Τρίτη, 30 Μαΐου 2017

What is it about old muscles?

Abstract

The World Health Organization has recognized aging as one of the most important bio-psycho-social challenges of the 21st century.

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Ecto-5′-nucleotidase (CD73) regulates peripheral chemoreceptor activity and cardiorespiratory responses to hypoxia

Abstract

Augmented sensory neuronal activity from the carotid body (CB) has emerged as a principal cause of hypertension in a number of cardiovascular related pathologies including obstructive sleep apnoea, heart failure and diabetes. Development of new targets and pharmacological treatment strategies aiming to reduce CB sensory activity may thus improve outcomes in these key patient cohorts. The current study tested whether ecto-5′-nucleotidase (CD73), an enzyme that generates adenosine, is functionally important in modifying CB sensory activity and cardiovascular respiratory responses to hypoxia. Inhibition of ecto-5′-nucleotidase by α,β-methylene ADP (AOPCP) in the whole CB preparation in vitro reduced basal discharge frequency by 76 ± 5% and reduced sensory activity throughout graded hypoxia. AOPCP also significantly attenuated elevations in sensory activity evoked by mitochondrial inhibition. These effects were mimicked by antagonism of adenosine receptors with 8-(p-sulfophenyl) theophylline. Infusion of AOPCP in vivo significantly decreased the hypoxic ventilatory response (Δinline imageE control 74 ± 6%, Δinline imageE AOPCP 64 ± 5%, P < 0.05). AOPCP also modified cardiovascular responses to hypoxia, as evidenced by reduced elevations in heart rate and exaggerated changes in femoral vascular conductance and mean arterial blood pressure. Thus we identify ecto-5′-nucleotidase as a novel regulator of CB sensory activity. Future investigations are warranted to evaluate whether inhibition of ecto-5′-nucleotidase can effectively reduce CB activity in CB-mediated cardiovascular pathology.

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Training alters the distribution of perilipin proteins in muscle following acute free fatty acid exposure

Abstract

Because the lipid droplet (LD)-associated perilipin (PLIN) proteins promote intramuscular triglyceride (IMTG) storage, we investigated the hypothesis that differential protein content of PLINs and their distribution with LDs may be linked to the diverse lipid storage in muscle between trained and sedentary individuals. Trained (n = 11) and sedentary (n = 10) subjects, matched for age, sex and BMI, received either a 6 h lipid or glycerol infusion in the setting of a concurrent hyperinsulinaemic-euglycaemic clamp. Sequential muscle biopsies (0 h, 2 h, 6 h) were analysed using confocal immunofluorescence microscopy for fibre type-specific IMTG content and PLIN associations with LDs. In both groups lipid infusion increased IMTG content in type I fibres (trained: +62%, sedentary: +79%; P < 0.05), but did not affect PLIN protein content. At baseline, PLIN2 (+65%), PLIN3 (+105%) and PLIN5 (+53%; all P < 0.05) protein content was higher in trained compared to sedentary individuals. In trained individuals, lipid infusion increased the number of LDs associated with PLIN2 (+27%), PLIN3 (+73%) and PLIN5 (+40%; all P < 0.05) in type I fibres. In contrast, in sedentary individuals lipid infusion only increased the number of LDs not associated with PLIN proteins. Acute FFA elevation, therefore, induces a redistribution of PLIN proteins to an expanded LD pool in trained individuals only, and this may be part of the mechanism which enables fatty acids to be stored in IMTG.

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Threshold position control of anticipation in humans: a possible role of corticospinal influences

Abstract

The role of corticospinal (CS) pathways in anticipatory motor actions was evaluated using transcranial magnetic stimulation (TMS) of the primary motor cortex projecting to motoneurons (MNs) of wrist muscles. Preloaded wrist flexors were suddenly unloaded by the experimenter or by the subject using the other hand (self-unloading). After sudden unloading, the wrist joint involuntarily flexed to a new position. In contrast, during self-unloading the wrist remained almost motionless, implying that an anticipatory postural adjustment occurred. In the self-unloading task, anticipation was manifested by a decrease in descending facilitation of pre-activated flexor MNs starting ∼72 ms before changes in the background EMG activity. Descending facilitation of extensor MNs began to increase ∼61 ms later. Conversely, these influences remained unchanged before sudden unloading, implying the absence of anticipation. We also tested TMS responses during EMG silent periods produced by brief muscle shortening, transiently resulting in similar EMG levels before the onset and after the end of self-unloading. We found reduced descending facilitation of flexor MNs after self-unloading. To explain why the wrist excursion was minimized in self-unloading due to these changes in descending influences, we relied on previous demonstrations that descending systems pre-set the threshold positions of body segments at which muscles begin to be activated, thus pre-determining the equilibrium point to which the system is attracted. Based on this notion, a more consistent explanation of the kinematic, EMG and descending patterns in the two types of unloading is proposed compared to the alternative notion of direct pre-programming of kinematic and/or EMG patterns.

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Differential inhibitory response to telcagepant on αCGRP induced vasorelaxation and intracellular Ca2+ levels in the perfused and non-perfused isolated rat middle cerebral artery

Calcitonin gene-related peptide (CGRP) is one of the most potent endogenous vasodilators identified to date. The present study elucidates the differential interaction of CGRP, its receptor and the effect of th...

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Post-traumatic headache: the use of the sport concussion assessment tool (SCAT-3) as a predictor of post-concussion recovery

Given that post-traumatic headache is one of the most prevalent and long-lasting post-concussion sequelae, causes significant morbidity, and might be associated with slower neurocognitive recovery, we sought t...

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The role of attachment insecurity in the emergence of anxiety symptoms in children and adolescents with migraine: an empirical study

It is widely recognised that there are associations between headache, psychiatric comorbidity and attachment insecurity in both adults and children. The aims of this study were: 1) to compare perceived attachm...

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Symptoms of central sensitization and comorbidity for juvenile fibromyalgia in childhood migraine: an observational study in a tertiary headache center

Central sensitization is an important epiphenomenon of the adult migraine, clinically expressed by allodynia, pericranial tenderness and comorbidity for fibromyalgia in a relevant number of patients. This stud...

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Peripancreatic paraganglioma mimics pancreatic/gastrointestinal neuroendocrine tumor on fine needle aspiration: report of two cases and review of the literature

Abstract

Cytologic diagnosis of extra-adrenal paraganglioma presenting as a peripancreatic mass is challenging with a high error rate due to its rarity. We report two cases of peripancreatic masses identified by radiology. Endoscopic ultrasound-guided fine needle aspiration (FNA) of the masses showed a moderately cellular tumor composed of small to medium sized neoplastic cells with round to oval nuclei, arranged singly and in loose clusters. Focal rosette-like structures were present. The cells were positive for neuroendocrine markers (synaptophysin and chromogranin). A diagnosis of a neoplasm with neuroendocrine differentiation and neuroendocrine tumor was made respectively on FNA for each case. The subsequent surgical resection of the tumors revealed peripancreatic paraganglioma. Although paraganglioma has been reported in the literature, the detailed comparison of perpancreatic paraganglioma versus pancreatic/gastrointestinal neuroendocrine tumor is still lacking. Therefore using these two cases with literature review, we wish to illustrate the differential diagnosis between these two entities based on cytomorphology and immunohistochemical study.



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Cytopathology of high-grade fetal adenocarcinoma of the lung: A case report and cytological analysis



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Significance of flower pot cells in effusion cytology

Cells with long polar hair-like processes referred to as ‘flower pot cells’ are a rare but beautiful morphological feature observed in effusions of diverse etiologies. This report describes these cells in effusions seen in ovarian borderline serous tumours, malignant mesothelioma and in reactive mesothelial cells with or without accompanying malignant cells. These processes were better appreciated in air-dried May-Grunwald-Giemsa stained smears.



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Kr-POK (ZBTB7c) regulates cancer cell proliferation through glutamine metabolism

Publication date: Available online 30 May 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Man-Wook Hur, Jae-Hyeon Yoon, Min-Young Kim, Hyeonseok Ko, Bu-Nam Jeon
Kr-POK (ZBTB7c) is a kidney cancer-related POK transcription factor that not only represses transcription of CDKN1A but also increases expression of FASN. However, precisely how Kr-POK affects cell metabolism by controlling gene expression in response to an energy source in rapidly proliferating cells remains unknown. In this study, we characterized the molecular and functional features of Kr-POK in the context of tumor growth and glutamine metabolism. We found that cells expressing Kr-POK shRNA exhibited more severe cell death than control cells in glucose-deprived medium, and that knockdown of Kr-POK decreased glutamine uptake. Glutamine is critical for tumor cell proliferation. Glutaminase (GLS1), which is activated by p-STAT1, catalyzes the initial reaction in the pathway of glutaminolysis. Kr-POK interacts with PIAS1 to disrupt the interaction between PIAS1 and p-STAT1, and free p-STAT1 can activate GLS1 transcription through an interaction with p300. Kr-POK can be also sumoylated by PIAS1, facilitating Kr-POK degradation by the ubiquitin-mediated proteasomal pathway. Finally, we showed that repression of Kr-POK inhibited tumor growth in vivo in a xenograft model by repressing GLS1 expression. Taken together, our data reveal that Kr-POK activates GLS1 transcription and increases glutamine uptake to support rapid cancer cell proliferation.



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Acetylation of MKL1 by PCAF regulates pro-inflammatory transcription

Publication date: Available online 30 May 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Liming Yu, Zilong Li, Mingming Fang, Yong Xu
Inflammation is considered a fundamental host defense mechanism and, when aberrantly activated, contributes to a host of human diseases. Previously we have reported that the transcriptional regulator megakaryocytic leukemia 1 (MKL1) plays a role programming cellular inflammatory response by modulating NF-κB activity. Here we report that MKL1 was acetylated in vivo and pro-inflammatory stimuli (TNF-α and LPS) augmented MKL1 acetylation accompanying increased MKL1 binding to NF-κB target promoters. Further analysis revealed that the lysine acetyltransferase PCAF mediated MKL1 acetylation: TNF-α and LPS promoted the interaction between MKL1 and PCAF while depletion of PCAF abrogated the induction of MKL1 acetylation by TNF-α and LPS. Acetylation of MKL1 was necessary for MKL1 to activate the transcription of pro-inflammatory genes because mutation of four conserved lysine residues in MKL1 attenuated its capacity as a trans-activator of NF-κB target genes. Mechanistically, MKL1 acetylation served to promote MKL1 nuclear enrichment, to enhance the MKL1-NF-κB interaction, and to stabilize the binding of MKL1 on target promoters. In conclusion, our data unveil an important pathway that contributes to the transcriptional regulation of inflammatory response.



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Miscalculations can lead to misinterpretation of the results

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Publication date: Available online 30 May 2017
Source:Cancer Epidemiology
Author(s): Leena Derwish




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Incidence and survival of childhood cancer in the French islands of Reunion and Mayotte (2005–2011)

Publication date: August 2017
Source:Cancer Epidemiology, Volume 49
Author(s): J. Ramiandrisoa, M. Jehanne, F. Sauvat, Y. Reguerre, A. Chamouine, E. Chirpaz
The aim of this study is to describe childhood cancer incidence and survival in the French islands of Reunion and Mayotte for the period 2005–2011. Data were taken from the population-based Cancer Registry of Reunion Island. All incident cases of malignant tumours and benign tumours of the Central Nervous System diagnosed between 2005 and 2011 in children under the age of 15 and living in Reunion or Mayotte were included. A total of 236 cases were registered (176 in Reunion, 60 in Mayotte). Age-standardised incidence rates (ASRs, world standard) for all cancers were 125.0 and 101.8 per million for Reunion and Mayotte, respectively. ASRs for the main cancer groups were lower than those described in mainland France for the same period. The 5-year overall survival rate for all patients was 78.5% (95%CI 71.9- 83.7), slightly lower than that reported in mainland France.



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Integration Pattern of Human Papillomavirus Is a Strong Prognostic Factor for Disease-Free Survival After Radiation Therapy in Cervical Cancer Patients

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Jungnam Joo, Hye-Jin Shin, Boram Park, Seog-Yun Park, Chong-Woo Yoo, Kyong-Ah Yoon, Sun-Young Kong, Youn-Jae Kim, Sang Soo Kim, Joo-Young Kim
PurposeThe standard chemoradiation therapy currently used for locally advanced cervical cancer (LACC) patients does not reflect the biological heterogeneity of this disease, and there is an increasing need for the development of biomarkers that can help guide the individualized treatment regimens. The purpose of this study was to investigate the prognostic value of the integration pattern of human papillomavirus (HPV) in LACC patients.Methods and MaterialsThe HPV integration pattern was determined by in situ hybridization and polymerase chain reaction, and the tumors were classified as the episomal pattern (group A), as the single-copy integrated or multicopy tandem repetition–integrated pattern (group B), or as undetectable HPV (group C). Ninety-eight LACC patients were included in a development dataset and 106 independent patients in a validation dataset. The multivariate Cox model was used to examine the effect of the HPV integration pattern on disease-free survival (DFS). The model was validated internally by the leave-one-out cross-validation method and externally by an independent dataset.ResultsAfter adjustment for significant prognostic factors (stage, histologic grade, histologic type, and tumor size), the HPV integration pattern was significantly associated with DFS in the development (P=.032) and validation (P=.023) datasets. Survival was worst in group C and best in group A. The multivariate model with HPV integration pattern as an explanatory variable showed good discrimination ability and could separate patients with different risk profiles.ConclusionsThis study identified the HPV integration pattern, as determined by in situ hybridization and polymerase chain reaction, as a strong prognostic biomarker for DFS in LACC patients treated by chemoradiation therapy. This finding may open the possibility of personalized treatment of these patients.



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Radiobiology and the Renewed Potential for Nanoparticles

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Brian Marples, Shanta Dhar




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Prostate Cancer With Isolated Bony Metastasis: Sternal Struggle

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Mark T. Corkum




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Treatment-Related Toxicity in Patients With Early-Stage Non-Small Cell Lung Cancer and Coexisting Interstitial Lung Disease: A Systematic Review

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Hanbo Chen, Suresh Senan, Esther J. Nossent, R. Gabriel Boldt, Andrew Warner, David A. Palma, Alexander V. Louie
PurposeDefinitive treatment for patients with early-stage non-small cell lung cancer (ES-NSCLC) is usually well tolerated. Patients with ES-NSCLC and coexisting interstitial lung disease (ILD) are at increased risk of severe treatment-related toxicity after definitive therapy. The main objective of this systematic review is to provide a pooled estimation of treatment-related mortality and ILD-specific toxicity in this population of patients and to identify trends for further study.Methods and MaterialsThe MEDLINE and Embase databases were queried from respective dates of inception to January 2016. Studies that included patients who underwent definitive treatment for ES-NSCLC not combined with other treatments were included. Patients with oligometastases who were treated with aggressive palliation were included if it did not constitute the majority of patients in a specific study. The results were summarized with weighted proportions according to the sample size of individual studies.ResultsOverall, 3056 records were reviewed and 50 journal articles were included in the abstraction. The weighted proportion of treatment-related mortality (and ILD-specific toxicity) in primarily medically inoperable patients was as follows: stereotactic ablative radiation therapy (SABR) 15.6% (25%), particle beam therapy 4.3% (18.2%) and radiofrequency ablation (RFA) 8.7% (25%). The data for medically operable patients who underwent surgery were extracted for reference. Treatment-related mortality and ILD-specific toxicity were 2.2% and 12%, respectively, in the surgical population. On analysis of reported SABR dose parameters, V20 ≤ 6.5% and mean lung dose ≤4.5 Gy were found to be metrics associated with reduced mortality.ConclusionA consistently high level of treatment-related mortality and ILD-specific toxicity was observed in primarily medically inoperable patients treated with SABR, particle beam therapy, and RFA. For these patients, curative treatment should be considered in the context of the high toxicity rates and overall poor prognosis. Stringent radiation dosimetric parameters may result in reduced toxicity.



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Treat All Known Disease

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Peter J. Hoskin




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Prostate-Specific Membrane Antigen PET Before Aggressive Local Therapy to the Sternum

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Shankar Siva




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Intriguing, but Not the Right Setting

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Kevin L. Stephans, Rupesh Kotecha




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Issue Highlights

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3





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Sternum First, Perhaps Pelvis Later

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Brian J. Davis, Sean S. Park




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Long-Term Survival Analysis of Stereotactic Ablative Radiotherapy Versus Liver Resection for Small Hepatocellular Carcinoma

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Ting-Shi Su, Ping Liang, Jian Liang, Huan-Zhen Lu, Hua-Yan Jiang, Tao Cheng, Yong Huang, Yang Tang, Xin Deng
PurposeTo compare the efficacy of stereotactic ablative radiation therapy (SABR) versus liver resection for small hepatocellular carcinoma (HCC) ≤5 cm with Child-Pugh A cirrhosis.Methods and MaterialsThis retrospective study included 117 patients with small HCCs with 1 or 2 nodules. Eighty-two patients received SABR (SABR group), and 35 patients underwent liver resection (resection group). Overall survival (OS) and progression-free survival (PFS) were analyzed. One-to-one matched pairs between the 2 groups were created using propensity score matching to reduce the potential confounding effect of treatment and selection bias.ResultsThere was no between-group difference in OS and PFS. Before propensity score matching, the 1-, 3-, and 5-year OS was 96.3%, 81.8%, and 70.0% in the SABR group and 93.9%, 83.1%, and 64.4% in the resection group, respectively (P=.558). The 1-, 3- and 5-year PFS was 81.4%, 50.2%, and 40.7% in the SABR group and 68.0%, 58.3%, and 40.3% in the resection group, respectively (P=.932). After propensity score matching, 33 paired patients were selected from the SABR and resection groups. The 1-, 3-, and 5-year OS was 100%, 91.8%, and 74.3% in the SABR group and 96.7%, 89.3%, and 69.2% in the resection group, respectively (P=.405). The 1-, 3-, and 5-year PFS was 84.4%, 59.2%, and 43.9% in the SABR group and 69.0%, 62.4%, and 35.9% in the resection group, respectively (P=.945). There was a similarity of hepatotoxicity between the 2 groups. The SABR group showed fewer complications, such as hepatic hemorrhage, hepatic pain, and weight loss. Acute nausea was significantly more frequent in the SABR group than in the resection group.ConclusionFor patients with small primary HCC with 1 or 2 nodules and Child-Pugh A cirrhosis, SABR has local effects that are similar to those with liver resection. Stereotactic ablative radiation therapy has an advantage over resection in being less invasive.



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Advancing Our Practice Through the Advanced Practice Radiation Therapist Model: Catching Up With Canada

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Neha Vapiwala, Meredith Giuliani, Nicole Harnett




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Conservative Treatments of Ocular Melanomas: Technology Used Wisely

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Juliette Thariat, Joel Herault, Frederic Mouriaux




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In Reply to Peñagarícano

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Oliver Micke, M. Heinrich Seegenschmiedt, Irenaeus A. Adamietz, Guenter Kundt, Khashayar Fakhrian, Ulrich Schaefer, Ralph Muecke




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Radiation Therapy in Palestine: Not Only Money, But Also Real Accessibility

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Maurizio Portaluri, Niveen Abu-Rmeileh, Emilio Gianicolo




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Is It Time for New Target Volumes in Radiation Oncology?

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): David Palma




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Plasma Levels of IL-8 and TGF-β1 Predict Radiation-Induced Lung Toxicity in Non-Small Cell Lung Cancer: A Validation Study

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Shulian Wang, Jeff Campbell, Matthew H. Stenmark, Jing Zhao, Paul Stanton, Martha M. Matuszak, Randall K. Ten Haken, Feng-Ming (Spring) Kong
Purpose and ObjectivesWe previously reported that the combination of mean lung dose (MLD) and inflammatory cytokines interleukin-8 (IL-8) and transforming growth factor-β1 (TGF-β1) may provide a more accurate model for radiation-induced lung toxicity (RILT) prediction in 58 patients with non-small cell lung cancer (NSCLC). This study is to validate the previous findings with new patients and to explore new models with more cytokines.Methods and MaterialsOne hundred forty-two patients with stage I-III NSCLC treated with definitive radiation therapy (RT) from prospective studies were included. Sixty-five new patients were used to validate previous findings, and all 142 patients were used to explore new models. Thirty inflammatory cytokines were measured in plasma samples before RT and 2 weeks and 4 weeks during RT (pre, 2w, 4w). Grade ≥2 RILT was defined as grade 2, and higher radiation pneumonitis or symptomatic pulmonary fibrosis was the primary endpoint. Logistic regression was performed to evaluate the risk factors of RILT. The area under the curve (AUC) for the receiver operating characteristic curves was used for model assessment.ResultsSixteen of 65 patients (24.6%) experienced RILT2. Lower pre IL-8 and higher TGF-β1 2w/pre ratio were associated with higher risk of RILT2. The AUC increased to 0.73 by combining MLD, pre IL-8, and TGF-β1 2w/pre ratio compared with 0.61 by MLD alone to predict RILT. In all 142 patients, 29 patients (20.4%) experienced grade ≥2 RILT. Among the 30 cytokines measured, only IL-8 and TGF-β1 were significantly associated with the risk of RILT2. MLD, pre IL-8 level, and TGF-β1 2w/pre ratio were included in the final predictive model. The AUC increased to 0.76 by combining MLD, pre IL-8, and TGF-β1 2w/pre ratio compared with 0.62 by MLD alone.ConclusionsWe validated that a combination of mean lung dose, pre IL-8 level, and TGF-β1 2w/pre ratio provided a more accurate model to predict the risk of RILT2 compared with MLD alone.



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Directly Improving the Quality of Radiation Treatment Through Peer Review: A Cross-sectional Analysis of Cancer Centers Across a Provincial Cancer Program

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Julie Rouette, Eric Gutierrez, Jennifer O'Donnell, Lindsay Reddeman, Margaret Hart, Sophie Foxcroft, Gunita Mitera, Padraig Warde, Michael D. Brundage
PurposeTo describe the outcomes of peer review across all 14 cancer centers in Ontario.Methods and MaterialsWe identified all peer-reviewed, curative treatment plans delivered in Ontario within a 3-month study period from 2013 to 2014 using a provincial cancer treatment database and collected additional data on the peer-review outcomes.ResultsConsiderable variation was found in the proportion of peer-reviewed plans across the centers (average 70.2%, range 40.8%-99.2%). During the study period, 5561 curative plans underwent peer review. Of those, 184 plans (3.3%) had changes recommended. Of the 184 plans, the changes were major (defined as requiring repeat planning or having a major effect on planning or clinical outcomes, or both) in 40.2% and minor in 47.8%. For the remaining 12.0%, data were missing. The proportions of recommended changes varied among disease sites (0.0%-7.0%). The disease sites with the most recommended changes to treatment plans after peer review and with the greatest potential for benefit were the esophagus (7.0%), uterus (6.7%), upper limb (6.3%), cervix and lower limb (both 6.0%), head and neck and bilateral lung (both 5.9%), right supraclavicular lymph nodes (5.7%), rectum (5.3%), and spine (5.0%). Although the heart is an organ at risk in left-sided breast treatment plans, the proportions of recommended changes did not significantly differ between the left breast treatment plans (3.0%, 95% confidence interval 2.0%-4.5%) and right breast treatment plans (2.4%, 95% confidence interval 1.5%-3.8%). The recommended changes were more frequently made when peer review occurred before radiation therapy (3.8%) than during treatment (1.4%-2.8%; P=.0048). The proportion of plans with recommended changes was not significantly associated with patient volume (P=.23), peer-review performance (P=.36), or center academic status (P=.75).ConclusionsPeer review of treatment plans directly affects the quality of care by identifying important clinical and planning changes. Provincial strategies are underway to optimize its conduct in radiation oncology.



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External Validity of a Risk Stratification Score Predicting Early Distant Brain Failure and Salvage Whole Brain Radiation Therapy After Stereotactic Radiosurgery for Brain Metastases

Publication date: 1 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 98, Issue 3
Author(s): Robert H. Press, Danielle M. Boselli, James T. Symanowski, Scott P. Lankford, Robert J. McCammon, Benjamin J. Moeller, John H. Heinzerling, Carolina E. Fasola, Stuart H. Burri, Kirtesh R. Patel, Anthony L. Asher, Ashley L. Sumrall, Walter J. Curran, Hui-Kuo G. Shu, Ian R. Crocker, Roshan S. Prabhu
BackgroundA scoring system using pretreatment factors was recently published for predicting the risk of early (≤6 months) distant brain failure (DBF) and salvage whole brain radiation therapy (WBRT) after stereotactic radiosurgery (SRS) alone. Four risk factors were identified: (1) lack of prior WBRT; (2) melanoma or breast histologic features; (3) multiple brain metastases; and (4) total volume of brain metastases <1.3 cm3, with each factor assigned 1 point. The purpose of this study was to assess the validity of this scoring system and its appropriateness for clinical use in an independent external patient population.MethodsWe reviewed the records of 247 patients with 388 brain metastases treated with SRS between 2010 at 2013 at Levine Cancer Institute. The Press (Emory) risk score was calculated and applied to the validation cohort population, and subsequent risk groups were analyzed using cumulative incidence.ResultsThe low-risk (LR) group had a significantly lower risk of early DBF than did the high-risk (HR) group (22.6% vs 44%, P=.004), but there was no difference between the HR and intermediate-risk (IR) groups (41.2% vs 44%, P=.79). Total lesion volume <1.3 cm3 (P=.004), malignant melanoma (P=.007), and multiple metastases (P<.001) were validated as predictors for early DBF. Prior WBRT and breast cancer histologic features did not retain prognostic significance. Risk stratification for risk of early salvage WBRT were similar, with a trend toward an increased risk for HR compared with LR (P=.09) but no difference between IR and HR (P=.53).ConclusionThe 3-level Emory risk score was shown to not be externally valid, but the model was able to stratify between 2 levels (LR and not-LR [combined IR and HR]) for early (≤6 months) DBF. These results reinforce the importance of validating predictive models in independent cohorts. Further refinement of this scoring system with molecular information and in additional contemporary patient populations is warranted.



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The HGF/c-MET pathway is a driver and biomarker of VEGFR-inhibitor resistance and vascular remodeling in non-small cell lung cancer.

Purpose: Resistance to vascular endothelial growth factor receptor (VEGFR) inhibitors is a major obstacle in the treatment of non-small cell lung cancer (NSCLC). We investigated the cellular mechanisms mediating resistance of NSCLCs to VEGFR tyrosine kinase inhibitors.<br /><br />Experimental Design: We generated murine models of human NSCLC and performed targeted inhibition studies with the VEGFR TKIs cediranib and vandetanib. We used species-specific hybridization of microarrays to compare cancer (human) and stromal (mouse) cell transcriptomes of TKI-sensitive and -resistant tumors. We measured tumor microvascular density and vessel tortuosity to characterize the effects of therapy on the tumor vascular bed. Circulating cytokine and angiogenic factor levels in patients enrolled in VEGFR TKI trials were correlated with clinical outcomes.<br /><br />Results: Murine xenograft models of human lung adenocarcinoma were initially sensitive to VEGFR TKIs, but developed resistance to treatment. Species-specific microarray analysis identified increased expression of stromal-derived hepatocyte growth factor (HGF) as a candidate mediator of TKI resistance and its receptor, c-MET, was activated in cancer cells and tumor-associated stroma. A transient increase in hypoxia-regulated molecules in the initial response phase was followed by adaptive changes resulting in a more tortuous vasculature. Forced HGF expression in cancer cells reduced tumor sensitivity to VEGFR TKIs and produced tumors with tortuous blood vessels. Dual VEGFR/c-MET signaling inhibition delayed the onset of the resistant phenotype and prevented the vascular morphology alterations. In cancer patients receiving VEGFR TKIs, high pretreatment HGF plasma levels correlated with poorer survival. <br /><br />Conclusions: HGF/c-MET pathway mediates VEGFR inhibitor-resistance and vascular remodeling in NSCLC.



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Expression of Five Neuroblastoma Genes in Bone Marrow or Blood of Patients with Relapsed/Refractory Neuroblastoma Provides a New Biomarker for Disease and Prognosis

Purpose: We determined if quantifying neuroblastoma (NB)-associated mRNAs (NB-mRNA) in bone marrow (BM) and blood improves assessment of disease and prediction of disease progression in patients with relapsed/refractory NB. <br /><br />Patients and Methods: mRNA for CHGA, DCX, DDC, PHOX2B, and TH was quantified in BM and blood from 101 patients concurrently with clinical disease evaluations. Correlation between NB-mRNA (delta cycle threshold [Ct] for the geometric mean of genes from the TaqMan® Low Density Array NB5 assay) and morphologically-defined tumor cell percentage in BM, 123I-meta-iodobenzylguanidine (MIBG) Curie score, and CT/MRI-defined tumor longest diameter was determined. Time-dependent covariate Cox regression was used to analyze the relationship between DCt and progression-free survival (PFS). <br /><br />Results: NB-mRNA was detectable in 83% of BM (185/223) and 63% (89/142) of blood specimens, and their DCts were correlated (Spearman r=0.67, p<0.0001) although BM Ct was 7.9±0.5 Ct stronger than blood Ct. When BM morphology, MIBG, or CT/MRI were positive, NB-mRNA was detected in 99% (99/100), 88% (100/113), and 81% (82/101) of BMs. When all three were negative, NB-mRNA was detected in 55% (11/20) of BMs. BM NB-mRNA correlated with BM morphology or MIBG positivity (p<0.0001 and p=0.007). BM and blood Cts correlated with PFS (p<0.001; p=0.001) even when BM was morphologically negative (p=0.001; p=0.014). Multivariate analysis showed that BM and blood Cts were associated with PFS independently of clinical disease and MYCN gene status (p<0.001; p=0.055). <br /><br />Conclusions: This five-gene NB5 assay for NB-mRNA improves definition of disease status and correlates independently with PFS in relapsed/refractory NB.



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Predicting Presence of Sleep Disordered Breathing in Children with Down Syndrome

Sleep disordered breathing (SDB) is highly prevalent in children with Down syndrome. Given the scarcity of resources and the presence of risk factors for SDB in this population, the objective of this study is to identify clinical predictors of SDB which would assist prioritization of children with Down syndrome for SDB evaluation.

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Quercetin attenuates, indomethacin-induced acute gastric ulcer in rats

Background: Peptic ulcer diseases are common and are induced by many factors, including stress, smoking, and ingestion of non-steroidal anti-inflammatory drugs. Quercetin is considered to be an anti-oxidant with healing effects on many experimental toxic injuries. The present study aimed to explore the possible effect of quercetin on acute gastric ulcer induced by indomethacin in rats.

Materials and methods: Three groups received indomethacin (30 mg/kg body weight) orally by orogastric gavage on two consecutive days. The rats received famotidine (50 mg/kg body weight), quercetin (50 mg/kg body weight), or vehicle alone for 15 consecutive days by oral gavage. The control group received no indomethacin but received vehicle for 15 days by oral gavage. The ulcer index, volume, and pH of gastric juice were measured, and the stomachs were examined by routine light microscopy.

Results: Compared with the control group, the indomethacin-treated rats showed a marked damage of the gastric mucosal surface and a high ulcer index. In the famotidine- and quercetin-treated groups, significantly increased antioxidant enzyme activities were observed. The congestion, erosions, and necrosis were reduced with mild inflammatory cell infiltration while no major damage of endothelial cells was observed in the treated rats.

Conclusions: The findings of the study show that quercetin had antioxidant effect and can protect gastric mucosa against indomethacin-induced gastric ulceration than famotidine.  



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Anatomical study of the renal excretory system in pigs. A review of its characteristics as compared to its human counterpart

Background: Despite the importance of the pyelocalyceal system in the pig as an experimental model, there is little information about this particular anatomical subject. We determined the morphological characteristics of the renal excretory system in pigs.

Materials and methods: This descriptive cross-sectional study evaluated 130 pairs of kidneys of pigs destined to slaughter. The pyelocalyceal system was subjected to injection technique — corrosion by infusion of polyester resin (85% Palatal and 15% Styrene) and subsequent infusion in potassium hydroxide (KOH) for 10 days. The significance level used was p < 0.05.

Results: The renal excretory system is characterised by the presence of type A major cranial and caudal calyxes seen in 34.3% of the kidneys (type A1 in 30% and type A2 in 4.3%). type B calyxes, corresponding to minor calyxes draining directly into the renal pelvis, were present in 65.7% of the specimens (type B1 59.2%; type B2 6.5% of the cases). The number of minor calyxes in the collector system was 7.9 ± 2.27 with statistically significant differences in side (p = 0.0047).

Conclusions: The morphometric characteristics of the kidneys in this study are slightly smaller than reported in humans. Similarly, the incidence of type A renal excretory system distribution is highest in humans and lowest in pigs. Due to its few morphological differences, the pig kidney is an excellent model for teaching- -learning processes, for research purposes, and for training of urologic applications.  



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Tetrafurcation of the subscapular artery. Anatomical and clinical implications

Anatomic variations of axillary artery branches are commonly encountered during radiological investigation and surgical operations. Their existence can confuse interpretation of radiological results and lead to undesired complications during surgery. In this report authors describe a rare case of a subscapular arterial trunk that gave origin to thoracodorsal, circumflex scapular, posterior humeral circumflex, and lateral thoracic artery. Such a variation might cause undesired sequelae during trauma management and a variety of common flap harvesting operations including latissimus dorsi, scapular and parascapular flaps. Furthermore it presents embryological interest as it gives insight to embryologic development of axillary area.



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The variable origin of the lateral circumflex femoral artery: a meta-analysis and proposal for a new classification system

The lateral circumflex femoral artery (LCFA) is responsible for vascularisation of the head and neck of the femur, greater trochanter, vastus lateralis and the knee. The origin of the LCFA has been reported to vary significantly throughout the literature, with numerous branching patterns described and variable distances to the mid-inguinal point reported. The aim of this study was to determine the estimated population prevalence and pooled means of these anatomical characteristics, and review their associated clinical relevance. A search of the major electronic databases was performed to identify all articles reporting data on the origin of the lateral circumflex femoral artery and its distance to the mid-inguinal point. Additionally, an extensive search of the references of all relevant articles was performed. All data on origin, branching, and distance to mid-inguinal point was extracted and pooled into a meta-analysis. A total of 26 articles (n = 3731 lower limbs) were included in the meta-analysis. Lateral circumflex femoral artery most commonly originates from the deep femoral artery with a pooled prevalence of 76.1% (95% confidence interval 69.4–79.3). The deep femoral artery-derived lateral circumflex femoral artery was found to originate with a mean pooled distance of 51.06 mm (95% confidence interval 44.61–57.51 mm) from the mid-inguinal point. Subgroup analysis of both gender and limb side data were consistent with these findings. Due to variability in the lateral circumflex femoral artery’s origin and distance to mid-inguinal point, anatomical knowledge is crucial for clinicians to avoid iatrogenic injuries when performing procedures in the femoral region, and thus radiographic assessment prior to surgery is recommended. Lastly, we propose a new classification system for origin of the lateral circumflex femoral artery



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An anatomical investigation of the carotid canal

Background: The carotid canal (CC) located in the petrous temporal bone transmits the internal carotid artery, internal carotid venous plexus and sympathetic nerve plexus from the neck into the cranial cavity. It is an accessible passage into the cranial cavity and is considered an important anatomical landmark for neurosurgeons. The aim of this study was to investigate the topographical, morphometric and morphological parameters of the CC.

Materials and methods: An examination of the CC and related adjacent structures in 81 dry skull specimens was performed. Distribution of sample by sex was 34 females and 47 males, and by race 77 African and 4 Caucasian. The mean age was 50 years (range: 14–100 years).

Results: The external opening of the CC was found to be round-shaped, oval-shaped and tear-drop-shaped in 28.4%, 49.4% and 22.2% of the specimens, respectively. (1) Mean diameters [mm]: (a) medio-lateral 7.52 mm and (b) antero-posterior 5.41mm. Statistically significant difference in the vertical diameter was recorded in the race groups and laterality of the samples. (2) Mean distances [mm] between: (a) medial margins of external opening of CC was 50.03 mm, (b) lateral margins of external opening of CC was 62.73 mm and (c) external openings of CC and foramen lacerum was 15.6 mm. There was a statistically significant correlation between race and location of the opening of external CC in relation to foramen lacerum (viz. postero-lateral, lateral and diagonal, and lateral).

Conclusions: The present study corroborated previous reports on the CC; however, the tear-drop shaped external CC opening was a unique finding. The knowledge of the reference measurements pertaining to the CC and its relationship to adjacent structures may postulate a suitable surgical “safe-zone” range within the CC area.



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A plea for extension of the anatomical nomenclature. Part 1: Nervous system and senses

A correct, exact, concise and detailed anatomical nomenclature is a cornerstone of communication not only in anatomy and related subjects but also in other medical branches and in the whole medical education. Terminologia Anatomica fulfils this task but some important structures are still missing there. The authors have collected and present here a list of terms including their definitions or explanations to provoke discussion about possible extension of the Terminologia Anatomica. The first part of this contribution, presented in this article, comprises 113 terms concerning the regulation systems of the human body: endocrine glands, central and peripheral nervous system, and senses. It also contains some corrections of anatomical mistakes, systemic inconsistencies and grammar changes.



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Enthesopathic patterns of two South African female cadavers

Enthesopathy is considered to be an osseous phenomenon, either disease-specific or bone-site specific, which occurs at the enthesis of bone. Upon routine cadaveric dissection of the glenohumeral region in two Caucasian females, enthesopathy of the right proximal humerus was observed unilaterally in both cases. Case 1 exhibited an inconsistent pattern of bony protuberances and crests dispersed across the lesser and greater tuberosities of the right humeral head. Varying degrees of ossification of the distal subscapularis muscle was also observed. Case 2 presented with a distinctively large enthesophyte that protruded supero-medially from the proximal right humerus. In addition, ossification of the distal-most aspect of the supraspinatus muscle was identified. Cases 1 and 2 were both reflective of osteophytic enthesopathy as proliferative change was clearly visible on the proximal aspect of each humerus. Whilst the presence of enthesopathies may be indicative of underlying pathology, it may prove beneficial to the field of bioarchaeology for the remodelling of lifestyles of ancient civilizations through the provision of current day variations as seen in these two case studies.



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The relationship between the dimensions of the internal auditory canal and the anomalies of the vestibulocochlear nerve

Background: Internal auditory canal (IAC) stenosis and vestibulocochlear nerve (VCN) abnormalities have been reported to be associated with sensorineural hearing loss. Previous studies classified the normal dimensions of the IAC and its anomalies with no consideration of the VCN. Other studies categorised the VCN development in only stenotic canals. In the present study, an anatomical classification of the normal dimensions of the IAC and its anomalies and their association with malformations of the VCN and its subdivisions were described.

Materials and methods: Retrospective review was undertaken for children ranged from 1 to 10 years. A total of 764 canals were investigated for pre-operative assessment of cochlear implantation. Other 100 canals of normal hearing ears were included as the control group. The maximum anteroposterior diameter, considered the width of the canal, was measured in axial plane and the length of the canal was identified in coronal plane. The canals were categorised normal: if they are from 3 to 8 mm, patulous: if they are more than 8 mm, stenotic: if they are less than 3 mm and atretic if absent, using multislice computed tomography. The VCN trunks and their subdivisions were investigated using magnetic resonance imaging.

Results: Internal auditory canals were found normal in 66% with a mean width: 5.27 ± ± 0.68, patulous in 17% with a mean width 113% more than that of the control group (p = 0.000), stenotic in 13% with a mean width 73% less as compared to that of the control group (p = 0.000) and atretic in 4% of the experimental canals. The VCN trunks were found normal with well-developed subdivisions in 77.8% of the normal canals, 98.4% of the patulous canals, and 19.2% of the stenotic canals. The VCN trunks were normal with hypoplastic subdivisions in 11.3% of the normal canals, 1.6% in the patulous canals, and 61.6% in the stenotic canals with a mean width 52% less than that of the normal trunk with developed subdivisions. Hypoplastic VCN trunks with absent subdivisions were reported in 7.3% of the normal canals, 11.1% of the stenotic canals and in 3.2% of the atretic canals. The VCN trunks were not found in 3.6% of the normal canals, in 8.1% of the stenotic canals and in 96.8% of the atretic canals.

Conclusions: Internal auditory canal formation was dependent on the process of development and growth of the eighth cranial nerve and its subdivisions that greatly affected the completion of IAC canalisation. This paper could serve as a reference providing a quantitative classification of the relationship between the dimensions of the IAC and the development of the VCN trunk and its subdivisions.



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An arthroscopic evaluation of the anatomical “critical zone”

Background: The “critical zone”, a region of speculated vascularity, is situated approximately 10 mm proximal to the insertion of the supraspinatus tendon. Despite its obvious role as an anatomical landmark demarcator, its patho-anatomic nature has been identified as the source of rotator cuff pathology. Although many studies have attempted to evaluate the vascularity of this region, the architecture regarding the exact length, width and shape of the critical zone, remains unreported. This study aimed to determine the shape and morphometry of the “critical zone” arthroscopically.

Materials and methods: The sample series, which was comprised of 38 cases (n = 38) specific to pathological types, employed an anatomical investigation of the critical zone during routine real-time arthroscopy. Demographic representation: i) sex: 19 males, 19 females; ii) age range: 18–76 years; iii) race: white (n = 29), Indian (n = 7) and coloured (n = 2).

Results: The incidence of shape and the mean lengths and widths of the critical zone were determined in accordance with the relevant demographic factors and patient history. Although the cresenteric shape was predominant, hemispheric and sail-shaped critical zones were also identified. The lengths and widths of the critical zone appeared markedly increased in male individuals. While the increase in age may account for the increased incidence of rotator cuff degeneration due to poor end-vascular supply, the additional factors of height and weight presented as major determinants of the increase in size of the critical zone.

Conclusions: In addition, the comparisons of length and width with each other and shape yielded levels of significant difference, therefore indicating a directly proportional relationship between the length and width of the critical zone. This detailed understanding of the critical zone may prove beneficial for the success of post-operative rotator cuff healing.



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Morphological characteristics of visual cells in the endemic Korean loach Kichulchoia multifasciata (Pisces; Cobitidae) by microscopy

The visual cell of the retina in the Korean loach Kichulchoia multifasciata, a bottom-dwelling freshwater loach in shallow water, contains double cones and large rods. With light microscopy, the cones form a row mosaic pattern in which the partners of double cones are linearly oriented with a large rod. In a double cone or twin cone, the two members are unequal such that one cone may be longer than the other. An anatomical unit is apparent which consists of 5 rod cells and 15 double cone cells per 20 × 20 μm area. We found that the cone cells of outer segments are linked to the inner segment by so-called “calyceal process” using a scanning electron microscopy, unlike rod cells. In the transmission electron microscopy, the outer membrane shows piles of membrane discs surrounded by double membranes.  



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What can anthropometric measurements tell us about obstructive sleep apnoea?

Background: Clinical detection of anatomic narrowing of the upper airway may facilitate early recognition of obstructive sleep apnoea (OSA). The aim of this study was to investigate whether anthropometric measurement can be used to predict OSA.

Materials and methods: One hundred forty-seven subject were included from those patients who were referred to our sleep laboratory with suspected sleep apnoea. All patients were divided two groups with respect to the apnoea-hypopnoea index (AHI). The first group was diagnosed as OSA, AHI greater than 5. The second group was not diagnosed with OSA, AHI less than 5 (non-OSA control). Anthropometric measurements such as lower face height (LFH), interincisial distance, nose height, anterior neck height (ANH), lateral neck height, posterior neck height (PNH), ramus mandible height, corpus mandible height (CML), bigonial distance (BGD), neck width, and neck depth were assessed.

Results: Patients with OSA had higher body mass index (BMI) and larger LFH, ANH, thyromental distance, CML, BGD, and neck circumference than those without OSA (p < 0.0001, p < 0.0001, p < 0.0001, p < 0.0001, p < 0.0001, p = 0.023, p < 0.0001, respectively). There was no difference between the two groups in terms of other parameters.

Conclusions: In this study, it was determined that BMI, lower face height, neck height, mandible length, bigonial width, thyromental distance and neck circumference are in significant relationship with sleep disordered breathing. Thus, these measurements may be used in clinical practice for prediction of OSA.



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Coronary artery dominance dependent collateral development in the human heart

Background: In obstructive coronary artery disease, coronary collateral arteries serve as alternative conduits for blood flow to the myocardial tissue supplied by the obstructed vessel(s). Therefore, they are a “natural coronary arterial bypass” to the region supplied by the obstructed vessels. This study aims to determine the influence of demographic and morphologic coronary arterial factors on coronary collateral development in coronary arterial obstruction.

Materials and methods: The study group was selected from the coronary angiographic records of 2029 consecutive patients (mean age: 59 ± 12 years). Coronary collaterals were graded from 0 to 3 based on the collateral connection between the donor and recipient arteries. The angiograms of the patients (n = 286) with total obstruction of the coronary arteries were selected for analysis.

Results: There were no significant association between patients’ age and sex and the formation of excellent collaterals. However, the location of atherosclerotic lesion affected collateral development in the right coronary artery. In addition, the right coronary arterial dominant pattern significantly influenced the formation of excellent coronary collaterals.

Conclusions: Coronary collateral arteries are better developed in right dominant pattern. It may be concluded that coronary arterial morphological pattern influences coronary collateral artery development.



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Ectopic arachnoid granulation involving a rare intracranial venous sinus variant

Arachnoid granulations are hypertrophied arachnoid villi, which extend from the subarachnoid space into the venous system and aid in the passive filtration and reabsorption of cerebrospinal fluid. These macroscopic structures have been described in various locations, with the transverse and sigmoid sinuses seen as normal variants on imaging. Here we present the occurrence of an enlarged arachnoid granulation at the foramen rotundum where a variant intracranial venous sinus was identified during routine dissection. Variations, such as the one described herein, should be recognised by those who operate or interpret images of the skull base.



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Anatomic assessment of the left main bifurcation and dynamic bifurcation angles using computed tomography angiography

Background: An understanding of the left main coronary artery (LMCA) anatomy is important for accurate diagnosis and therapy. We aimed to investigate LMCA anatomy via 128-multisliced coronary computed-tomography-angiography (CCTA) in patients with normal LMCA.

Materials and methods: A total of 201 CCTA studies were included in this study. Anatomical features of LMCA including cross-sectional areas of the LMCA ostial, LMCA distal, left anterior descending artery (LAD) ostial and left circumflex artery (LCX) ostial, and degree of tapering and LMCA bifurcation angles (BA) in the form of LMCA-LCX BA, LMCA-LAD BA, LAD-LCX BA at end-diastole and end-systole.

Results: The mean age was 55 ± 11; 55.7% of patients were males. Right coronary artery was dominant in 173 (86.1%) patients. Mean LMCA length was 10.0 ± 4.5 mm. The mean values of LMCA ostial, LMCA distal, LAD ostial and LCX ostial areas were 18.2 ± 5.1 mm2, 13.2 ± 4.0 mm2, 9.0 ± 3.2 mm2 and 7.6 ± ± 2.8 mm2, respectively. LMCA ostial-distal area, LMCA distal-LAD ostial area and LMCA distal-LCX ostial area ratios were ≥ 1.44 – < 1.69 in 47 (23.4%), 53 (26.4%), 47 (23.4%) patients, respectively, and were ≥ 1.69 – < 1.96 in 19 (9.5%), 24 (11.9%), 40 (19.9%) patients respectively. Systolic motion modifies LMCA BAs; systolic motion begets an increment of LMCA-LAD angle in 72.6% of patients and decrement of LAD-LCX angle in 75.6% of patients. Patients with T-shaped LAD-LCX BA was shown to have significantly longer LMCA, larger LAD ostial area, larger LCX ostial area and higher diastolic-to-systolic range (DSR) of LAD-LCX BA compared to patients with Y-shaped LAD-LCX BA.

Conclusions: LMCA with T-shaped distal BA was found to have significantly longer LMCA, larger LAD ostial area, larger LCX ostial area and higher DSR of distal BA compared to patients with Y-shaped distal BA. These findings may provide useful information for LMCA bifurcation stenting or designing dedicated stents for LMCA.



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The report on the co-occurrence of two different rare anatomic variations of the plantaris muscle tendon on both sides of an individual

The plantaris muscle usually begins with a short and small muscle belly on the popliteal surface of the femur and on the knee joint capsule. It continues distally to form a long and thin tendon typically fixed to the calcaneal tuberosity. However, the course and the insertion of the plantaris muscle is variable, which may influence the development of Achilles tendinopathy. The plantaris tendon may also be used for reconstruction of tendons and ligaments, such as talofibular and calcaneofibular ligament. In literature review no data concerning the co-occurrence of anatomic variations of the plantaris muscle tendon in different individuals has been found. This report presents a rare variant of the plantaris muscle insertion into the deep crural fascia on the left leg and absence of the plantaris muscle on the right leg of the same individual.



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Congenital coronary artery anomalies in adult population detected using dual source ECG-gated CTA in a single institution

Background: Congenital anomalies of the coronary arteries (CAs) are rare and are often diagnosed incidentally during a conventional coronary angiography. Recently, the incidence of these congenital defects is on the rise particularly after the introduction of the electrocardiography (ECG) gated coronary computed tomographic angiography (CCTA). This innovative radiological screening modality has led to the most precise mapping of the course of the CAs on computed tomographic scan. The aim of the study is to determine the prevalence and describe the CAs congenital anomalies and their variations in Kuwaiti population at a single institution experience.

Materials and methods: We analysed the CCTA data obtained consecutively from 842 patients (2013–2014), retrospectively. The inclusion criteria for patients’ selection were: atypical chest pain, equivocal ECG, assessment of patency of coronary stents or grafts and pre-operative screening. Information was acquiesced using a dual-source CT scanner with ECG gating.

Results: Data analysis revealed that 22 (2.61%) patients were found to have CA anomalies out of the 842 patients who underwent CCTA. Out of these CA anomalies, 13 cases showed more than two ostia, 7 cases showed the ectopic origin of a CA from opposite sinus or non-aortic sinus, 2 cases showed single coronary ostium and 1 case showed coronary artery with pulmonary fistula. Also, myocardial bridging was identified in 78 (9.26%) patients whereas ramus intermedius branch was identified in 160 (19%) patients.

Conclusions: The prevalence of CA anomalies in Kuwait was 2.6%, which is relatively higher than previously reported studies from different countries.



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Antler velvet is thicker in adult than in yearling pampas deer (Ozotoceros bezoarticus): a histological study

Background: Antlers are lined by soft velvet tissue during antler growth. Later, the velvet is shed before rut onset. There are no detailed histological descriptions of the growing velvet, nor whether the velvet changes according to stag age. Our aims were to: 1) describe the basic histology of pampas deer antler velvet from adult and yearling males; and 2) determine the influence of age and time of antler growth on velvet’s tissues morphometry.

Materials and methods: Samples were collected from 10 stags allocated in two groups, either adult (3–5 years old, n = 5) or yearling males (2 years old, n = 5). The day of antler cast was recorded for each animal. In spring, the stags were anaesthetised and velvet samples were collected from the third tine’s distal end. Samples were described qualitatively and a restricted morphometrical analysis of the antler velvet was performed.

Results: The number of keratinocyte layers and the thicknesses of: total epidermis, corneum, intermediate and basale epidermal strata, total dermis, superficial and deep dermis were determined. Age and days after antler casting positively influenced in conjunction epidermal thickness (p = 0.037), and tended to influence both stratum intermedium (p = 0.076) and stratum corneum (p = 0.1) thicknesses. Age influenced stratum corneum thickness (p = 0.04). The pampas deer antler velvet lacked both sweat glands and arrector pili muscles.

Conclusions: The deep dermis was densely irrigated but displayed abundant and well developed collagen bundles. Both total epidermal and stratum corneum thicknesses related positively to the age of the animals but were not to the time since antler cast.  



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An anatomical investigation of the superficial and deep palmar arches

Background: The superficial palmar arch (SPA) and deep palmar arch (DPA) provide the dominant vascular supply to the hand. The SPA is considered to be highly variable and can be classified as either complete or incomplete. The simplest definition states that the anastomosis between the vessels contributing to the arch represent a complete arch, while an incomplete arch is described as characterised by an absence of anastomosis between the vessels contributing to it. This study aimed to describe the anatomical landmarks, formation and branching patterns of the SPA and DPA. In this study, the SPA and DPA were dissected in 50 specimens (n = 100 adult hands), respectively.

Materials and methods: A complete SPA was observed in 92% of specimens and classified into three types. In Type A (44%), the SPA was formed by the anastomosis of the superficial palmar branch of the radial artery with the ulnar artery. Type B (46%) was formed by the ulnar artery alone and Type C (2%) was formed by anastomosis of the ulnar artery with the superficial palmar branch of the radial artery and the persistent median artery.

Results: An incomplete SPA was observed in 8% of the specimens and divided into three types formed by the radial and ulnar arteries. The DPA was divided into five types viz. Type G (72%), where the DPA was formed by anastomosis of the deep palmar branch of the radial artery (DPBRA) with the deep palmar branch of the ulnar artery (DPBUA). Type H (12%), was formed by anastomosis of the DPBRA, the DBUA and the interosseous artery. Type I (8%), was formed by the anastomosis of the DPBRA with the superior and inferior DPBUA. Type J (4%), the deep ulnar artery had two branches whereby either one branch anastomosed with the DPBRA to form the DPA. Type K (4%), the DBUA exhibited two deep branches with one branch anastomosing with the DPBRA to complete the DPA.

Conclusions: The interosseous artery anastomosed with either the DPA or the additional DPBUA. Knowledge of the variability of the SPA and DPA is crucial for safe and successful hand surgeries.  



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Anatomy of the long peroneal muscle of the leg

Background: The aim of the work was to perform a morphometric analysis of the long peroneal muscle (LPM) of the leg and explore the relationship between muscle belly and tendon.

Materials and methods: Ten lower limbs (8 right and 2 left) were fixed in formaldehyde and dissected using standard technique. The LPM was exposed from the proximal attachment to the top of a lateral malleolus.

Results: The tendon was subsequently freed and various measurements were taken. The tendon of the LPM enters deep into the muscle belly. Muscle fibres surround the tendon and descend as far down as 4 cm above the lateral malleolus. Muscle fibres insert mainly along posterior border of the tendon and on its medial surface, leaving lateral surface only partly covered.

Conclusions: The LPM contains a long intramuscular segment of the tendon and area of the musculotendinous junction varies along the LPM. It makes the idea of uniform pennation pattern of the LPM unlikely  



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Investigations on renal vascularisation pathology in the Polish population. 1. Incidence of multiple kidney arteries

Background: The aim of the study was to determine the incidence of multiple kidney arteries in the Polish population.

Materials and methods: The study group comprised 924 deceased patients aged between 1 month and 94 years (mean age: 63.4 ± 22.4 years) who were subject to aortonephrography and sample preparation. The ratio of male to female patients was 479:445.

Results: Multiple kidney arteries were observed in 44.8% male and 31.5% female patients (p = 0.004). Considering male patients, right multiple kidney arteries were diagnosed in 24.4%, and left multiple kidney arteries in 31.3% of cases (p = 0.017). In female patients, right multiple kidney arteries were observed in 17.8% of cases, and left multiple kidney arteries in 19.6% of cases (p = 0.49).

Conclusions: The incidence of multiple kidney arteries in the Polish population is a frequent phenomenon, and should be considered in case of urological surgery and kidney transplantation.  



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Reporting the results of meta-analyses: A plea for incorporating clinical relevance referring to an example

The results of meta-analyses are frequently reported, but understanding and interpreting them is difficult for both clinicians and patients. Statistical significances are presented without referring to values that imply clinical relevance.

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The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials

Radiofrequency denervation is commonly used for the treatment of chronic facet joint pain that has been refractory to more conservative treatments, although the evidence supporting this treatment has been controversial.

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Epithelial-to-mesenchymal transition in tumor progression

Abstract

The epithelial-to-mesenchymal transition (EMT) is a biological process in which a non-motile epithelial cell changes to a mesenchymal state with invasive capacities. However, the EMT program is involved in both physiological and pathological processes. Cancer-associated EMT is known to contribute to increase invasiveness and metastasis, resistance to therapies, and generation of cell populations with stem cell-like characteristics and therefore is deeply involved in tumor progression. This process is finely orchestrated by multiple signaling pathways and regulatory transcriptional networks. The hallmark of EMT is the loss of epithelial surface markers, mainly E-cadherin, and the acquisition of mesenchymal phenotype. These events can be mediated by EMT transcription factors which can cooperate with several enzymes to repress the E-cadherin expression and regulate EMT at the epigenetic and post-translational level. A growing body of evidence indicates that cancer cells can reside in various phenotypic states along the EMT spectrum, where cells can jointly retain epithelial traits with mesenchymal ones. This type of phenotypic plasticity endows cancer cells with tumor-initiating potential. The identification of the signaling pathways and modulators that lead to activation of EMT programs during these disease processes is providing new insights into the plasticity of cellular phenotypes and possible therapeutic interventions.



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Molecular analysis of sentinel lymph node in colon carcinomas by one-step nucleic acid amplification (OSNA) reduces time to adjuvant chemotherapy interval

The interval between surgery and adjuvant chemotherapy (AC) is a predictive factor of survival in high-risk colon cancer (CC). This study aimed to evaluate the impact of intraoperative sentinel lymph node (SLN) analysis using the one-step nucleic acid amplification (OSNA) technique on the time interval between surgery and AC.

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An unusual cause of biliary metal stent obstruction



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Hymenolepis nana infection detected by magnifying colonoscopy with narrow-band imaging (with video)



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Diffuse gastric metastases from salivary duct carcinoma



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Cronkhite-Canada syndrome



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Successful endoscopic submucosal dissection for superficial esophageal cancer on solitary esophageal varix



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Time and Speed of Vascular Pedicle Dissection in Deep Inferior Epigastric Artery Perforator Flap Elevation

J reconstr Microsurg
DOI: 10.1055/s-0037-1603351

Introduction Breast reconstruction using deep inferior epigastric artery perforator (DIEP) free flap is widely used because of the advantages of minimizing donor-site morbidity, but it requires technical competency in vascular dissection. This study evaluated the influence of patient factors and vascular status on the time and speed of dissection of the vascular pedicle. Methods DIEP free flap procedures were performed in 49 patients assigned to immediate or delayed reconstruction groups. Factors that significantly influenced the time required and the speed of dissection were evaluated. Results The average total dissection time was 55.9 minutes (34.5 minutes for the intramuscular dissection and 21.4 minutes for the submuscular dissection). The dissection speed for the total vascular pedicle was 2.65 cm/10 minutes (1.71 cm/10 minutes for the intramuscular dissection and 4.30 cm/10 minutes for the submuscular dissection). The presence of a Pfannenstiel scar, length of the vascular pedicle in the intramuscular area, and the number of microclips used significantly correlated with the total dissection time. Conclusion The length of the intramuscular pedicle, number of microclips used, and presence of a Pfannenstiel scar significantly correlated with the total dissection time of the vascular pedicle. An assessment prior to the surgery can reduce the time of operation and make it easier to elevate the flap.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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The Role of Patients

Shared decision-making affords patients and their families the autonomy to make difficult decisions after receiving comprehensive information about medical facts and treatment options. It is essential that patients’ values are respected. The essential steps include first informing patients of the need for a decision, then explaining the various facts involved; after which, it is important to elicit patients’ preferences and goals. Once the treatment options and outcomes important to patients are identified, an actual decision can be made. This activity is complex and requires a commitment of time and is enhanced through employment of a multidisciplinary team approach.

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Decision Making for Diagnosis and Management

The diagnosis and treatment of head and neck cancer is extremely complex. As a result, multiple medical providers are involved in a patient’s care, and the multidisciplinary tumor boards provide a forum whereby they can share and discuss the intricacies of each individual patient’s case. When recommendations are presented to the patient and decisions are to be finalized, the patient should benefit from the collective wisdom of a team of providers to achieve and implement a patient-centric and clinically sound consensus.

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Molecular analysis of sentinel lymph node in colon carcinomas by one-step nucleic acid amplification (OSNA) reduces time to adjuvant chemotherapy interval

The interval between surgery and adjuvant chemotherapy (AC) is a predictive factor of survival in high-risk colon cancer (CC). This study aimed to evaluate the impact of intraoperative sentinel lymph node (SLN) analysis using the one-step nucleic acid amplification (OSNA) technique on the time interval between surgery and AC.

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An unusual cause of biliary metal stent obstruction



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Outcome of carotid artery stenting in the hands of vascular surgeons

Abstract

Objectives

To analyze the procedural and clinical outcomes of carotid artery stenting (CAS) in the hands of endovascular trained vascular surgeons.

Methods

Between April 2008 to May 2013, 1197 patients were treated for extracranial internal carotid artery (ICA) stenosis. The proportion of endovascular treated patients was 5.0% (CAS n = 60 vs. carotid endarterectomy (CEA) n = 1137). All patients in the CAS group (44 males, median age 70 years) were treated by two senior vascular surgeons experienced in endovascular methods. Restenosis was the indication for CAS in 32 out of 60 patients (53.3%). Further indications were contralateral ICA occlusion (n = 14, 23.3%), radiogenic ICA stenosis (n = 5, 8.3%), high-risk candidates for CEA (n = 4, 6.6%), and the presence of contralateral recurrent paresis (n = 2, 3.3%). High-risk patients for CEA were defined as patients with history of severe cardiac disease and patients with impaired general condition. 84.4% (n = 27) of the restenosis were asymptomatic with a mean degree of stenosis of 83.7%, and 12.9% (n = 4) were symptomatic (degree of stenosis of 90%). Mean procedural and fluoroscopy time were 61 and 14 min. Study endpoints were periprocedural stroke-related mortality and morbidity, restenosis rate, and overall survival. Follow-up was performed by duplex ultrasound with a median follow-up period of 12 months (range 1–55).

Results

The periprocedural stroke rate of CAS within 30 days was 3.3% (one ischemic stroke, one intracranial hemorrhage); two additional patients suffered TIA (3.3%). None of the patients had a myocardial infarction perioperatively. The mortality rate was 0. CAS procedures were completed in 90.0% (n = 54) of cases. Dropout rate was 8.3% (n = 5) for morphological reasons (e.g., carotid kinking). Intraoperative complication rate was 1.7% (n = 1) including one patient who suffered intraoperative rupture of access vessels. The conversion rate with subsequent CEA procedure was 6.6% (n = 4 of 5). The restenosis rate during follow-up was 3.3% after CAS. The reintervention rate during the median follow-up period of 12 months (1–55 months) was 5.5% (n = 3/54). Two patients received a reintervention with successful balloon angioplasty; in one case, a diagnostic angiography was performed excluding the presence of a relevant restenosis. No additional stent was implanted. The survival rate was 100% at 1 year, 90.4% at 2 years, and 77.7% at 3 years.

Conclusion

CAS, in the hands of vascular surgeons, is feasible with a moderate perioperative risk in a highly selected patient cohort. A procedure termination rate of approximately 10% shows that the complementary therapy using CAS procedure is not overused by surgeons.



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Kuwaiti Teachers' Perceptions of Voice Handicap

Publication date: Available online 30 May 2017
Source:Journal of Voice
Author(s): Sana A. Albustan, Basem S. Marie, Yaser S. Natour, Wesam B. Darawsheh
ObjectivesThe study aimed to investigate the effects of age, gender, level of education, experience, and class level taught on the perception of voice handicap by Kuwaiti teachers using the Arabic version of the Voice Handicap Index (VHI-Arab). The mean VHI scores of Kuwaiti teachers were compared with those of Jordanian and Emirati teachers.MethodsThe study had a cross-sectional survey design. A total of 460 individuals (100 controls and 360 teachers) participated in this study and completed the paper copy of the VHI-Arab. We recruited 360 teachers, 180 males and 180 females (age range: 20–50 years), from 60 schools in 6 Kuwaiti districts. Teachers' VHI scores were compared with 100 nonteaching voice users (50 males and 50 females, with an age range of 18–42 years).ResultsFemale teachers scored significantly higher than male teachers in all subscales (ie, physical: P = 0.02; emotional: P = 0.007; total: P = 0.017), except for the functional subscale (P = 0.147). Elementary school teachers scored significantly higher than teachers of other levels (middle and high school) in all VHI subscales (physical: P = 0.047; emotional: P = 0.01; total: P = 0.039), except for the functional subscale (P = 0.47). The mean score of Jordanian teachers was higher than that of Kuwaiti and Emirati teachers in all VHI subscales.ConclusionsTeachers with a more favorable teaching environment scored better on the VHI. Gender differences were found in all the Arabic nationalities studied. Female teachers of the elementary level, in particular, should be the focus of attention of efforts to prevent voice damage.



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Working Toward a Common Vocabulary: Reconciling the Terminology of Teachers of Singing, Voice Scientists, and Speech-Language Pathologists

Publication date: Available online 30 May 2017
Source:Journal of Voice
Author(s): Matthew Hoch, Mary J. Sandage




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Occurrence of BAP1 germline mutations in cutaneous melanocytic tumors with loss of BAP1-expression: a pilot study

Abstract

Melanocytic BAP1-associated intradermal tumors (MBAITs) can either be sporadic or associated with a cancer-predisposition syndrome. In this study we explored the clinical status of 136 patients in which at least one MBAIT was found. 49/136 (36%) of them gave their signed consent for an oncogenetic BAP1 blood test. 28/136 patients (20%) diagnosed with an MBAIT had other MBAITs and/or a personal or familial history of BAP1-related cancers that could clinically designate them as potential carriers of a BAP1 germline mutation. 17 of these 28 patients underwent oncogenetic testing. A deleterious mutation of BAP1 was confirmed in 12/17 cases. 4/17 cases were wild-type; all had a single MBAIT and a history of skin melanoma. A variant of unknown significance was found in one case with multiple MBAITs. Among the 12 mutated cases, multiple MBAITs were present in 10/12 cases and were the only clinical sign in 4/12 cases. The remaining 32/49 blood-tested cases with an isolated MBAIT were wild type for BAP1 in 25/32 cases or showed a variant of unknown significance in 7/32 cases. We recommend, following the diagnosis of a MBAIT, performing a BAP1 immunohistochemistry in all other cutaneous melanocytic tumors removed previously or simultaneously and all skin melanomas. This screening could help clinicians prioritize which patients would most benefit from oncogenetic testing. This article is protected by copyright. All rights reserved.



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Working Toward a Common Vocabulary: Reconciling the Terminology of Teachers of Singing, Voice Scientists, and Speech-Language Pathologists

Agreement on vocal terminology is vital for the continued merger of voice pedagogy and voice science. Currently, conflicting terminologies abound, particularly among the following groups: classical singing teachers, theater voice and contemporary commercial music (CCM) pedagogues, speech-language pathologists, voice scientists, choral directors, and the performance community at large. By examining the vocabulary of five aspects of vocal technique—vocal loudness/intensity, breath management, the singer's formant/ring, vibrato, and registration—we can engage in discussion that works toward mutual understanding and uniform language.

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Kuwaiti Teachers' Perceptions of Voice Handicap

The study aimed to investigate the effects of age, gender, level of education, experience, and class level taught on the perception of voice handicap by Kuwaiti teachers using the Arabic version of the Voice Handicap Index (VHI-Arab). The mean VHI scores of Kuwaiti teachers were compared with those of Jordanian and Emirati teachers.

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Towards standardization of 18 F-FET PET imaging: do we need a consistent method of background activity assessment?

Abstract

Background

PET with O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) has reached increasing clinical significance for patients with brain neoplasms. For quantification of standard PET-derived parameters such as the tumor-to-background ratio, the background activity is assessed using a region of interest (ROI) or volume of interest (VOI) in unaffected brain tissue. However, there is no standardized approach regarding the assessment of the background reference. Therefore, we evaluated the intra- and inter-reader variability of commonly applied approaches for clinical 18F-FET PET reading.

The background activity of 20 18F-FET PET scans was independently evaluated by 6 readers using a (i) simple 2D-ROI, (ii) spherical VOI with 3.0 cm diameter, and (iii) VOI consisting of crescent-shaped ROIs; each in the contralateral, non-affected hemisphere including white and gray matter in line with the European Association of Nuclear Medicine (EANM) and German guidelines. To assess intra-reader variability, each scan was evaluated 10 times by each reader. The coefficient of variation (CoV) was assessed for determination of intra- and inter-reader variability. In a second step, the best method was refined by instructions for a guided background activity assessment and validated by 10 further scans.

Results

Compared to the other approaches, the crescent-shaped VOIs revealed most stable results with the lowest intra-reader variabilities (median CoV 1.52%, spherical VOI 4.20%, 2D-ROI 3.69%; p < 0.001) and inter-reader variabilities (median CoV 2.14%, spherical VOI 4.02%, 2D-ROI 3.83%; p = 0.001). Using the guided background assessment, both intra-reader variabilities (median CoV 1.10%) and inter-reader variabilities (median CoV 1.19%) could be reduced even more.

Conclusions

The commonly applied methods for background activity assessment show different variability which might hamper 18F-FET PET quantification and comparability in multicenter settings. The proposed background activity assessment using a (guided) crescent-shaped VOI allows minimization of both intra- and inter-reader variability and might facilitate comprehensive methodological standardization of amino acid PET which is of interest in the light of the anticipated EANM technical guidelines.



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Monitoring response to anti-angiogenic mTOR inhibitor therapy in vivo using 111 In-bevacizumab

Abstract

Background

The ability to image vascular endothelial growth factor (VEGF) could enable prospective, non-invasive monitoring of patients receiving anti-angiogenic therapy. This study investigates the specificity and pharmacokinetics of 111In-bevacizumab binding to VEGF and its use for assessing response to anti-angiogenic therapy with rapamycin.

Specificity of 111In-bevacizumab binding to VEGF was tested in vitro with unmodified radiolabelled bevacizumab in competitive inhibition assays. Uptake of 111In-bevacizumab in BALB/c nude mice bearing tumours with different amounts of VEGF expression was compared to that of isotype-matched control antibody (111In-IgG1κ) with an excess of unlabelled bevacizumab. Intratumoural VEGF was evaluated using ELISA and Western blot analysis. The effect of anti-angiogenesis therapy was tested by measuring tumour uptake of 111In-bevacizumab in comparison to 111In-IgG1κ following administration of rapamycin to mice bearing FaDu xenografts. Uptake was measured using gamma counting of ex vivo tumours and effect on vasculature by using anti-CD31 microscopy.

Results

Specific uptake of 111In-bevacizumab in VEGF-expressing tumours was observed. Rapamycin led to tumour growth delay associated with increased relative vessel size (8.5 to 10.3, P = 0.045) and decreased mean relative vessel density (0.27 to 0.22, P = 0.0015). Rapamycin treatment increased tumour uptake of 111In-bevacizumab (68%) but not 111In-IgGκ and corresponded with increased intratumoural VEGF165.

Conclusions

111In-bevacizumab accumulates specifically in VEGF-expressing tumours, and changes after rapamycin therapy reflect changes in VEGF expression. Antagonism of mTOR may increase VEGF in vivo, and this new finding provides the basis to consider combination studies blocking both pathways and a way to monitor effects.



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Kuwaiti Teachers' Perceptions of Voice Handicap

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Publication date: Available online 30 May 2017
Source:Journal of Voice
Author(s): Sana A. Albustan, Basem S. Marie, Yaser S. Natour, Wesam B. Darawsheh
ObjectivesThe study aimed to investigate the effects of age, gender, level of education, experience, and class level taught on the perception of voice handicap by Kuwaiti teachers using the Arabic version of the Voice Handicap Index (VHI-Arab). The mean VHI scores of Kuwaiti teachers were compared with those of Jordanian and Emirati teachers.MethodsThe study had a cross-sectional survey design. A total of 460 individuals (100 controls and 360 teachers) participated in this study and completed the paper copy of the VHI-Arab. We recruited 360 teachers, 180 males and 180 females (age range: 20–50 years), from 60 schools in 6 Kuwaiti districts. Teachers' VHI scores were compared with 100 nonteaching voice users (50 males and 50 females, with an age range of 18–42 years).ResultsFemale teachers scored significantly higher than male teachers in all subscales (ie, physical: P = 0.02; emotional: P = 0.007; total: P = 0.017), except for the functional subscale (P = 0.147). Elementary school teachers scored significantly higher than teachers of other levels (middle and high school) in all VHI subscales (physical: P = 0.047; emotional: P = 0.01; total: P = 0.039), except for the functional subscale (P = 0.47). The mean score of Jordanian teachers was higher than that of Kuwaiti and Emirati teachers in all VHI subscales.ConclusionsTeachers with a more favorable teaching environment scored better on the VHI. Gender differences were found in all the Arabic nationalities studied. Female teachers of the elementary level, in particular, should be the focus of attention of efforts to prevent voice damage.



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Working Toward a Common Vocabulary: Reconciling the Terminology of Teachers of Singing, Voice Scientists, and Speech-Language Pathologists

alertIcon.gif

Publication date: Available online 30 May 2017
Source:Journal of Voice
Author(s): Matthew Hoch, Mary J. Sandage




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Fibrin sealant (Tisseel™) for mesh fixation in repair of the deep circumflex iliac artery (DCIA) free flap donor site

The iliac crest free flap, based on the deep circumflex iliac artery (DCIA) is well described and considered an excellent choice for composite reconstruction in the head and neck.1,2

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Rhabdomyosarcoma of the head and neck: impact of demographic and clinicopathologic factors on survival

Publication date: Available online 30 May 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Robert J. Lee, Kevin K. Lee, Thomas Lin, Armin Arshi, Serena A. Lee, Russell E. Christensen
ObjectiveTo determine the survival factors for patients diagnosed with rhabdomyosarcoma of the head and neck.Study DesignPatients diagnosed with rhabdomyosarcoma of the head and neck between 1973 and 2012 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier and Cox proportional hazard regression models were performed to determine the demographics, prognostic factors, and treatment modalities that determine overall survival (OS) and disease-specific survival (DSS).Results503 patients diagnosed with rhabdomyosarcoma of the head and neck were analyzed. 51.3% were male and 48.7% were female with a median OS of 4.9 years. Kaplan-Meier analysis determined 5-year survival rates of 30% for OS and 50% for DSS. Multivariate analysis found that age at diagnosis, tumor extent of disease, surgical resection, and radiation therapy were independent predictors of OS and DSS.ConclusionsThis study, to our knowledge, is the largest year span study to date determining the factors of survival for rhabdomyosarcoma of the head and neck. Older age at diagnosis, histological subtype of alveolar rhabdomyosarcoma, and further extent of disease were associated with decreased survival. Surgical resection improves survival in patients with localized or regional disease while radiation therapy confers survival benefit in patients with distant extent.



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Triggers of oral lichen planus flares and the potential role of trigger avoidance in disease management

Publication date: Available online 30 May 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Hannah X. Chen, Rachel Blasiak, Edwin Kim, Ricardo Padilla, Donna A. Culton
ObjectiveMany patients with oral lichen planus (OLP) report triggers of flares, some of which overlap with triggers of other oral diseases including oral allergy syndrome and oral contact dermatitis. The purpose of this study was to evaluate the prevalence of commonly reported triggers of OLP flares, the overlap with triggers of other oral diseases, and the potential role of trigger avoidance as a management strategy.Study DesignQuestionnaire-based survey of 51 patients with biopsy-proven lichen planus with oral involvement seen in an academic Dermatology specialty clinic and/or Oral Pathology clinic between June 2014 and June 2015.ResultsOf the participants, 94% identified at least one trigger of their OLP flares. Approximately half of participants (51%) reported at least one trigger that overlapped with known triggers of oral allergy syndrome, and 63% identified at least one trigger that overlapped with known triggers of oral contact dermatitis. Emotional stress was the most commonly reported trigger (77%). Regarding avoidance, 79% of the study participants reported avoiding their known triggers in daily life. Of those who actively avoided triggers, 89% reported an improvement in symptoms and 70% reported a decrease in frequency of flares.ConclusionsTrigger identification and avoidance can play a potentially effective role in the management of OLP.



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Safer VL intubation: Don't lift or displace the tongue

Another tip for safer intubations.

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Effects of exercise on brain activity during walking in older adults: a randomized controlled trial

Physical activity may preserve neuronal plasticity, increase synapse formation, and cause the release of hormonal factors that promote neurogenesis and neuronal function. Previous studies have reported enhance...

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Brain-Computer Interface application: auditory serial interface to control a two-class motor-imagery-based wheelchair

Certain diseases affect brain areas that control the movements of the patients’ body, thereby limiting their autonomy and communication capacity. Research in the field of Brain-Computer Interfaces aims to prov...

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Feature selection for elderly faller classification based on wearable sensors

Wearable sensors can be used to derive numerous gait pattern features for elderly fall risk and faller classification; however, an appropriate feature set is required to avoid high computational costs and the ...

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A muscle-driven approach to restore stepping with an exoskeleton for individuals with paraplegia

Functional neuromuscular stimulation, lower limb orthosis, powered lower limb exoskeleton, and hybrid neuroprosthesis (HNP) technologies can restore stepping in individuals with paraplegia due to spinal cord i...

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