Long-Term Clinical Outcomes After Switching from Remicade ® to Biosimilar CT-P13 in Inflammatory Bowel Disease

Abstract

Background

Limited data are available on long-term clinical outcomes regarding the switch from Remicade^® to the infliximab biosimilar CT-P13 in inflammatory bowel disease (IBD) patients.

Aims

To investigate long-term efficacy, safety, pharmacokinetic profile, and immunogenicity.

Methods

We performed a single-center prospective observational cohort study following an elective switch from Remicade^® to CT-P13 in IBD patients.

Results

Eighty-three patients were included (57 Crohn's disease, 24 ulcerative colitis, and 2 IBD unclassified), and 68 patients completed one-year follow-up. Disease activity (Harvey–Bradshaw Index and Simple Clinical Colitis Activity Index) as well as inflammatory markers (CRP, fecal calprotectin) did not change significantly during the 1-year follow-up. In total, 7 out of 83 patients (8%) demonstrated detectable antidrug antibodies during follow-up, and 5 out of 7 antidrug antibody titers were already detectable at baseline prior to switching. Six patients (7%) discontinued CT-P13 due to adverse events.

Conclusions

Following a switch from Remicade^® to CT-P13, 82% of IBD patients continued treatment through 1 year. Disease activity scores and inflammatory markers remained unchanged during follow-up, and no CT-P13-related serious adverse events occurred. These 1-year data suggest that switching to CT-P13 in Remicade^®-treated IBD patients is safe and feasible.

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Abstracts Author Index

Journal of Neurotrauma Jul 2017, Vol. 34, No. 13: A-165-A-174.


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Anatomical Recruitment of Spinal V2a Interneurons into Phrenic Motor Circuitry after High Cervical Spinal Cord Injury

Journal of Neurotrauma , Vol. 0, No. 0.


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Effects of Multiple Injection of Bone Marrow Mononuclear Cells on Spinal Cord Injury of Rats

Journal of Neurotrauma , Vol. 0, No. 0.


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Letter to the editor

This is in reference to a very well-written article titled ‘Surgical timing for facial paralysis after temporal bone trauma’ by Xu P et al. [1]. The paper is well-written and the authors have conducted a good study. However, there are certain points of concern regarding the methodology which I would like to highlight through your esteemed journal.

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Intracranial granulocytic sarcoma as the first presentation of chronic myeloid leukemia in chronic phase

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Exploration of Two Training Paradigms Using Forced Induced Weight Shifting With the Tethered Pelvic Assist Device to Reduce Asymmetry in Individuals After Stroke: Case Reports.

Many robotic devices in rehabilitation incorporate an assist-as-needed haptic guidance paradigm to promote training. This error reduction model, while beneficial for skill acquisition, could be detrimental for long-term retention. Error augmentation (EA) models have been explored as alternatives. A robotic Tethered Pelvic Assist Device has been developed to study force application to the pelvis on gait and was used here to induce weight shift onto the paretic (error reduction) or nonparetic (error augmentation) limb during treadmill training. The purpose of these case reports is to examine effects of training with these two paradigms to reduce load force asymmetry during gait in two individuals after stroke (>6 mos). Participants presented with baseline gait asymmetry, although independent community ambulators. Participants underwent 1-hr trainings for 3 days using either the error reduction or error augmentation model. Outcomes included the Borg rating of perceived exertion scale for treatment tolerance and measures of force and stance symmetry. Both participants tolerated training. Force symmetry (measured on treadmill) improved from pretraining to posttraining (36.58% and 14.64% gains), however, with limited transfer to overground gait measures (stance symmetry gains of 9.74% and 16.21%). Training with the Tethered Pelvic Assist Device device proved feasible to improve force symmetry on the treadmill irrespective of training model. Future work should consider methods to increase transfer to overground gait. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft.

Background: The integrity of the flexor tendon pulley apparatus is crucial for unimpaired function of the digits. Although secondary reconstruction is an established procedure in multi-pulley injuries, acute reconstruction of isolated, closed pulley ruptures is a rare occurrence. There are 3 factors influencing the functional outcome of a reconstruction: gapping distance between tendon and bone (E-space), bulkiness of the reconstruction, and stability. As direct repair is rarely done, grafts are used to reinforce the pulley. An advantage of the first extensor retinaculum graft is the synovial coating providing the possibility to be used both as a direct graft with synovial coating or as an onlay graft after removal of the synovia when the native synovial layer is present. Methods: A graft from the first dorsal extensor compartment is used as an onlay graft to reinforce the sutured A4 pulley. This technique allows reconstruction of the original dimensions of the pulley system while stability is ensured by anchoring the onlay graft to the bony insertions of the pulley. Results: Anatomical reconstruction can be achieved with this method. The measured E-space remained 0 mm throughout the recovery, while the graft incorporated as a slim reinforcement of the pulley, displaying no bulkiness. Conclusions: The ideal reconstruction should provide synovial coating and sufficient strength with minimal bulk. Early reconstruction using an onlay graft offers these options. The native synovial lining is preserved and the graft is used to reinforce the pulley. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Clinical neurophysiology of prolonged disorders of consciousness: from diagnostic stimulation to therapeutic neuromodulation

The philosopher David Chalmers (1995) defined the quest for the ultimate theory of consciousness as the "hard problem" of science. For the clinician, the "hard problem" is probing consciousness in non-communicating patients lying in the vegetative state (VS) or in the minimally conscious state (MCS), the most severe conditions along the spectrum of prolonged disorders of consciousness (DoC) from acquired brain injury (Young, 1998). By definition, VS patients exhibit signs of wakefulness but no signs of awareness (non-responsive; Jennett and Plum, 1972), whereas MCS patients show signs of wakefulness and fluctuating signs of awareness (responsive; Giacino et al, 2002), with behavioural interactions of lower (MCS-) or higher (MCS+) level of complexity (Bruno et al, 2011).

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Takotsubo Cardiomyopathy after Head and Neck Reconstructive Surgery.

Summary: Takotsubo cardiomyopathy (TCM) is a form of transient heart failure that clinically mimics acute coronary syndrome and is characterized by left ventricular wall motion abnormalities. The pathophysiology of TCM is not well established. TCM is often preceded by emotional or physical stress and may occur after surgery. We present 3 cases of TCM occurring after head and neck reconstructive surgery. Echocardiography plays a central role in the diagnosis of TCM. Left ventricular wall motion abnormalities extend beyond the territory of a single coronary artery. Coronary angiography and cardiac computed tomography can demonstrate the absence of coronary atherosclerosis and are useful for confirming the diagnosis of TCM. Particularly after reconstructive surgery, it is necessary to carefully monitor fluid replacement to avoid dehydration, which may compromise flap blood flow, although congestive heart failure is the most common complication of TCM. It is important to encourage ambulation as soon as possible, while considering the degree of cardiac impairment. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Effect of the upper instrumented vertebral level (upper vs. lower thoracic spine) on gait ability after corrective surgery for adult spinal deformity

The relationship between gait pattern and the level of upper instrumented vertebra (UIV) in surgically treated patients with adult spinal deformity (ASD) has not been fully documented.

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Pelvic incidence: a fixed value or can you change it?

There has been renewed interest in the pelvic vertebrae by spinal surgeons recently. Those involved in working with patients with adult spinal deformity, focus on the position of the fused spine as it relates to the pelvis, and determine success or failure by specific numbers for given pelvic parameters. The pelvic parameters that are commonly measured for these patients are pelvic tilt, sacral slope, and pelvic incidence. Out of the three, pelvic incidence has always been considered to be the fixed measurement, while pelvic tilt and sacral slope have the capacity to change in relation to external forces.

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Change in pain catastrophizing in patients with lumbar spinal surgery

Even though catastrophizing can negatively moderate the outcome of surgery for LSS, it is still unclear whether pain catastrophizing is an enduring stable or a dynamic structure related to pain intensity after spine surgery.

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Goldilocks Mastectomy: A Safe Bridge to Implant-Based Breast Reconstruction in the Morbidly Obese.

Background: Reconstructive surgeons are encountering an increasing number of obese women requiring postmastectomy reconstruction. These patients are poor candidates for autologous and prosthetic-based reconstructions as they have a high rate of reconstructive failure, surgical complications, and poor aesthetic outcomes. We demonstrate here the utility of the previously described Goldilocks mastectomy with free nipple grafts as a safe bridge to second stage implant-based breast reconstruction. Methods: Ten consecutive morbidly (BMI > 40) or super obese (BMI>50) women underwent bilateral Goldilocks mastectomy with free nipple grafts followed by second stage subpectoral implant placement at least three months postoperatively. Patients were assessed for implant-related complications including malposition, capsular contracture, dehiscence, and extrusion. Results: Ten postmastectomy reconstructions in patients with BMIs ranging from 37 to 50 with a mean BMI of 45 underwent bilateral Goldilocks mastectomy with free nipple grafts. Two patients had wound healing complications after Goldilocks mastectomy but were completely healed within 8 weeks. There were no instances of delayed wound healing or reconstructive failure after prosthetic placement. With at least 9 months of follow-up on all patients, no patient has had a capsular contracture, significant malposition, or other complication requiring reoperation. Conclusion: The obese patient poses a significant reconstructive challenge for which no reproducible approach has been described. Here, we present a 2-stage strategy: the previously described Goldilocks mastectomy with free nipple grafts followed by second stage subpectoral definitive implant placement. This is the first proposed description of a reliable strategy for postmastectomy reconstruction in the morbidly and super obese. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Coronary Artery Disease in Patients with Critical Limb Ischemia Undergoing Major Amputation or Not.

Background: Due to the increase of elderly and diabetes patients, surgeons encounter patients requiring treatment of critical limb ischemia (CLI) in the presence of systemic arteriosclerotic diseases. In this study, we retrospectively investigated the prevalence of coronary artery disease (CAD) in patients with CLI who underwent major (above-the-ankle) amputation or nonmajor amputation (below-the-ankle amputation or debridement of wound). Methods: We retrospectively investigated 129 consecutive patients surgically managed for CLI in our institution between January 2013 and December 2015. The prevalence of CAD was defined as a cardiac treatment history or significant vascular stenosis (stenosis of > 75%). The outcomes were compared between patients who underwent major amputation (n = 36) and nonmajor amputation (n = 93). Additionally, archived record of 566 patients treated nonsurgically by percutaneous transluminal angioplasty in our institution was investigated to evaluate patients with milder peripheral artery disease. Results: CAD was present in 83 patients (69%), including 82% of patients who underwent major amputation and 63% of nonmajor amputation group. The prevalence of CAD was significantly higher in the major amputation group (P = 0.042). Ejection fraction was not significantly different (P > 0.05). Among the 566 CLI patients treated by only percutaneous transluminal angioplasty, 227 (40%) had CAD, which was a significantly lower prevalence than those surgically treated (P

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Psychological Aspects of a Patient with Neglected Skin Tumor of the Scalp.

No abstract available

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An Extremely Rare Condition: Unilateral and Isolated Temporalis Muscle Hypertrophy.

Summary: Unilateral and isolated temporalis muscle hypertrophy is an extremely rare condition causing cosmetic problems and pain in the temporal region. Up to date, 8 isolated and unilateral cases were reported in the English literature. In this article, the authors report 2 new cases of unilateral isolated temporal muscle hypertrophy. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Abstracts Author Index

Journal of Neurotrauma Jul 2017, Vol. 34, No. 13: A-165-A-174.


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Anatomical Recruitment of Spinal V2a Interneurons into Phrenic Motor Circuitry after High Cervical Spinal Cord Injury

Journal of Neurotrauma , Vol. 0, No. 0.


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Effects of Multiple Injection of Bone Marrow Mononuclear Cells on Spinal Cord Injury of Rats

Journal of Neurotrauma , Vol. 0, No. 0.


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Would brief alcohol intervention be helpful in facial trauma patients?A Narrative Review

Abstract

Facial trauma is commonly associated with excessive consumption of alcohol and is often associated with interpersonal violence or motor vehicle accidents. Alcohol-related trauma presentation to hospitals causes a major service burden, and there have been efforts to reduce such trauma load with educational programs and social support. Brief alcohol intervention (BAI) in an acute setting (emergency department or trauma centre) has been shown as an effective means to reduce future alcohol intake and the incidence of future alcohol-related injuries, especially in the period immediately following injuries. Less is known about the potential benefit of BAI when provided by the surgical team in the same clinical context. This article explores the individual component of brief alcohol intervention and its provision by an acute surgical service by way of a narrative review. The progress of research into brief alcohol intervention for facial trauma patients is also reviewed. The methods and rationale behind screening patients for targeted BAI are discussed in a separate article.

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Exploration of Two Training Paradigms Using Forced Induced Weight Shifting With the Tethered Pelvic Assist Device to Reduce Asymmetry in Individuals After Stroke: Case Reports.

Many robotic devices in rehabilitation incorporate an assist-as-needed haptic guidance paradigm to promote training. This error reduction model, while beneficial for skill acquisition, could be detrimental for long-term retention. Error augmentation (EA) models have been explored as alternatives. A robotic Tethered Pelvic Assist Device has been developed to study force application to the pelvis on gait and was used here to induce weight shift onto the paretic (error reduction) or nonparetic (error augmentation) limb during treadmill training. The purpose of these case reports is to examine effects of training with these two paradigms to reduce load force asymmetry during gait in two individuals after stroke (>6 mos). Participants presented with baseline gait asymmetry, although independent community ambulators. Participants underwent 1-hr trainings for 3 days using either the error reduction or error augmentation model. Outcomes included the Borg rating of perceived exertion scale for treatment tolerance and measures of force and stance symmetry. Both participants tolerated training. Force symmetry (measured on treadmill) improved from pretraining to posttraining (36.58% and 14.64% gains), however, with limited transfer to overground gait measures (stance symmetry gains of 9.74% and 16.21%). Training with the Tethered Pelvic Assist Device device proved feasible to improve force symmetry on the treadmill irrespective of training model. Future work should consider methods to increase transfer to overground gait. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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The medial pterygoid muscle: a stabilizer of horizontal jaw movement

Abstract

There is limited information of the normal function of the human medial pterygoid muscle (MPt). The aims were to determine whether (a) the MPt is active throughout horizontal jaw movements with the teeth apart and (b) whether single motor units (SMUs) are active during horizontal and opening - closing jaw movements. Intramuscular electrodes were placed in the right MPt of 18 participants who performed 5 teeth-apart tasks: 1) postural position, 2) ipsilateral (i.e. right) jaw movement, 3) contralateral movement, 4) protrusive movement, 5) opening–closing movement. Movement tasks were guided by a target and were divided into BEFORE, OUT, HOLDING, RETURN and AFTER phases according to the movement trajectories recorded by a jaw tracking system. Increased EMG activity was consistently found in the OUT, HOLDING and RETURN phases of the contralateral and protrusive movement tasks. An increased RETURN phase activity in the ipsilateral task indicates an important role for the MPt in the contralateral force vector. Of the 14 SMUs active in the opening-closing task, 64% were also active in at least 1 horizontal task. There were tonically active SMUs at the postural jaw position in 44% of participants. These new data point to an important role for the MPt in the fine control of low forces as required for stabilization of vertical mandibular position not only to maintain postural position, but also throughout horizontal jaw movements with the teeth apart. These findings provide baseline information for future investigations of the possible role of this muscle in orofacial pain conditions.

This article is protected by copyright. All rights reserved.

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Reduction of severe oropharyngeal hemorrhage following transoral robotic surgery

The epidemic of human papillomavirus-associated-oropharyngeal carcinoma (HPV OPSCC) has significantly impacted the practice of head and neck surgical oncology. The rising rates of this disease, younger age and better prognosis have charged our community to explore de-intensification treatment modalities particularly as a growing population will suffer from the long term sequelae of treatment for a greater period of time. Concurrent chemoradiation therapy (CCRT) has become a standard of care but the improved survival conferred with this modality has a price of increasing rates of early and late toxicities [1,2].

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Would brief alcohol intervention be helpful in facial trauma patients?A Narrative Review

Abstract

Facial trauma is commonly associated with excessive consumption of alcohol and is often associated with interpersonal violence or motor vehicle accidents. Alcohol-related trauma presentation to hospitals causes a major service burden, and there have been efforts to reduce such trauma load with educational programs and social support. Brief alcohol intervention (BAI) in an acute setting (emergency department or trauma centre) has been shown as an effective means to reduce future alcohol intake and the incidence of future alcohol-related injuries, especially in the period immediately following injuries. Less is known about the potential benefit of BAI when provided by the surgical team in the same clinical context. This article explores the individual component of brief alcohol intervention and its provision by an acute surgical service by way of a narrative review. The progress of research into brief alcohol intervention for facial trauma patients is also reviewed. The methods and rationale behind screening patients for targeted BAI are discussed in a separate article.

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Association between severity of untreated Sleep Apnoea and postoperative complications following major cardiac surgery: A prospective observational cohort study

Publication date: Available online 30 June 2017
Source:Sleep Medicine
Author(s): Martina Mason, Jules Hernández Sánchez, Alain Vuylsteke, Ian Smith
ObjectiveTo examine whether untreated Sleep Apnoea is associated with prolonged Intensive Care Unit (ICU) stay and increased frequency of postoperative ICU complications, in patients undergoing major cardiac surgery.Patients/MethodsAdult patients, undergoing elective coronary artery bypass grafting with or without cardiac valve surgery, between March 2013 and July 2014, were considered. We excluded patients participating in other interventional studies, those who had a tracheostomy before surgery, required emergency surgery or were due to be admitted on the day of surgery. Patients underwent inpatient overnight oximetry on the night prior to their surgery to assess for the presence of sleep apnoea. Since oximetry alone cannot differentiate obstructive from central apnoea, the results are reported as sleep apnoea which was diagnosed in patients with an arterial oxygen desaturation index (ODI) ≥ 5/hr.ResultsThe primary outcome measure was length of stay (LoS) in ICU in days. The secondary outcome was a composite measure of post-operative complications in ICU. Multivariate models were developed to assess associations between ODI and the primary and secondary outcome measures, adjusting for preselected predictor variables, relative to primary and secondary outcomes. There was no significant association between ODI and ICU LoS, HR 1.0, 95% CI 0.99-1.02; p=0.12. However we did find a significant association between ODI and postoperative complications in the ICU, OR=1.1; 95% CI 1.02-1.17; p=0.014. The probability of developing complications rose with higher ODI, reflecting sleep apnoea severity.ConclusionsAcknowledging the limitations of this prospective study, untreated sleep apnoea did not predict an increased length of stay in ICU but we do report an association with postoperative complications in patients undergoing major cardiac surgery.



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Actigraphy scoring for sleep outcome measures in chronic obstructive pulmonary disease

Publication date: Available online 30 June 2017
Source:Sleep Medicine
Author(s): Mary C. Kapella, Sachin Vispute, Bingqian Zhu, James J. Herdegen
BackgroundActigraphy is commonly used to measure sleep outcomes so sleep can be measured conveniently at home over multiple nights. Validity of actigraphy has been demonstrated in people with sleep disturbances; however, validity of scoring settings in people with chronic medical illnesses such as chronic obstructive pulmonary disease remains unclear. The purpose of this secondary analysis was to compare actigraphy customized scoring settings with polysomnography for measurement of sleep outcomes in people with chronic obstructive pulmonary disease who have insomnia.MethodsParticipants underwent overnight sleep assessment simultaneously by polysomnography and actigraphy at the University of Illinois of Chicago Sleep Science Center. Fifty participants (35 men, 15 women) with mild to severe chronic obstructive pulmonary disease and insomnia were included in the analysis. Sleep onset latency, total sleep time, wake after sleep onset, and sleep efficiency were calculated independently from data derived from polysomnography and from actigraphy. Actigraphy sleep outcome scores obtained at the default setting and several customized actigraphy settings were compared to the scored polysomnography results.ResultsAlthough no single setting was optimal for all sleep outcomes, the combination of 10 consecutive immobile minutes for sleep onset or end and activity threshold of 10 worked well. Actigraphy overestimated TST and SE and underestimated WASO but there was no difference in variance between PSG and actigraphy in TST and SE when the 10*10 combination was used. As the average TST and SE increased, the agreement between PSG and actigraphy appeared to increase and as the average WASO decreased, the agreement between PSG and actigraphy appeared to increase.ConclusionResults support the conclusion that the default actigraphy settings may not be optimal for people with chronic obstructive pulmonary disease and insomnia.



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The medial pterygoid muscle: a stabilizer of horizontal jaw movement

Abstract

There is limited information of the normal function of the human medial pterygoid muscle (MPt). The aims were to determine whether (a) the MPt is active throughout horizontal jaw movements with the teeth apart and (b) whether single motor units (SMUs) are active during horizontal and opening - closing jaw movements. Intramuscular electrodes were placed in the right MPt of 18 participants who performed 5 teeth-apart tasks: 1) postural position, 2) ipsilateral (i.e. right) jaw movement, 3) contralateral movement, 4) protrusive movement, 5) opening–closing movement. Movement tasks were guided by a target and were divided into BEFORE, OUT, HOLDING, RETURN and AFTER phases according to the movement trajectories recorded by a jaw tracking system. Increased EMG activity was consistently found in the OUT, HOLDING and RETURN phases of the contralateral and protrusive movement tasks. An increased RETURN phase activity in the ipsilateral task indicates an important role for the MPt in the contralateral force vector. Of the 14 SMUs active in the opening-closing task, 64% were also active in at least 1 horizontal task. There were tonically active SMUs at the postural jaw position in 44% of participants. These new data point to an important role for the MPt in the fine control of low forces as required for stabilization of vertical mandibular position not only to maintain postural position, but also throughout horizontal jaw movements with the teeth apart. These findings provide baseline information for future investigations of the possible role of this muscle in orofacial pain conditions.

This article is protected by copyright. All rights reserved.

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Long-term stability of limiting nasal alar base width changes with a cinch suture following Le Fort I osteotomy with submental intubation

The aim of this study was to assess the effectiveness of the nasal alar base cinch suture following Le Fort I osteotomy at long-term follow-up. One hundred and forty participants (89 female, 51 male) aged between 16 and 51 years underwent Le Fort I osteotomy with submental intubation. Anthropometric measurements of the nose were taken intraoperatively, immediately postoperative, and for up to 3 years postoperative: the maximum lateral convexity of the alae (Al–Al) and the lateral extremity of the alar base curvature at the alar groove (Ac–Ac).

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Method of osteotomy fixation and need for removal following bimaxillary orthognathic, osseous genioplasty, and intranasal surgery: a retrospective cohort study

The purpose of this study was to determine the incidence and causes of fixation hardware removal after bimaxillary orthognathic, osseous genioplasty, and intranasal surgery. A retrospective study was performed, involving subjects with a bimaxillary developmental dentofacial deformity (DFD) and symptomatic chronic obstructive nasal breathing. At a minimum, subjects underwent Le Fort I osteotomy, bilateral sagittal ramus osteotomies (SROs), septoplasty, inferior turbinate reduction, and osseous genioplasty.

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Vertebral anomalies in craniofacial microsomia: a systematic review

Craniofacial microsomia (CFM) is characterized by a heterogeneous underdevelopment of the facial structures arising from the first and second branchial arches, but extracraniofacial malformations such as vertebral anomalies also occur. This systematic review provides an overview of the literature on the types and prevalence of vertebral anomalies found in patients with CFM. A systematic search was conducted. Data on the number of patients, patient characteristics, types and prevalence of vertebral anomalies, and other associations between CFM and vertebral anomalies were extracted from the articles identified.

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Immunotherapy of Prostate Cancer: Facts and Hopes

In the last few years immunotherapy has become an important cancer treatment modality and while the principles of immunotherapy evolved over many decades, the FDA approvals of sipuleucel-T and ipilimumab began a new wave in immuno-oncology. Despite the current enthusiasm, it is unlikely that any of the immunotherapeutics alone can dramatically change prostate cancer outcomes, but combination strategies are more promising and provide a reason for optimism. Several completed and ongoing studies have shown that the combination of cancer vaccines or checkpoint inhibitors with different immunotherapeutic agents, hormonal therapy (enzalutamide), radiation therapy (radium 223), DNA-damaging agents (olaparib), or chemotherapy (docetaxel) can enhance immune responses and induce more dramatic, long-lasting clinical responses without significant toxicity. The goal of prostate cancer immunotherapy does not have to be complete eradication of advanced disease, but rather the return to an immunologic equilibrium with an indolent disease state. In addition to determining the optimal combination of treatment regimens, efforts are also ongoing to discover biomarkers of immune response. With such concerted efforts, the future of immunotherapy in prostate cancer looks brighter than ever.

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Simultaneous Versus Sequential Ptosis and Strabismus Surgery in Children.

Purpose: The authors sought to compare the clinical outcomes of simultaneous versus sequential ptosis and strabismus surgery in children. Methods: Retrospective, single-center cohort study of children requiring both ptosis and strabismus surgery on the same eye. Simultaneous surgeries were performed during a single anesthetic event; sequential surgeries were performed at least 7 weeks apart. Outcomes were ptosis surgery success (margin reflex distance 1 >= 2 mm, good eyelid contour, and good eyelid crease); strabismus surgery success (ocular alignment within 10 prism diopters of orthophoria and/or improved head position); surgical complications; and reoperations. Results: Fifty-six children were studied, 38 had simultaneous surgery and 18 sequential. Strabismus surgery was performed first in 38/38 simultaneous and 6/18 sequential cases. Mean age at first surgery was 64 months, with mean follow up 27 months. A total of 75% of children had congenital ptosis; 64% had comitant strabismus. A majority of ptosis surgeries were frontalis sling (59%) or Fasanella-Servat (30%) procedures. There were no significant differences between simultaneous and sequential groups with regards to surgical success rates, complications, or reoperations (all p > 0.28). Conclusions: In the first comparative study of simultaneous versus sequential ptosis and strabismus surgery, no advantage for sequential surgery was seen. Despite a theoretical risk of postoperative eyelid malposition or complications when surgeries were performed in a combined manner, the rate of such outcomes was not increased with simultaneous surgeries. Performing ptosis and strabismus surgery together appears to be clinically effective and safe, and reduces anesthesia exposure during childhood. (C) 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Pressure and Flow Comparisons Across Vocal Pathologies

The aim of this study was to aid in the distinction among hyperadductive dysphonias by evaluating peak glottal pressure, release burst, and mid and final airflow values across repeated /pa/ syllable trains.

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Rat Supraspinatus Tendon Responds Acutely and Chronically to Exercise

The objective of this study was to identify acute responses and chronic adaptations of supraspinatus tendon to non-injurious exercise. We hypothesized that chronic exercise increases tendon mechanical properties, and a single exercise bout increases MMP activity acutely. Rats were divided into acute or chronic exercise (EX) or cage activity (CA) groups. Animals in acute EX groups were euthanized 3, 12, 24, 48, or 72 hours upon completion of a single bout of exercise (10 m/min, 1 hour) on a flat treadmill. Animals in chronic EX groups walked on a flat treadmill for 3 days, 1 week, 2 weeks, or 8 weeks. Tendon histology, MMP activity, and mechanics were measured. A single bout of exercise trended toward reducing tendon mechanical properties, but 2 or 8 weeks of chronic exercise increased tendon mechanics. Cell density was not affected. Cells became rounder with chronic exercise. All tendons were highly organized. MMP activity decreased after a single bout of exercise and returned to baseline by 72 hours. MMP activity decreased after 8 weeks of chronic exercise. Decreased MMP activity may indicate an anabolic instead of catabolic response, in contrast to injury. Results suggest that mild, acute decreases in MMP activity and tendon mechanics following a single exercise bout lead to enhanced tendon mechanical adaptations with repeated exercise bouts. This study defines acute and chronic changes MMP activity, mechanical properties, and histology of the rat supraspinatus tendon in response to beneficial exercise and proposes a mechanism by which acute responses translate to chronic adaptations.

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A study of clinical and physiological relations of daily physical activity in precapillary pulmonary hypertension.

Daily physical activity is reduced in precapillary pulmonary hypertension (PH) but the underlying mechanisms are inadequately explored. We sought to investigate clinical and physiological relations of daily physical activity and profile differences between less and more active patients with precapillary PH. A prospective, cross-sectional study of 20 patients with precapillary PH who undertook a) a comprehensive clinical assessment, b) a preliminary treadmill test, c) 7-day monitoring of daily walking intensity with triaxial accelerometry and d) a personalized treadmill test corresponding to the individual patient mean daily walking intensity with real-time physiological measurements. Significant clinical correlations with individual patient mean walking intensity (1.71±0.27 m/s²) were observed for log N-terminal pro-brain natriuretic peptide (log-NTproBNP: r=-.75, p=<.001), age (r=-.70, p=.001), transfer factor for carbon monoxide %predicted (r=.51, p=0.022) and 6-minute walk distance (r=.50, p=.026). Significant physiological correlations were obtained for heart rate reserve (r=.68, p=.001), quadriceps tissue oxygenation index (Q-StO₂: r=.58, p=.008), change in Q-StO2 from rest (r=.60, p=.006) and ventilatory equivalent for oxygen uptake (r=-.56, p=.013). Stepwise multiple regression analyses retained log-NTproBNP (R²=0.55), heart rate reserve (R²=0.44) and Q-StO (R²=0.13) accounting for a significant variance in individual walking intensity. Less active patients had greater physical activity-induced cardiopulmonary impairment, worse quadriceps oxygenation profile and compromised health-related quality of life compared to more active patients. These preliminary findings suggest a significant relation between right ventricular and peripheral muscle oxygenation status and reduced daily physical activity in precapillary PH. Further research is warranted to unravel the physiological determinants, establish clinical predictors, and identify beneficial interventions.

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SEXUALLY DIMORPHIC SKELETAL MUSCLE AND CARDIAC DYSFUNCTION IN A MOUSE MODEL OF LIMB GIRDLE MUSCULAR DYSTROPHY 2I

The fukutin-related protein P448L mutant mouse replicates pathologies common to limb-girdle muscular dystrophy 2i (LGMD2i) and is a strong candidate for relevant drug screening studies. Because striated muscle function remains relatively uncharacterized in this mouse, we sought to identify metabolic, functional and histological metrics of exercise and cardiac performance by quantifying voluntary exercise on running wheels, forced exercise on respiratory treadmills and cardiac output with echocardiography and isoproterenol stress tests. Voluntary exercise revealed few differences between wild-type and P448L mice. By contrast, peak oxygen consumption (VO₂peak) was lower in P448L mice or reduced with repeated low intensity treadmill exercise while it increased in wild-type mice. P448L mice fatigued quicker and ran shorter distances while expending 2-fold more calories/meter. They also received 6-fold more motivational shocks with repeated exercise. Differences in VO₂peak and resting metabolic rate were consistent with left ventricle dysfunction, which often develops in human LGMD2i patients and was more evident in female P448L mice, as indicated by lower fractional shortening and ejection fraction values and higher left ventricle systolic volumes. Several traditional markers of dystrophinopathies were expressed in P448L mice and were exacerbated by exercise, some in a muscle-dependent manner. These include elevated serum creatine kinase and muscle central nucleation, smaller muscle fiber cross-sectional area and more striated muscle fibrosis. These studies together identified several markers of disease pathology that are shared between P448L mice and human subjects with LGMD2i. They also identified novel metrics of exercise and cardiac performance that could prove invaluable in preclinical drug trials.

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Bone Microvascular Flow Differs from Skin Microvascular Flow in Response to Head-Down Tilt

Loss of hydrostatic pressures in microgravity may alter skin and bone microvascular flows in the lower extremities and may potentially reduce wound healing and bone fracture repair. The purpose of this study was to determine the rate at which skin and bone microvascular flows respond to head down tilt (HDT). We hypothesized that microvascular flows in tibial bone and overlying skin would increase at different rates during HDT. Tibial bone and skin microvascular flows were measured simultaneously using photoplethysmography (PPG) in a total of 17 subjects during sitting (control posture), supine, 6° HDT, 15° HDT, and 30° HDT postures in random order. With greater angles of HDT bone microvascular flow increased significantly, but skin microvascular flow did not change. Tibial bone microvascular flow increased from the sitting control posture (0.77 ± 0.41 V) to supine (1.95 ± 1.01 V, p=0.001), and from supine posture to 15° HDT (3.74 ± 2.43 V, p=0.004) and 30° HDT (3.91 ± 2.68 V, p=0.006). Skin microvascular flow increased from sitting (0.703 ± 0.75 V) to supine (2.19 ± 1.72 V, p=0.02), but did not change from supine posture to HDT (p=1.0). We show for the first time that microcirculatory flows in skin and bone of the leg respond to simulated microgravity at different rates. These altered levels of blood perfusion may affect rates of wound and bone fracture healing in spaceflight.

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FACTORS CONTRIBUTING TO LOWER METABOLIC DEMAND OF ECCENTRIC THAN CONCENTRIC CYCLING

This study compared muscle-tendon behavior, muscle oxygenation and muscle activity between eccentric and concentric cycling exercise at the same work output to investigate why metabolic demand is lower during eccentric than concentric cycling. Eleven untrained men (27.1 ± 7.0 y) performed concentric cycling (CONC) and eccentric cycling (ECC) for 10 min (60 rpm) at 65% of the maximal concentric cycling power output (191 ± 45 W) four weeks apart. During cycling, oxygen consumption (VO₂), heart rate (HR), vastus lateralis (VL) tissue total hemoglobin (tHb) and oxygenation index (TOI) were recorded, and muscle-tendon behavior was assessed using ultrasonography. The surface electromyogram (EMG) was recorded from VL, vastus medialis (VM), rectus femoris (RF) and biceps femoris (BF) muscles, and cycling torque and knee joint angle during each revolution were also recorded. Average (-65 ± 7%) and HR (-35 ± 9%) were lower and average TOI was greater (16 ± 1%) during ECC than CONC, but tHb was similar between bouts. Positive and negative cycling peak crank torques were greater (32 ± 21% and 48 ± 24%, respectively) during ECC than CONC, but muscle-tendon unit, fascicle and tendinous tissue length changes during pedal revolutions were similar between CONC and ECC. VL, VM, RF and BF peak EMG amplitudes were smaller (24 ± 15%, 22 ± 18%, 16 ± 17% and 18 ± 9%, respectively) during ECC than CONC. These results suggest that the lower metabolic cost of eccentric than concentric cycling was mainly due to a lower level of muscle activation per torque output.

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In obese mice exercise training increases 11{beta}-HSD1 expression, contributing to glucocorticoid activation and suppression of pulmonary inflammation

Exercise training is advocated for treating chronic inflammation and obesity-related metabolic syndromes. Glucocorticoids (GCs), the anti-inflammatory hormones, are synthesized or metabolized in extra-adrenal organs. This study aims to examine whether exercise training affects obesity-associated pulmonary inflammation by regulating local GCs synthesis or metabolism. We found that the sedentary obese (ob/ob) mice exhibited increased levels of interleukin (IL)-1β, IL-18, monocyte chemotactic protein (MCP)-1, and leukocyte infiltration in lung tissues compared with the lean mice, which was alleviated by 6 weeks of exercise training. Pulmonary corticosterone levels were decreased in the ob/ob mice. Exercise training increased pulmonary corticosterone levels in both lean and ob/ob mice. Pulmonary corticosterone levels were negative correlated with IL-1β, IL-18 and MCP-1. Immunohistochemical staining of the adult mouse lung sections revealed positive immunoreactivities for the steroidogenic acute regulatory (StAR) protein, the cholesterol side-chain-cleavage enzyme (CYP11A1), the steroid 21-hydroxylase (CYP21), 3β-hydroxysteroid dehydrogenase (3β-HSD), type I and type II 11β-hydroxysteroid dehydrogenase (11β-HSD), but not for 11β-hydroxylase (CYP11B1). Exercise training significantly increased pulmonary 11β-HSD1 expression in both the lean and ob/ob mice. In contrast, exercise training per se had no effect on pulmonary 11β-HSD2 expression, although pulmonary 11β-HSD2 levels in ob/ob mice were significantly higher than in the lean mice. RU486, a glucocorticoid receptor antagonist, blocked the anti-inflammatory effects of exercise training in lung tissues of obese mice, and increased inflammatory cytokines in lean exercised mice. These findings indicate that exercise training increases pulmonary expression of 11β-HSD1, thus contributing to local GCs activation and suppression of pulmonary inflammation in obese mice.

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ORIGIN OF THE FORWARD-GOING "BACKWARD" WAVE

n/a

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Extra and intra-cranial blood flow regulation during the cold pressor test: influence of age

We determined how the extra- and intra-cranial circulations respond to generalized sympathetic activation evoked by a cold pressor test (CPT) and whether this was affected by healthy aging. Ten young (23±2 yr; mean±SD) and nine older (66±3 yr) individuals performed a 3-min CPT by immersing the left foot into 0.8±0.3°C water. Common carotid artery (CCA) and internal carotid artery (ICA) diameter, velocity and flow were simultaneously measured (duplex ultrasound), along with middle cerebral artery and posterior cerebral artery mean blood velocity (MCAv_mean and PCAv_mean), and cardiorespiratory variables. The increases in heart rate (~6 bpm) and mean arterial blood pressure (~14 mmHg) were similar in young and older groups during the CPT (P<0.01 vs. baseline). In the young group, the CPT elicited a ~5% increase in CCA diameter (P<0.01 vs. baseline) and tendency for an increase in CCA flow (~12%; P=0.08); in contrast, both diameter and flow remained unchanged in the older group. Although ICA diameter was not changed during the CPT in either group, ICA flow increased (~8%; P=0.02) during the first minute of the CPT in both groups. While the CPT elicited an increase in MCAv_mean and PCAv_mean in the young group (by ~20% and ~10%, respectively; P<0.01 vs. baseline), these intra-cranial velocities were unchanged in the older group. Collectively, during the CPT, these findings suggest a differential mechanism(s) of regulation between the ICA compared to the CCA in young individuals, and a blunting of the CCA and intra-cranial responses in older individuals.

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CORP: The assessment of total hemoglobin mass by carbon monoxide rebreathing

In this CORP article we present the theory and practical aspects of the carbon monoxide (CO) rebreathing method for the determination of total hemoglobin mass in humans. With CO rebreathing, a small quantity of CO is diluted in O₂ and rebreathed for a specified time period, during which most of the CO is absorbed and bound to circulating hemoglobin. The dilution principle then allows calculation of the total number of circulating hemoglobin molecules based on the number of absorbed CO molecules and the resulting changes in the fraction of carboxyhemoglobin in blood. Total hemoglobin mass is derived by multiplication with the molar weight of hemoglobin. CO rebreathing has been used for > 100 years and has undergone steady improvement so that today excellent values in terms of accuracy and precision can be achieved if the methodological precautions are carefully followed.

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Muscle Hypertrophy in Pre-Diabetic Men after Sixteen Weeks of Resistance Training

Resistance training of healthy young men typically results in muscle hypertrophy and a shift in vastus lateralis composition away from type IIx fibers to an increase in IIa fiber content. Our previous studies of eight weeks of resistance training found many metabolic syndrome men and women paradoxically increased IIx fibers with a decrease in IIa fibers. To confirm the hypothesis that obese subjects might have muscle remodeling after resistance training very different from healthy lean subjects, we subjected a group of nine obese men volunteers to progressive resistance training for a total of sixteen weeks. In these studies, weight loss was discouraged so that muscle changes would be attributed to the training alone. Detailed assessments included comparisons of histologic examinations of needle biopsies of vastus lateralis muscle pre-training and at eight and sixteen weeks. Prolonging the training from eight to sixteen weeks resulted in increased strength, improved body composition and more muscle fiber hypertrophy, but euglycemic clamp-quantified insulin responsiveness did not improve. Similar to prior studies, muscle fiber composition shifted toward more fast-twitch type IIx fibers (23% to 42%). Eight weeks of resistance training increased the muscle expression of phosphorylated AKT2, AMPK, and mTOR. Muscle GLUT4 expression increased although insulin receptor and IRS-1 expression did not change. We conclude that resistance training of pre-diabetic obese subjects is effective at changing muscle, resulting in fiber hypertrophy and increased type IIx fiber content, and these changes continue up to 16 weeks of training.

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Sodium nitrate ingestion increases skeletal muscle nitrate content in humans

Nitrate (NO₃^-) ingestion has been shown to have vasoactive and ergogenic effects that have been attributed to increased nitric oxide (NO) production. Recent observations in rodents suggest skeletal muscle tissue to serve as an endogenous NO₃^- "reservoir". The current study determined NO₃^- contents in human skeletal muscle tissue in a post-absorptive state, and following ingestion of a sodium nitrate bolus (NaNO3). Seventeen male, type 2 diabetes patients (age 72±1 y; BMI 26.5±0.5 m·kg^-2) were randomized to ingest a dose of NaNO3 (NIT; 9.3 mg NO₃^- per kg bodyweight) or placebo (PLA; 8.8 mg NaCl per kg bodyweight). Blood and muscle biopsy samples were taken before and up to 7 h following NO₃^- or placebo ingestion to assess NO₃^- (and plasma nitrite (NO₂^-)) concentrations. Additionally, basal plasma and muscle NO₃^- concentrations were assessed in 10 healthy young (CON-Y: age 21±1 y) and 10 healthy older (CON-O: age 75±1 y) control subjects. In all groups, baseline NO₃^- concentrations were higher in muscle (NIT: 57±7, PLA: 61±7, CON-Y: 80±10, CON-O: 54±6 µmol·L^-1) than in plasma (NIT: 35±3, PLA: 32±3, CON-Y: 38±3, CON-O: 33±3 µmol·L^-1;P≤0.011). Ingestion of NaNO3 resulted in a sustained increase in plasma NO₃^-, plasma NO₂^-, and muscle NO₃^- concentrations (up to 185±25 µmol·L^-1) in the NIT group (time effect P<0.001), when compared with PLA (treatment effect P<0.05). In conclusion, basal NO₃^- concentrations are substantially higher in human skeletal muscle tissue when compared with plasma. Ingestion of a bolus of dietary NO₃^- increases both plasma and muscle NO₃^- contents in humans.

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I125 brachytherapy guided by individual three-dimensional printed plates for recurrent ameloblastoma of the skull base

Publication date: Available online 29 June 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J.-Y. Liu, Q.-W. Man, Y.-Q. Ma, B. Liu
Ameloblastoma is one of the most common benign odontogenic tumours of the mandible and the maxilla. Wide excision of the tumour is the first choice for treatment (except for unicystic ones). Patients with invaded margins or unresectable lesions may require radiotherapy. Today, permanent implantation of I¹²⁵ seeds is widely used in the treatment of cancer of the head and neck. We report a case of recurrent ameloblastoma of the base of the skull that was treated with I¹²⁵ brachytherapy. The outcome has been encouraging, with total disappearance of the tumour on positron emission tomography 18 months later.



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Long-term influence of mandibular advancement on the volume of the posterior airway in skeletal Class II-patients: a retrospective analysis

Publication date: Available online 29 June 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): D. Dalla Torre, D. Burtscher, G. Widmann, M. Rasse, T. Puelacher, W. Puelacher
In the past, maxillomandibular advancement has resulted in considerable improvement in the volume of the posterior airway space. The objective of the present study was to find out how mandibular advancement without maxillary involvement would affect the posterior airway space in patients with mandibular retrognathism. Cone-beam computed tomographic (CT) scans were done for 20 patients before, and six months after, mandibular advancement. Cephalometric analysis at both time points included 2-dimensional and 3-dimensional assessment of the upper airway. Eight men and 12 women presented a preoperative mean (SD) Wits value of 7.4 (1.54) mm, with an airway area of 7.11 (1.88) cm² and a volume of 14.92 (4.46) cm³. Six months postoperatively they showed a Wits value of 2.7 (0.41) mm, an airway area of 11.33 (3.49) cm², and a volume of 25.7 (6.10) cm³. There was a mean (range) enlargement of 59 (22-82) % of the area and 73 (29-108) % of the volume. A preoperative Wits value of 8mm or more correlated significantly with a larger increase of the posterior airway space (p=0.002). At the same time, an improvement in the Wits value of 4.5mm or more correlated significantly with an increase in volume (p=0.016). The effect of mandibular advancement on the posterior airway space was significant, and the volumetric effect seems to be even more relevant than the two-dimensional changes.



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Reduction of severe oropharyngeal hemorrhage following transoral robotic surgery

The epidemic of human papillomavirus-associated-oropharyngeal carcinoma (HPV OPSCC) has significantly impacted the practice of head and neck surgical oncology. The rising rates of this disease, younger age and better prognosis have charged our community to explore de-intensification treatment modalities particularly as a growing population will suffer from the long term sequelae of treatment for a greater period of time. Concurrent chemoradiation therapy (CCRT) has become a standard of care but the improved survival conferred with this modality has a price of increasing rates of early and late toxicities [1,2].

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Would brief alcohol intervention be helpful in facial trauma patients?A Narrative Review

Abstract

Facial trauma is commonly associated with excessive consumption of alcohol and is often associated with interpersonal violence or motor vehicle accidents. Alcohol-related trauma presentation to hospitals causes a major service burden, and there have been efforts to reduce such trauma load with educational programs and social support. Brief alcohol intervention (BAI) in an acute setting (emergency department or trauma centre) has been shown as an effective means to reduce future alcohol intake and the incidence of future alcohol-related injuries, especially in the period immediately following injuries. Less is known about the potential benefit of BAI when provided by the surgical team in the same clinical context. This article explores the individual component of brief alcohol intervention and its provision by an acute surgical service by way of a narrative review. The progress of research into brief alcohol intervention for facial trauma patients is also reviewed. The methods and rationale behind screening patients for targeted BAI are discussed in a separate article.

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Frontal brain activation changes due to dual-tasking under partial body weight support conditions in older adults with multiple sclerosis

Gait impairments present while dual-tasking in older adults with multiple sclerosis (MS) have been associated with an increased risk of falls. Prior studies have examined prefrontal cortex (PFC) activity using...

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Inactivation of the kinase domain of CDK10 prevents tumor growth in a preclinical model of colorectal cancer, and is accompanied by downregulation of Bcl-2

Cyclin dependent kinase 10 (CDK10), a CDC2 related kinase, is highly expressed in colorectal cancer (CRC). Its role in the pathogenesis of CRC is unknown. This study examines the function of CDK10 in CRC, and demonstrates its role in suppressing apoptosis and in promoting tumor growth in vitro and in vivo. Modulation of CDK10 expression in CRC cell lines demonstrates that CDK10 promotes cell growth, reduces chemosensitivity and inhibits apoptosis by upregulating the expression of Bcl-2. This effect appears to depend on its kinase activity, as kinase-defective mutant CRC cell lines have an exaggerated apoptotic response and reduced proliferative capacity. In vivo, inhibiting CDK10 in CRC following intratumoral injections of lentivirus-mediated CDK10 siRNA in a patient-derived xenograft mouse model demonstrated its efficacy in suppressing tumor growth. Furthermore, using a tissue microarray of human CRC tissues, the potential for CDK10 to be a prognostic biomarker in CRC was explored. In tumors of individuals with CRC, high expression of CDK10 correlates with earlier relapse and shorter overall survival. The findings of this study indicate that CDK10 plays a role in the pathogenesis in CRC and may be a potential therapeutic target for treatment.

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Mitochondrial genomic backgrounds affect nuclear DNA methylation and gene expression

Mitochondrial DNA (mtDNA) mutations and polymorphisms contribute to many complex diseases, including cancer. Using a unique mouse model that contains nuclear DNA (nDNA) from one mouse strain and homoplasmic mitochondrial haplotypes from different mouse strain(s) - designated Mitochondrial Nuclear Exchange (MNX) - we show that mtDNA can alter mammary tumor metastasis. Since retrograde and anterograde communication exist between the nuclear and mitochondrial genomes, we hypothesized that there are differential mtDNA-driven changes in nDNA expression and DNA methylation. Genome-wide nDNA methylation and gene expression were measured in harvested brain tissue from paired wild-type and MNX mice. Selective differential DNA methylation and gene expression were observed between strains having identical nDNA, but different mtDNA. These observations provide insights into how mtDNA might alter epigenetic regulation and thereby contribute to the pathogenesis of metastasis.

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Overview of Cancer Stem Cells and Stemness for Community Oncologists

Abstract

Advances in cancer research in the past have led to an evolving understanding of cancer pathogenesis and the development of novel drugs that significantly improve patient outcomes. However, many patients still encounter treatment resistance, recurrence, or metastasis and eventually die from progressing disease. Experimental evidence indicates that a subpopulation of cancer cells, called cancer stem cells (CSCs), possess “stemness” properties similar to normal stem cells, including self-renewal, differentiation, and proliferative potential. These stemness properties are lost during differentiation and are governed by pathways such as STAT3, NANOG, NOTCH, WNT, and HEDGEHOG, which are highly dysregulated in CSCs due to genetic and epigenetic changes. Promising results have been observed in preclinical models targeting these CSCs through the disruption of stemness pathways in combination with current treatment modalities. This has led to anti-CSC–based clinical trials in multiple stages of development. In this review, we discuss the role of CSCs and stemness pathways in cancer treatment and how they relate to clinical observations. Because CSCs and the stemness pathways governing them may explain the negative clinical outcomes observed during treatment, it is important for oncologists to understand how they contribute to cancer progression and how they may be targeted to improve patient outcomes.

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Gene2Function: An Integrated Online Resource for Gene Function Discovery

One of the most powerful ways to develop hypotheses regarding biological functions of conserved genes in a given species, such as in humans, is to first look at what is known about function in another species. Model organism databases (MODs) and other resources are rich with functional information but difficult to mine. Gene2Function (G2F) addresses a broad need by integrating information about conserved genes in a single online resource.

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Comparative Genomics of Two Sequential Candida glabrate Clinical Isolates

Candida glabrate is an important fungal pathogen which develops rapidly antifungal resistance in treated patients. It is known that azole treatments lead to antifungal resistance in this fungal species and that multidrug efflux transporters are involved in this process. Specific mutations in the transcriptional regulator PDR1 result in upregulation of the transporters. In addition, we showed that the PDR1 mutations can contribute to enhance virulence in animal models. We were interested in this study to compare genomes of two specific C. glabrate related isolates, one of which was azole-susceptible (DSY562) while the other was azole-resistant (DSY565). DSY565 contained a PDR1 mutation (L280F) and was isolated after a time lapse of 50 days of azole therapy. We expected that genome comparisons between both isolates could reveal additional mutations reflecting host adaptation or even additional resistance mechanisms. The PacbBio technology used here yielded 14 major contigs (sizes 0.18 Mb-1.6 Mb) and mitochondrial genomes from both DSY562 and DSY565 isolates that were highly similar to each other. Comparisons of the clinical genomes with the published CBS138 genome indicated important genome rearrangements, but not between the clinical strains. Among unique features, several retrotransposons were identified in the genomes of the investigated clinical isolates. DSY562 and DSY565 contained each a large set of adhesin-like genes (101 and 107, respectively), which exceed by far the number of reported adhesins (66) in the CBS138 genome. Comparison between DSY562 and DSY565 yielded 17 non-synonymous SNPs (among which the expected PDR1 mutation) as well as small size indels in coding regions (11) but mainly in adhesin-like genes. The genomes were containing a DNA mismatch repair allele of MSH2 known to be involved in the so-called hypermutator phenotype of this yeast species and the number of accumulated mutations between both clinical isolates is consistent with the presence of a MSH2 defect. In conclusion, this study is the first to compare genomes of C. glabrate sequential clinical isolates using the PacBio technology as an approach. The genomes of these isolates taken in the same patient at two different time points were exhibiting limited variations, even if submitted to the host pressure.

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Fine Mapping, Transcriptome Analysis, and Marker Development for Y2, the Gene that Conditions Beta-Carotene Accumulation in Carrot (Daucus carota L.)

Domesticated carrots, Daucus carota subsp. sativus, are the richest source of beta-carotene in the US diet, which when consumed is converted into vitamin A, an essential component of eye health and immunity. The Y₂ locus plays a significant role in beta-carotene accumulation in carrot roots, but a candidate gene has not been identified. To advance our understanding of this locus, the genetic basis of beta-carotene accumulation was explored by utilizing an advanced mapping population, transcriptome analysis, and nucleotide diversity in diverse carrot accessions with varying levels of beta-carotene. A single large effect Quantitative Trait Locus (QTL) on the distal arm of chromosome 7 overlapped with the previously identified beta-carotene accumulation QTL, Y₂. Fine mapping efforts reduced the genomic region of interest to 650 kb including 72 genes. Transcriptome analysis within this fine mapped region identified four genes differentially expressed at two developmental time points and 13 genes differentially expressed at one time point. These differentially expressed genes included transcription factors and genes involved in light signaling and carotenoid flux, including a member of the Di19 gene family involved in Arabidopsis photomorphogenesis, and a homolog of the bHLH36 transcription factor involved in maize carotenoid metabolism. Analysis of nucleotide diversity in 25 resequenced carrot accessions revealed a drastic decrease in diversity of this fine-mapped region in orange cultivated accessions as compared to white and yellow cultivated and to white wild samples. The results presented in this study provide a foundation to identify and characterize the gene underlying beta-carotene accumulation in carrot.

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Corticosterone influences gerbil (Meriones unguiculatus) prostatic morphophysiology and alters its proliferation and apoptosis rates

Summary

Glucocorticoids (GCs) are hormones that are widely used in medicine; but although side effects are generally recognised, little is known about the precise mechanisms that implicated in many of these side effects. Furthermore, GCs are highly correlated with stress and behaviour disorders. This study evaluated the effects of the glucocorticoid corticosterone on the ventral prostate of the Mongolian gerbil. Male gerbils (Meriones unguiculatus) (n = 5) received intraperitoneal injections of saline or corticosterone in doses of 0.5 mg/kg/day and 1.5 mg/kg/day for 5 days; while some of the animals were killed immediately after the treatment, the others were killed 5 days after the treatment period. The data show that corticosterone influences the structure and functionality of this organ. This hormone has anti-proliferative and anti-apoptotic properties in the prostate. In addition, the frequencies of the androgen (AR), oestrogen (ERα, ERβ) and glucocorticoid (GR) receptors changed. The frequencies of AR, GR and ERβ decreased in the Ct1/5 group; in the groups with rest period, the frequencies of GR increased and ERβ decreased in the epithelium. Changes in the proliferative index, apoptotic index and receptor activity may have contributed to the emergence of prostatic morphological alterations, such as the presence of cellular debris and inflammatory cells. Different doses of corticosterone had variable effects on the prostate, with a higher dose showing subtler effects and a lower dose showing more striking effects. The corticosterone effects on nuclear receptors were reverted or attenuated after a rest period, which was not observed for proliferation and apoptosis. In summary, we have demonstrated that corticosterone might influence the prostatic morphophysiology and that these changes may be linked in some way to the altered receptor distribution.

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Successful management of primary atrophic rhinitis by turbinate reconstruction using autologous costal cartilage

Publication date: Available online 29 June 2017
Source:Auris Nasus Larynx
Author(s): Marn Joon Park, Yong Ju Jang
Initial management of primary atrophic rhinitis is conservative, with nasal ointments, saline irrigation, and antibiotics prescribed to relieve symptoms. However, in cases that show no improvement, a surgical approach is considered. Recently, many studies have reported successful surgical outcomes using various nasal implants. However, no study has reported implantation of autologous costal cartilage in PAR patients. We report here the case of a 63-year-old woman diagnosed with PAR that was intractable to medical therapy. Under general anesthesia, bilateral inferior turbinate reconstruction with autologous costal cartilage was successfully performed without any complications. One month after surgery, her symptoms improved dramatically. At the 2-year follow-up, her Sinonasal Outcome Test 25 (SNOT-25) score was 6, down from an initial score of 108. Her OMU CT showed improved sinonasal mucosal thickness and disappearance of thick mucosal secretion compared with preoperative CT image. Although this is a single case experience, it is suggested that turbinate reconstruction using autologous costal cartilage can serve as promising surgical modality for management of atrophic rhinitis.



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Frontal brain activation changes due to dual-tasking under partial body weight support conditions in older adults with multiple sclerosis

Gait impairments present while dual-tasking in older adults with multiple sclerosis (MS) have been associated with an increased risk of falls. Prior studies have examined prefrontal cortex (PFC) activity using...

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In-Vivo Patellar Motion Under a Dynamic Weight-Bearing Condition in Individuals With Patellofemoral Pain Syndrome: Erratum

No abstract available

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Comparison Between Single and Combined Clinical Postural Stability Tests in Individuals With and Without Chronic Ankle Instability

Objective: To determine if a single or/and combined clinical tests match group membership based on self-reported ankle function. Design: Cross-sectional. Setting: Biomechanics Laboratory. Participants: From participants, 58 meeting inclusion/exclusion criteria were divided into a chronic ankle instability (CAI) group (n = 25) who reported ≤25 on the Cumberland Ankle Instability Tool (CAIT) and a history of moderate–severe ankle sprain(s) and a control group (n = 33) who reported ≥29 on the CAIT and no history of ankle sprain(s). Interventions: Participants completed the following clinical tests: Foot Lift Test (FLT), the Star Excursion Balance Test (SEBT), the Single-Leg Hop Test (SLHT), and the Time in Balance Test (TIB) in a randomized order. A linear regression model was applied to determine measures that matched ankle group membership. Main Outcome Measures: The mean of SEBT reach distance was normalized to percentage leg length. The mean of number of errors in the FLT was recorded. The SLHT and TIB were reported as time in seconds, and the means were calculated. Results: The most parsimonious combination of tests (SLHT and SEBT) resulted in correctly matching 70.69% (41/58) of participants into groups, which was significantly better than chance. The multiple correlation coefficients (R value) for combining the SLHT and SEBT was 0.39. Conclusions: Using SLHT and SEBT resulted in improved recognition of participants designated into the CAI or control groups. Self-report perception of ankle function provides limited information for clinicians and researchers. Using multiple clinical function tests may be more helpful in determining deficits and intervention effectiveness.

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Does Acupressure Hit the Mark? A Three-Arm Randomized Placebo-Controlled Trial of Acupressure for Pain and Anxiety Relief in Athletes With Acute Musculoskeletal Sports Injuries

Objectives: Injuries are a common consequence of sports and recreational activity. The optimal management of symptoms is a crucial element of sports injury management. Acupressure has previously been shown to effectively decrease symptoms of musculoskeletal injury, thus may be considered a potentially useful intervention in the management of sport-related injuries. Therefore, this study was conducted to examine the effectiveness of acupressure in decreasing pain and anxiety in acutely injured athletes. Design: A prospective 3-arm randomized placebo-controlled trial. Setting: A sports injury clinic, Dunedin, New Zealand. Patients: Seventy-nine athletes who sustained a sport-related musculoskeletal injury on the day. Intervention: Three minutes of either acupressure, sham acupressure, or no acupressure. Main Outcome Measures: The primary outcomes of pain and anxiety intensity were measured before and immediately after the intervention on a 100-mm visual analog scale (VAS). Pain and anxiety relief, satisfaction with treatment, willingness to repeat a similar treatment, and belief in the effect of acupressure were secondary outcomes measured on Likert scales after the intervention. Results: The acupressure group reported 11 mm less pain (95% CI: 5-17) on average than the sham acupressure group, and 9 mm less (95% CI: 3-16) than the control group as a result of the intervention (P

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Triple Fracture of the Intra-Articular Second Metacarpal Head, Intra-Articular Fourth Metacarpal Base, and Ulnar Styloid of An Ice Hockey Player: A Case Report

Abstract: We present a case of simultaneous ipsilateral fractures at the intra-articular second metacarpal head, intra-articular fourth metacarpal base, and ulnar styloid. These fractures were caused by the peculiar condition of a blow to the fist during an ice hockey game; the hand was struck while it was gripping a stick. The specific combination of these fractures has not been previously reported in the literature. In this incident, axial compression force was transmitted from the second and fourth metacarpal heads while skipping the third metacarpal head to the ulnar side of the wrist via the carpometacarpal joints and carpal bones. Because each fracture exhibited only slight displacement, we used conservative treatment with good outcomes.

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Impact of a Short-Term Water Abstinence on Airway Hyperresponsiveness in Elite Swimmers

Objective: To investigate the effect of a swimming break on airway hyperresponsiveness (AHR) and to evaluate perception of bronchoconstriction-related symptoms after methacholine challenge testing (MCT). Design: Observational, controlled study. Setting: University department. Participants: Overall, 25 healthy, elite, competitive swimmers aged ≥14 years from the local Olympic training center and 25 healthy control subjects. Independent Variable: Duration of water abstinence. Main Outcome Measures: Primary outcome measures were a positive MCT with a provocation dose (PD) and the perception score of bronchoconstriction-related symptoms at visit 1 (V1, training period) and visit 2 (V2, after swimming break). Results: In the study, 13 swimmers (52%) and 10 control subjects (40%) showed AHR. The PD did not differ significantly between V1 and V2 in the swimmers (P = 0.81) or in the control subjects (P = 0.74). No correlation of fraction of exhaled nitric oxide with the PD could be established in both the groups (swimmers: P = 0.97; controls: P = 0.99). The majority of swimmers with AHR were asymptomatic, and only minimal differences in perception of bronchoconstriction-related symptoms between swimmers and control subjects were observed (P = 0.23). Conclusions: A swimming break of 25 ± 8 days does not seem sufficient to significantly reduce AHR in elite swimmers. Thus, relevant and systematic effects of short-term water abstinence on AHR seem unlikely. Because the majority of swimmers remain asymptomatic, AHR may escape routine screening examinations. The impact of AHR on athletic performance and the long-term clinical consequences remain to be clarified.

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Reliability and Practicality of the Core Score: Four Dynamic Core Stability Tests Performed in a Physician Office Setting

Objective: Pilot study to determine the practicality and inter-rater reliability of the “Core Score,” a composite measure of 4 clinical core stability tests. Design: Repeated measures. Setting: Academic hospital physician clinic. Participants: 23 healthy volunteers with mean age of 32 years (12 females, 11 males). Assessment of Variables: All subjects performed 4 core stability maneuvers under direct observation from 3 independent physicians in sequence. Main Outcome Measures: Inter-rater reliability and time necessary to perform examination. Results: The Core Score scale is 0 to 12, with 12 reflecting the best core stability. The mean composite score of all 4 tests for all subjects was 9.54 (SD, 1.897; range, 4-12). The intraclass correlation coefficients (ICC 1,1) for inter-rater reliability for the composite Core Score and 4 individual tests were 0.68 (Core Score), 0.14 (single-leg squat), 0.40 (supine bridge), 0.69 (side bridge), and 0.46 (prone bridge). The time required for a single examiner to assess a given subject's core stability in all 4 maneuvers averaged 4 minutes (range, 2-6 minutes). Conclusions: Even without specialized equipment, a clinically practical and moderately reliable measure of core stability may be possible. Further research is necessary to optimize this measure for clinical application. Clinical Relevance: Despite the known value of core stability to athletes and patients with low back pain, there is currently no reliable and practical means for rating core stability in a typical office-based practice. This pilot study provides a starting point for future reliability research on clinical core stability assessments.

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A Comparison of Clinical Outcome Between Athletes and Nonathletes Undergoing Hip Arthroscopy for Femoroacetabular Impingement

Objective: To compare the clinical outcome of arthroscopic surgery for femoroacetabular impingement (FAI) between athlete and nonathlete patients. Design: Retrospective case-control study. Level of Evidence III. Patients and Methods: Seventy-four patients who underwent arthroscopic FAI correction from March 2009 to April 2012 were enrolled in this study. The patients were divided into 2 groups, according to their sports participation (47 in the athlete group and 27 in the nonathlete group). Main Outcome Measures: We reviewed clinical and radiographic data for all patients, up to a minimum of 2 years after surgery. We used analysis of covariance to compare the mean patient reported outcome scores including modified Harris hip score (MHHS) and the nonarthritis hip score (NAHS) preoperatively, at 6, 12, and 24 months after surgery. Results: The mean age at the time of surgery in the athlete group was significantly lower than that in the nonathlete group. Although there was no significant difference in preoperative MHHS and NAHS, the mean NAHS at 6, 12, and 24 months postoperatively and the mean MHHS at 24 months postoperatively in athletes were significantly higher than that in nonathletes (P

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An Unusual Cause of Headache and Fatigue in a Division 1 Collegiate Athlete

Abstract: Variegate porphyria (VP) is an autosomal dominant disorder of porphyrin metabolism. We report a case of a 21-year-old male collegiate athlete who complained of recurrent headache and fatigue. Extensive testing after initial presentation failed to identify a cause. Months later, his grandmother was diagnosed with VP after being hospitalized; hence, he was tested. He was positive for a heterozygous missense mutation, R168H, in one protoporphyrinogen oxidase allele. This case highlights a rare disorder of heme synthesis that should be considered in the differential diagnosis of exertional fatigue and headaches in athletes. When other more common causes of fatigue and/or headache are unable to be identified, a more focused history and examination may lead to a more unusual but crucial diagnosis. To our knowledge, there are no reported cases of this condition in Division I collegiate athletes.

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Arthroscopic Shoulder Surgery in Female Professional Tennis Players: Ability and Timing to Return to Play

Objective: To assess the outcome and time to return to previous level of competitive play after shoulder surgery in professional tennis players. Design: Retrospective case series. Setting: Tertiary academic centre. Patients and Interventions: The records of all female tennis players on the Women's Tennis Association (WTA) professional circuit between January 2008 and June 2010 were reviewed to identify players who underwent shoulder surgery on their dominant (serving) shoulder. Main Outcome Measures: Primary outcomes were the ability and time to return to professional play and if they were able to return to their previous level of function as determined by singles ranking. Preoperative and postoperative singles rankings were used to determine rate and completeness of return to preoperative function. Results: During the study period, 8 professional women tennis players from the WTA tour underwent shoulder surgery on their dominant arm. Indications included rotator cuff debridement or repair, labral reconstruction for instability or superior labral anterior posterior lesion, and neurolysis of the suprascapular nerve. Seven players (88%) returned to professional play. The mean time to return to play was 7 months after surgery. However, only 25% (2 of 8) players achieved their preinjury singles rank or better by 18 months postoperatively. In total, 4 players returned to their preinjury singles ranking, with their peak singles ranking being attained at a mean of 2.4 years postoperatively. Conclusions: In professional female tennis players, a high return to play rate after arthroscopic shoulder surgery is associated with a prolonged and often incomplete return to previous level of performance. Thus, counseling the patient to this fact is important to manage expectations. Level Of Evidence: Level IV—Case Series.

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The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness

Objective: To assess the impact of heat applied for 8 hours immediately after or 24 hours after exercise on delayed-onset muscle soreness (DOMS) in large skeletal muscle groups measured by subjective and objective means. Design: Cross-sectional repeated measure design study. Setting: Research laboratory. Subjects: Three groups of 20 subjects, age range 20 to 40 years. Intervention: Squats were conducted in three 5-minute bouts to initiate DOMS; 3 minutes of rest separated the bouts. One group had heat applied immediately after exercise, and a second group had heat applied 24 hours after exercise. A third group was the control group where no heat was applied. Main Outcome Measures: Visual analog pain scales, muscle strength of quads, range of motion of quads, stiffness of quads (Continuous Passive Motion machine), algometer to measure quadriceps soreness, and blood myoglobin. Results: The most significant outcome was a reduction in soreness in the group that had low-temperature heat wraps applied immediately after exercise (P

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Can a Repeated Sprint Ability Test Help Clear a Previously Injured Soccer Player for Fully Functional Return to Activity? A Pilot Study

Objective: To investigate the effects of fatigue induced by a repeated sprint ability (RSA) test on the neuromuscular responses of soccer players with a recent history of lower limb injuries (CH) and a matched control group in good fitness condition (GH). Design: This was a case–control study. Participants: Nine CH and 9 GH. Independent Variable: Allocation to CH or GH. Main Outcome Measures: Each player was assessed for blood lactate concentration and jumping performance [squat jump (SJ) and countermovement jump (CMJ)] before/after RSA. Post-RSA rate of perceived exertion (RPE) was obtained. Receiver operating characteristic analysis was performed to calculate RSA sensitivity and specificity in distinguishing between CH and GH. Intraclass correlation coefficient was used to assess reliability. Results: No baseline differences were found for any variable. ΔSJ before/after RSA was −14 ± 2% and −5 ± 2% in CH and GH, respectively (P

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Comparison of Different Physical Activity Measurement Methods in Adults Aged 45 to 64 Years Under Free-Living Conditions

Objective: To compare physical activity (PA) measured by 4 methods in adults under free-living conditions in relation to selected demographic and anthropometric variables. Design: Cohort study. Setting: Department of Sports Medicine. Participants: Clinically healthy men (81) and women (69) aged 45 to 64 years. Interventions: Physical activity monitoring for 7 consecutive days under free-living conditions by pedometer (P) and accelerometer (A) simultaneously and PA questionnaires: International Physical Activity Questionnaire (IPAQ) and Seven-Day Physical Activity Questionnaire Recall (SDPAR) completed after the 7-day PA. Main Outcome Measures: Comparison of PA measured by pedometer, IPAQ, and SDPAR with accelerometer with regard to age, body mass, gender, and obesity type. Results: Total energy expenditure (EE) by IPAQ was higher than A (P

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Delayed Onset Vascular Stiffening Induced by Eccentric Resistance Exercise and Downhill Running

Objectives: Eccentric exercise induces muscle stiffening and soreness as well as unfavorable changes in macrovascular function. We tested the hypothesis that systemic eccentric exercise could evoke greater arterial stiffening than local eccentric resistance exercise. Design and Intervention: Twenty healthy young men were randomly assigned into either the downhill running (DR) and the eccentric resistance exercise (RE) group followed by a crossover design with an exercise and sham control trial. Main Outcome Measures: Carotid–femoral pulse wave velocity (cfPWV), central hemodynamic measures, and biomarkers were obtained. Results: Muscle soreness and plasma creatine kinase concentrations increased similarly after exercise in both groups. The cfPWV increased significantly at 48 hours post-exercise in both groups and remained elevated at 72 hours in DR. C-reactive protein (CRP) was elevated at 24 and 48 hours in DR, and 48 hours in RE. The increases in cfPWV were associated with the corresponding elevations in CRP in DR (r = 0.70, P

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Cancers of the Esophagus and Stomach: Potential Mechanisms Behind the Beneficial Influence of Physical Activity

Objective: To compare findings from several recent meta-analyses showing a reduced risk of gastric and esophageal cancers in physically active individuals, to assess the magnitude of this benefit, and to seek information on potential underlying mechanisms. Data Sources: A comprehensive search of Ovid/Medline from 1996 to February 2016, using the terms physical activity or exercise or training and esophageal or gastric cancer, and supplementing the articles identified by material from references lists and personal files. Main Results: Moderate-to-vigorous physical activity is associated with a 20% to 30% reduction in the risk of gastroesophageal adenocarcinomas, with a significant dose/response relationship. Benefit is greater in women than in men, and greater for noncardia than for cardia or esophageal tumors. Mechanisms could include a reduction of visceral fat (with a lesser production of cancer promoting hormones and reduced gastroesophageal reflux) and/or a lesser likelihood of smoking and excessive alcohol consumption. Physical activity does not protect against Helicobacter pylori infections or gastric ulceration, but mechanisms related to the impact of exercise on immune function, antioxidant mechanisms, and gastroesophageal reflux remain to be explored. Conclusions: Regular, moderate-to-vigorous physical activity is associated with a clinically significant reduction in the risk of gastroesophageal adenocarcinomas, but mechanisms are as yet unclear, and a causal relationship remains to be proven.

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Factors Influencing the Underreporting of Concussion in Sports: A Qualitative Study of Minor Hockey Participants

Objective: The present study is to identify factors contributing to underreporting of concussion in adolescent athletes. Design: Qualitative interviews. Setting: Participants were interviewed in an office environment. Participants: Interviews were conducted with 31 minor hockey players, 10 parents, 6 coaches, 4 trainers, 2 managers, and one game official. Players were 13 to 15 year old. With selective sampling, an inductive approach of analyzing the interviews was undertaken and themes were identified and analyzed. Assessment of Risk Factors: Underreporting is a complex phenomenon. A number of risk factors related to hockey culture, players, reference others, and rules of play were assessed. Main Outcome Measures: Reasons not reporting concussion is accepted in minor hockey. Results: Aspects of hockey culture such as an overemphasis on winning games and upheld misperceptions about the risks associated with concussion were identified as relevant to the underreporting of concussions. Various factors relevant to the underreporting of concussions include player's motivation to win, group membership dynamics such as a player's role as the team's “enforcer,” coaches' own motivation to win to further their own opportunities in the sport, and parents' personal financial interest or alternative agenda in terms of time commitments and their child's future career prospects. Conclusions: Our findings indicate that underreporting of concussion among those players interviewed appears to be prevalent and associated with misconceptions about injury risk, and a culture that both reinforces and encourages underreporting with tacit or overt complicity of parents and coaches. Our findings support the need to alter the culture of violence and tough play in hockey by education, rule changes, economic measures, and changes in governance of the sport. Interviewing more stakeholders and policy makers would shed light on such potential interventions.

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Exercise-Associated Hyponatremia in a Lactating Female

Abstract: A 37-year-old woman presented to the emergency department with severe headache, which quickly progressed to altered mental status and seizure activity in hospital. Her initial serum sodium concentration ([Na+]) was 126 mmol/L. In the 24 hours before admission, she exercised vigorously for 120 minutes (interval training plus yoga) and also consumed more than 4 liters of fluid during that time to both stay hydrated and facilitate milk production because she was actively nursing 2 children. Her serum [Na+] and altered mental status corrected slowly over the next 48 hours with furosemide, hypertonic saline, and fluid restriction. This case is unique because it discusses the possible pathogenic role that lactation-induced oxytocin release may have on sustained antidiuresis and dilutional exercise-associated hyponatremia (EAH). This would be the first report documenting EAH in a lactating woman, which may highlight an underrecognized risk factor for physically active women who are concurrently breast-feeding.

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Baseline Performance and Psychometric Properties of the Child Sport Concussion Assessment Tool 3 (Child-SCAT3) in 5- to 13-year-old Athletes

Objective: To determine the normative, baseline performance and psychometric properties of the Child Sport Concussion Assessment Tool 3 (Child-SCAT3) in 5- to 13-year-old athletes. Design: Cross-sectional study. Setting: Practice fields. Participants: Contact sport athletes (N = 155) 5 to 13 years old. Independent Variables: Age, gender, verbal intellectual functioning (receptive vocabulary). Main Outcome Measures: Child-SCAT3: self-reported and parent-reported symptoms, cognitive performance (child form of the Standardized Assessment of Concussion; SAC-C), and balance (modified Balance Error Scoring System, mBESS-C; tandem gait). A subset of the sample repeated the Child-SCAT3 at another date. Some subjects also completed the Adult-SCAT3 version of the symptom checklist and mBESS. Results: Small-to-medium-sized effects of age were observed on all Child-SCAT3 components. Effects of gender and receptive vocabulary were observed on select components of the SCAT3. Younger age and lower receptive vocabulary were independently associated with greater symptom endorsement, yet parents rated higher symptom burden for older children. Internal consistency reliability and stability of symptom ratings was good to excellent. Stability was more modest for SAC-C and tandem gait scores and very poor for mBESS-C scores, perhaps due to restricted variance. Inter-rater reliability (self-rated vs parent-rated symptoms) was fair. Conclusions: The Child-SCAT3 self-report symptom checklist may be inappropriate to administer to younger school-aged children. Some of the age effects observed warrant use of demographically appropriate norms in Child-SCAT3 interpretation. The findings can provide guidance for clinicians assessing children of varying ages and point to directions for further development of refined approaches for pediatric concussion assessment.

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A Case Report of Traumatic Partial Extensor Carpi Ulnaris Subluxation in an Elite Hockey Player With Review of the Literature

Abstract: In this article, we present a unique case of traumatic partial recurrent extensor carpi ulnaris (ECU) subluxation in an elite hockey player. To the best of our knowledge, this is the only report of partial ECU subluxation due to a split in the ECU tendon presented in the literature. This case illustrates the importance of proper diagnosis and treatment of such a lesion. We also emphasize that dynamic ultrasound is an excellent and cost-effective imaging modality that can help with the diagnosis of partial ECU subluxation. Finally, surgical treatment for failed conservative management showed excellent results in an elite athlete.

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Epidemiology of Chest, Rib, Thoracic Spine, and Abdomen Injuries Among United States High School Athletes, 2005/06 to 2013/14

Objective: Describe chest and abdominal injury epidemiology among US high school athletes. Design: Retrospective analysis of longitudinal surveillance data. Setting: Injury data from 2005/06 to 2013/14 academic years were collected using an internet-based surveillance system. Participants: A large sample of US high schools. Assessment of Risk Factors: Injuries sustained as a function of sport. Main Outcome Measures: Chest, rib, thoracic spine, and abdominal injuries sustained during high school athletic events. Results: Overall 1487 chest, rib, thoracic spine, and abdominal injuries occurred during 30 415 179 athletic exposures (AEs); an injury rate of 4.9 injuries per 100 000 AEs. Over half (56.8%) of injured athletes were evaluated by another medical provider in addition to the athletic trainer, and 34 injuries (2.3%) required surgery. Diagnostic techniques, including x-ray, magnetic resonance imaging or computed tomography were used in 729 (49.0%) injuries. The injury rate was higher in boys' (6.8) than girls' (2.0) sports [rate ratio (RR), 3.43; 95% CI, 3.04-4.10]. Football (47.7%) accounted for the highest proportion of injuries followed by wrestling (18.5%), boys' soccer (4.6%), and girls' soccer (3.7%). The rate of injury was higher in competition than practice, (RR, 2.86; 95% CI, 2.59-3.23). Only 57.7% of injured athletes were able to return to play within 1 week. Conclusions: Chest and abdominal injuries in high school sports although relatively rare, can result in loss of playing time and frequently prompt medical evaluation. Thus, they present a physical and economic burden. To optimize prevention, further studies can focus on subgroup risk factor identification to drive development of targeted prevention strategies.

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