Παρασκευή, 2 Ιουνίου 2017

Aerophagia and Abdomino-phrenic Dyssynergia in a 3-year-old.

No abstract available

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Functional Neuroimaging in IBS, A Brain Twister.

No abstract available

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How Secure is the Diagnosis of Ulcerative Colitis in Children, Even After Colectomy?.

Objectives: We reviewed all children who have undergone a colectomy for ulcerative colitis in our tertiary referral centre in a twelve-year period to assess the rate of reclassification as Crohn's disease. In contrast to Crohn's Disease, a colectomy is considered to be definitive treatment for patients with ulcerative colitis. Distinguishing between the two can be challenging when disease is manifest only within the colon - even histological examination of a colectomy specimen may be inconclusive. Historically, the recognised 'rediagnosis' rate (post colectomy) was reported at around 3-7%. A recent study suggested that a higher rate of 13% should be expected in children. This has implications in terms of pre-operative counselling and surgical decision making. Methods: A retrospective case-note review of all patients who underwent a colectomy for ulcerative colitis between 2003 and 2014 in a single paediatric tertiary referral centre was performed. Results: Of the 570 children diagnosed with inflammatory bowel disease in this period, 190 were diagnosed as ulcerative colitis. Of these 190 cases, 29 underwent a colectomy. None of these was re-classified following histological examination of the colectomy sample. Seven out of the 29 patients (24%) were subsequently diagnosed with Crohn's disease (median follow-up 7.6 years). This is significantly higher than previously reported rates (p = 0.003). Conclusions: Our data suggests that later manifestation of Crohn's disease is more common than previously thought (24%). Therefore, a diagnosis of ulcerative colitis in children should be regarded as provisional and a potential later diagnosis of Crohn's disease taken into account when considering colectomy and J-pouch formation. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Reply to “Need for updating safety recommendations on repetitive transcranial magnetic stimulation in stroke patients”

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Publication date: Available online 3 June 2017
Source:Clinical Neurophysiology
Author(s): Ela B. Plow, Vishwanath Sankarasubramanian, Kelsey A. Potter-Baker, Yin-Liang Lin




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Need for updating safety recommendations on repetitive transcranial magnetic stimulation in stroke patients

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Publication date: Available online 3 June 2017
Source:Clinical Neurophysiology
Author(s): Bertrand Glize, Dominique Guehl, Mélanie Cogné




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Editorial Board



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Particulate matter air pollution: individual choices for improving cardiometabolic well-being

Abstract

Exposure to small particulate matter (PM2.5) has become the 5th highest ranking risk factor for death, responsible for 4.2 million deaths worldwide. PM pollution is also associated with cardiovascular disease and type 2 diabetes, and may contribute to deteriorate the already poor cardiometabolic outlook of the diabetic patient. Although most sources of outdoor air pollution are well beyond the control of individuals, there is still room for personal action. Health behaviors (smoking cessation, avoiding obesity, and increasing physical activity) may increase the poor life expectancy of individuals in the lowest income quartile of the Western population; moreover, a favorable lifestyle, (no current smoking, no obesity, physical activity at least once weekly, and a healthy diet pattern), may cut by nearly 50% the risk of coronary heart disease among people at high genetic risk. Things seem not immutable, as individual healthy choices do matter.



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Be a Teacher



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Acoustic Reflexes in Normal-Hearing Adults, Typically Developing Children, and Children with Suspected Auditory Processing Disorder: Thresholds, Real-Ear Corrections, and the Role of Static Compliance on Estimates



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Hearing Characteristics of Stroke Patients: Prevalence and Characteristics of Hearing Impairment and Auditory Processing Disorders in Stroke Patients



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A Qualitative Case Study of Smartphone-Connected Hearing Aids: Influences on Patients, Clinicians, and Patient‐Clinician Interactions



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Social Representation of “Loud Music” in Young Adults: A Cross-Cultural Study



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Cortical Auditory-Evoked Potential and Behavioral Evidence for Differences in Auditory Processing between Good and Poor Readers

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Tinnitus Management: Randomized Controlled Trial Comparing Extended-Wear Hearing Aids, Conventional Hearing Aids, and Combination Instruments



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The Potential in Preparing Community Health Workers to Address Hearing Loss



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The Association between Hearing Loss, Postural Control, and Mobility in Older Adults: A Systematic Review



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JAAA CEU Program



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The effectiveness of creatine treatment for Parkinson’s disease: an updated meta-analysis of randomized controlled trials

The effectiveness of creatine in treating Parkinson’s disease (PD) has not been conclusively determined. Therefore, we performed a meta-analysis to address this issue.

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Multiple laser pulses in conjunction with an optical clearing agent to improve the curative effect of cutaneous vascular lesions

Abstract

Port-wine stains (PWSs) usually respond poorly to pulsed dye laser treatment because of the shallow penetration and light absorption of melanin in the epidermis. Multiple laser pulses (MLPs) Nd:YAG laser in conjunction with an optical clearing agent can help to reduce the total laser energy required for blood coagulation. The quantitative optical clearing effect (OCE) of glycerol was investigated by using a tissue-like phantom. Thereafter, an in vitro capillary tube experimental system and an in vivo hamster dorsal skin chamber experiment for the laser treatment of PWSs were established to visually obtain the quantitative relationship between the OCE and the blood coagulation properties under the irradiation of 1064 nm MLPs. Diffuse reflection coefficient decreases by 36.69% and transmission coefficient increases by 38.73% at 1064 nm, after applying 0.5 mL anhydrous glycerol for 10 min on the surface of the tissue-like phantom. The number of laser pulses required for blood coagulation decreases by 25% after the application of 0.5 mL anhydrous glycerol for 4 min, thrombosis appears after 10 min, and the 0.0854 clotting area completely blocks the capillary tubes in 6 pulses. For 10 min, the incident energy can be reduced by 35.09 and 29.82%. When the 0.3-mm vessel’s buried depths are 1 and 0.5 mm, the pulse number can be reduced from 11 to 8 and from 6 to 4, respectively. Adding anhydrous glycerol directly on the hamster dorsal skin is an effective way to reduce the number of laser pulses from 4∼5 to 2∼3 for similar capillary tube diameter. Therefore, the MLPs of 1064 nm Nd:YAG demonstrates a substantial curative effect for large capillary tubes. In conjunction with glycerol, this approach may treat deeply buried cutaneous capillary tubes and prevent the unwanted thermal damage of normal dermal tissue.



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Comparison of dimensional accuracy of conventionally and digitally manufactured intracoronal restorations

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Publication date: Available online 2 June 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Reza Eftekhar Ashtiani, Leila Nasiri Khanlar, Minoo Mahshid, Alireza Moshaverinia
Statement of problemAdvances have been made in digital dentistry for the fabrication of dental prostheses, but evidence regarding the efficacy of digital techniques for the fabrication of intracoronal restorations is lacking.PurposeThe purpose of this in vitro study was to compare the dimensional accuracy of intracoronal restorations fabricated with digital and conventional techniques.Material and methodsA sound mandibular molar tooth received a standard onlay preparation, and onlays were fabricated with 1 of 3 fabrication techniques. In group CC, the onlays were made after conventional impression and conventional fabrication of a resin pattern. In group CP, the onlays were made after conventional impression and 3-dimensional (3D) printing of the pattern. In group IP, the onlays were made after intraoral scanning, and 3D printing produced the resin pattern. Ten specimens in each group (N=30) were evaluated. Glass-ceramic restorations were fabricated using the press technique. The replica technique was used to assess the marginal fit. Each replica was assessed at 8 points. One-way ANOVA was used to compare the marginal discrepancy among the 3 groups. The Tukey honest significant differences test was applied for pairwise comparisons of the groups (α=.05).ResultsNo significant differences were noted in the marginal discrepancy at the gingival margin among the 3 groups (P=.342), but significant differences were noted among the 3 groups in the pulpal (P=.025) and lingual (P=.031) areas. Comparison of the absolute discrepancy among the 3 groups revealed that only groups CC and CP were significantly different (P=.020) from each other.ConclusionsWithin the limitations of this in vitro study, the conventional method yielded more accuracy than the 3D printing method, and no differences were found between the methods which used the 3D printer (groups CP and IP).



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Toward Defining “Vocal Constriction”: Practitioner Perspectives

This research investigated the terminology used in relation to constriction of the singing voice from a range of practitioner perspectives. It focused on the locality, causes, consequences, management, trends, identification, and vocabulary of constriction. The research aimed to develop a holistic understanding of the term “vocal constriction” from participant experiences and perceptions (N = 10).

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Intraoperative 1-Hour Electrical Nerve Stimulation Enhances Outcomes of Nerve–Muscle-Endplate Band Grafting Technique for Muscle Reinnervation

J reconstr Microsurg
DOI: 10.1055/s-0037-1602824

Background Increasing evidence suggests that 1-hour electrical nerve stimulation during surgery improves nerve regeneration and functional recovery. However, it remains unknown if this approach has beneficial effects on the outcomes of our recently developed nerve–muscle-endplate band grafting-native motor zone (NMEG-NMZ) technique for muscle reinnervation. Methods In this study, NMEG-NMZ transplantation was performed in a rat model. The right sternomastoid muscle was experimentally denervated and immediately reinnervated by implanting a NMEG harvested from the ipsilateral sternohyoid (SH) muscle into the NMZ of the target muscle. Before implantation of the NMEG, the SH nerve branch innervating the NMEG was subjected to intraoperative 1-hour continuous electrical stimulation (20 Hz). Three months after surgery, the degree of functional recovery was evaluated with muscle force measurement and the extent of nerve regeneration and endplate reinnervation was examined using histological and immunohistochemical methods. Results A combination of NMEG-NMZ with electrical nerve stimulation resulted in a greater degree of functional recovery than the NMEG-NMZ alone. The mean muscle force of the treated muscles was 90% of the contralateral control. The muscle mass was recovered up to 90% of the control. The mean number and percentage of area of the regenerated axons in the treated muscles was computed to be 81 and 84% of the control muscles, respectively. On average, 83% of the denervated endplates in the treated muscles were reinnervated by regenerated axons. Conclusion Intraoperative brief nerve stimulation promotes nerve regeneration, endplate reinnervation, and functional recovery of the muscles reinnervated with NMEG-NMZ technique.
[...]

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 treatment of juvenile/adult GM1-gangliosidosis with Miglustat may reverse disease progression

Abstract

Juvenile and adult GM1-gangliosidosis are invariably characterized by progressive neurological deterioration. To date only symptomatic therapies are available. We report for the first time the positive results of Miglustat (OGT 918, N-butyl-deoxynojirimycin) treatment on three Italian GM1-gangliosidosis patients. The first two patients had a juvenile form (enzyme activity ≤5%, GLB1 genotype p.R201H/c.1068 + 1G > T; p.R201H/p.I51N), while the third patient had an adult form (enzyme activity about 7%, p.T329A/p.R442Q). Treatment with Miglustat at the dose of 600 mg/day was started at the age of 10, 17 and 28 years; age at last evaluation was 21, 20 and 38 respectively. Response to treatment was evaluated using neurological examinations in all three patients every 4–6 months, the assessment of Movement Disorder-Childhood Rating Scale (MD-CRS) in the second patient, and the 6-Minute Walking Test (6-MWT) in the third patient. The baseline neurological status was severely impaired, with loss of autonomous ambulation and speech in the first two patients, and gait and language difficulties in the third patient. All three patients showed gradual improvement while being treated; both juvenile patients regained the ability to walk without assistance for few meters, and increased alertness and vocalization. The MD-CRS class score in the second patient decreased from 4 to 2. The third patient improved in movement and speech control, the distance covered during the 6-MWT increased from 338 to 475 m. These results suggest that Miglustat may help slow down or reverse the disease progression in juvenile/adult GM1-gangliosidosis.



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Association mapping to discover significant marker-trait associations for resistance against fusarium wilt variant 2 in pigeonpea [ Cajanus cajan (L.) Millspaugh] using SSR markers

Abstract

Pigeonpea production is severely constrained by wilt disease caused by Fusarium udum. In the current study, we discover the putative genomic regions that control resistance response to variant 2 of fusarium wilt using association mapping approach. The association panel comprised of 89 diverse pigeonpea genotypes including seven varieties, three landraces and 79 germplasm lines. The panel was screened rigorously for 3 consecutive years (2013–14, 2014–15 and 2015–2016) against variant 2 in a wilt-sick field. A total of 65 pigeonpea specific hypervariable SSR markers (HASSRs) were screened representing seven linkage groups and 29 scaffolds of the pigeonpea genome. A total of 181 alleles were detected, with average values of gene diversity and polymorphism information content (PIC) of 0.55 and 0.47, respectively. Further analysis using model based (STRUCTURE) and distance based (clustering) approaches separated the entire pigeonpea collection into two distinct subgroups (K = 2). The marker trait associations (MTAs) were established based on three-year wilt incidence data and SSR dataset using a unified mixed linear model. Consequently, six SSR markers were identified, which were significantly associated with wilt resistance and explained up to 6% phenotypic variance (PV) across the years. Among these SSRs, HASSR18 was found to be the most stable and significant, accounting for 5–6% PV across the years. To the best of our knowledge, this is the first report of identification of favourable alleles for resistance to variant 2 of Fusarium udum in pigeonpea using association mapping. The SSR markers identified here will greatly facilitate marker assisted resistance breeding against fusarium wilt in pigeonpea.



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Dysregulation of lysophosphatidic acids in multiple sclerosis and autoimmune encephalomyelitis

Bioactive lipids contribute to the pathophysiology of multiple sclerosis. Here, we show that lysophosphatidic acids (LPAs) are dysregulated in multiple sclerosis (MS) and are functionally relevant in this dise...

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Evaluation of haematological and serum biochemical changes associated with constant rate infusion tramadol hydrochloride as an adjunct to ketoprofen in laparotomized and ovariohysterectomized dogs

Abstract

Tramadol hydrochloride (an opioid-like analgesic) and ketoprofen (a non-steroidal anti-inflammatory drug) are routinely used in human and veterinary medicine for the management of post-surgical pain. However, data on the safety of constant rate infusion tramadol as an adjunct to ketoprofen for peri-operative analgesia is lacking. This study evaluated changes in haematology and serum biochemistry associated with constant rate infusion (CRI) tramadol hydrochloride as an adjunct to ketoprofen for analgesia in adult female dogs following laparotomy (LP) and ovariohysterectomy (OVH). Thirty (30) adult female dogs randomly assigned into six groups of five dogs each were used in studies 1 and 2. In both studies, group 3 served as the control which received normal saline while groups 1 and 2 were given 1.0 and 2.0 mg/kg/h of tramadol Hcl, respectively. Dogs in study 1 were laparotomized while OVH was performed on dogs in study 2. Ketoprofen (4 mg/kg) was given subcutaneously for 3 days post-surgery (PS) to all the groups. There was no significant difference in the haematological parameters of treated and control groups. There was a transient significant rise in some serum biochemical parameters of the treated groups but these decreased to baseline values by day 7 post-surgery. Based on the findings in this study, it was concluded that constant rate infusion of 1 and 2 mg/kg/h of tramadol hydrochloride as an adjunct to ketoprofen caused no clinically observable deleterious effect on haematology and serum biochemistry of dogs post-laparotomy and ovariohysterectomy.



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The Content of As and Heavy Metals in TSP and PM 10 Near Copper Smelter in Bor, Serbia

Abstract

The content of As and heavy metals (Pb, Cd, Ni, and Cu) in total suspended particulate (TSP) and PM10 at 3 locations (Park, Institute, and Jugopetrol) near the copper smelter in Bor (Serbia) has been analyzed within the period 2004 to 2015 with the aim of investigating the seasonal and spatial changes of those pollutants in the suspended particles. The content of As in TSP and PM10 was over the annual EU limit value at all measuring points during the entire period of observation, while contents of Cd and Pb were periodically above the annual EU limits. There were no statistically significant seasonal changes between mean levels of the observed elements in the cold (October–March) and warm (April–September) periods during the year. A strong and moderate positive correlation was detected between the concentrations of each particular element (except Ni) at all measuring points. Additionally, Cd was the most enriched element followed by Pb, As, and Cu, while Ni was low-enriched. The constant air pollution with As particles, sometimes in concentrations even 20 times higher than the permitted annual value, requires urgent undertaking of concrete actions in order to reduce anthropogenic emission of suspended particles in Bor.



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Light-emitting diode modulates carbohydrate metabolism by pancreatic duct regeneration

Abstract

Pancreatic lesions can produce metabolic disorders. Light-emitting diode (LED) has been used as a safe and effective phototherapy for cell proliferation and regeneration. We investigate the effects of phototherapy using LED irradiation on the pancreas after the injection of streptozotocin (STZ) to induce experimental diabetes and evaluate that the β cells can regenerate in the pancreas in an in vivo model and observe its implications on the control of carbohydrate metabolism. Twenty Wistar rats were randomized into three groups: non-diabetic control, diabetic control, and diabetic treated with LED. Except for the non-diabetic control group, all were induced to diabetes type I by streptozotocin injection. Treated groups were irradiated by LED: λ = 805 nm; 40 mW, 22 s; spot diameter 5 mm, spot area 0.196 cm2, 0.88 J that it was applied on pancreas projection area for 5 consecutive days and monitored for 30 days. Diabetic group treated with LED showed regeneration of islets and ducts (p = 0.001) on the pancreas. Intraperitoneal insulin tolerance test showed differences between the diabetic control and diabetic treated groups (p = 0.03). In diabetic control group, the hepatic glycogen content was 296% lower when compared with diabetic treated with LED. Furthermore, in the diabetic control group, the glycogen content of the gastrocnemius muscle was 706% smaller when compared with diabetic treated with LED. This study shows that LED was able to modify morphological and metabolic features and also altered carbohydrate metabolism on irradiated pancreas in experimental model of diabetes.



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Präoperative Evaluation erwachsener Patienten vor elektiven, nicht herz-thoraxchirurgischen Eingriffen1*

Anästhesiol Intensivmed Notfallmed Schmerzther
DOI: 10.1055/s-0043-111784

Die präoperative Anamnese und körperliche Untersuchung sind anerkannter Standard bei der Risikoevaluation von Patienten vor elektiven chirurgischen Eingriffen. Ob und unter welchen Umständen technische Voruntersuchungen dazu beitragen können, das perioperative Risiko zu reduzieren, ist bislang nur unzureichend untersucht. Auch besteht unter Anästhesisten, Chirurgen und Internisten vielfach Unsicherheit im perioperativen Umgang mit der Dauermedikation. Die deutschen wissenschaftlichen Fachgesellschaften für Anästhesiologie und Intensivmedizin (DGAI), Chirurgie (DGCH) und Innere Medizin (DGIM) haben daher eine gemeinsame Empfehlung zur präoperativen Evaluation erwachsener Patienten vor elektiven, nicht herz-thoraxchirurgischen Eingriffen erarbeitet und erstmals im Jahr 2010 publiziert. Die vorliegende Fassung ist eine Überarbeitung der Stellungnahme von 2010 unter Einbeziehung der seither publizierten Literatur sowie von aktuellen Leitlinien internationaler Fachgesellschaften. Zunächst werden die allgemeinen Prinzipien der präoperativen Evaluation dargestellt (Teil A). Das Vorgehen bei Patienten mit bekannten oder vermuteten kardiovaskulären Vorerkrankungen wird gesondert betrachtet (Teil B: „Erweiterte kardiale Diagnostik"). Abschließend wird der perioperative Umgang mit der Dauermedikation diskutiert (Teil C). Die vorgestellten Konzepte stellen fachübergreifende Empfehlungen dar, die ein strukturiertes und gemeinsames Vorgehen ermöglichen sollen. Ihr Ziel ist es, durch transparente und verbindliche Absprachen eine hohe Patientenorientierung unter Vermeidung unnötiger Voruntersuchungen zu gewährleisten, präoperative Untersuchungsabläufe zu verkürzen sowie letztlich Kosten zu reduzieren. Die gemeinsamen Empfehlungen von DGAI, DGCH und DGIM spiegeln den gegenwärtigen Kenntnisstand, aber auch die Meinungen von Experten wider, da nicht für jede Fragestellung wissenschaftliche Evidenz besteht. Daher werden eine regelmäßige Überprüfung und Aktualisierung der Empfehlungen erfolgen, sobald gesicherte neue Erkenntnisse vorliegen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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



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Need for updating safety recommendations on repetitive transcranial magnetic stimulation in stroke patients

A paper entitled "Inhibition versus facilitation of contralesional motor cortices in stroke: Deriving a model to tailor brain stimulation" was published by Sankarasubramanian et al. in Clinical Neurophysiology in March 2017 (Sankarasubramanian et al., 2017). That article reported the results of a study that aimed at investigating whether facilitation of contralesional dorsal premotor cortex by repetitive transcranial magnetic stimulation (rTMS) permitted to improve upper-limb function in severely affected post-stroke patients.

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Reply to “Need for updating safety recommendations on repetitive transcranial magnetic stimulation in stroke patients”

We are pleased to receive the correspondence from Glize et al. in regards to our paper published recently in Clinical Neurophysiology (Sankarasubramanian et al., 2017). We thank the authors for their interest and insightful comments regarding approaches used in our study. In brief, our study investigated the effectiveness of facilitating excitability of the contralesional dorsal premotor cortex (PMd) in patients severely affected by stroke. PMd was targeted using high-frequency (5 Hz) repetitive transcranial magnetic stimulation (rTMS).

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Cold Fusion: Massive Karyotype Evolution in the Antarctic Bullhead Notothen Notothenia coriiceps

Half of all vertebrate species share a series of chromosome fusions that preceded the teleost genome duplication, but we don't understand the causative evolutionary mechanisms. The "Robertsonian-translocation hypothesis" suggests a regular fusion of each ancestral acro- or telocentric chromosome to just one other by centromere fusions, thus halving the karyotype. An alternative "genome-stirring hypothesis" posits haphazard and repeated fusions, inversions, and reciprocal and non-reciprocal translocations. To study large-scale karyotype reduction, we investigated the decrease of chromosome numbers in Antarctic notothenioid fish. Most notothenioids have 24 haploid chromosomes, but bullhead notothen (Notothenia coriiceps) has eleven. To understand mechanisms, we made a RAD-tag meiotic map with about 10,000 polymorphic markers. Comparative genomics aligned about a thousand orthologs of platyfish and stickleback genes along bullhead chromosomes. Results revealed that nine of eleven bullhead chromosomes arose by fusion of just two ancestral chromosomes and two others by fusion of three ancestral chromosomes. All markers from each ancestral chromosome remained contiguous, implying no inversions across fusion borders. Karyotype comparisons support a history of: 1) Robertsonian fusions of 22 ancestral chromosomes in pairs to yield 11 fused plus two small unfused chromosomes, like N. angustata; 2) fusion of one of the remaining two ancestral chromosomes to a pre-existing fused pair, giving 12 chromosomes like N. rossii; and 3) fusion of the remaining ancestral chromosome to another fused pair, giving 11 chromosomes in N. coriiceps. These results raise the question of what selective forces promoted the systematic fusion of chromosomes in pairs and the suppression of pericentric inversions in this lineage and provide a model for chromosome fusions in stem teleosts.



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RNA Binding Protein Vigilin Collaborates with miRNAs To Regulate Gene Expression for Caenorhabditis elegans Larval Development

Extensive studies have suggested that most miRNA functions are executed through complex miRNA-target interaction networks, and such networks function semi-redundantly with other regulatory systems to shape gene expression dynamics for proper physiological functions. We found that knocking down vgln-1, which encodes a conserved RNA-binding protein associated with diverse functions, causes severe larval arrest at the early L1 stage in animals with compromised miRISC functions (an ain-2/GW182 mutant). Through an enhancer screen, we identified five specific miRNAs and miRNA families that act semi-redundantly with VGLN-1 to regulate larval development. By RIP-Seq analysis, we identified mRNAs that are directly bound by VGLN-1 and highly enriched for miRNA binding sites, leading to a hypothesis that VGLN-1 may share common targets with miRNAs to regulate gene expression dynamics for development.



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Excessive daytime somnolence is associated with hypoglycemia in adult Latinos with type 2 diabetes mellitus

S13899457.gif

Publication date: August 2017
Source:Sleep Medicine, Volume 36
Author(s): M. Arosemena Coronel, J. Sánchez Armijos, D. Tettamanti Miranda, D. Vásquez Cedeño, R. Mariani Carrera, M. Navarro Chávez, P.R. Castillo
ObjectiveThis study aimed to determine the frequency of sleep disorders in hypoglycemic diabetic patients and possible relationships with scores of sleep disorders and restless legs syndrome in mestizo population in Guayaquil, Ecuador.MethodsA multicenter, cross-sectional study conducted at an outpatient endocrinology clinic in urban and rural Ecuador regions, included 290 participants with type 2 diabetes mellitus with severe hypoglycemic episodes, completed, validated, and culturally adapted sleep questionnaires to assess daytime sleepiness, risk of sleep apnea and restless legs syndrome. Logistic regression analysis was conducted to identify factors associated with severe hypoglycemia.ResultsThe prevalence of EDS was 56.8%, RLS prevalence of 46.2%, and 38.6% prevalence of high risk Berlin score. Multivariate logistic regression indicated hypoglycemic T2DM in the range of 56–75 years old were more likely to have high ESS (p 0.0001).ConclusionA high prevalence of sleep disorders in diabetic Latinos living in Ecuador was evidenced. The presence of somnolence in patients older than 56 years and high HbA1c levels should alert the clinician for the occurrence of hypoglycemic episodes.



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Need for updating safety recommendations on repetitive transcranial magnetic stimulation in stroke patients

A paper entitled “Inhibition versus facilitation of contralesional motor cortices in stroke: Deriving a model to tailor brain stimulation” was published by Sankarasubramanian et al. in Clinical Neurophysiology in March 2017 (Sankarasubramanian et al., 2017). That article reported the results of a study that aimed at investigating whether facilitation of contralesional dorsal premotor cortex by repetitive transcranial magnetic stimulation (rTMS) permitted to improve upper-limb function in severely affected post-stroke patients.

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Reply to “Need for updating safety recommendations on repetitive transcranial magnetic stimulation in stroke patients”

We are pleased to receive the correspondence from Glize et al. in regards to our paper published recently in Clinical Neurophysiology (Sankarasubramanian et al., 2017). We thank the authors for their interest and insightful comments regarding approaches used in our study. In brief, our study investigated the effectiveness of facilitating excitability of the contralesional dorsal premotor cortex (PMd) in patients severely affected by stroke. PMd was targeted using high-frequency (5 Hz) repetitive transcranial magnetic stimulation (rTMS).

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Total disc replacement versus multidisciplinary rehabilitation in patients with chronic low back pain and degenerative discs: Eight-year follow-up of a randomized controlled multicenter trial

Lumbar total disc replacement is a treatment option for selected patients with chronic low back pain that is non-responsive to conservative treatment. The long-term results of disc replacement compared to multidisciplinary rehabilitation have not been reported previously.

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Early evaluation of circulating tumor DNA as marker of therapeutic efficacy in metastatic colorectal cancer patients (PLACOL study)

Purpose. Markers of chemotherapy efficacy in metastatic colorectal cancer (mCRC) are essential for optimization of treatment strategies. We evaluated the applicability of early changes in circulating tumor DNA (ctDNA) as a marker of therapeutic efficacy. <p>Experimental design. This prospective study enrolled consecutive mCRC patients receiving a first- or second-line chemotherapy. CtDNA was assessed in plasma collected before the first (C0), second (C1) and/or third (C2) chemotherapy cycle, using picodroplet-digital PCR assays based either on detection of gene mutation (KRAS, BRAF, TP53) or hypermethylation (WIF1, NPY). Computed tomography scans were centrally assessed using RECIST v1.1 criteria. Multivariate analyses were adjusted on age, gender, ECOG performance status (PS), metastatic synchronicity and treatment line.</p> <p>Results. Eighty-two mCRC patients treated in first (82.9%) or second (17.1%) line chemotherapy were included. Patients with a high (>10ng/mL) versus low (≤0.1ng/mL) ctDNA concentration at C0 had a shorter overall survival (OS) (6.8 versus 33.4 months: adjusted HR=5.64; CI95%[2.5-12.6], P<0.0001). By analyzing the evolution of the ctDNA concentration between C0 and C2 or C1 (C2or1), we classified the patients in two groups (named "good" or "bad ctDNA responders"). In multivariate analysis, patients belonging to the group called "good ctDNA responder" (n=58) versus "bad ctDNA responder" (n=15) had a better objective response rate (P<0.001), and a longer median progression-free survival (8.5 vs 2.4 months: HR=0.19, CI95%[0.09-0.40], P<0.0001) and OS (27.1 vs 11.2 months: HR=0.25, CI95%[0.11-0.57], P<0.001).</p> <p>Conclusion. This study suggests that early change in ctDNA concentration is a marker of therapeutic efficacy in mCRC patients.</p> <p> 



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Präoperative Evaluation erwachsener Patienten vor elektiven, nicht herz-thoraxchirurgischen Eingriffen1*

Anästhesiol Intensivmed Notfallmed Schmerzther
DOI: 10.1055/s-0043-111784

Die präoperative Anamnese und körperliche Untersuchung sind anerkannter Standard bei der Risikoevaluation von Patienten vor elektiven chirurgischen Eingriffen. Ob und unter welchen Umständen technische Voruntersuchungen dazu beitragen können, das perioperative Risiko zu reduzieren, ist bislang nur unzureichend untersucht. Auch besteht unter Anästhesisten, Chirurgen und Internisten vielfach Unsicherheit im perioperativen Umgang mit der Dauermedikation. Die deutschen wissenschaftlichen Fachgesellschaften für Anästhesiologie und Intensivmedizin (DGAI), Chirurgie (DGCH) und Innere Medizin (DGIM) haben daher eine gemeinsame Empfehlung zur präoperativen Evaluation erwachsener Patienten vor elektiven, nicht herz-thoraxchirurgischen Eingriffen erarbeitet und erstmals im Jahr 2010 publiziert. Die vorliegende Fassung ist eine Überarbeitung der Stellungnahme von 2010 unter Einbeziehung der seither publizierten Literatur sowie von aktuellen Leitlinien internationaler Fachgesellschaften. Zunächst werden die allgemeinen Prinzipien der präoperativen Evaluation dargestellt (Teil A). Das Vorgehen bei Patienten mit bekannten oder vermuteten kardiovaskulären Vorerkrankungen wird gesondert betrachtet (Teil B: „Erweiterte kardiale Diagnostik“). Abschließend wird der perioperative Umgang mit der Dauermedikation diskutiert (Teil C). Die vorgestellten Konzepte stellen fachübergreifende Empfehlungen dar, die ein strukturiertes und gemeinsames Vorgehen ermöglichen sollen. Ihr Ziel ist es, durch transparente und verbindliche Absprachen eine hohe Patientenorientierung unter Vermeidung unnötiger Voruntersuchungen zu gewährleisten, präoperative Untersuchungsabläufe zu verkürzen sowie letztlich Kosten zu reduzieren. Die gemeinsamen Empfehlungen von DGAI, DGCH und DGIM spiegeln den gegenwärtigen Kenntnisstand, aber auch die Meinungen von Experten wider, da nicht für jede Fragestellung wissenschaftliche Evidenz besteht. Daher werden eine regelmäßige Überprüfung und Aktualisierung der Empfehlungen erfolgen, sobald gesicherte neue Erkenntnisse vorliegen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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



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Congratulations to SLHS’ student NSSLHA chapter for receiving National Silver Chapter Honors!

Congratulations to SLHS’ student NSSLHA chapter for receiving National Silver Chapter Honors!

NSSHLA logo

 



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Prevalence and type distribution of human papillomavirus in squamous cell carcinoma and intraepithelial neoplasia of the vulva: A systematic review and meta-analysis

Abstract

In this updated systematic review and meta-analysis we estimate the pooled prevalence of human papillomavirus (HPV) DNA and HPV type distribution in squamous cell carcinoma of the vulva (vulvar cancer) and vulvar intraepithelial neoplasia (VIN). PubMed, Embase, and Cochrane Library databases were used to identify studies published between 1990 and 2015 and using a PCR-based or hybrid capture test to evaluate the presence of HPV DNA in vulvar cancer or VIN. Pooled estimates of the HPV prevalence with corresponding 95% confidence intervals (CI) were calculated based on a random effects model. The I2 statistic was used to describe the amount of heterogeneity. In meta-regression analyses potential sources of heterogeneity were evaluated. We identified 92 eligible papers, comprising altogether 5015 cases of vulvar cancer (64 papers) and 2764 cases of VIN (48 papers). The pooled prevalence of HPV in vulvar cancer was 39.7% (95% CI: 35.1–44.4%). Overall, 76.3% (95% CI: 70.1–82.1%) of VIN lesions tested HPV-positive, while the HPV prevalence in new subcategories of VIN, uVIN and dVIN, was 86.2% (95% CI: 73.5–95.5%) and 2.0% (95% CI: 0–10.0%), respectively. Substantial between-study heterogeneity was observed (vulvar cancer: I2 = 88.4%; VIN: I2 = 90.7%) with the largest variation between geographical regions. Among HPV-positive cases the predominant high-risk HPV type was HPV16, followed by HPV33 and HPV18. HPV6 was detected as a single infection in a small subset of VIN and vulvar cancer samples. Thus, HPV vaccination targeting these HPV types may prevent a substantial number of vulvar lesions. This article is protected by copyright. All rights reserved.



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Elucidating the molecular basis of msh2-deficient tumors by combined germline and somatic analysis

Abstract

In a proportion of patients presenting mismatch repair (MMR)-deficient tumors, no germline MMR mutations are identified, the so-called Lynch-like syndrome (LLS). Recently, MMR-deficient tumors have been associated with germline mutations in POLE and MUTYH or double somatic MMR events. Our aim was to elucidate the molecular basis of MSH2-deficient LS-suspected cases using a comprehensive analysis of colorectal cancer (CRC)-associated genes at germline and somatic level.

Fifty-eight probands harboring MSH2-deficient tumors were included. Germline mutational analysis of MSH2 (including EPCAM deletions) and MSH6 was performed. Pathogenicity of MSH2 variants was assessed by RNA analysis and multifactorial likelihood calculations. MSH2 cDNA and methylation of MSH2 and MSH6 promoters were studied. Matched blood and tumor DNA were analyzed using a customized next generation sequencing panel.

Thirty-five individuals were carriers of pathogenic or probably pathogenic variants in MSH2 and EPCAM. Five patients harbored 4 different MSH2 variants of unknown significance (VUS) and one had 2 novel MSH6 promoter VUS. Pathogenicity assessment allowed the reclassification of the 4 MSH2 VUS and 6 probably pathogenic variants as pathogenic mutations, enabling a total of 40 LS diagnostics. Predicted pathogenic germline variants in BUB1, SETD2, FAN1 and MUTYH were identified in 5 cases. Three patients had double somatic hits in MSH2 or MSH6, and another 2 somatic alterations in other MMR genes and/or proof-reading polymerases.

In conclusion, our comprehensive strategy combining germline and somatic mutational status of CRC-associated genes by means of a subexome panel allows the elucidation of up to 86% of MSH2-deficient suspected LS tumors. This article is protected by copyright. All rights reserved.



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The association between individual metabolic syndrome components, primary liver cancer and cirrhosis: a study in the Swedish AMORIS cohort

Abstract

Metabolic syndrome (MetS) is associated with non-alcoholic fatty liver disease, which may progress to cirrhosis, a significant risk factor of hepatocellular carcinoma (HCC), the commonest malignant primary liver cancer (PLC). We investigated the association between the individual components of MetS (lipids, apolipoproteins, raised glucose, diabetes and obesity), PLC and cirrhosis.

A total of 509,436 participants from the Swedish AMORIS cohort, recruited between January 1985 to December 1996 (end-date December 2011), aged ≥20 with baseline triglycerides (TG), total cholesterol (TC), glucose and liver enzymes were included. Those with baseline benign liver tumours, PLC or cirrhosis were excluded. Multivariate Cox regression, adjusted for age, gender, socio-economic status, liver disease (excluding cirrhosis) and MetS factors were used to estimate the association with PLC and cirrhosis.

There were 766 PLC and 2,775 cirrhosis cases over 13-years. Raised TG, low TC, raised glucose, diabetes and low HDL were associated with an increased risk of developing PLC and cirrhosis. ApoB/ApoA-I ratio were also associated with PLC, whilst low LDL, raised TG/HDL, low ApoA-I and low ApoB were associated with cirrhosis. Obesity was significantly associated with PLC but not cirrhosis. Raised TG, low TC, raised glucose and diabetes showed stronger associations with PLC in participants with cirrhosis but many participants developed PLC without cirrhosis.

Individual components of MetS (lipids, apolipoproteins, raised glucose, diabetes and obesity) were associated with an increased risk of developing PLC or cirrhosis. MetS components were more strongly associated with PLC with preceding cirrhosis history but many participants developed PLC without cirrhosis. This article is protected by copyright. All rights reserved.



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Cetuximab or Nimotuzumab plus Intensity-modulated Radiotherapy Versus Cisplatin plus Intensity-modulated Radiotherapy for Stage II-IVb Nasopharyngeal Carcinoma

Abstract

To compare intensity-modulated radiotherapy (IMRT) with cisplatin (CDDP) versus cetuximab (CTX) and nimotuzumab (NTZ) for Stage II-IVb Nasopharyngeal Carcinoma (NPC). A total of 1,837 patients with stage II - IVb NPC who received IMRT plus CTX or NTZ, or CDDP between January 2009 and December 2013 were included in the current analysis. Using propensity scores to adjust for potential prognostic factors, a well-balanced cohort of 715 patients was created by matching each patient who underwent IMRT plus concomitant NTZ/CTX with four patients who underwent IMRT plus concomitant CDDP (1:4). Efficacy and safety were compared between the CTX/NTZ and CDDP groups of this well-balanced cohort. Furthermore, we conducted multivariate analysis and subgroup analysis based on all the 1,837 eligible cases. There was no significant difference between CTX/NTZ group and CDDP group in terms of DFS (3-year, 86.7% vs. 86.2%, P>0.05), LRRFS (96.2% vs. 96.3%, P>0.05), DMFS (91.1% vs. 92.3%, P>0.05), and OS (91.7% vs. 91.9%, P>0.05). Subgroup analysis demonstrated a significant interaction effect between patients with IMRT plus CTX/NTZ and N3 node stage on LRRFS with the highest risk of loco-regional relapse (HR 8.85, P=0.001). Significantly increased hematologic toxicities, gastrointestinal reactions were observed in the CDDP group (P<0.05). 3.4-4.7% patients experienced severe hematologic toxicities during the treatment with concomitant CTX and NTZ. Increased rate of CTX related-skin reaction and mucositis was observed in the CTX group. CTX/NTZ used concurrently with IMRT may be comparable to those of the standard CDDP-IMRT combination for maximizing survival for patients with stage II-IVb NPC. This article is protected by copyright. All rights reserved.



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uPA/uPAR system activation drives a glycolytic phenotype in melanoma cells

Abstract

In the present manuscript we show the involvement of the uPA/uPAR system in the regulation of aerobic glycolysis of melanoma cells. uPAR over-expression in human melanoma cells controls an invasive and glycolytic phenotype in normoxic conditions. uPAR down-regulation by siRNA or its uncoupling from integrins, and hence from integrin-linked tyrosine kinase receptors (IL-TKRs), by an antagonist peptide induced a striking inhibition of the PI3K/AKT/mTOR/HIF1α pathway, resulting into impairment of glucose uptake, decrease of several glycolytic enzymes and of PKM2, a checkpoint that controls metabolism of cancer cells. Further, binding of uPA to uPAR regulates expression of molecules that govern cell invasion, including extracellular matrix metallo-proteinases inducer (EMPPRIN) and enolase, a glycolytyc enzyme that also serves as a plasminogen receptor, thus providing a common denominator between tumor metabolism and phenotypic invasive features. Such effects depend on the α5β1-integrin-mediated uPAR connection with EGFR in melanoma cells with engagement of the PI3K-mTOR-HIFα pathway. HIF-1α trans-activates genes whose products mediate tumor invasion and glycolysis, thus providing the common denominator between melanoma metabolism and its invasive features. These findings unveil a unrecognized interaction between the invasion-related uPAR and IL-TKRs in the control of glycolysis and disclose a new pharmacological target (i.e. uPAR/IL-TKRs axis) for the therapy of melanoma. This article is protected by copyright. All rights reserved.



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The Role of Sonoelastography in Breast Lesions

There is a large body of published material that supports the use of elastography, both strain and shear wave, for characterization of breast lesions. To a lesser extent elastography can be used in the detection of breast abnormalities. This article reviews the principles of elastography regarding breast imaging, reviews the techniques to perform both strain and shear wave elastography, reviews the literature and discuss how elastography can be used to improve the characterization of breast lesions to allow for decrease in the number of short-term follow-up examinations and benign biopsies.

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Predictive validity of the GOSLON Yardstick index in patients with unilateral cleft lip and palate: A systematic review

by Cindy Buj-Acosta, Vanessa Paredes-Gallardo, José María Montiel-Company, Alberto Albaladejo, Carlos Bellot-Arcís

Among the various indices developed for measuring the results of treatment in patients born with unilateral cleft lip and palate (UCLP), the GOSLON Yardstick index is the most widely used to assess the efficacy of treatment and treatment outcomes, which in UCLP cases are closely linked to jaw growth. The aim of this study was to conduct a systematic review to validate the predictability of growth using the GOSLON Yardstick in patients born with UCLP. A systematic literature review was conducted in four Internet databases: Medline, Cochrane Library, Scopus and Embase, complemented by a manual search and a further search in the databases of the leading journals that focus on this topic. An electronic search was also conducted among grey literature. The search identified a total of 131 articles. Duplicated articles were excluded and after reading titles and abstracts, any articles not related to the research objective were excluded, leaving a total of 21 texts. After reading the complete text, only three articles fulfilled the inclusion criteria. The results showed a predictive validity of between 42.2% and 64.7%, which points to a lack of evidence in the literature for the predictive validity of the GOSLON Yardstick index used in children born with UCLP.

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Evaluation of the safety and efficacy of a novel product for the removal of impacted human cerumen

Abstract

Background

This open-label study evaluated the safety and efficacy of a novel product for the removal of impacted cerumen in adult patients.

Methods

This was a prospective, single-center, single-arm, self-controlled clinical trial conducted in a community general practice setting. The novel product contains glycolic acid in an otologically-acceptable buffer containing sodium bicarbonate and glycerin and other buffering agents. The product was instilled into the ear canal prior to irrigation with warm water. Severity of cerumen impaction was graded using a 5-point scale. Improvement in tympanic membrane visualization was assessed after instillation and irrigation.

Results

A majority (83%, 25/30) of ears showed improvement with one application: with 53% (16/30) totally dissolved and gained 100% TM visualization. Total dissolution was observed in 80% (24/30) of the study ears per the intent-to-treat analysis and 86% (24/28) if irrigation instructions were followed. Most of the ears/participants that had cerumen blockage symptoms experienced significant improvement with the application. Feelings of fullness disappeared in 92% (11/12) of the affected ears; ears itching, 91% (10/11); water trapping or cracking, 78%, and decreased hearing disappeared in 71% (10/14). All (100%, 18) of the participants who completed the application satisfaction assessment were satisfied with the application process in terms of time needed and the overall rinse procedure. Only one mild adverse event (ear pruritis) occurred that was related to application.

Conclusions

The tested cerumen removal product was effective and safe for removing moderate to severe blockage in patients with impacted cerumen. Procedure satisfaction for the product was high.

Trial Registration

This trial is registered on http://ift.tt/PmpYKN. The registration number is NCT02829294. The trial was retrospectively registered on July 8, 2016.



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The 5D Framework: A Clinical Primer for Fecal Microbiota Transplantation to Treat Clostridium difficile infection



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Pancreatic pseudocyst localized in the gastric wall after EUS-guided fine-needle aspiration of type 1 autoimmune pancreatitis



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Thoracic Outlet Syndrome after the Nuss Procedure for Pectus Excavatum―Is It a Rare Complication?

The present study aims to elucidate the frequency of thoracic outlet syndrome after the Nuss procedure for pectus excavatum and the conditions in which thoracic outlet syndrome is likely to develop.

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Reliability and validity of Mamma Balance®: Novel software to assess the symmetry of the nipple-areola-complex position

It is important to achieve as much symmetry in the breasts as possible during breast reconstruction. The nipple-areola complex (NAC) position is an important component of a breast appearance, and it critically affects the aesthetic outcome of surgery. Mamma Balance® (MB) (Medic Engineering K.K, ver. 1.0.3) can automatically calculate and assess the degree of the NAC position’s symmetry with one continuous variable. The purpose of this study was to evaluate the reliability and validity of this software to assess the NAC’s symmetry.

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An objective assessment of Botulinum toxin type A injection in the treatment of post facial palsy synkinesis and hyperkinesis using the Synkinesis Assessment Questionnaire (SAQ)

The aim of this study is to provide reliable and valid evidence that Botulinum toxin (BTX-A) is a successful treatment for facial synkinesis in facial palsy using the synkinesis assessment questionnaire tool (SAQ). 51 patients completed questionnaires pre and post BTX-A treatment over 103 cycles of treatment. Each patient was individually assessed and then treated according to their presenting symptoms with a dosage in each injection site of between 0.5 to 5 U of BTX-A. A two-tailed, paired samples t-test was used to compare the scores for each question before and after treatment.

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Impact of adjuvant anti-estrogen therapies (tamoxifen and aromatase inhibitors) on perioperative outcomes of breast reconstruction

Hormone (anti-estrogen) therapy (HT) plays a major role in hormone receptor-positive breast cancer management. The latest guidelines propose to extend adjuvant treatment duration from 5 to 10 years. The link between HT and thromboembolic or microvascular complications during breast reconstruction has been investigated. However, while estrogens play a crucial role in skin healing, no study has assessed the impact of tamoxifen or aromatase inhibitors on other postoperative complications, including wound healing complications.

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Refining the Extended Circumflex Scapular Flap for Neck Burn Reconstruction: A 30-Year Experience

Neck burn sequelae remain a major challenge for the reconstructive surgeon. To achieve satisfactory functional and aesthetic results, the anterior neck aesthetic unit must be covered as a single unit. In cases where free flaps are required, harvesting a flap of sufficient size can cause major donor site morbidity. In 1994, we published our favorable 6-year experience reconstructing neck burn sequelae with an Extended Circumflex Scapular Flap (ECSF). We have since made several modifications to the technique that improve long-term functional and aesthetic results.

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Donor Site Morbidity in DIEP Free Flap Breast Reconstructions: A Comparison of Unilateral, Bilateral, and Bipedicled Surgical Procedure Types

The use of abdominal tissue in post-mastectomy autologous breast reconstruction is a popular choice among reconstructive surgeons. This is the first study to evaluate donor complications comparing unilateral, bilateral and bipedicled DIEP breast reconstructions.

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The Indian Nose: An anthropometric analysis

Anthropometric measurements of nose are of great importance in planning aesthetic nasal surgery. Abundant literature is available on anthropometric analysis of Caucasians and Orientals, without similar references on Indian nose and its regional differences. Thus, we conducted a descriptive cross sectional epidemiological study of one thousand volunteers, with equal number of subjects derived from five geographic groups namely North; Central; West; South; and Himalayan region to determine differences in nasal morphology of Indian population and amongst its various regions.

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Incidence and Risk Factors for Venous Thromboembolism in Bilateral Breast Reduction Surgery: An Analysis of the National Surgical Quality Improvement Program

Risk of venous thromboembolism (VTE) in patients undergoing bilateral breast reduction surgery remains unknown. Aim of this study was to determine VTE incidence and risk factors in this patient cohort.

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Letter to the editor



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The effect of training level on complications after free flap surgery of the head and neck

Analyze postoperative complications after free flap surgery based on PGY training level.

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Letter to the editor



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Antagonistic Effect of Laver, Pyropia yezonensis and P. haitanensis , on Subchronic Lead Poisoning in Rats

Abstract

Lead, one of the most harmful heavy metals, can cause various hazardous effects on living organisms. This study was undertaken to evaluate the antagonistic and protective effects of two economically important laver species, Pyropia yezoensis and P. haitanensis, against subchronic lead poisoning in rats by a 30-day feeding test. Sixty-four healthy Wistar rats were randomly divided into eight groups with eight rats (4♂ + 4♀) per group, among which, one group was served as the control, the others were respectively treated with lead acetate (5 mg/kg b w), and a combination of lead acetate and P. yezoensis or P. haitanensis at different dosages. Weight gain of rats was observed and recorded. Changes in antioxidant indexes, and liver and renal function markers were determined to evaluate the antagonistic effect. Lead content in rats was determined to investigate lead excretion effect of laver. The results showed that exposure to lead caused lead accumulation in kidney and liver, thus leading to significant oxidative damage and impaired liver and renal function compared to the control group. The co-treatment of laver slightly increased body weight compared to the lead-treated group. The co-administration of laver restored liver and renal function of rats by preventing the increment in the activities of alanine transaminase (ALT), alkaline phosphatase (ALP), and aspartate transaminase (AST), and the levels of blood urea nitrogen (BUN) and creatinine (Cr). The increasing of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) activities, and lowering of the enhanced malondialdehyde (MDA) contents of rats were observed in the laver co-treated groups, which indicated that laver enhanced the antioxidative capacity of rats. The laver also enhanced lead content in feces and reduced it in liver and kidney. The results indicated that P. yezoensis and P. haitanensis could maintain or promote the normal physiological and biochemical function of lead-induced subchronic poisoning of rats, probably owing to their enhancements of antioxidant capacity and lead excretion.



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Dietary Iodine Affected the GSH-Px to Regulate the Thyroid Hormones in Thyroid Gland of Rex Rabbits

Abstract

Iodine (I) is an essential trace element that can influence animal health and productivity. In this study, we investigated the effects of dietary iodine on the antioxidant indices of organ (liver and thyroid gland) and messenger RNA (mRNA) expression of glutathione peroxidase (GSH-Px) in Rex rabbits. A total of 120 4-month-old Rex rabbits (2235.4 ± 13.04 g BW) were divided into four equal groups, and their diets were supplemented with iodine (0, 0.2, 2, or 4 mg/kg dry matter (DM)). The iodine concentration in basal diet (control group) was 0.36 mg/kg DM. In most of measured parameters, supplemental iodine exerted no significant effect. Growth and slaughter performance and organ weight were not influenced significantly by iodine supplementation. Serum T3 was significantly lower in 2-mg I group than in 0.2 and 4-mg I groups (P < 0.05). Superoxide dismutase (SOD), GSH-Px, methane dicarboxylic aldehyde (MDA), and thyroperoxidase (TPO) in the serum and liver were not influenced (P > 0.05). Conversely, serum catalase (CAT) was significantly reduced (P < 0.05). In the thyroid, GSH-Px was higher in the 2-mg I group than in the 0.2- and 4-mg I groups (P < 0.05). RT-PCR results showed that the mRNA expression level of GSH-Px in the liver was not significantly influenced (P > 0.05). In the thyroid gland, the mRNA expression level of GSH-Px was higher in the 2-mg I group than in the 4-mg I group (P < 0.05), which agreed with the activity of GSH-Px. In conclusion, iodine supplementation exerted no effect on the performance and antioxidant capacity of the body, but dietary iodine influenced serum T3 or GSH-Px in the thyroid gland. Thus, on the basis of serum T3 and GSH-Px levels in the thyroid gland, we hypothesized that GSH-Px secretion was increased by adding dietary iodine in the thyroid, which may inhibit the H2O2 generation and further influence the thyroid hormone synthesis.



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Phosphaturic mesenchymal tumor of the nasal cavity and paranasal sinuses: A clinical curiosity presenting a diagnostic challenge

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Publication date: Available online 1 June 2017
Source:Auris Nasus Larynx
Author(s): Shubhada V. Kane, Aanchal Kakkar, Nikita Oza, Epari Sridhar, Prathamesh S. Pai
Phosphaturic mesenchymal tumor (PMT) is a rare mesenchymal neoplasm associated with tumor-induced osteomalacia (TIO) and elevated serum FGF-23. Common in extremities, PMT rarely occurs in sinonasal region. We report a series of sinonasal PMT diagnosed at our institute over a 6-year period.Six cases of sinonasal PMT were identified during this period, of which five presented with features of TIO. Median age of patients was 45.5 years. All six tumors were composed of stellate to spindled cells, with prominent staghorn vasculature in four cases. Typical smudgy matrix was seen in all cases, but only focally; grungy calcification was absent.Accurate diagnosis of PMTs is imperative, as complete excision leads to dramatic resolution of TIO symptoms. Lack of knowledge of this entity prevents clinicians from ordering relevant investigations. Absence of specific morphological features, like grungy calcification, and presentation at atypical locations makes the diagnosis challenging. Awareness of this entity is essential in order to suspect PMT in patients presenting with a soft tissue mass and features of TIO, however unusual the location may be.



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Is sedation administration strategy and analysis during drug-induced sedation endoscopy objective and systematic?



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Grant funding for rural EMS-Hospital mobile telemedicine

RURAL AMERICA — GD is pleased to share this important information with you. In short, the US Department of Agriculture (USDA) Distance Learning and Telemedicine Grant Program (DLT) is designed to provide access to healthcare resources that benefit rural communities. Of specific interest, this year's program has prioritized $1.6 million dollars specifically for Mobile Telemedicine (communications upgrades ...

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The Art and Science of Lifelong Singing

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Publication date: Available online 1 June 2017
Source:Journal of Voice
Author(s): Brenda Smith




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Toward Defining “Vocal Constriction”: Practitioner Perspectives

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Publication date: Available online 2 June 2017
Source:Journal of Voice
Author(s): Belinda Lemon-McMahon, Diane Hughes
ObjectivesThis research investigated the terminology used in relation to constriction of the singing voice from a range of practitioner perspectives. It focused on the locality, causes, consequences, management, trends, identification, and vocabulary of constriction. The research aimed to develop a holistic understanding of the term “vocal constriction” from participant experiences and perceptions (N = 10).MethodData collection occurred through in-depth, semi-structured interviews with a range of voice care professionals. Participants included three professional groups: (1) Ear, Nose, and Throat medical specialists or laryngologists, (2) speech pathologists or speech therapists, and (3) singing teachers. Purposive sampling was used to ensure that the participants from groups 1 and 2 had extensive experience with singers in their practice. The singing teachers were experienced in either classical or contemporary styles, or both.ResultsParticipant responses highlighted a discrepancy in preferred terminology, with “constriction” being less favored overall. Several anatomical locations were identified including postural, supraglottic (anteroposterior and false fold), articulatory, and in the intrinsic and extrinsic laryngeal musculature; psychological issues were also identified. Primary causes, secondary causes, and influencing factors were identified. Inefficient technique and poor posture or alignment were considered primary causes; similarly, emotion and anxiety or stress were identified as influencing factors by the majority of participants. There was less uniformity in responses regarding other causes.ConclusionsThe major findings of this research are the respective participant group distinctions, an uncertainty regarding anteroposterior constriction, and that the location and effects of constriction are individual to the singer and must be considered contextually. A definition is offered, and areas for further research are identified.



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A novel mutation in the MYO7A gene is associated with Usher syndrome type 1 in a Chinese family

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Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Xiaoguang He, Qi Peng, Siping Li, Pengyuan Zhu, Chunqiu Wu, Chunbao Rao, Jingqi Lin, Xiaomei Lu
ObjectivesWe aimed to investigate the genetic causes of hearing loss in a Chinese proband with autosomal recessive congenital deafness.MethodsThe targeted capture of 159 known deafness genes and next-generation sequencing were performed to study the genetic causes of hearing loss in the Chinese family. Sanger sequencing was employed to verify the variant mutations in members of this family.ResultsThe proband harbored two mutations in the MYO7A gene in the form of compound heterozygosity. She was found to be heterozygous for a novel insertion mutation c.3847_3848 ins TCTG (p.N1285LfsX24) in exon 30 and for the known mutation c.2239_2240delAG (p.R747S fsX16)in exon 19. The novel mutation was absent in the 1000 Genomes Project. These variants were carried in the heterozygous state by the parents and were therefore co-segregated with the genetic disease. Clinical re-assessment, including detailed audiologic and ocular examinations, revealed congenital deafness and retinitis pigmentosa in the proband. Collectively, the combination of audiometric, ophthalmologic and genetic examinations successfully confirmed the phenotype of Usher syndrome type 1 (USH1).ConclusionThis study demonstrates that the novel mutation c.3847_3848insTCTG (p. N1285LfsX24) in compound heterozygosity with c.2239_2240delAG in the MYO7A gene is the main cause of USH1 in the proband. Our study expands the mutational spectrum of MYO7A and provides a foundation for further investigations elucidating the MYO7A-related mechanisms of USH1.



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Utility of intraoperative and postoperative radiographs in pediatric cochlear implant surgery

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Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Samantha Anne, Jose Miguel Juarez, Amber Shaffer, David Eleff, Dennis Kitsko, Sarah Sydlowski, Erika Woodson, David Chi
ObjectiveRoutine plain film radiographs are often obtained to confirm proper placement of electrode after pediatric cochlear implant surgery. Objective is to evaluate necessity of routine radiographs in pediatric cochlear implant cases.Study designRetrospective review.SettingTwo tertiary care academic centers.Subjects and methodsReview of all children that underwent cochlear implantation from January 2003 thru June 2015. Exclusions include patients without intraoperative evoked compound action potential (ECAP) data or radiographs and patients undergoing revision surgeries.Results235 pediatric patients underwent 371 cochlear implants. ECAP measurements were not available in two cases and were excluded from study. Radiographs were obtained in 35/369 cases due to intraoperative concern and four had abnormal findings. All four cases underwent change in management. One other patient had an x-ray because of difficult insertion and abnormal ECAP. Radiograph was normal; however, incision was opened and electrodes inserted further. Overall, 5/369 cases had changes in management intraoperatively. In all five cases, abnormalities were suspected by clinician judgment or abnormal ECAP measurements. Routine radiographs were completed in 349/369 cases and one was abnormal. This patient had known partial insertion due to cochlear fibrosis from meningitis and abnormal radiograph did not result in change in management.ConclusionClinician suspicion and/or abnormal ECAP prompted suspicion for abnormal electrode placement prior to evaluation with radiograph in all cases in which change in management occurred. Intraoperative radiographs may be valuable in setting of clinical suspicion. Routine radiographs do not result in change in management and are, therefore, unnecessary.



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Is sedation administration strategy and analysis during drug-induced sedation endoscopy objective and systematic?



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The Art and Science of Lifelong Singing

Publication date: Available online 1 June 2017
Source:Journal of Voice
Author(s): Brenda Smith




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Toward Defining “Vocal Constriction”: Practitioner Perspectives

Publication date: Available online 2 June 2017
Source:Journal of Voice
Author(s): Belinda Lemon-McMahon, Diane Hughes
ObjectivesThis research investigated the terminology used in relation to constriction of the singing voice from a range of practitioner perspectives. It focused on the locality, causes, consequences, management, trends, identification, and vocabulary of constriction. The research aimed to develop a holistic understanding of the term “vocal constriction” from participant experiences and perceptions (N = 10).MethodData collection occurred through in-depth, semi-structured interviews with a range of voice care professionals. Participants included three professional groups: (1) Ear, Nose, and Throat medical specialists or laryngologists, (2) speech pathologists or speech therapists, and (3) singing teachers. Purposive sampling was used to ensure that the participants from groups 1 and 2 had extensive experience with singers in their practice. The singing teachers were experienced in either classical or contemporary styles, or both.ResultsParticipant responses highlighted a discrepancy in preferred terminology, with “constriction” being less favored overall. Several anatomical locations were identified including postural, supraglottic (anteroposterior and false fold), articulatory, and in the intrinsic and extrinsic laryngeal musculature; psychological issues were also identified. Primary causes, secondary causes, and influencing factors were identified. Inefficient technique and poor posture or alignment were considered primary causes; similarly, emotion and anxiety or stress were identified as influencing factors by the majority of participants. There was less uniformity in responses regarding other causes.ConclusionsThe major findings of this research are the respective participant group distinctions, an uncertainty regarding anteroposterior constriction, and that the location and effects of constriction are individual to the singer and must be considered contextually. A definition is offered, and areas for further research are identified.



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Totally laparoscopic right colectomy versus laparoscopically assisted right colectomy: a propensity score analysis

Abstract

Introduction

The aim of this study is to compare short- and long-term outcomes of totally laparoscopic right colectomy (TLRC) and laparoscopically assisted right colectomy (LARC), using propensity score matching (PSM) analysis.

Materials and methods

A retrospective analysis of patients who underwent laparoscopic right colectomy between January 2006 and July 2016 was conducted. PSM analysis was performed to overcome patient selection bias between the two surgical techniques.

Results

A total of 116 patients were reviewed. After PSM, 54 patients for the TLRC group and 54 patients for the LARC group were compared. TLRC was associated with shorter post-operative hospital stay (6.81 vs. 4.79 days; p < 0.001) with no difference in 30-day morbidity and mortality. A lower incidence of long-term incisional hernia was observed in the TLRC group (1.9 vs. 21.2%; p = 0.002). TLRC showed better oncological accuracy as demonstrated by a greater number of lymph node achieved (19.21 vs. 15.19; p = 0.001) and higher vascular pedicle length (131.81 vs. 114.76 mm; p = 0.014).

Discussion

TLRC is a safe and feasible technique with similar results of LARC in terms of short-term morbidity and mortality. Major advantages related to TLRC are represented by shorter post-operative hospital stay and lower incidence of long-term incisional hernias. Further investigations are needed to assess the oncological outcomes for this technique.



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Totally laparoscopic right colectomy versus laparoscopically assisted right colectomy: a propensity score analysis

Abstract

Introduction

The aim of this study is to compare short- and long-term outcomes of totally laparoscopic right colectomy (TLRC) and laparoscopically assisted right colectomy (LARC), using propensity score matching (PSM) analysis.

Materials and methods

A retrospective analysis of patients who underwent laparoscopic right colectomy between January 2006 and July 2016 was conducted. PSM analysis was performed to overcome patient selection bias between the two surgical techniques.

Results

A total of 116 patients were reviewed. After PSM, 54 patients for the TLRC group and 54 patients for the LARC group were compared. TLRC was associated with shorter post-operative hospital stay (6.81 vs. 4.79 days; p < 0.001) with no difference in 30-day morbidity and mortality. A lower incidence of long-term incisional hernia was observed in the TLRC group (1.9 vs. 21.2%; p = 0.002). TLRC showed better oncological accuracy as demonstrated by a greater number of lymph node achieved (19.21 vs. 15.19; p = 0.001) and higher vascular pedicle length (131.81 vs. 114.76 mm; p = 0.014).

Discussion

TLRC is a safe and feasible technique with similar results of LARC in terms of short-term morbidity and mortality. Major advantages related to TLRC are represented by shorter post-operative hospital stay and lower incidence of long-term incisional hernias. Further investigations are needed to assess the oncological outcomes for this technique.



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A simplified pressure adjustment clinical pathway for programmable valves in NPH patients

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Publication date: August 2017
Source:Clinical Neurology and Neurosurgery, Volume 159
Author(s): Tracy S. Ma, Nikhil Sharma, M. Sean Grady
ObjectiveThe goal of this study is to provide a clinical pathway for shunt valve adjustment in the treatment of normal pressure hydrocephalus (NPH) patients.Patient and methodsThe authors conducted a single-center retrospective study of 102 patients (mean age 74 years, 66 men, 36 women) diagnosed with NPH. In all cases, a Medtronic Strata Adjustable Pressure valve set initially at 1.5 was implanted. Outcome was based on the clinical status of the patient at the last contact point with the senior author. Patients were adjusted with reductions or increases of 0.5 per follow-up visit to achieve the best clinical outcome and avoid complications. Complications were categorized as infection, shunt malfunction, subdural hygroma/hematoma, or any adverse event able to be attributed to a change in shunt setting or surgical procedure.ResultsOf the 102 patients, 60% had the triad of clinical symptoms, 5% had gait dysfunction only, 2% had dementia only, 4% had urine incontinence and gait dysfunction, 1% had urine incontinence and dementia, and 28% had gait dysfunction and dementia. Over a mean clinical follow-up of 19 months, 71 patients had improvement or resolution of NPH symptoms at the last point of contact with the senior author. Of the 71 patients, 24% improved in all 3 symptoms, 8% improved in urine incontinence only, 17% improved in gait dysfunction only, 15% improved in dementia only, 15% improved in urine incontinence and gait dysfunction only, 4% improved in urine incontinence and dementia only, and 15% improved in gait dysfunction and dementia only. Valve pressure adjustment was required at least once in 85 patients (mean number of 1.68 adjustments, 7 maximum); 10% had 0.5 as the final setting, 47% had 1.0 as the final setting, 36% had 1.5 as the final setting, 7% had 2.0 as the final setting, and 0% had 2.5 as the final setting. There were 41 (40%) complications overall: 28 subdural hygromas/hematomas, of which 5 required surgical evacuation; 9 distal obstructions requiring surgical revision; 4 seizures; 2 infections; 1 exposed shunt tubing; 1 intraparenchymal hematoma of unknown etiology.ConclusionStandardization of post-operative care for patients with NPH is possible. The present manuscript offers a safe and effective pathway for treatment of NPH patients with the Strata Adjustable Pressure Valve.



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The impact of white matter lesions on the cognitive outcome of subthalamic nucleus deep brain stimulation in Parkinson’s disease

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Publication date: August 2017
Source:Clinical Neurology and Neurosurgery, Volume 159
Author(s): J. Blume, M. Lange, E. Rothenfusser, C. Doenitz, U. Bogdahn, A. Brawanski, J. Schlaier
ObjectivesWhite Matter lesions (WML) are a risk factor for cognitive impairment in Parkinson’s disease. There is no clear evidence of reduced general cognitive function after DBS. However, a subgroup of patients develops dementia rapidly after DBS despite careful patient selection processes. The aim of this study was to evaluate the load of WML as a possible risk factor for cognitive decline following STN DBS.Patients and methods40 PD-patients receiving bilateral STN-DBS were followed at least three years after surgery to detect dementia. All patients underwent comprehensive neuropsychological assessment and MRI before surgery. The extent of WML was assessed using an automated approach. WML volume was correlated to the onset of dementia and the decline of a cognitive composite score retrospectively.ResultsPatients with a rapid onset of dementia within one, respective three following DBS showed significant higher WML volumes compared to cognitive normal and MCI patients (55.8cm3±18.836 vs. 9.3cm3±12.2; p=0.002). The same significant association was found in a multivariable model, including the covariables age, gender and PD disease duration (p=0.01). WML volume was associated to the rate of decline in cognitive composite score within three years after DBS surgery (p=0.006; R2=0.40) after correction for age.ConclusionsDamaged white matter may lead to a reduced compensation of disconnections in cognitive circuits caused by the implantation of the DBS electrodes or by chronic stimulation.The role of WML as a prognostic factor for the cognitive outcome after DBS may be underestimated. The WML burden should be taken seriously in preoperative risk stratification.



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Use of HT Associated with Higher Risk of Hearing Loss Among Women

Women who take postmenopausal hormone therapy (HT) to alleviate symptoms of menopause may be subject to an increased risk of hearing loss, according to a new study (Menopause. 2017 May 8 [Epub ahead of print]). Researchers at Brigham and Women's Hospital in Boston, MA, analyzed the data of 80,972 women aged 27 to 44 in the Nurses' Health Study II collected over 22 years (1991-2013). Among menopausal women, oral HT, whether it's estrogen therapy or estrogen plus progestogen therapy, was associated with higher risk of hearing loss, and longer duration of use was associated with higher risk as well. The adjusted risk of hearing loss among women who used oral HT was 1.15 (95% CI 1.06, 1.24) for five to 9.9 years and 1.21 (95% CI 1.07, 1.37) for more than 10 years, compared with women who never used HT.

 

Heather Currie, MB BS, FRCOG, DRCOG, MRCGP, chairman of the British Menopause Society, warned people not to jump to conclusions immediately based on this study. "This type of trial relies on women's self-reported hearing loss, and does not prove that [HT] causes this — only that there may be an association," Dr. Currie said in an email to Medscape. "This should not terrify women and, as we have always said, the decision about [HT] should be an individual choice based on the balance of benefits and risks." ​

Published: 6/2/2017 9:13:00 AM


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Consumers Can Now Buy Earwax MD Through Amazon

Earwax MD.jpgEosera (http://eosera.com/) is launching their over-the-counter earwax removal product Earwax MD with Amazon Exclusives. The popular online retailer will be the first to carry this product besides the company's website. Elyse Dickerson, founder and CEO of Eosera, said they decided to go with Amazon.com because they reach all consumers. "Our earwax solution will help people worldwide, and Amazon is the first step," Dickerson said. "By bringing this innovation to market, our goal is to improve the lives of both doctors and patients by saving people time and money."​

Amazon Exclusives features new and innovative items, including products showcased on "Shark Tank." Earwax MD, a topical drop that dissolves earwax buildup recently introduced to the market, was found in a clinical evaluation by Eosera to fully clear the cerumen impaction in 86 percent of the test subjects in 15 to 30 minutes. This product was first reported in The Hearing Journal in the March issue (The Hearing Journal. 2017;70[3]:58; http://bit.ly/2rowNF1).

Published: 5/26/2017 9:14:00 AM


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Fascial reinforcement fixing the bronchi to the heart: its anatomy and clinical significance

Abstract

Purpose

The details of the mediastinal fascia have been scarcely described and the bronchopericardial membrane is the only known structure that is present between the bronchi and the pericardium. However, the anatomical description of this structure is unclear. This study aimed to investigate the fascial structures between the bronchi and the pericardium based on surgical findings.

Methods

The connective tissues in the mid-mediastinum were observed surgically when lung lobectomy, including mediastinal lymph node dissection for lung cancer, was performed at our institute from April 2011 to March 2016.

Results

In total, 96 lobectomies were performed in 94 patients. A firm fibrous structure connecting the tracheobronchus and the fibrous pericardium was observed. It fixes the central bronchi to the pericardium and is composed of three parts. The largest part exists in front of the carina, its appearance is membranous, and runs behind the pulmonary artery. The other parts run over the right pulmonary artery and diverge at its superior trunk. The location at which all these structures fuse to the pericardium is the venous part of the hilum cordis (VHC).

Conclusions

The results showed that connections of the dense fibrous tissues existed between the tracheobronchus and VHC. The structure not only works as a ligament that fixes the bronchi to the mid-mediastinum, but also divides the mid-mediastinum into two compartments: the Baréty and subcarinal spaces. The anatomy of the structure observed in this study differs from the previous description of the bronchopericardial membrane.



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Fascial reinforcement fixing the bronchi to the heart: its anatomy and clinical significance

Abstract

Purpose

The details of the mediastinal fascia have been scarcely described and the bronchopericardial membrane is the only known structure that is present between the bronchi and the pericardium. However, the anatomical description of this structure is unclear. This study aimed to investigate the fascial structures between the bronchi and the pericardium based on surgical findings.

Methods

The connective tissues in the mid-mediastinum were observed surgically when lung lobectomy, including mediastinal lymph node dissection for lung cancer, was performed at our institute from April 2011 to March 2016.

Results

In total, 96 lobectomies were performed in 94 patients. A firm fibrous structure connecting the tracheobronchus and the fibrous pericardium was observed. It fixes the central bronchi to the pericardium and is composed of three parts. The largest part exists in front of the carina, its appearance is membranous, and runs behind the pulmonary artery. The other parts run over the right pulmonary artery and diverge at its superior trunk. The location at which all these structures fuse to the pericardium is the venous part of the hilum cordis (VHC).

Conclusions

The results showed that connections of the dense fibrous tissues existed between the tracheobronchus and VHC. The structure not only works as a ligament that fixes the bronchi to the mid-mediastinum, but also divides the mid-mediastinum into two compartments: the Baréty and subcarinal spaces. The anatomy of the structure observed in this study differs from the previous description of the bronchopericardial membrane.



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Vitamin D Supplements May Raise Sex Hormone Levels in Men

A small study suggests that vitamin D supplementation in men with normal testosterone levels is followed by increases in estradiol and reductions in sex-steroid-hormone-binding globulin.
Medscape Medical News

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Doctors Perform First Robot-Assisted Surgery Inside Eye

A team of surgeons has successfully performed what they say is the world’s first robotic-assisted surgery inside the human eye.
Reuters Health Information

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Tumor infiltrating lymphocytes in acral lentiginous melanoma: a study of a large cohort of cases from Latin America

Abstract

Purpose

Acral lentiginous melanoma (ALM) is a poor prognosis subtype and is the most prevalent in non-Caucasian populations. The presence of tumor infiltrating lymphocytes (TILs) has been associated with poor prognosis in melanoma. A large cohort of ALM cases was studied to determine status of TIL and its association with outcome.

Methods

All patients with cutaneous melanoma presenting from 2005 to 2012 at Instituto Nacional de Enfermedades Neoplasicas in Peru were retrospectively identified. Clinicopathological information was obtained from the medical charts. A prospective evaluation of TIL was performed. Analysis of association between ALM and clinicopathological features including TIL as well as survival analysis compared the outcome of ALM to whole group and extremity NALM was performed.

Results

537 ALM from a total of 824 cutaneous melanoma cases were studied. Older age (p = 0.022), higher Breslow (p = 0.008) and ulceration (p < 0.001) were found to be more frequent in ALM. Acral had worse overall survival (OS) compared with the whole group (p = 0.04). Clinical stage (CS) I–II patients had a median OS of 5.3 (95% CI 4.3–6.2) for ALM and 9.2 (95% CI 5.0–7.0) for extremity NALM (p = 0.016). Grade 0 (absence of TIL), I, II and III were found in 7.5, 34.5, 32.1, and 25.9%, respectively. Lower TIL grade was associated with larger tumor size (p = 0.003), higher Breslow (p = 0.001), higher Clark level (p = 0.007), higher CS (p = 0.002), extremity location (p = 0.048), histological subtype ALM (p = 0.024) and better OS (p = 0.001).

Conclusions

ALM is highly prevalent in Peru and carries poor outcome. Lower TIL levels were associated with poor outcome and ALM.



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Population pharmacokinetic analyses of the effect of carboplatin pretreatment on olaparib in recurrent or refractory women’s cancers

Abstract

Purpose

Combining olaparib with carboplatin was recently shown to be active in both BRCA and non-BRCA mutant cancers in a recent phase I/Ib combination trial. The optimal drug sequence recommended was carboplatin 1-day before olaparib. However, carboplatin pre-treatment induced a ~50% faster olaparib clearance.

Methods

To further explore this drug interaction, a population pharmacokinetic (PK) model was designed that included a lag time parameter, a second absorption compartment from tablet formulation, a single distribution/elimination compartment, and covariance among the clearance and volume parameters.

Results

Clearance (6.8 L/h) and volume (33 L) estimates were comparable with literature. The only significant covariate was the presence of carboplatin on olaparib clearance, consistent with published noncompartmental PK and in vitro data.

Conclusions

Simulations predicted lower steady-state peak/trough olaparib exposure through 24–36 h post carboplatin pre-treatment, but this effect was lost by day 2 and thus no dose adjustment is recommended.



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Static and dynamic validation of inertial measurement units

Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Leah Taylor, Emily Miller, Kenton R. Kaufman
Optical motion capture systems are used to assess human motion. While these systems provide a reliable analysis, they limit collection to a laboratory based setting. Devices such as Inertial Measurement Units (IMUs) have been developed as alternative tools. Commercially available IMUs are utilized for a variety of applications; however limited work has been done to determine the reliability of these devices. The objective of this study was to assess the accuracy and precision of a commercially available IMU, containing tri-axial accelerometers, gyroscopes, and magnetometers, under controlled static and dynamic conditions. The sensor output was validated against the gold standard measures of custom made mechanical testing apparatuses. The IMUs provide an accurate (within 0.6°) and precise (within 0.1°) measurement of static sensor orientation and an accurate (within 4.4° per second) and precise (within 0.2° per second) representation of angular velocity. The sensors are more accurate at lower velocities, but the percent error remains relatively constant across all angular velocities. Inclusion of IMUs as an appropriate measurement tool should be based on the application, specific demands and necessary reliability.



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Altered leverage around the ankle in people with diabetes: A natural strategy to modify the muscular contribution during walking?

Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Milos Petrovic, Kevin Deschamps, Sabine M. Verschueren, Frank L. Bowling, Constantinos N. Maganaris, Andrew J.M. Boulton, Neil D. Reeves
Diabetes patients display gait alterations compared to controls including a higher metabolic cost of walking. This study aimed to investigate whether differences in external moment arm (ExtMA) and effective mechanical advantage (EMA) at the ankle in diabetes patients could partly explain the increased cost of walking compared to controls. Thirty one non-diabetic controls (Ctrl); 22 diabetes patients without peripheral neuropathy (DM) and 14 patients with moderate/severe diabetic peripheral neuropathy (DPN) underwent gait analysis using a motion analysis system and force plates. The internal Achilles tendon moment arm length was determined using magnetic resonance imaging during weight-bearing and ExtMA was calculated using gait analysis. A greater value (P<0.01) for the EMA at the ankle was found in the DPN (0.488) and DM (0.46) groups compared to Ctrl (0.448). The increased EMA was mainly caused by a smaller ExtMA in the DPN (9.63cm; P<0.01) and DM (10.31cm) groups compared to Ctrl (10.42cm) These findings indicate that the ankle plantarflexor muscles would need to generate lower forces to overcome the external resistance during walking compared to controls. Our findings do not explain the previously observedhigher metabolic cost of walking in the DM and DPN groups, but uncover a new mechanism through which patients with diabetes and particularly those with DPN reduce the joint moment at the ankle during walking: by applying the ground reaction force more proximally on the foot, or at an angle directed more towards the ankle, thereby increasing the EMA and reducing the ankle joint moment.



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Effectiveness of an innovative hip energy storage walking orthosis for improving paraplegic walking: A pilot randomized controlled study

Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Mingliang Yang, Jianjun Li, Xinyu Guan, Lianjun Gao, Feng Gao, Liangjie Du, Hongmei Zhao, Degang Yang, Yan Yu, Qimin Wang, Rencheng Wang, Linhong Ji
BackgroundThe high energy cost of paraplegic walking using a reciprocating gait orthosis (RGO) is attributed to limited hip motion and excessive upper limb loading for support. To address the limitation, we designed the hip energy storage walking orthosis (HESWO) which uses a spring assembly on the pelvic shell to store energy from the movements of the healthy upper limbs and flexion-extension of the lumbar spine and hip and returns this energy to lift the pelvis and lower limb to assist with the swing and stance components of a stride. Our aim was to evaluate gait and energy cost indices for the HESWO compared to the RGO in patients with paraplegia.MethodsThe cross-over design was used in the pilot study. Twelve patients with a complete T4-L5 chronic spinal cord injury underwent gait training using the HESWO and RGO. Gait performance (continuous walking distance, as well as the maximum and comfortable walking speeds) and energy expenditure (at a walking speed of 3.3m/min on a treadmill) were measured at the end of the 4-week training session.ResultsCompared to the RGO, the HESWO increased continuous walking distance by 24.7% (P<0.05), maximum walking speed by 20.4% (P<0.05) and the comfortable walking speed by 15.3% (P<0.05), as well as decreasing energy expenditure by 13.9% (P<0.05).ConclusionOur preliminary results provide support for the use of the HESWO as an alternative support for paraplegic walking.



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