule to function and on stability following hip arthroscopy. It has been suggested that capsular closure after hip arthroscopy may prevent microinstability and macroinstability of the hip joint and reduce revision rate. However, it remains unknown whether capsular closure should be performed as a standard procedure when performing hip arthroscopies, especially in patients without additional risk factors for instability such as hypermobility or dysplasia of the hip. We hypothesised that capsular closure will lead to a superior outcome in hip arthroscopy for femoroacetabular impingement syndrome (FAIS) compared with non-capsular closure.

Methods and analysis

In this randomised controlled, multicentre trial, 200 patients scheduled for hip arthroscopy for FAIS will be cluster randomised into one of two groups (group I: hip arthroscopy without capsular closure, group II: hip arthroscopy combined with capsular closure). Inclusion criteria are: age between 18 years and 50 years and FAIS according to the Warwick agreement. Exclusion criteria are: previous hip surgery in either hip, previous conditions of Legg-Calvé-Perthes or slipped capital femoral epiphysis, malignant disease, recent hip or pelvic fractures, arthritis, Ehlers-Danlos or Marfan disease, recent (within 6 weeks) application of intra-articular corticosteroids, language problems of any kind, and radiological signs of osteoarthritis, acetabular dysplasia or acetabular retroversion. Surgery will be performed in Denmark at four centres by four surgeons, all performing an interportal capsulotomy and closure with at least two absorbable sutures. Patients in both groups, who are blinded for the intervention, will receive the same standardised rehabilitation programme. As primary outcome scores, HAGOS (sport) will be used with HAGOS (symptoms, pain, function in daily living, participation in physical activities and hip and/or groin-related quality of life), Hip Sports Activity Scale, short validated version of the International Hip Outcome Tool, EQ-5D, Visual Analogue Scale for pain, complications and reoperation rate as secondary outcome tools. Using HAGOS (sport) as primary outcome parameter the power analysis required a minimum of 84 individuals per group. Together with a clinical examination performed by the patient’s surgeon 1 year after surgery, patient reported outcome measures will be completed preoperatively, as well as at 3 months, 1 year, 2 years and 5 years postoperatively. In addition, adverse effects will be recorded.

Ethics and dissemination

The study is approved by the Central Denmark Region Committee on Biomedical research ethics. The results of this study will be presented at national and international congresses and published in peer-reviewed journals.

Trial registration number

NCT03158454; Pre-results.

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Correction: Epidural analgesia in critically ill patients with acute pancreatitis: the multicentre randomised controlled EPIPAN study protocol

Bulyez S, Pereira B, Caumon E, et al. Epidural analgesia in critically ill patients with acute pancreatitis: the multicentre randomised controlled EPIPAN study protocol. BMJ Open 2017;7:e015280. doi: 10.1136/bmjopen-2016-015280.

The list of Collaborators (EPIPAN study group) was missed off the article. This list should read:

Collaborators Sophie Kauffmann, Florian Grimaldi, Charlotte Fernandez-Canal, Philippe Chevaldonné, Julien Pascal, Renaud Guérin, Sébastien Perbet, Sophie Cayot, Thomas Godet, Sophiano Radji, Camille Verlhac, Sandrine Thibault, Christine Rolhion, Justine Bourdier, Emmanuel Futier, Jean-Etienne Bazin, Laetitia Sturma (CHU Clermont-Ferrand, Clermont-Ferrand, France); Lydie Marie-Anne, Olivier Windisch (Geneva university hospitals, Geneva, Switzerland); Annick Puchois, Cyril Boronad, Marine Agullo (Cannes general hospital, Cannes, France); Boris Jung, Gérald Chanques, Cécile Spirito, Albert Prades, Cisse Moussa, Anne Verchere, Claudine Gniadek, Fouad Belafia, Daniel Verzilli, Julie Carr, Audrey De Jong, Yannael Coisel, Jean-Marc Delay, Matthieu Conseil, Marie Gonzalez, Delphine Rosant (Montpellier university hospital, Montpellier, France); Michel Prevot (Nancy university hospital,...

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Clinician, patient and general public beliefs about diagnostic imaging for low back pain: protocol for a qualitative evidence synthesis

Introduction

Little is known about how to reduce unnecessary imaging for low back pain. Understanding clinician, patient and general public beliefs about imaging is critical to developing strategies to reduce overuse.

Objective

To synthesise qualitative research that has explored clinician, patient or general public beliefs about diagnostic imaging for low back pain.

Methods and analysis

We will perform a qualitative evidence synthesis of relevant qualitative research exploring clinician, patient and general public beliefs about diagnostic imaging for low back pain. Exclusions will be studies not using qualitative methods and studies not published in English. Studies will be identified using sensitive search strategies in MEDLINE, EMBASE, CINAHL, AMED and PsycINFO. Two reviewers will independently apply inclusion and exclusion criteria, extract data, and use the Critical Appraisal Skills Programme quality assessment tool to assess the quality of included studies. To synthesise the data we will use a narrative synthesis approach that involves developing a theoretical model, conducting a preliminary synthesis, exploring relations in the data, and providing a structured summary. We will code the data using NVivo. At least two reviewers will independently apply the thematic framework to extracted data. Confidence in synthesis findings will be evaluated using the GRADE Confidence in the Evidence from Reviews of Qualitative Research tool.

Ethics and dissemination

Ethical approval is not required to conduct this review. We will publish the results in a peer-reviewed journal.

PROSPERO registration number

CRD42017076047.

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Bilateral 'coronoid foramina' with accessory foramina on the 'lateral aspect of ramus' of mandible: an unseen variance discovery in humans.

Bilateral 'coronoid foramina' with accessory foramina on the 'lateral aspect of ramus' of mandible: an unseen variance discovery in humans.

Surg Radiol Anat. 2018 Feb 08;:

Authors: Firdoose Chintamani Subhan N

Abstract
The normal flexibility in morphology and topography of body structures may be termed as an anatomical variation. This manuscript, aims to present a unique discovery of 'coronoid foramina' bilaterally along with bilateral accessory foramina over the 'lateral aspect of the ramus of the mandible' which has never been seen or documented in the literature so far in a live patient. It is noteworthy to realize a trait of phylogenetic context in these discoveries.

PMID: 29423703 [PubMed - as supplied by publisher]

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Linburg-Comstock variation: histoanatomy and classification of the connection between flexor pollicis longus and flexor digitorum profundus to the index finger.

Linburg-Comstock variation: histoanatomy and classification of the connection between flexor pollicis longus and flexor digitorum profundus to the index finger.

Surg Radiol Anat. 2018 Feb 08;:

Authors: Yurasakpong L, Meemon K, Suwannakhan A

Abstract
PURPOSE: The aim of the study was to investigate the anatomy and histology of Linburg-Comstock variation, or the anomalous connection between flexor pollicis longus and flexor digitorum profundus to the index finger, in Thai population.
METHODS: One hundred and thirty cadaveric upper limbs were dissected. Skin and superficial fascia on the anterior distal forearm and hand were removed. The tendons of the flexor pollicis longus and flexor digitorum profundus to the index finger were identified for the possible occurrence of the intertendinous connection. For histological analysis, selected specimens were sampled, and were stained with hematoxylin and eosin.
RESULTS: Out of 130 dissected upper limbs, interconnection between the two tendons was found in 32 limbs (25%). The connection was classified into three types including fibrous, tendinous, and musculotendinous. In 29 cases (22%), the connection was simply the thickening of synovial sheath between the two tendons. In two cases (1%) the connection was found as an additional tendinous slip of dense regular collagen bundles running from the flexor pollicis longus to flexor digitorum profundus of the index. In one case (1%), there was an aberrant reversed musculotendinous unit running from flexor pollicis longus, and later joined the first lumbrical.
CONCLUSIONS: This study provides a detailed anatomo-histological description of the interconnection between flexor pollicis longus and flexor digitorum profundus to the index finger. Its etiology could either be congenital or secondarily acquired. Surgeons should be aware of this connection for better diagnosis, surgical planning and treatment of diseased hands.

PMID: 29423702 [PubMed - as supplied by publisher]

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Referees in 2017.

Referees in 2017.

Surg Radiol Anat. 2018 Feb 08;:

Authors:

PMID: 29423701 [PubMed - as supplied by publisher]

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IJERPH, Vol. 15, Pages 310: Inappropriate Use of Medication by Elderly, Polymedicated, or Multipathological Patients with Chronic Diseases

IJERPH, Vol. 15, Pages 310: Inappropriate Use of Medication by Elderly, Polymedicated, or Multipathological Patients with Chronic Diseases

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15020310

Authors: Virtudes Pérez-Jover José Mira Concepción Carratala-Munuera Vicente Gil-Guillen Josep Basora Adriana López-Pineda Domingo Orozco-Beltrán

The growth of the aging population leads to the increase of chronic diseases, of the burden of multimorbility, and of the complexity polypharmacy. The prevalence of medication errors rises in patients with polypharmacy in primary care, and this is a major concern to healthcare systems. This study reviews the published literature on the inappropriate use of medicines in order to articulate recommendations on how to reduce it in chronic patients, particularly in those who are elderly, polymedicated, or multipathological. A systematic review of articles published from January 2000 to October 2015 was performed using MEDLINE, EMBASE, PsychInfo, Scopus, The Cochrane Library, and Index Medicus databases. We selected 80 studies in order to analyse the content that addressed the question under consideration. Our literature review found that half of patients know what their prescribed treatment is; that most of elderly people take five or more medications a day; that in elderly, polymedicated people, the probability of a medication error occurring is higher; that new tools have been recently developed to reduce errors; that elderly patients can understand written information but the presentation and format is an important factor; and that a high percentage of patients have remaining doubts after their visit. Thus, strategies based on the evidence should be applied in order to reduce medication errors.

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IJERPH, Vol. 15, Pages 311: Gender Difference and Spatial Heterogeneity in Local Obesity

IJERPH, Vol. 15, Pages 311: Gender Difference and Spatial Heterogeneity in Local Obesity

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15020311

Authors: Hee-Jung Jun Mi Namgung

This study asks if there is gender-specific spatial heterogeneity in local obesity. By using the 2015 Korea Community Health Survey and employing spatial analyses, this study found that there is considerable gender-specific spatial heterogeneity in local obesity rates. More specifically, we found that: (1) local obesity rates are more spatially dependent for women than for men; (2) environmental factors, in general, have stronger effects on local obesity rates for women than for men; (3) environmental factors have more spatially varying effects on local obesity rates for women than for men. Based on these findings, we suggest that policies for obesity prevention should not be based on the assumption of spatial homogeneity and gender indifference, but rather should be refined based on gender-specific spatial heterogeneity in local obesity.

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IJMS, Vol. 19, Pages 536: Special Protein Molecules Computational Identification

IJMS, Vol. 19, Pages 536: Special Protein Molecules Computational Identification

International Journal of Molecular Sciences doi: 10.3390/ijms19020536

Authors: Quan Zou Wenying He

Computational identification of special protein molecules is a key issue in understanding protein function. It can guide molecular experiments and help to save costs. I assessed 18 papers published in the special issue of Int. J. Mol. Sci., and also discussed the related works. The computational methods employed in this special issue focused on machine learning, network analysis, and molecular docking. New methods and new topics were also proposed. There were in addition several wet experiments, with proven results showing promise. I hope our special issue will help in protein molecules identification researches.

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Dysbiosis of inferior turbinate microbiota is associated with high total IgE levels in allergic rhinitis patients.

Dysbiosis of inferior turbinate microbiota is associated with high total IgE levels in allergic rhinitis patients.

Infect Immun. 2018 Feb 05;:

Authors: Hyun DW, Min HJ, Kim MS, Whon TW, Shin NR, Kim PS, Kim HS, Lee JY, Kang W, Choi AMK, Yoon JH, Bae JW

Abstract
Abnormalities in the human microbiota are associated with the etiology of allergic diseases. Although disease site-specific microbiota may be associated with disease pathophysiology, the role of the nasal microbiota is unclear. We sought to characterize the microbiota of the site of allergic rhinitis, inferior turbinate, in subjects with allergic rhinitis (n=20) and healthy controls (n=12), and to examine the relationship of mucosal microbiota with disease occurrence, sensitized allergen number, allergen-specific- and total-IgE levels. Microbial dysbiosis correlated significantly with total IgE levels representing combined allergic responses, but not with disease occurrence, the number of sensitized allergens or house dust mite allergen-specific IgE levels. Comparing to individuals with low total IgE levels (group IgElow), low microbial biodiversity with high relative abundance of Firmicutes phylum (Staphylococcus aureus) and low relative abundance of Actinobacteria phylum (Propionibacterium acnes) were observed in individuals with high total serum IgE levels (group IgEhigh). Phylogeny-based microbial functional potential predicted by 16S rRNA gene indicated an increase in signal transduction-related genes and a decrease in energy metabolism-related genes in group IgEhigh as shown in the microbial features with atopic and/or inflammatory diseases. Thus, dysbiosis of the inferior turbinate mucosa microbiota, particularly an increase in S. aureus and a decrease in P. acnes, is linked to high total IgE levels in allergic rhinitis, suggesting that inferior turbinate microbiota may be affected by accumulated allergic responses against sensitized allergens and site-specific microbial alterations play a potential role in disease pathophysiology.

PMID: 29426044 [PubMed - as supplied by publisher]

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Buccal drug delivery technologies for patient-centred treatment of radiation-induced xerostomia (dry mouth).

Buccal drug delivery technologies for patient-centred treatment of radiation-induced xerostomia (dry mouth).

Int J Pharm. 2018 Feb 06;:

Authors: Malallah OS, Garcia CMA, Proctor GB, Forbes B, Royall PG

Abstract
Radiotherapy is a life-saving treatment for head and neck cancers, but almost 100% of patients develop dry mouth (xerostomia) because of radiation-induced damage to their salivary glands. Patients with xerostomia suffer symptoms that severely affect their health as well as physical, social and emotional aspects of their life. The current management of xerostomia is the application of saliva substitutes or systemic delivery of saliva-stimulating cholinergic agents, including pilocarpine, cevimeline or bethanechol tablets. It is almost impossible for substitutes to replicate all the functional and sensory facets of natural saliva. Salivary stimulants are a better treatment option than saliva substitutes as the former induce the secretion of natural saliva from undamaged glands; typically, these are the minor salivary glands. However, patients taking cholinergic agents systemically experience pharmacology-related side effects including sweating, excessive lacrimation and gastrointestinal tract distresses. Local delivery direct to the buccal mucosa has the potential to provide rapid onset of drug action, i.e. activation of minor salivary glands within the buccal mucosa, while sparing systemic drug exposure and off-target effects. This critical review of the technologies for the local delivery of saliva-stimulating agents includes oral disintegrating tablets (ODTs), oral disintegrating films, medicated chewing gums and implantable drug delivery devices. Our analysis makes a strong case for the development of ODTs for the buccal delivery of cholinergic agents: these must be patient-friendly delivery platforms with variable loading capacities that release the drug rapidly in fluid volumes typical of residual saliva in xerostomia (0.05 to 0.1 mL).

PMID: 29425763 [PubMed - as supplied by publisher]

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Intragenic DNA methylation of PITX1 and the adjacent long non-coding RNA C5orf66-AS1 are prognostic biomarkers in patients with head and neck squamous cell carcinomas.

Intragenic DNA methylation of PITX1 and the adjacent long non-coding RNA C5orf66-AS1 are prognostic biomarkers in patients with head and neck squamous cell carcinomas.

PLoS One. 2018;13(2):e0192742

Authors: Sailer V, Charpentier A, Dietrich J, Vogt TJ, Franzen A, Bootz F, Dietrich D, Schroeck A

Abstract
BACKGROUND: Patients with squamous cell cancer of the head and neck region (HNSCC) are at risk for disease recurrence and metastases, even after initial successful therapy. A tissue-based biomarker could be beneficial to guide treatment as well as post-treatment surveillance. Gene methylation status has been recently identified as powerful prognostic biomarker in HNSCC. We therefore evaluated the methylation status of the homeobox gene PITX1 and the adjacent long intergenic non-coding RNA (lincRNA) C5orf66-AS1 in publicly available datasets.
METHODS: Gene methylation and expression data from 528 patients with HNSCC included in The Cancer Genome Atlas (TCGA, there obtained by using the Infinium HumanMethylation450 BeadChip Kit) were evaluated and methylation and expression levels of PITX1 and lincRNA C5orf66-AS1 was correlated with overall survival and other parameters. Thus, ten beads targeting PITX1 exon 3 and three beads targeting lincRNA C5orf66-AS1 were identified as significant candidates. The mean methylation of these beads was used for further correlation and the median was employed for dichotomization.
RESULTS: Both PITX1 exon 3 and lincRNA C5orf66-AS1 were significantly higher methylated in tumor tissue than in normal adjacent tissue (NAT) (PITX1 exon 3: tumor tissue 58.1%, NAT: 31.7%, p<0.001; lincRNA C5orf66-AS1: tumor tissue: 27.4%, NAT: 18.9%, p<0.001). In a univariate analysis, hypermethylation of both loci was significantly associated with the risk of death (univariate: exon 3: Hazard ratio (HR): 4.97 [1.78-16.71], p = 0.010, lincRNA C5orf66-AS1: Hazard ratio (HR): 12.23 [3.01-49.74], p<0.001). PITX1 exon 3 and lincRNA C5orf66-AS1 methylation was also significantly correlated with tumor localization, T category, human papilloma virus (HPV)-negative and p16-negative tumors and tumor grade. Kaplan-Meier analysis showed, that lincRNA C5orf66-AS1 hypomethylation was significantly associated with overall survival (p = 0.001) in the entire cohort as well in a subgroup of HPV-negative tumors (p = 0.003) and in patients with laryngeal tumors (p = 0.022).
CONCLUSION: Methylation status of PITX1 and even more so of lincRNA C5orf66-AS1 is a promising prognostic biomarker in HNSCC, in particular for HPV-negative patients. Further prospective evaluation is warranted.

PMID: 29425237 [PubMed - in process]

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Regulatory role of CDX2 and NOX4 expression associated with recurrent nasopharyngeal carcinoma.

Regulatory role of CDX2 and NOX4 expression associated with recurrent nasopharyngeal carcinoma.

Eur Rev Med Pharmacol Sci. 2018 Jan;22(2):450-455

Authors: Chen G, Hao H, Ai JW

Abstract
OBJECTIVE: Nasopharyngeal carcinoma (NPC) is a malignancy caused by Epstein-Barr virus (EBV). NPC is radiosensitive and has a high frequency of treatment failure due to metastasis, which results in recurrent nasopharyngeal carcinoma (rNPC).
PATIENTS AND METHODS: In the present study, nasopharyngeal carcinoma biopsies were obtained from NPC and rNPC patients, as well as healthy controls, and reverse transcription-polymerase chain reaction (RT-PCR), immunohistochemistry, and immunoblotting analyses were performed.
RESULTS: The RTPCR data showed expression of CDX2 and NOX4 in rNPC biopsy samples but not in control or NPC samples. Immunohistochemical and immunoblotting analyses confirmed the expression of CDX2 and NOX4 in rNPC samples, but not in NPC biopsy samples.
CONCLUSIONS: The finding concludes that an association of CDX2 and NOX4 expression with rNPC was noted; thus, these proteins may have value as prognostic indicators and may facilitate the development of novel therapeutics for rNPC patients.

PMID: 29424902 [PubMed - in process]

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Synovial cell sarcoma: a rare laryngeal tumor.

Synovial cell sarcoma: a rare laryngeal tumor.

Tunis Med. 2017 Feb;95(2):149-151

Authors: Turki S, Kedous S, Dhaha M, Merdassi A, Lahjouri M, Dhambri S, Attia Z

Abstract
Synovial cell sarcoma is a soft tissue tumor that occurs predominately in the lower limbs near the joints. Lesions of the head and neck are extremely rare. The larynx is the least frequent site with only about 20 cases reported in the literature. Treatment of these tumors is controversial and should follow the guidelines for other tumor sites. We report the case of a 37-year-old man with primary laryngeal synovial cell sarcoma, who was surgically managed by a narrow field laryngectomy.

PMID: 29424878 [PubMed - in process]

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Response to "Breaking the Myth of Central Neurological Complications in Stapedial Artery Surgery".

Response to "Breaking the Myth of Central Neurological Complications in Stapedial Artery Surgery".

Otol Neurotol. 2018 Mar;39(3):388

Authors: Hensen EF, Goderie TPM, Smit CF

PMID: 29424822 [PubMed - in process]

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Breaking the Myth of Central Neurological Complications in Stapedial Artery Surgery.

Breaking the Myth of Central Neurological Complications in Stapedial Artery Surgery.

Otol Neurotol. 2018 Mar;39(3):387-388

Authors: Hitier M, Moreau S, Labrousse M, Patron V

PMID: 29424821 [PubMed - in process]

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Temporal Bone Meningo-Encephalic-Herniation: Etiological Categorization and Surgical Strategy.

Temporal Bone Meningo-Encephalic-Herniation: Etiological Categorization and Surgical Strategy.

Otol Neurotol. 2018 Mar;39(3):320-332

Authors: Grinblat G, Dandinarasaiah M, Prasad SC, Piras G, Piccirillo E, Fulcheri A, Sanna M

Abstract
OBJECTIVE: To study the clinical presentation, intraoperative findings and surgical management in meningo-encephalic-herniation (MEH) based on the etiology.
STUDY DESIGN: A retrospective clinical study and is a follow-up on the previously published report in 2009.
SETTING: A quaternary referral otology and skull base center PATIENTS AND METHODS:: The inclusion criteria were intraoperatively verified MEH in patients with a minimum follow-up of 12 months, which yielded 262 operated ears. The data were extracted regarding demographics, laterality, clinical presentation, past surgeries, contralateral-ear condition, intraoperative findings, complications, recurrences, revision-surgeries, audiometric-data, and follow-up.
RESULTS: The mean age at surgery was 49.7 years with the involvement of right-ear in 53.8% of patients. Lesions were categorized based on the etiology as chronic-otitis-media with/without cholesteatoma-MEH (COM/CHOL-MEH)-47.7%, iatrogenic-MEHs -20.9%; traumatic-MEHs -8% and spontaneous-MEHs -23.3%. At presentation, hearing loss (100 and 98.2%) and otorrhea (65.6 and 49.1%) were predominant in COM/CHOL-MEHs and iatrogenic-MEHs, respectively. On the other hand, meningitis (23.9 and 14.3%) and cerebrospinal fluid-leak (52.4 and 42.8%) were more pronounced in spontaneous and traumatic MEHs, respectively. Surgical approaches included 1) transmastoid, 2) middle-cranial-fossa-approach, 3) combined, and 4) middle-ear-obliteration (MEO) techniques. A total of 52.8% of COM/CHOL-MEHs and 49.1% of iatrogenic-MEHs underwent MEO. Middle-cranial-fossa approach was predominantly used in spontaneous-MEHs (52.5%) and traumatic-MEHs (38.1%). The defect was mostly single (75.2%). Smaller, multiple, bilateral lesions were more common in spontaneous-MEHs with tegmen-tympani involvement (57.4%).
CONCLUSION: Incorporating etiology into MEHs is a key-step that can be used as a guidance in choosing the right surgery. MEO is a part of armamentarium, and should be used whenever needed, if the objective is performing a definitive surgery.

PMID: 29424819 [PubMed - in process]

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Open Access: Is There a Predator at the Door?

Open Access: Is There a Predator at the Door?

Otol Neurotol. 2018 Mar;39(3):271-272

Authors: Chandra R, Fisher EW, Jones TM, Kennedy DW, Kraus DH, Krouse JH, Link M, Lustig LR, O'Malley BW, Piccirillo JF, Ruben R, Sataloff RT, Schwartz S, Sindwani R, Smith RJ, Stewart MG, Weber PC, Welling DB, Youngs R

PMID: 29424818 [PubMed - in process]

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Group B Streptococcal Cellulitis and Necrotizing Fasciitis in Infants: A Systematic Review.

Group B Streptococcal Cellulitis and Necrotizing Fasciitis in Infants: A Systematic Review.

Pediatr Infect Dis J. 2018 Feb 07;:

Authors: Wojtera M, Cheng H, Fiorini K, Coughlin K, Barton M, Strychowsky J

Abstract
BACKGROUND: There is no consensus regarding approaches to infantile group B streptococcal (GBS) head and neck cellulitis and necrotizing fasciitis. We present a case of GBS necrotizing cellulitis and summarizes the literature regarding the presentation and management of infantile head and neck GBS cellulitis and necrotizing fasciitis.
METHODS: The literature was searched using PubMed, Web of Science, EMBASE, and Medline (inception to April 2017) by two independent review authors. Inclusion criteria encompassed case reports or case series of infants less than 12 months of age with GBS cellulitis of the head and neck, or with GBS necrotizing fasciitis without restriction to the head and neck. Data were extracted using tables developed a priori by two independent review authors, and discrepancies were resolved by consensus.
RESULTS: An infant presenting at 33 days of age with GBS facial necrotizing fasciitis was successfully treated conservatively with antibiotics. Our literature search identified 40 infants with GBS head and neck cellulitis. Late-onset (98%), male gender (65%), and prematurity (58%) predominated. Penicillins were the main therapy used (97%). The 12 identified cases of necrotizing fasciitis were associated with polymicrobial etiology (36%) and broad-spectrum antibiotic use. Seventy-five percent required debridement, including four of five (80%) cases involving the head and neck.
CONCLUSIONS: Skin and soft tissue involvement is an uncommon manifestation of late-onset GBS infection which requires antibiotic therapy and possibly surgical debridement cases with necrotizing fasciitis.

PMID: 29424798 [PubMed - as supplied by publisher]

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Vascular malformations: classification, diagnosis and treatment.

Vascular malformations: classification, diagnosis and treatment.

Int Angiol. 2018 Feb 08;:

Authors: Carqueja IM, Sousa J, Mansilha A

Abstract
BACKGROUND: Vascular malformations are congenital lesions with complex clinical presentations and management. Their classification and treatment options have considerably changed throughout the years, with conflicting evidence in the literature. In this article, we aim to review the classification, diagnosis and treatment of the main vascular malformations.
METHODS: A thorough non-systematic review of the literature was conducted using PubMed/Medline. Seventy-nine articles were selected and included, according to their scientific relevance and relation with the subject.
RESULTS: Vascular malformations occur due to errors during vasculogenesis. They are present at birth, though they may not be apparent until later in life. These malformations are most frequently found in the head and neck, but can occur in any part of the body. They can be divided according to the predominant vessel type into arteriovenous, venous, capillary and lymphatic. Combined malformations occur when more than one type of vessel is present. Clinical presentation is variable and depends on the type of malformation, as well as location, size and relation with other structures. Symptoms such as ischemia, swelling, pain, thrombosis, deformity and functional impairment can be caused by these lesions. The diagnosis of vascular malformations is based in both clinical presentation and complementary imaging techniques, with special emphasis on magnetic resonance imaging. Depending on the malformation and clinical presentation, treatment may be medical or interventional, by means of both interventional techniques or surgery.
CONCLUSIONS: Vascular malformations are a complex group of pathologies, with different clinical presentations and treatment options, and therefore management by a multi-disciplinary team is essential. Their cure is often challenging and when not possible, treatment should aim at symptomatic control and improvement of patient's quality of life.

PMID: 29424187 [PubMed - as supplied by publisher]

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The patient's perioperative perspective during the treatment of obstructive sleep apnea: a pilot study.

The patient's perioperative perspective during the treatment of obstructive sleep apnea: a pilot study.

Sleep Breath. 2018 Feb 08;:

Authors: Rudolph MA, Rotsides JM, Zapanta PE

Abstract
PURPOSE: This study aims to determine patients' pre-operative and post-operative experiences relating to surgical treatment for obstructive sleep apnea (OSA), while understanding how patients' perceptions influence their outcome and satisfaction.
METHODS: This is a phenomenological qualitative study using a semi-structured interview to evaluate patients who failed continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea and underwent airway surgery. Meaningful codes from the interviews were organized into overarching themes of patient experiences. The same surgeon in a tertiary care otolaryngology practice treated all patients. All patients underwent a modified or traditional uvulopalatopharyngoplasty (UPPP) between 2009 and 2013. Patients were diagnosed with OSA by polysomnogram and had failed CPAP use. Patients were interviewed regarding their experience with OSA, CPAP, and surgery. Thematic saturation was reached after 17 patients.
RESULTS: Six themes exemplify patient's experience of OSA and treatment: (1) OSA impacted patients personally and professionally, (2) CPAP discomfort limited its therapeutic use, (3) patients had personal motivations for undergoing surgery, (4) patient knowledge influenced their perceptions, (5) post-operative challenges exceeded patient expectations, and (6) post-operative outcomes reflected positive effect on patients.
CONCLUSIONS: Patients' experiences prior to surgery can largely influence their perceived outcome and satisfaction. Post-operative sleep studies may not capture the full outcome of the patients' response to surgery. This study suggests that the patient's subjective reported outcomes should be used in conjunction with objective post-operative sleep studies.

PMID: 29423766 [PubMed - as supplied by publisher]

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