Prognostic factors and patterns of locoregional failure after surgical resection in patients with cholangiocarcinoma without adjuvant radiation therapy: optimal field design for adjuvant radiation therapy

Publication date: Available online 5 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Zahra Ghiassi-Nejad, Paola Tarchi, Erin Moshier, Meng Ru, Parissa Tabrizian, Myron Schwartz, Michael Buckstein
PurposeTo identify prognostic factors and patterns of local failure in patients with cholangiocarcinoma, following surgical resection in the absence of adjuvant radiation, for optimal definition of target volumes encompassing the majority of local recurrences.Methods and MaterialsA chart review was performed in patients who underwent resection for primary CCA (intrahepatic, hilar, and distal) between 1999 and 2014. Local failure was defined as recurrence in a theoretical reasonable post-operative radiation volume. This includes the cut surface of liver, biliary anastomosis, hilum, portal nodes, celiac nodes, peri-pancreatic nodes, gastro-hepatic nodes, and retroperitoneal nodes. Patients who received adjuvant radiation were excluded.Results189 patients underwent surgical resection for CCA, of which 145 patients had sufficient follow up. Median follow up was 41.6 months (95% CI: 35.4-48.7). 102 cases were intrahepatic, and 43 were hilar/distal CCA. Adjuvant chemotherapy was given in 38 (26%) of cases, of which 20 (54%) were gemcitabine based. Eighty six patients (59%) had a documented recurrence, of which 44 (51%) had a locoregional component. Among patients that had a recurrence, 23 (27%) had a recurrence at the biliary anastomosis and/or cut liver surface. Twenty eight (32.6%) patients had a recurrence in the regional lymph nodes, most prevalent in the portal (16.3%), and retroperitoneal (17.4%) lymph nodes. Univariable analysis identified tumor size, any vascular invasion, presence of satellites, stage/nodal status and receipt of chemotherapy were significant prognostic factors of overall recurrence among IHC patients. Presence of satellites, and stage 3/Nx status remained statistically significant in multivariable modeling.ConclusionsThe areas at highest risk for locoregional recurrence following surgical resection are the biliary anastomosis/cut liver surface, portal lymph nodes, and retroperitoneal lymph nodes. While these results need to be validated, adjuvant radiation should possibly cover these areas to maximize locoregional control.

Teaser

Locoergional recurrences following surgical resection for cholangiocarcinoma (CCA) cause significant morbidity and mortality. This retrospective analysis explores risk factors for local failures and maps locoregional recurrences in patients who underwent surgery without adjuvant radiation. The recurrence map provides valuable information for delineating optimal planning target volumes for adjuvant radiation.


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Timing Is Everything: Where Status Epilepticus Treatment Fails

Abstract

Status epilepticus is an emergency, however prompt treatment of patients with status epilepticus is challenging. Clinical trials, such as the Established Status Epilepticus Treatment Trial (ESETT), compare effectiveness of antiepileptic medications, and rigorous examination of effectiveness of care delivery is similarly warranted. We reviewed the medical literature on observed deviations from guidelines, clinical significance, and initiatives to improve timely treatment. We found pervasive, substantial gaps between recommended and “real world” practice with regard to timing, dosing, and sequence of antiepileptic therapy. Applying quality improvement methodology at the institutional level can increase adherence to guidelines, and may improve patient outcomes. This article is protected by copyright. All rights reserved.

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Familial mesial temporal lobe epilepsy and the borderland of déjà vu

Abstract

Objective: The cause of mesial temporal lobe epilepsy (MTLE) is often unknown. We ascertained to what extent newly-diagnosed non-lesional MTLE actually represents familial MTLE (FMTLE).

Methods: We identified all consecutive patients presenting to the Austin Heath First Seizure Clinic with MTLE and a normal MRI or MRI-evidence of hippocampal sclerosis over a 10-year period. Patients' first-degree relatives and pairwise age- and sex-matched controls underwent a comprehensive epilepsy interview. Each interview transcript was reviewed independently by two epileptologists, blinded to relative or control status. Reviewers classified each subject as follows: epilepsy, specifying if MTLE; manifestations suspicious of epilepsy; or unaffected. Physiological déjà vu was noted.

Results: Forty-four patients were included. At the Clinic, MTLE had been recognized to be familial in 2 patients only. Among 242 subjects interviewed, MTLE was diagnosed in 9/121 relatives vs 0/121 controls (p=0.008). All affected relatives had seizures with intense déjà vu and accompanying features; 6 relatives had not been previously diagnosed. Déjà vu experiences which were suspicious, but not diagnostic, of MTLE occurred in 6 additional relatives vs none of the controls (p=0.04). Physiological déjà vu was common, and did not differ significantly between relatives and controls. After completing the relatives' interviews, FMTLE was diagnosed in 8 of 44 patients (18.2%).

Interpretation: FMTLE accounts for almost one-fifth of newly diagnosed non-lesional MTLE, and it is largely unrecognized without direct questioning of relatives. Relatives of patients with MTLE may experience déjà vu phenomena which clinically lie in the ‘borderland' between epileptic seizures and physiological déjà vu. This article is protected by copyright. All rights reserved.

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Time-Dependent Risk of Seizures in Critically Ill Patients on Continuous EEG

ABSTRACT

OBJECTIVE: Find the optimal Continuous EEG (cEEG) monitoring duration for seizure detection in critically ill patients.

METHODS: We analyzed prospective data from 665 consecutive cEEGs, including clinical factors and time-to-event emergence of EEG findings over 72-hours. Clinical factors were selected using logistic regression. EEG risk factors were selected a priori. Clinical factors were used for baseline (pre-EEG) risk. EEG findings were used for creation of multistate survival model with three states (entry, EEG risk, and seizure). EEG Risk state is defined by emergence of epileptiform patterns.

RESULTS: Clinical variables of greatest predictive value were coma (31% had seizures; OR 1.8; p<0.01) and history of seizures, either remotely or related to acute illness (34% had seizures; OR 3.0; p<0.001). If there were no epileptiform findings on EEG, the risk of seizures within 72-hour was between 9% (no clinical risk factors) and 36% (coma and history of seizures). If epileptiform findings developed the seizure incidence was between 18% (no clinical risk factors) and 64% (coma and history of seizure). In the absence of epileptiform EEG abnormalities, the duration of monitoring needed for seizure risk of <5% was between 0.4hrs (for patients who are not comatose, and no prior seizure) to 16.4hrs (comatose and prior seizure).

INTERPRETATION: The initial risk of seizures on cEEG is dependent on history of prior seizures and presence of coma. The risk of developing seizures on cEEG decays to <5% by 24 hours if no epileptiform EEG abnormalities emerge, independent of initial clinical risk factors. This article is protected by copyright. All rights reserved.

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MMP9 is decreased in natalizumab-treated MS patients at risk for PML

Abstract

Objective: To identify biomarkers associated with the development of progressive multifocal leukoencephalopathy (PML) in multiple sclerosis (MS) patients treated with natalizumab (NTZ).

Methods: Relapsing-remitting MS (RRMS) patients who developed PML under NTZ therapy (pre-PML) and non-PML natalizumab-treated patients (NTZ-ctr) were included in the study. Cryopreserved peripheral blood mononuclear cells (PBMC) and serum samples collected at baseline, at one- and two-year treated time points, and during PML were analyzed for gene expression by RNA-sequencing and for serum protein levels by LUMINEX and ELISA assays respectively.

Results: Among top differentially expressed genes in the RNA-sequencing between pre-PML and NTZ-ctr patients, pathway analysis revealed a high representation of genes belonging to the following categories: pro-angiogenic factors (MMP9, VEGFA), chemokines (CXCL1, CXCL5, IL8, CCL2), cytokines (IL1B, IFNG), and plasminogen- and coagulation-related molecules (SERPINB2, PLAU, PLAUR, TFPI, THBD). Serum protein levels for these candidates were measured in a two-step manner in a screening cohort and a validation cohort of pre-PML and NTZ-ctr patients. Only MMP9 was validated and, in pre-PML patients MMP9 protein levels were significantly reduced at baseline compared with NTZ-ctr patients and levels remained lower at later time points during NTZ treatment.

Interpretation: The results from this study suggest that the pro-angiogenic factor MMP9 may play a role as biomarker associated with the development of PML in MS patients treated with NTZ. This article is protected by copyright. All rights reserved.

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Microbleeds in the SPS3 Trial: Stroke, Mortality and Treatment Interactions

Abstract

Objectives: To characterize cerebral microbleeds (CMBs) in lacunar stroke patients in the SPS3 trial and to assess their relationship with recurrent stroke and death, and response to assigned treatment.

Methods: SPS3 is a randomized, clinical trial conducted between 2003 and 2011. Patients with recent MRI-documented lacunar infarcts were randomly assigned in a factorial design to target levels of systolic blood pressure (SBP; 130–149 mmHg vs <130 mmHg; open-label) and to antiplatelet treatment (aspirin/clopidogrel vs aspirin/placebo; double-blinded). The current analysis involves 1278 trial participants who had a baseline axial T2*- GRE MRI sequence allowing for CMB detection.

Results: CMBs were present in 30% of 1278 patients (mean age 63 y). Male gender (OR 1.7, 95%CI 1.3-2.3)·, history of hypertension (1.6, 1.2-2.3), increased systolic blood pressure (1.2 per 20 mmHg, 1.1-1.4), non-diabetic (1.4, 1.1-1.9), multiple old lacunar infarcts(1.9, 1.5-2.5) and moderate(1.7, 1.2-2.3) or severe (4.2, 3.0-5.9) white matter hyperintensities on MRI were independently associated with CMBs. During a mean follow-up of 3.3 y, overall stroke recurrence was 2.5% per patient-y. Patients with CMBs had an adjusted two-fold increased risk of recurrent stroke (HR 2.1, 1.4-3.1). CMBs were not a risk factor for death. There were no statistically significant interactions between CMBs and treatment assignments.

Interpretation: Patients with lacunar stroke and CMBs likely harbor a more advanced form of cerebral small vessel disease in need of efficacious therapeutic strategies. This article is protected by copyright. All rights reserved.

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THIRD GENERATION EGFR TKIs IN EGFR-MUTATED NSCLC: WHERE ARE WE NOWAND WHERE ARE WE GOING

Publication date: Available online 5 July 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): A. Russo, T. Franchina, G.R.R. Ricciardi, V. Smiroldo, M. Picciotto, M. Zanghì, C. Rolfo, V. Adamo
The therapeutic landscape of Non Small Lung Cancer (NSCLC) has been profoundly changed over the last decade with the clinical introduction of Epidermal Growth Factor Receptor (EGFR) tyrosine kinase inhibitors (TKIs) and the discovery of EGFR activating mutations as the major predictive factor to these agents. Despite impressive clinical activity against EGFR-mutated NSCLCs, the benefit seen with 1st and 2nd generation EGFR TKIs is usually transient and virtually all patients become resistant. Several different mechanisms of acquired resistance have been reported to date, but the vast majority of patients develop a secondary exon 20 mutation in the ATP-binding site of EGFR, namely T790M. The discovery of mutant-selective EGFR TKIs that selectively inhibit EGFR-mutants, including T790M-harboring NSCLCs, while sparing EGFR wild type, provide the opportunity for overcoming the major mechanism of acquired resistance to 1st and 2nd generation EGFR TKIs, with a relatively favorable toxicity profile. The development of this novel class of EGFR inhibitors poses novel challenges in the rapidly evolving therapeutic paradigm of EGFR-mutated NSCLCs and the next few years will witness the beginning of a new era for EGFR inhibition in lung cancer. The aim of this paper is to provide a comprehensive overview of the increasing body of data emerging from the ongoing clinical trials with this promising novel therapeutic class of EGFR inhibitors.



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A Molecular and Preclinical Comparison of the PD-1 targeted T cell Checkpoint Inhibitors Nivolumab and Pembrolizumab

Publication date: Available online 4 July 2017
Source:Seminars in Oncology
Author(s): Petros Fessas, Hassal Lee, Shinji Ikemizu, Tobias Janowitz
T cell checkpoint inhibition has a profound impact on cancer care and the two Programmed cell death protein 1 (PD-1) targeted antibodies nivolumab and pembrolizumab have been leading this therapeutic revolution. Their clinical comparability is a highly relevant topic of discussion, but to a significant degree is a consequence of their molecular properties. Here we provide a molecular, preclinical, and early clinical comparison of the two antibodies, based on the available data and recent literature. We acknowledge the limitations of such comparisons, but suggest that based on the available data, differences in clinical trial outcomes between nivolumab and pembrolizumab are more likely drug-independent than drug-dependent.



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Comparing nasal packing with trans-septal suturing following septoplasty: a randomized clinical trial

Abstract

It has been shown that nasal packing after septoplasty is associated with several complications. Our aim was to compare post-septoplasty nasal packing and trans-septal suturing, in terms of complications and outcome of operation. This randomized clinical trial was performed on patients with deviated nasal septum who were candidates for septoplasty. Patients were visited three times after operation (on the first 48 h, first week, and third post-operative month). Participants were checked for having common complications. Rhinomanometric evaluation was performed to measure nasal air flow and airway resistance, as indicators of operation efficacy, both prior to and after surgery. A total of 72 patients were allocated into the two trial arms. Patients in nasal pack group reported higher pain scores on the first 48 h (P < 0.001) and one week after surgery (P < 0.001). Epiphora (P = 0.028), sleep disturbance (P = 0.012), and dyspnea (P < 0.001) were also more commonly observed in patients using nasal pack. Objective evaluation of bleeding demonstrated that more severe bleeding occurred in patients with trans-septal sutures (P = 0.001). No differences were found comparing the indices of rhinomanometry between the two groups. Using trans-septal sutures after septoplasty compared to nasal packing, might be associated with lower frequencies of several specific complications and a lower rate of patients’ discomfort. Nevertheless, increase in the risk of bleeding and hematoma was noted in the trans-septal suture group. No differences were observed between the nasal air flow and resistance of patients in the two groups.

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Role of oxidative stress in melasma: a prospective study on serum and blood markers of oxidative stress in melasma patients

Abstract

Background

Melasma is a common pigmentary disorder presenting in the dermatological clinic. Many factors have been implicated in the pathogenesis, however, the cause still remains elusive. Recently the effect of oxidative damage has been proposed in the etiopathogenesis of melasma. This study was undertaken to evaluate the role of oxidative stress in patients with melasma.

Material and methods

Fifty patients with melasma, age 18 years of age and older, and an equal number of age and sex-matched controls were included in the study. Baseline severity assessment using the modified Melasma Area and Severity Index (modified MASI score) was done in all patients. Serum malondialdehyde, blood superoxide dismutase, and blood glutathione peroxidase levels were measured in cases and controls group and results were compared.

Result

The serum levels of malondialdehyde, superoxide dismutase, and blood glutathione were significantly higher among the cases compared to controls. The difference in the serum concentrations was significant between the two groups (P < 0.01). A positive correlation was found between these enzyme levels and severity of melasma (modified MASI score); however, this correlation was statistically significant with serum malondialdehyde only. The level of oxidative stress among the male and female melasma patients was not statistically different.

Conclusion

Oxidative stress was found to be increased in cases of melasma compared to the control group in this study. This substantiates the role of oxidative stress in etiopathogenesis of melasma; however, further studies are required to reach a definitive conclusion.

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Loss of Hippo Signaling Promotes Polyploidy and Tumorigenesis [Signaling]

YAP activates AKT signaling to promote mitotic arrest, polyploidy, and hepatocellular carcinoma.

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Transdifferentiation as a Mechanism of Treatment Resistance in a Mouse Model of Castration-Resistant Prostate Cancer [Research Articles]

Current treatments for castration-resistant prostate cancer (CRPC) that target androgen receptor (AR) signaling improve patient survival, yet ultimately fail. Here, we provide novel insights into treatment response for the antiandrogen abiraterone by analyses of a genetically engineered mouse (GEM) model with combined inactivation of Trp53 and Pten, which are frequently comutated in human CRPC. These NPp53 mice fail to respond to abiraterone and display accelerated progression to tumors resembling treatment-related CRPC with neuroendocrine differentiation (CRPC-NE) in humans. Cross-species computational analyses identify master regulators of adverse response that are conserved with human CRPC-NE, including the neural differentiation factor SOX11, which promotes neuroendocrine differentiation in cells derived from NPp53 tumors. Furthermore, abiraterone-treated NPp53 prostate tumors contain regions of focal and/or overt neuroendocrine differentiation, distinguished by their proliferative potential. Notably, lineage tracing in vivo provides definitive and quantitative evidence that focal and overt neuroendocrine regions arise by transdifferentiation of luminal adenocarcinoma cells. These findings underscore principal roles for TP53 and PTEN inactivation in abiraterone resistance and progression from adenocarcinoma to CRPC-NE by transdifferentiation.

Significance: Understanding adverse treatment response and identifying patients likely to fail treatment represent fundamental clinical challenges. By integrating analyses of GEM models and human clinical data, we provide direct genetic evidence for transdifferentiation as a mechanism of drug resistance as well as for stratifying patients for treatment with antiandrogens. Cancer Discov; 7(7); 736–49. ©2017 AACR.

See related commentary by Sinha and Nelson, p. 673.

This article is highlighted in the In This Issue feature, p. 653

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Loss of Hippo Signaling Promotes Polyploidy and Tumorigenesis [Signaling]

YAP activates AKT signaling to promote mitotic arrest, polyploidy, and hepatocellular carcinoma.

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Transdifferentiation as a Mechanism of Treatment Resistance in a Mouse Model of Castration-Resistant Prostate Cancer [Research Articles]

Current treatments for castration-resistant prostate cancer (CRPC) that target androgen receptor (AR) signaling improve patient survival, yet ultimately fail. Here, we provide novel insights into treatment response for the antiandrogen abiraterone by analyses of a genetically engineered mouse (GEM) model with combined inactivation of Trp53 and Pten, which are frequently comutated in human CRPC. These NPp53 mice fail to respond to abiraterone and display accelerated progression to tumors resembling treatment-related CRPC with neuroendocrine differentiation (CRPC-NE) in humans. Cross-species computational analyses identify master regulators of adverse response that are conserved with human CRPC-NE, including the neural differentiation factor SOX11, which promotes neuroendocrine differentiation in cells derived from NPp53 tumors. Furthermore, abiraterone-treated NPp53 prostate tumors contain regions of focal and/or overt neuroendocrine differentiation, distinguished by their proliferative potential. Notably, lineage tracing in vivo provides definitive and quantitative evidence that focal and overt neuroendocrine regions arise by transdifferentiation of luminal adenocarcinoma cells. These findings underscore principal roles for TP53 and PTEN inactivation in abiraterone resistance and progression from adenocarcinoma to CRPC-NE by transdifferentiation.

Significance: Understanding adverse treatment response and identifying patients likely to fail treatment represent fundamental clinical challenges. By integrating analyses of GEM models and human clinical data, we provide direct genetic evidence for transdifferentiation as a mechanism of drug resistance as well as for stratifying patients for treatment with antiandrogens. Cancer Discov; 7(7); 736–49. ©2017 AACR.

See related commentary by Sinha and Nelson, p. 673.

This article is highlighted in the In This Issue feature, p. 653

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Brigatinib Approved, but Treatment Role Uncertain [News in Brief]

The FDA has approved the ALK inhibitor brigatinib for patients with metastatic non-small cell lung cancer who cannot take crizotinib or whose disease worsened despite its use. The decision was based upon results of a phase II study that assessed two drug doses, with overall response rates of 45% and 56% respectively. The drug's effect on overall survival remains unclear, as does the optimal sequence of brigatinib and the three other ALK inhibitors.

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Findings May Lead to New Strategies for GVHD [News in Brief]

A new study in mice demonstrates that activating the RIG-I and STING signaling pathways, normally associated with antiviral immunity, can help protect the intestinal epithelium from damage caused by chemotherapy and radiation following stem cell transplantation. The findings may help in developing strategies to prevent graft-versus-host disease in patients with leukemia and other blood disorders.

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Ceritinib Has Clinical Activity in Patients with ROS1-Rearranged NSCLC [Clinical Trials]

Ceritinib has manageable toxicity and achieves whole-body and intracranial responses.

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Brigatinib Approved, but Treatment Role Uncertain [News in Brief]

The FDA has approved the ALK inhibitor brigatinib for patients with metastatic non-small cell lung cancer who cannot take crizotinib or whose disease worsened despite its use. The decision was based upon results of a phase II study that assessed two drug doses, with overall response rates of 45% and 56% respectively. The drug's effect on overall survival remains unclear, as does the optimal sequence of brigatinib and the three other ALK inhibitors.

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Three Drugs Approved for Urothelial Carcinoma by FDA [News in Brief]

The FDA has approved one PD-1 checkpoint inhibitor, pembrolizumab, and two PD-L1 checkpoint inhibitors, avelumab and durvalumab, to treat metastatic urothelial carcinoma in patients whose disease continues to progress despite platinum-based chemotherapy. This brings the total number of checkpoint inhibitors for the disease to five, prompting questions about how best to use them.

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Gefitinib Delays NSCLC Recurrence After Surgery [News in Brief]

For patients with non-small cell lung cancer and activating EGFR mutations who have had surgery, gefitinib appears to be more effective than chemotherapy in delaying disease recurrence. In a phase III trial, patients given the EGFR inhibitor were disease-free for 10 months longer than those who received chemotherapy.

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Capecitabine Extends Survival for Biliary Tract Cancer [News in Brief]

Based on results of the phase III BILCAP study, adjuvant capecitabine should become standard treatment for patients with biliary tract cancer. Among 430 patients who were treated according to the study protocol, capecitabine was associated with a 25% lower risk of death than observation.

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Loss of Vhl, Trp53, and Rb1 Induces Clear Cell Renal Carcinoma in Mice [Renal Cell Carcinoma]

An autochthonous mouse model of clear cell renal cell carcinoma (ccRCC) recapitulates the human disease.

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Midostaurin Gets FDA Nod for AML [News in Brief]

The FDA has approved the small-molecule inhibitor midostaurin in combination with chemotherapy to treat acute myeloid leukemia. It is the first approved drug for the disease that specifically targets FLT3 mutations, which occur in about a quarter of all AML cases and are associated with particularly poor outcomes.

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DNA Damage and Repair Biomarkers of Immunotherapy Response [Review]

DNA-damaging agents are widely used in clinical oncology and exploit deficiencies in tumor DNA repair. Given the expanding role of immune checkpoint blockade as a therapeutic strategy, the interaction of tumor DNA damage with the immune system has recently come into focus, and it is now clear that the tumor DNA repair landscape has an important role in driving response to immune checkpoint blockade. Here, we summarize the mechanisms by which DNA damage and genomic instability have been found to shape the antitumor immune response and describe clinical efforts to use DNA repair biomarkers to guide use of immune-directed therapies.

Significance: Only a subset of patients respond to immune checkpoint blockade, and reliable predictive biomarkers of response are needed to guide therapy decisions. DNA repair deficiency is common among tumors, and emerging experimental and clinical evidence suggests that features of genomic instability are associated with response to immune-directed therapies. Cancer Discov; 7(7); 675–93. ©2017 AACR.

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HPV Vaccine Slashes Rates of Oral Infection [News in Brief]

Vaccination against human papillomavirus (HPV) reduces the prevalence of oral infection by an estimated 88% among young adults in the United States, a protection that could help reduce rates of HPV-related oropharyngeal cancers, according to data that will be presented at the American Society of Clinical Oncology Annual Meeting in Chicago, IL. However, the population-level benefit will remain low unless more people get vaccinated.

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Capecitabine Extends Survival for Biliary Tract Cancer [News in Brief]

Based on results of the phase III BILCAP study, adjuvant capecitabine should become standard treatment for patients with biliary tract cancer. Among 430 patients who were treated according to the study protocol, capecitabine was associated with a 25% lower risk of death than observation.

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Chemotherapy-Activated Caspase 3 Cleaves GSDME to Drive Pyroptosis [Chemotherapy]

GSMDE promotes a switch of chemotherapy-mediated cell death from apoptosis to pyroptosis.

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Noted [News in Brief]

A collection of recently published news items.

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Brigatinib Achieves Whole-Body and Intracranial Responses [Clinical Trials]

Brigatinib is tolerable and has antitumor activity in crizotinib-resistant ALK-positive NSCLC.

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Hardware complications in oromandibular defects: Comparing scapular and fibular based free flap reconstructions

The advent of microvascular free tissue transfer has revolutionized oromandibular reconstruction. The combination of osseocutaneous or osseomyogeneous free flaps in addition to advances in instrumentation with locking screw technology and low profile plates has greatly improved the functional and cosmetic outcomes for patients with mandibular defects [1]. Despite these advances, hardware complications remains a significant challenge with roughly 15% of patients experiencing hardware related complications [2].

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Early detection of squamous cell carcinoma in carcinogen induced oral cancer rodent model by ratiometric activatable cell penetrating peptides

Head and neck squamous cell carcinoma (HNSCC), which comprises cancer of the oral cavity, pharynx and larynx, is the 6th leading malignancy worldwide. With a reported annual burden of 633,000 incident cases, 355,000 deaths, and a 5year overall survival rate ∼60%, patient prognosis remains poor as diagnosis often occurs late into disease progression when advanced stage cancer is unresponsive to therapy [1–3]. Established risk factors for HNSCC include tobacco use and alcohol consumption [4]. Human Papilloma Virus (HPV) status has also been identified as a risk factor for HNSCC [5,6].

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Predictive and prognostic value of CT based radiomics signature in locally advanced head and neck cancers patients treated with concurrent chemoradiotherapy or bioradiotherapy and its added value to Human Papillomavirus status

The current standard of care for patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC) is concurrent chemoradiotherapy (CRT), although it is associated with frequent severe acute and late toxicities [1]. In the recent years there has been a growing interest in increasing the benefit/risk ratio in human papillomavirus (HPV)-positive patients [2,3]. Due to improved prognosis, CRT could be safely postponed in HPV positive patients, reducing toxicity while not jeopardizing survival.

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On the Potential of Hydrogen-Powered Hydraulic Pumps for Soft Robotics

Soft Robotics , Vol. 0, No. 0.


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Benign breast disease and risk of thyroid cancer

Abstract

Background

It has been suggested that breast and thyroid diseases may be linked. The aim of this study was to investigate the association between benign breast disease and subsequent risk of thyroid cancer.

Methods

Postmenopausal women (n = 133,875) aged 50–79 years were followed up for a mean of 14 years. Benign breast disease was defined by history of biopsy. Incident thyroid cancer cases were confirmed by medical record review. Multivariable Cox proportional hazard modeling was used to estimate hazard ratios.

Results

There were 370 incident thyroid cancer cases during the follow-up period. Compared to women without BBD, women with BBD had a significant increased risk of thyroid cancer after adjusting for potential confounders (HR 1.38 95% CI 1.10–1.73), especially for women with more than two biopsies (HR 1.59 95% CI 1.10–2.26). There were no significant differences in thyroid tumor size, stage or histologic types between women with and without BBD.

Conclusion

Our large prospective study observed that postmenopausal women with BBD had an increased risk for thyroid cancer compared with women without BBD. A more detailed investigation of thyroid cancer risk according to different subtypes of benign breast disease is needed to better understand the association observed between thyroid and benign breast diseases.

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A phase I study of cabazitaxel in combination with platinum and 5-fluorouracil (PF) in locally advanced squamous cell carcinoma of head and neck (LA-SCCHN)

There is a clinical need to improve outcomes for patients with locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN), especially in Human Papilloma Virus (HPV) negative and HPV positive subtypes with a significant history of tobacco use. In animal models bearing SCCHN, Cabazitaxel showed an excellent response rate compared to docetaxel and might prove useful in treatment of patients. The primary objective of this study was to determine the dose-limiting toxicity (DLT) and maximum tolerated dose (MTD) of cabazitaxel when combined with cisplatin and 5-fluorouracil (PF) in induction chemotherapy (IC) for patients with SCCHN.

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Inflammation in the assessment of salivary cytokines in oral squamous cell carcinoma diagnosis

During a literature search about the role of molecular markers in accurate diagnosis and prognosis of oral malignant lesions, we have encountered a valuable paper entitled “Oral squamous cell carcinoma detection by salivary biomarkers in a Serbian population”, authored by Brinkmann O, Kastratovic DA, Dimitrijevic MV, Konstantinovic VS, Jelovac DB, Antic J, Nesic VS, Markovic SZ, Martinovic ZR, Akin D, Spielmann N, Zhou H, Wong DT, published in Oral Oncology 2011 January; 47(1): 51–55. In that study, the authors investigated six transcriptome (DUSP1, IL8, IL1β, OAZ1, SAT1, S100P) and three proteome (IL1β, IL8, M2BP) biomarkers on 18 early and 17 late stage OSCC patients and 51 healthy controls with quantitative PCR and ELISA.

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Prediction of distant metastases from nasopharyngeal carcinoma: Improved diagnostic performance of MRI using nodal volume in N1 and N2 stage disease: Methodological issues

We read the study conducted by Ai and colleagues that was published in Oral Oncology, enthusiastically and meticulously [1]. The authors tried to examine the predictive performance of the magnetic resonance imaging (MRI) of the head and neck for distant metastases (DM) from nasopharyngeal carcinoma (NPC). The results have suggested MRI nodal stage (N) stage and total nodal volume (NV) have an important predictive effects for DM and distant metastases free survival (DMFS) [1].

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Editorial Board/Aims & Scope

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Therapy experiences and preferences among patients with anemia: results of a cross-sectional survey among Italian patients with inflammatory bowel disease

Anemia represents one of the most common and often the least treated complications of inflammatory bowel disease (IBD).

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Dose-dependent enhancement of T-lymphocyte priming and CTL lysis following ionizing radiation in an engineered model of oral cancer

While many patients with head and neck squamous cell carcinoma (HNSCC) display a T-cell inflamed phenotype [1], only a small subset respond to programmed death (PD) pathway checkpoint inhibition [2]. Strategies to enhance response rates to checkpoint inhibition in HNSCC are needed. PD-based checkpoint blockade has the potential to unleash an existing anti-tumor immune response being blocked by the expression of PD-1/PD-L1, but cannot induce a de novo anti-tumor immunity [3]. The addition of PD-based checkpoint blockade to other anti-cancer treatments that have the potential to induce adaptive anti-tumor immune responses may be additive or synergistic due to reversal of adaptive immune resistance [3,4].

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Early detection of squamous cell carcinoma in carcinogen induced oral cancer rodent model by ratiometric activatable cell penetrating peptides

Head and neck squamous cell carcinoma (HNSCC), which comprises cancer of the oral cavity, pharynx and larynx, is the 6th leading malignancy worldwide. With a reported annual burden of 633,000 incident cases, 355,000 deaths, and a 5year overall survival rate ∼60%, patient prognosis remains poor as diagnosis often occurs late into disease progression when advanced stage cancer is unresponsive to therapy [1–3]. Established risk factors for HNSCC include tobacco use and alcohol consumption [4]. Human Papilloma Virus (HPV) status has also been identified as a risk factor for HNSCC [5,6].

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Predictive and prognostic value of CT based radiomics signature in locally advanced head and neck cancers patients treated with concurrent chemoradiotherapy or bioradiotherapy and its added value to Human Papillomavirus status

The current standard of care for patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC) is concurrent chemoradiotherapy (CRT), although it is associated with frequent severe acute and late toxicities [1]. In the recent years there has been a growing interest in increasing the benefit/risk ratio in human papillomavirus (HPV)-positive patients [2,3]. Due to improved prognosis, CRT could be safely postponed in HPV positive patients, reducing toxicity while not jeopardizing survival.

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Treatment guidelines and patterns of care in oral cavity squamous cell carcinoma: Primary surgical resection vs. nonsurgical treatment

The 2017 National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines provide level 2A recommendations for surgical excision with neck dissection or for definitive radiation therapy (RT) in early-stage oral cavity cancers, as well as 2A recommendations for surgery with postoperative adjuvant therapy or multimodality clinical trials for resectable late-stage oral cavity lesions [1]. Despite this, with significant advancements in reconstructive techniques and subsequent improvements in functional outcomes, surgical resection has become the preferred treatment modality for resectable oral cavity malignancies [2,3].

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Dose-dependent enhancement of T-lymphocyte priming and CTL lysis following ionizing radiation in an engineered model of oral cancer

While many patients with head and neck squamous cell carcinoma (HNSCC) display a T-cell inflamed phenotype [1], only a small subset respond to programmed death (PD) pathway checkpoint inhibition [2]. Strategies to enhance response rates to checkpoint inhibition in HNSCC are needed. PD-based checkpoint blockade has the potential to unleash an existing anti-tumor immune response being blocked by the expression of PD-1/PD-L1, but cannot induce a de novo anti-tumor immunity [3]. The addition of PD-based checkpoint blockade to other anti-cancer treatments that have the potential to induce adaptive anti-tumor immune responses may be additive or synergistic due to reversal of adaptive immune resistance [3,4].

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PD-1+ polyfunctional T cells dominate the periphery after tumor-infiltrating lymphocyte therapy for cancer

Purpose: Infusion of highly heterogeneous populations of autologous tumor-infiltrating lymphocytes (TILs) can result in tumor regression of exceptional duration. Initial tumor regression has been associated with persistence of tumor-specific TILs one month after infusion, but mechanisms leading to long-lived memory responses are currently unknown. Here we studied the dynamics of bulk tumor-reactive CD8⁺ T cell populations in patients with metastatic melanoma following treatment with TILs. <p>Experimental Design: We analyzed the function and phenotype of tumor-reactive CD8⁺ T cells contained in serial blood samples of sixteen patients treated with TILs</p> <p>Results: Polyfunctional tumor-reactive CD8⁺ T cells accumulated over time in the peripheral lymphocyte pool. Combinatorial analysis of multiple surface markers (CD57, CD27, CD45RO, PD-1 and LAG-3) showed a unique differentiation pattern of polyfunctional tumor-reactive CD8⁺ T cells, with highly specific PD-1 upregulation early after infusion. The differentiation and functional status appeared largely stable for up to 1 year post-infusion. Despite some degree of clonal diversification occurring in vivo within the bulk tumor-reactive CD8⁺ T cells, further analyses showed that CD8⁺ T cells specific for defined tumor-antigens had similar differentiation status.</p> <p>Conclusions: We demonstrated that tumor-reactive CD8⁺ T cell subsets which persist after TIL therapy are mostly polyfunctional, display a stable partially differentiated phenotype and express high levels of PD-1. These partially differentiated PD-1⁺ polyfunctional TILs have a high capacity for persistence and may be susceptible to PD-L1/PD-L2-mediated inhibition.

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Detection of Activating Estrogen Receptor Gene (ESR1) Mutations in Single Circulating Tumor Cells

Purpose: Early detection is essential for treatment plans before onset of metastatic disease. Our purpose was to demonstrate feasibility to detect and monitor estrogen receptor 1 (ESR1) gene mutations at the single circulating tumor cell (CTC) level in metastatic breast cancer (MBC). <br /><br />Experimental Design: We used a CTC molecular characterization approach to investigate heterogeneity of 14 hot spot mutations in ESR1 and their correlation with endocrine resistance. Combining the CellSearch^® and DEPArray™ technologies allowed recovery of 71 single CTCs and 12 WBC from 3 ER-positive MBC patients. 40 CTCs and 12 WBC were subjected to whole genome amplification by MALBAC and Sanger sequencing.<br /><br />Results: Among 3 selected patients, 2 had an ESR1 mutation (Y537). One showed two different ESR1 variants in a single CTC and another showed loss of heterozygosity. All mutations were detected in matched cell-free DNA (cfDNA). Furthermore, one had 2 serial blood samples analyzed and showed changes in both cfDNA and CTCs with emergence of mutations in ESR1 (Y537S and T570I), which has not been reported previously.<br /><br />Conclusions: : CTCs are easily accessible biomarkers to monitor and better personalize management of patients with previously demonstrated ER-MBC who are progressing on endocrine therapy. We showed that single CTC analysis can yield important information on clonal heterogeneity, and can be a source of discovery of novel and potential driver mutations. Finally, we also validate a workflow for liquid biopsy that will facilitate early detection of ESR1 mutations, the emergence of endocrine resistance and the choice of further target therapy.

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SYD985, a Novel Duocarmycin-Based HER2-Targeting Antibody-Drug Conjugate, Shows Antitumor Activity in Uterine and Ovarian Carcinosarcoma with HER2/Neu Expression

Purpose: Carcinosarcomas (CS) are highly aggressive gynecologic malignancies containing both carcinomatous and sarcomatous elements with heterogeneous HER2/neu expression. We compared the efficacy of SYD985, (Synthon Biopharmaceuticals BV), a novel HER2-targeting antibody-drug conjugate (ADC), to Trastuzumab emtansine (T-DM1, Genentech-Roche) against primary uterine and ovarian CS. <p>Experimental Design: Eight primary CS cell lines were evaluated for HER2/neu surface expression by IHC and gene amplification by FISH assays. The in vitro experiments included cytotoxicity, antibody-dependent cellular cytotoxicity (ADCC), proliferation, viability and bystander killing. In vivo activity was studied in mouse xenograft and patient-derived-xenograft (PDX) models.</p> <p>Results: SYD985 and T-DM1 induced similar levels of ADCC against CS cell lines with low and high HER2/neu expression when challanged in the presence of effector cells. In contrast, SYD985 was 7 to 54 fold more potent than T-DM1 in the absence of effector cells. SYD985, unlike T-DM1, was active against CS demonstrating low or heterogeneous HER2/neu expression. Specifically, the mean IC₅₀'s were 0.060 µg/mL and 3.221 µg/mL (p<0.0001) against HER2/neu 0/1+ cell lines and 0.013 µg/mL and 0.096 µg/mL (p<0.0001) against HER2/neu 3+ cell lines for SYD985 vs T-DM1, respectively. Importantly, unlike T-DM1, SYD985 induced efficient bystander killing of HER2/neu 0/1+ tumor cells admixed with HER2/neu 3+ cells. In vivo studies confirmed that SYD985 is more active than T-DM1 in CS and highly effective against HER2/neu expressing xenografts and PDX.</p> <p>Conclusions: SYD985 may represent a novel and highly effective ADC against HER2-expressing CS. Clinical studies with SYD985 in patients harboring chemotherapy-resistant CS with low/moderate and high HER2 expression are warranted.

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Sequential tracking of PD-L1 expression and RAD50 induction in circulating tumor and stromal cells of lung cancer patients undergoing radiotherapy

Evidence suggests that PD-L1 can be induced with radiotherapy and may be an immune escape mechanism in cancer. Monitoring this response is limited as repetitive biopsies during therapy is impractical, dangerous and misses tumor stromal cells. Monitoring PD-L1 expression in both circulating tumor cells (CTCs) and circulating stromal cells (CStCs) in blood based biopsies might be a practical alternative for sequential, non-invasive assessment of changes in tumor and stromal cells. <br /><br />Peripheral blood was collected before and after radiotherapy from 41 lung cancer patients, as was primary biopsies. We evaluated the expression of PD-L1 and formation of RAD50 foci in CTCs and a CStC subtype, cancer associated macrophage-like cells (CAMLs), in response to DNA damage caused by radiotherapy at the tumor site. <br /> <p>Only 24% of primary biopsies had sufficient tissue for PD-L1 testing, tested with IHC clones 22c3 and 28-8. A CTC or CAML was detectable in 93% and 100% of samples, prior to and after radiotherapy, respectively. RAD50 foci significantly increased in CTCs (>7X, p<0.001) and CAMLs (>10X, p=0.001) after radiotherapy confirming their origin from the radiated site. PD-L1 expression increased overall, 1.6X in CTCs (p=0.021) and 1.8X in CAMLs (p=0.004): however, individual patient PD-L1 expression varied, consistently low/negative (51%), consistently high (17%) or induced (31%).<br /><br />These data suggest that RAD50 foci formation in CTCs and CAMLs may be used to track cells subjected to radiation occurring at primary tumors, and following PD-L1 expression in circulating cells may be used as a surrogate for tracking adaptive changes in immunotherapeutic targets.

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Histopathological investigation of intranodular echogenic foci detected by thyroid ultrasonography

To determine the predictability of sonography for detection of calcifications in thyroid nodules by histopathologic examination and to demonstrate the association between calcification pattern and malignancy.

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Metastatic squamous cell carcinoma to the superior cervical ganglion mimicking a retropharyngeal lymph node

Metastasis of squamous cell carcinoma (SCC) to the superior cervical ganglion (SCG) has never been reported. Its anatomic location may easily be mistaken for a retropharyngeal lymph node. We present the first case of SCC metastasis to the SCG.

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The contemporary utility of intraoperative frozen sections in thyroid surgery

To determine the accuracy of intraoperative frozen section analysis on thyroidectomy specimens stratified by the Bethesda classification scheme and its utility for intraoperative decision-making.

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Moyamoya disease associated with ankylosing spondylitis in a 9-year-old child: a case report

Abstract

Background

Ankylosing spondylitis was reported to associate with an increased risk of cerebrovascular diseases. In this article, we aimed to report the first case of ankylosing spondylitis associated with moyamoya disease treated with encephalo-duroarterio-synangiosis.

Case presentation

A 9-year-old boy with ankylosing spondylitis appeared a symptom of repeated transient ischemic attacks which performed as left hemiparesis. Magnetic resonance angiography showed a typical finding of left anterior cerebral artery, bilateral middle cerebral arteries and the supraclinoid portion of the right internal carotid artery stenosis with an abnormal vascular network at the base of the brain, diagnosed with moyamoya disease. He received a medication treatment but did not underwent revascularization surgery. After three months, ankylosing spondylitis symptoms got some relief, whereas transient ischemic attacks was more frequency. Due to the bad cerebral blood flow on acetazolamide computed tomography perfusion and poor clinical manifestation, he underwent a right encephalo-duroarterio-synangiosis. Postoperatively, the symptoms of transient ischemic attacks disappeared.

Conclusions

We reported the first case of ankylosing spondylitis associated with moyamoya disease. Moyamoya disease could appear in patients with ankylosing spondylitis. Revascularization surgery probably is an effective treatment for preventing preoperative ischemic events recurrence.

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The potential role of platelets in the consensus molecular subtypes of colorectal cancer

Abstract

The consensus molecular subtypes (CMS) in colorectal cancer (CRC) represent distinct molecular subcategories of disease as reflected by comprehensive molecular profiling. The four CMS subtypes represent unique biology. CMS1 represents high immune infiltration. CMS2 demonstrates upregulation of canonical pathways such as WNT signaling. Widespread metabolic changes are seen in CMS3. CMS4 represents a mesenchymal phenotype with hallmark features including complement activation, matrix remodeling, angiogenesis, epithelial-mesechymal transition (EMT), integrin upregulation and stromal infiltration. In contrast to this new paradigm, a number of observations regarding CRC remain disconnected. Cancers are associated with thrombocytosis. Venous thromboembolic events are more likely in malignancy and may signify worse prognosis. Aspirin, an anti-platelet agent, has been linked in large observational studies to decrease incidence of adenocarcinoma and less advanced presentations of cancer, in particular CRC. Inflammatory bowel disease is a risk factor for CRC. Gross markers to recognize the immunothrombotic link such as the platelet to lymphocyte ratio are associated with poorer outcomes in many cancers. Platelets are increasingly recognized for their dual roles in coordinating the immune response in addition to hemostasis. Here, we explore how these different but related observations coalesce. Platelets, as first responders to pathogens and injury, form the link between hemostasis and immunity. We outline how platelets contribute to tumorigenesis and how some disconnected ideas may be linked through inflammation. CMS4 through its shared mechanisms has predicted platelet activation as a hallmark feature. We demonstrate a platelet gene expression signature that predicts platelet presence within CMS4 tumors.

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Simultaneous integrated boost therapy of carcinoma of the hypopharynx/larynx with and without flattening filter - a treatment planning and dosimetry study

The aim of this study was to investigate if the flattening filter free (FFF) irradiation mode of a linear accelerator (linac) is advantageous as compared to the flat beam (FF) irradiation mode in intensity mod...

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An Examination of Pre- and Posttreatment Acoustic Versus Auditory Perceptual Analyses of Voice Across Four Common Voice Disorders

Publication date: Available online 5 July 2017
Source:Journal of Voice
Author(s): Amanda I. Gillespie, Jackie Gartner-Schmidt, Ali Lewandowski, Shaheen N. Awan
ObjectiveThe objective, instrumental acoustic measure of Cepstral Spectral Index of Dysphonia (CSID) correlates with audio-perceptual measures, is sensitive in detecting voice abnormalities, and tracks change following treatment. The goals of the current study were to (1) test the agreement between CSID versus auditory perceptual measures of pre- versus posttreatment voice change, and (2) investigate whether change in scores is based on voice disorder or phonemic structure of sentence stimuli.MethodsForty patients with benign voice disorders produced sentences and a sustained /a/ vowel from the Consensus Auditory Perceptual Evaluation of Voice protocol before and after treatment. CSID was calculated, and overall audio-perceptual voice severity was judged by 7 blinded, trained raters using a 100-mm visual analog scale. Differences between CSID and audio-perceptual measures of voice change across voice disorder and stimuli, and correlation between change in CSID and perceptual rating scores were assessed pre- and postintervention.ResultsAcross all subjects, there were significant correlations between CSID and perceptual ratings change scores (P < 0.001), and no significant differences in pre- and posttreatment change. Disorder-specific analyses indicated that all tested sentence/vowel contexts are effective measures for pre- versus posttreatment change in atrophy and paralysis cases. Acoustic versus perceptual measures of voice change were significantly correlated in lesion cases for the sentence “How hard did he hit him” and with all sentences combined. There were no significant findings observed for muscle tension dysphonia.ConclusionCSID provides an accurate objective correlate to auditory-perceptual posttreatment change in overall voice severity ratings. Implications for outcomes testing and disorder-specific findings are discussed.



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Vertical gaze palsy due to acute bilateral thalamic infarct without midbrain ischemia

Shakya Bhattacharjee, Kher Lik Ng

Neurology India 2017 65(4):919-920



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Patient profiling can identify adult spinal deformity (ASD) patients at risk for conversion from nonoperative to surgical treatment; initial steps to reduce ineffective ASD management

Non-operative management is a common initial treatment for adult spinal deformity (ASD) patients despite reported superiority of surgery with regard to outcomes. Ineffective medical care is a large source of resource drain on the health system. Characterization of ASD patients likely to elect for operative treatment from nonoperative management may allow for more efficient patient counseling and cost savings.

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Will the 8th editions of the UICC & AJCC staging manuals improve the pathological diagnosis of extranodal extension from cervical lymph nodes?

Garcia et al. [1] present noteworthy data having applied the criteria of the 8th edition of the Union for International Cancer Control (UICC) [2] to a series of mucosal squamous cell carcinomas of the head and neck which had originally been reported using the criteria of earlier editions. It is interesting they do not use the term “extranodal extension” (ENE), which has been introduced into the 8th editions of both the UICC and American Joint Committee on Cancer (AJCC) [3] staging manuals, except where the new criteria are quoted in Table 1, instead preferring “extracapsular spread” (ECS).

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A case report of complete tibia diaphysis extrusion in chronic osteomyelitis

Thaddeus C Agu

African Journal of Medical and Health Sciences 2017 16(1):68-71

Late presentation to hospital is still a common occurrence in Nigeria. Chronic osteomyelitis of the tibia is not an uncommon infective condition in a 4-year-old boy, but delaying the search for hospital treatment until a full length of the diaphysis is extruded is uncommon. He complained of pain and fever and was noticed by the mother to be listless and was no longer playful. Over several months, his condition seemed to be improving, but a large bone was sticking out of a sinus. It was at this advanced stage that the patient was brought to our level II surgical facility. The entire tibia diaphysis was removed as a sequestrum, and the boy was ambulant again after 11 weeks. The aim of this report is to highlight this unusual condition and the need for continued health education as well as for the clinician not to despair in the management of similar neglected cases in a resource-poor setting.

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Arthroscopic outside-in meniscal repair: A short-term clinical experience

Ranti O Babalola, Emmanuel A Laiyemo, Shopekhai E Itakpe, Christian Madubueze, Olaoluwa M Shodipo

African Journal of Medical and Health Sciences 2017 16(1):1-5

Objective: Meniscal injuries are very common knee injuries that are presented to an orthopaedic surgeon. The goal of our study was to assess the early outcome of outside-in meniscal repair in the management of meniscal tears. Patients and Methods: This study was a prospective case series conducted at the National Orthopaedic Hospital, Lagos. Consecutive cases of patients with meniscal tears who met the inclusion criteria were recruited. Anterior cruciate ligament reconstruction was performed with semitendinosus autograft. Meniscal repair was performed arthroscopically by only two surgeons using the outside-in technique with size 2 polydioxanone suture. The Western Ontario and McMaster University Evaluation Tool (WOMET) score was computed during the pre-operative stage and at least 6-months post-operatively as outcome measure. The visual analogue scale (VAS) and WOMET scores in the pre- and post-operative periods were noted. Results: Five patients with injured menisci underwent meniscal repair. The median duration of follow-up was 14 months (range 8–30 months). Using Barret's criteria, we determined that a clinically healed meniscus was obtained in only 2 (40%) patients. The WOMET score improved from a mean of 46 (±18) to 20 (±10.7) between the pre- and post-operative stages, and the mean VAS score decreased from 4.6 (±0.5) to 2.5 (±1.3). Discussion: The poor health-seeking behaviour in our environment would explain the delayed presentations of our patients. However, it has been established that chronic tears do heal. Outside-in technique remains at the moment our method of choice for meniscal repair because of the challenges we face for equipment and funding of health care in our environment. Trephination of the meniscus was performed to improve the chances of healing. Using Barret's criteria, we had a healing rate of 40% (2). Conclusions: The outside-in technique remains an option for the treatment of chronic tears with good clinical improvement in the short term.

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Qualitative study on determinants of HIV risk behaviors among Nigerian seafarers

Ibitein N Okeafor, Chukwuma U Okeafor

African Journal of Medical and Health Sciences 2017 16(1):6-11

Background: Seafarers constitute a highly mobile population who are vulnerable to acquiring and transmitting human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) due to their engagement in HIV risk behaviors. Hence, this study aimed to identify the determinants of HIV risk behaviors among seafarers. Materials and Methods: The study was conducted among Nigerian seafarers in Port Harcourt Seaport, Rivers State Nigeria. A qualitative study was employed using a total of four focus group discussions (FGDs) and comprised of three male groups and one female group. Snow-ball method of sampling was used to recruit participants. Data were collected using a FGD guide. Thematic analysis was performed using QSR NVivo version 10 software (QSR International Pty Ltd., Melbourne, Australia). Data were presented as quotes and charts. Results: The study had a total of 28 participants and comprised of 24 males and four females. The mean age of all participants was 39.3 ± 7.8 years. The participants were knowledgeable on HIV/AIDS risk behaviors. The major determinants of these behaviors as revealed by the participants were lack of self-discipline and not being God-fearing (individual-level factors). Other determinants were long duration (more than 6 months) on sea and not traveling with spouse during sea voyage (seafaring-related factors). The determinants on environment of the port and government-related factors included the presence of brothels in port areas and the absence of sensitization visits, respectively. Conclusion: The study noted varying determinants of HIV risk behaviors from individual level to the government level. The authors advocate the need for peer education among seafarers as well as the implementation of HIV enlightenment programs to discourage HIV risk behaviors.

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Glaucoma medication adherence in an adult population in Nigeria

Jennifer A Ebeigbe

African Journal of Medical and Health Sciences 2017 16(1):12-18

Introduction: Glaucoma is a common and potentially blinding condition, which can be managed with the use of appropriate medication therapy. For the medication to be effective, there has to be strict adherence to drug regimen. However, this is not usually the case for many glaucoma patients. The aim of this study was to identify the barriers and facilitators related to glaucoma medication adherence among an adult population. Materials and Methods: Forty-nine participants who had been diagnosed with glaucoma and had been on glaucoma medications for at least a year were recruited and interviewed. They were aged between 18 and 70 years with a mean age of 54 years. The one-on-one in-depth interviews were recorded using an audio recorder. Data obtained were transcribed and analysed using rank ordering to determine the degree of importance. Results: Results identified eight barriers to drug adherence among which were finance/cost of medication (195), forgetfulness (160) and side effects of drops (155). Other barriers were difficulty with drop administration (143), busy schedule (130) and non-availability of eye drops (122) among others. Facilitators identified included fear of blindness (185), desire for improved vision (152) and knowledge about the disease (112). Other facilitators were convenience of eye drop schedule (99), availability of drops (91) and use of alarms (89) among others. Conclusion: Understanding these factors would help eye care practitioners to advice their patients better and greatly slow down the progression of the disease.

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Determinants of occupational health and safety: Knowledge, attitude, and safety practices toward occupational hazards of sawmill workers in Egor Local Government Area, Edo State

Amenze O Onowhakpor, Gabriel O Abusu, Bunmi Adebayo, Hendrith A Esene, Obehi H Okojie

African Journal of Medical and Health Sciences 2017 16(1):58-64

Background: Sawmilling operations involve a lot of manual handling which exposes the workers to numerous occupational health hazards, which can impact on their occupational health and safety. The knowledge, attitude and safety practices of sawmill workers are paramount for the mitigation and control of these hazards to ensure optimal health and safety. Objectives: This study assessed the knowledge, attitude and safety practices of sawmill workers towards occupational health hazards in Egor Local Government Area, Edo State. Materials and methods: A descriptive cross sectional study was carried out amongst 178 sawmills workers selected using stratified sampling technique. Structured interviewer's administered questionnaires were used for data collection. Data was analysed with statistical package for scientific solutions version 21.0 software. Univariate and bivariate analysis were done and level of significance was set at P<0.05. Results: The mean age (standard deviation) of respondents was 34.69±9.91. One hundred and seventy five (98.3%) of the respondents were males. A majority 165 (92.7%) of the respondents were aware of dust and noise 160 (89.9%), as occupational hazards in sawmill. One hundred and forty eight (83.1%) of the respondents had positive attitude towards occupational health hazards in sawmill while almost three fifth 103 (57.9%) of the respondent had poor work safety practices. Conclusion: Majority of the sawmill workers had fair knowledge of occupational hazards and positive attitudes towards occupational hazards. However, poor safety practices were evident. There is need to improve the knowledge of sawmill workers in relation to occupational hazards and safety practices so as to mitigate its negative consequences.

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A 4-year retrospective review of stillbirths at the Federal Teaching Hospital, Abakaliki, Southeast Nigeria

Anthony T Agbata, Justus N Eze, Chukwuemeka I Ukaegbe, Bartholomew N Odio

African Journal of Medical and Health Sciences 2017 16(1):19-24

Objective: Stillbirth is one of the most common adverse outcomes of pregnancy, yet among the least studied. The objective of this study was to estimate stillbirth rate and describe maternal and obstetric characteristics of stillbirths at the Federal Teaching Hospital, Abakaliki (FETHA), Ebonyi State, southeast Nigeria. Material and Methods: This was a 4-year review of stillbirths at the FETHA, from January 2012 to December 2015. All stillbirth folders were retrieved and relevant information entered in a proforma designed for the study. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 24.0 (IBM Corp., Armonk, NY). Stillbirth rate was calculated as a proportion of total births. Results were presented as mean ± standard deviation, rates, and percentages/proportions. Results: A stillbirth rate of 41.4 was calculated for this study. The mean age for stillbirth was 28.8 years ± 5.4 (range 17–45 years). The median parity was 3, with a range of 0 to 13. About 68.8% or 276/401 of the women were unbooked. Among women who had stillbirths, only about 14% had tertiary education. Women of low social class constituted the greatest percentage (73.5%) who experienced stillbirth. The proportion of male stillbirths was higher than female stillbirth (54.1% or 216/392). About 58.4% or (230/394) of the stillbirths turned out to be macerated. In about 22.4% of cases, the immediate complication leading to stillbirth was not indicated. None of the stillbirths had autopsy performed. Conclusion: The stillbirth rate of 41.4 per 1000 observed at the study center was high. This reflects the overall picture in developing countries. A major finding from the study is the absence of postmortem examination to determine cause of stillbirth. This may be a major challenge in the effort to reduce stillbirth rate in resource-poor setting like ours.

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Musculoskeletal hydatid masquerading as malignancy: A diagnostic dilemma

Mir Abdul Wahid, Sheikh Zahoor Ahmed, Haji Altaf Gowher, Azhar Jan Butoo, Syed Arshad Ahmed, Mushood Ghulam Nabi

African Journal of Medical and Health Sciences 2017 16(1):75-77

Hydatid cyst in the iliac bone is rare and is usually an incidental finding at any site other than liver and lung. It is a zoonotic disease which is due to infection with larval stage of Echinococcus granulosus. The disease is chronic, and cysts can be lodged in different organs. It has cosmopolitan distribution and impacts on health and economic indices in many countries throughout the world. Therefore, accurate information on the distribution of the disease is first step for the control and prevention. We present an unusual case of hydatid cyst found in the right iliac bone extending into the gluteal region.

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Neural tube defects and maternal characteristics in a North Indian Province

Yogender S Kadian, Roopa Malik, Nirmala Duhan, Kamal N Rattan

African Journal of Medical and Health Sciences 2017 16(1):25-29

Background: Neural tube defects (NTD) affect fewer than 2 per 1000 pregnancies, account for a major burden on healthcare globally and have wide geographic prevalence. The present study was carried out with the aim to evaluate the maternal characteristics in cases of babies born with various neural tube defects in a tertiary care centre in Northern India. Methods: This retrospective analytical study was carried out by accessing and analyzing the medical case records of women who delivered babies with neural tube defects between January 2005 to December 2008 in the Department of Obstetrics and Gynaecology at Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India. Results: Sixty seven babies had neural tube defects thus accounting for a NTD prevalence of 2.62/1000 births. Among these, there were 48 cases of anencephaly, 15 cases of meningocele and/or meningomyelocele, 4 cases of spina bifida occulta. Anencephaly was most prevalent in primiparous women of low literacy aged between 21–25 years. Similar trends were visible in meningomyelocele and spina bifida groups. Most women in the study were homemakers with almost equitable distribution in rural and urban areas. No preponderance of any particular blood group was evident for any of the neural tube defects. Conclusion: Neural tube defects affect a substantial number of newborns in India. Lower age and parity, low literary and rural residence are some of the maternal factors associated with increased risk of these disorders. Preventive strategies like periconceptional folic acid supplementation and health education may help reduce the incidence of these conditions even in low resource settings.

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Computed tomography findings in pediatric traumatic head injury in Abuja, Nigeria

Ukamaka D Itanyi, Hadijat O Kolade-Yunusa

African Journal of Medical and Health Sciences 2017 16(1):52-57

Background: Pediatric traumatic brain injury (TBI) remains one of the leading causes of acquired disability and death in children. The morbidity and mortality associated with significant intracranial injury may be ameliorated by early diagnosis and treatment. Cranial computed tomography (CT) is a reliable imaging method for identification of intracranial lesions in patients with head trauma. Aim: To document the radiologic features of cranial CT in pediatric head trauma patients in a Tertiary Hospital in Abuja, Nigeria. Method: This was a retrospective, cross-sectional study of cranial CT findings in 104 pediatric head trauma patients visiting a tertiary referral hospital in Abuja Nigeria from January 2014 to January 2017. Numerical and graphical descriptors were used to summarize the data. In all statistical tests, significance level was set at an alpha level of 0.05. Result: Ages of studied patients ranged from 3 months to 18 years with mean age of 9.7 (SD 5.4) years with males dominating (66.35%). Road traffic accident, RTA occurred in 82 (79.6%) as the commonest etiologic factor across all age groups with slight dominance in children older than 16 years. Radiologic abnormalities were seen in 89 (85.6%), especially in males. Fractures coexisting with intracranial lesions were the most prevalent findings occurring in 43 (41.3%) patients. Hemorrhagic contusion was the commonest intracranial pathology. Diffuse brain lesions were seen exclusively in patients with clinically severe brain injury. Conclusion: RTA is the commonest etiology of pediatric TBI in our environment with combined fractures and coexisting intracranial hemorrhages as the prevalent finding.

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Chronic kidney disease risk factors in workers of an agricultural research institute in Southern Nigeria

Enajite I Okaka, Bibiana O Eiya, Afeaje B Olokor, Ikponmwosa O Iyawe, Chimezie G Okwuonu, Oluseyi A Adejumo, Odigie E Ojeh-Oziegbe, Frank A Imarhiagbe, Evelyn I Unuigbe

African Journal of Medical and Health Sciences 2017 16(1):30-35

Background: The incidence and prevalence of chronic kidney disease (CKD) is on the increase worldwide. Treatment for end-stage kidney disease constitutes a huge burden on the economy of nations affected. Early identification, modification, and treatment of CKD risk factors are the best options. Objective: This study assessed common CKD risk factors in a population of workers in an organization. Materials and Methods: A cross-sectional survey that involved 242 workers in an agricultural research institute. CKD risk factors assessed were hypertension (HTN), hyperglycemia, abdominal obesity using waist–hip ratio (WHR), general obesity using body mass index (BMI), proteinuria, and serum creatinine. Results: The prevalence of HTN, elevated blood sugar, general obesity, abdominal obesity, proteinuria, and elevated serum creatinine were 47.1, 9.7, 14.2, 66.5, 5.9, and 20.4%, respectively. Older participants were more likely to have elevated blood pressure, BMI, WHR, and blood sugar serum creatinine. Being a known hypertensive was associated with elevated BMI, WHR, and blood sugar compared with those without a previous diagnosis of HTN. Conclusion: The presence of HTN and being middle aged to elderly was associated with higher CKD risk. Workers in organizations should have mandatory annual screening for CKD and its risk factors to aid risk modification, early detection, and treatment.

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A case report of acute kidney injury following the use of herbal vaginal pessary

Oluseyi A Adejumo, Ayodeji A Akinbodewa, Adeyemi Ogunleye, Oluwaseun F Agoi, Olatunji S Abolarin

African Journal of Medical and Health Sciences 2017 16(1):65-67

The demand and use of complementary and alternative medicine (CAM) is on the increase in many countries. Majority of the population using these herbal medicines are ignorant of their potential toxicities. We present an uncommon case of a 22 year old female who developed oliguric AKI following the use of herbal vaginal pessary. She was managed with haemodialysis and had complete renal recovery. This case highlights the potential nephrotoxicity of some herbal medication even when used locally and the urgent need to regulate CAM practice.

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Socio-demographic and clinical predictors of hypoxaemia among high-risk term neonates in Ilesa, Nigeria

Bankole P Kuti, Tolulope A Ogundele, Demilade K Kuti

African Journal of Medical and Health Sciences 2017 16(1):36-42

Background: Hypoxaemia is a common feature occurring in ill neonates. Prompt identification and intervention are important to ameliorate deleterious consequences. This study set out to determine the socio-demographic and clinical predictors of hypoxaemia among ill babies at the Wesley Guild Hospital, Ilesa, Nigeria. Patients and Methods: Term neonates admitted to the special care baby unit were consecutively recruited over a 7-month period. Peripheral oxygen saturation (SpO2) was measured at presentation using a portable pulse oximeter (Nellcor® N-200, USA), and hypoxaemia was defined as SpO2 < 90%. Relevant history and examination findings were compared among hypoxaemic and non-hypoxaemic babies. Multivariate analysis was used to identify predictors of hypoxaemia. Results: Two hundred and two babies (male-to-female ratio of 1.3:1) were recruited. The predominant presentations were perinatal asphyxia (51.5%), sepsis (31.7%) and jaundice (28.2%). Thirty-nine (19.3%) babies were hypoxaemic at admission. Female sex, infants of primigravidae, delivery outside health facilities, lack of antenatal care (ANC), grunting respiration and cyanosis were associated with hypoxaemia (P < 0.05). Grunting [odds ratios (OR) = 14.535; P < 0.001] and cyanosis at presentation (OR = 11.143; P = 0.005) independently predicted hypoxaemia. Twenty (7.5%) babies died, and hypoxaemia at presentation was significantly associated with mortality (P < 0.001). Conclusion: Hypoxaemia was common among the study participants and was significantly associated with mortality. Efforts should be made to make essential obstetric care affordable and widely available, as babies delivered outside the health facility to mothers with no ANC and those with grunting and cyanosis are at increased risk of having hypoxaemia.

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Incidental gravid adult filarial worm in the spermatic cord and the axillary tissue: Report of two cases

Preeti Agarwal, Shweta Katiyar, Mala Sagar, Anushree Rai, Babli Gupta, Madhu M Goel

African Journal of Medical and Health Sciences 2017 16(1):72-74

Gravid adult female worm of Wuchereria bancrofti was seen in the histology sections of axillary dissection of a radical mastectomy specimen in a patient with infiltrating ductal carcinoma and in sections from spermatic cord lesion in a 4-year-old boy. Careful observation and recognition of histologic features are important for the diagnosis in hematoxylin and eosin stained sections. In the present report, we highlight the salient morphologic features of the adult worm.

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Knowledge of malaria and adherence to its preventive measures among adults attending out-patient clinics of a Nigerian tertiary hospital: Has anything changed?

Godpower C Michael, Ibrahim Aliyu, Bukar A Grema

African Journal of Medical and Health Sciences 2017 16(1):43-51

Background: Despite global control efforts, malaria still accounts for preventable morbidity and mortality in Africa. Reported knowledge of its preventive measures appears high, but disparity exists between knowledge and uptake of preventive practices in Nigeria. It becomes necessary to evaluate adherence to use of insecticide-treated nets (ITN) and other malaria preventive measures at peak periods of malaria transmission as the Millennium Development Goal era terminates. Materials and Methods: A cross-sectional study was conducted at the general and pediatric out-patient clinics of Aminu Kano Teaching Hospital, among 413 adult patients and caregivers of children selected by systematic sampling technique and using a validated interviewer-administered questionnaire. Their knowledge of malaria and utilization of and adherence to preventive measure utilization were assessed. Results: The respondents' mean age was 33.6 ± 8.9 years. Majority (90.6%) had adequate knowledge of malaria. Their mean malaria knowledge score was 78.7%. Among those who used ITNs, only 54.1% adhered to daily use. For other preventive measures, 65.3, 52.3, 46.5, and 25.2% adhered to environmental sanitation, insecticide spraying, wearing protective clothing, and mosquito repellent use, respectively. Hot weather was the main barrier to ITNs and wearing protective clothing adherence, whereas cost, lack of time, fear of side effects was the barrier to adherence to insecticide spraying, environmental sanitation, and mosquito repellent, respectively. Tertiary education was associated with adequate knowledge of malaria (χ2 = 8.36, P = 0.004). There was also association between adequate knowledge of malaria and monthly environmental sanitation participation (χ2 = 9.06, P = 0.003). Conclusion: Knowledge of malaria was high but adherence to practice was low. Nonadherence with preventive measures is an obstacle to achieving malaria control and could be overcome by effective mass education and addressing adherence barriers.

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Stocking and sale of misoprostol by patent and proprietary medicine vendors in Nigeria

Abubakar Ibrahim Jatau, Abubakar Sha'aban, Najib Yahaya Sani, Ahmed Tijjani Mora

African Journal of Medical and Health Sciences 2017 16(1):78-79



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Kleine–Levin syndrome: A neurological rarity

Samhita Panda

Neurology India 2017 65(4):873-878



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Dose fractionated gamma knife radiosurgery for large arteriovenous malformations

Ajay Niranjan, John C Flickinger

Neurology India 2017 65(4):697-698



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Recurrent brown tumor of the vertebral column

Michal Paradowski, Joanna Bladowska, Agnieszka Halon, Boguslaw Paradowski

Neurology India 2017 65(4):908-909



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Dose fractionated gamma knife radiosurgery for large arteriovenous malformations: A word of caution

L Dade Lunsford

Neurology India 2017 65(4):699-700



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Puzzling cases in stroke

MV Padma Srivastava

Neurology India 2017 65(4):930-931



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Fractionated gamma knife radiosurgery for large brain arteriovenous malformations

Manmohan Singh

Neurology India 2017 65(4):701-702



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Recurrent brown tumor of the vertebral column

Michal Paradowski, Joanna Bladowska, Agnieszka Halon, Boguslaw Paradowski

Neurology India 2017 65(4):908-909



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Dose fractionated gamma knife radiosurgery for large arteriovenous malformations: A word of caution

L Dade Lunsford

Neurology India 2017 65(4):699-700



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Puzzling cases in stroke

MV Padma Srivastava

Neurology India 2017 65(4):930-931



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Fractionated gamma knife radiosurgery for large brain arteriovenous malformations

Manmohan Singh

Neurology India 2017 65(4):701-702



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Commentary: Neurocysticercosis: Evolution of our understanding

Natarajan Muthukumar

Neurology India 2017 65(4):885-887



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The enigma of neuroinflammation

Prakash N Tandon

Neurology India 2017 65(4):703-705



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Lumbar extradural arteriovenous malformation mimicking a schwannoma in a child: Rare presentation of neurofibromatosis type-1

Gandham E Jonathan, Bijesh R Nair, Vivek Joseph, Sunithi Mani, Geeta Chacko

Neurology India 2017 65(4):900-902



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Alarm criteria for motor evoked potentials

Parthasarathy D Thirumala, Jessie Huang, Indraneel S Brahme, Karthy Thiagarajan, Hannah Cheng, Donald J Crammond, Jeffrey Balzer

Neurology India 2017 65(4):708-715

Objective: To evaluate three commonly used alarm criteria for interpreting the significance and diagnostic value of transcranial motor evoked potential (TcMEP) changes during spinal surgery. Materials and Methods: A systematic literature search was performed using PubMed/MEDLINE, Web of Science, and EMBASE from 1945 to January 2014. We included all those studies that were (1) randomized controlled trials, prospective studies, or retrospective cohort studies, (2) conducted among patients undergoing surgery on the spine or spinal cord with TcMEP monitoring, (3) conducted in a group of ≥50 patients, (4) that were inclusive of immediate postoperative neurological assessment (within 24 h), and (5) which were published in English. Results: Twenty-five studies involving 9409 patients were included. The incidence of neurological deficits was 1.82%. The overall sensitivity and specificity of all reported TcMEP changes was 82.1% (95% confidence interval [CI]: 73–88.6%) and 95.7% (95% CI: 93.7–97.1%), respectively. The sensitivity and specificity of each alarm criteria were evaluated: 50% reduction in amplitude, sensitivity 63.2% (95% CI: 47–76.8%), and specificity 96.7% (95% CI: 96.4–99.2%); 80% reduction in amplitude, sensitivity 71.7% (95% CI; 42–89.9%), and specificity 98.3% (95% CI: 96.4–99.2%); total signal loss, sensitivity 30% (95% CI: 17.6–46.4%), and specificity 99.3% (95% CI: 98.6–99.7%). Conclusions: No statistically significant differences between using reductions in amplitude of 50% and 80% as alarm criteria were found in terms of sensitivity and specificity. Total loss was found to have a statistically significant increase in specificity. TcMEP monitoring is a highly specific and sensitive diagnostic tool for the detection of neurological defects during spinal surgery.

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Molecular mechanisms of the intracranial aneurysms and their association with the long noncoding ribonucleic acid ANRIL – A review of literature

Jiang Che

Neurology India 2017 65(4):718-728

Long noncoding ribonucleic acids (RNAs) are important regulators of gene expression. Antisense noncoding RNA in the INK4 locus (ANRIL), which was coded on the Chr9p21.3 loci, participates in the pathogenesis of tumor, coronary artery disease, type 2 diabetes mellitus, and other diseases. A genome-wide association study indicated ANRIL to be a candidate gene that may lead to the development of an intracranial aneurysm (IA) formation. However, the detailed molecular mechanisms are unknown and have not been studied. Through reviewing the molecular mechanisms responsible for the development of IA and the regulation pathway of ANRIL, this paper presents four possible molecular mechanisms that may be responsible for the influence of ANRIL on the development of IAs, that is, cell cycling, Krüppel-like factor 2 (KLF2), caspase recruitment domain family member 8, and retinoid metabolism. ANRIL may become a molecular marker or therapeutic target of IA in the future. To the best of our knowledge, this is the first paper elucidating the molecular linkage between ANRIL and IAs.

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Reversed Robin Hood syndrome treated with verapamil

Karim M Mahawish

Neurology India 2017 65(4):880-882



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Will the 8th editions of the UICC & AJCC staging manuals improve the pathological diagnosis of extranodal extension from cervical lymph nodes?

Garcia et al. [1] present noteworthy data having applied the criteria of the 8th edition of the Union for International Cancer Control (UICC) [2] to a series of mucosal squamous cell carcinomas of the head and neck which had originally been reported using the criteria of earlier editions. It is interesting they do not use the term “extranodal extension” (ENE), which has been introduced into the 8th editions of both the UICC and American Joint Committee on Cancer (AJCC) [3] staging manuals, except where the new criteria are quoted in Table 1, instead preferring “extracapsular spread” (ECS).

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An Examination of Pre- and Posttreatment Acoustic Versus Auditory Perceptual Analyses of Voice Across Four Common Voice Disorders

The objective, instrumental acoustic measure of Cepstral Spectral Index of Dysphonia (CSID) correlates with audio-perceptual measures, is sensitive in detecting voice abnormalities, and tracks change following treatment. The goals of the current study were to (1) test the agreement between CSID versus auditory perceptual measures of pre- versus posttreatment voice change, and (2) investigate whether change in scores is based on voice disorder or phonemic structure of sentence stimuli.

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Japanese standard for clinical stabilometry assessment: Current status and future directions

Publication date: Available online 5 July 2017
Source:Auris Nasus Larynx
Author(s): Masahiko Yamamoto, Kazuo Ishikawa, Mitsuhiro Aoki, Keisuke Mizuta, Yatsuji Ito, Masatsugu Asai, Hideo Shojaku, Toshiaki Yamanaka, Chisato Fujimoto, Toshihisa Murofushi, Tomoe Yoshida
Stabilometry is a useful tool for examining patients with functional disorders of the vestibular system. However, measurement techniques and devices vary by country. Therefore, international standardization of stabilometry is mandatory to validate the exchange of important findings. This was advocated at the 1983 Posturography Meeting in Kyoto but has not been adopted worldwide, and each country has continued to use unique regional measurement methods. In Japan, stabilometry has widespread application in medical practice in conjunction with research into its applications. With a goal of international standardization, we present details of stabilometry measurement methods and their application in Japan, together with a brief history and potential future directions of stabilometry.



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A cross-sectional analysis of the prevalence of tooth agenesis and structural dental anomalies in association with cleft type in non-syndromic oral cleft patients

The aim of this study was to investigate the prevalence of tooth agenesis, microdontia, and tooth malformation among non-syndromic oral cleft patients and their potential association with cleft type and gender.

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Infectious Complications and Malignancies Arising After Liver Transplantation

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Dame W. Idossa, Douglas Alano Simonetto

Teaser

Since the first liver transplant was performed in 1963, great advancements have been made in hepatic transplantation. Surgical techniques have been revised and improved, diagnostic methods for identifying and preventing infections have been developed, and more conservative use of immunosuppressive agents have resulted in better long-term posttransplant outcomes. A total of 7841 liver transplantations were performed in the United States in 2016, resulting in greater than 85% survival at 1 year posttransplant. However, technical surgical complications, infections, rejections, and chronic medical conditions persist. In this review, we discuss the infectious complications and malignancies that may arise after liver transplantation.


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Musculoskeletal hydatid masquerading as malignancy: A diagnostic dilemma

Mir Abdul Wahid, Sheikh Zahoor Ahmed, Haji Altaf Gowher, Azhar Jan Butoo, Syed Arshad Ahmed, Mushood Ghulam Nabi

African Journal of Medical and Health Sciences 2017 16(1):75-77

Hydatid cyst in the iliac bone is rare and is usually an incidental finding at any site other than liver and lung. It is a zoonotic disease which is due to infection with larval stage of Echinococcus granulosus. The disease is chronic, and cysts can be lodged in different organs. It has cosmopolitan distribution and impacts on health and economic indices in many countries throughout the world. Therefore, accurate information on the distribution of the disease is first step for the control and prevention. We present an unusual case of hydatid cyst found in the right iliac bone extending into the gluteal region.

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Assessment of a modified technique for air delivery during fluoroscopic-monitored pneumatic intussusception reduction

Abstract

Background

Intussusception is one of the most common causes of acute abdominal emergency in children. Image-monitored pressure reduction is the first line of treatment.

Objective

We report on a modified technique of air delivery during fluoroscopic-monitored pneumatic intussusception reductions, and compare it with an established technique.

Materials and methods

We modified the Shiels intussusception reduction device so that the air used for intussusception reduction is delivered not by the device’s insufflator bulb, but rather by the hospital medical air supply system, eliminating the need for continuous pumping of the insufflator bulb during the procedure. Subsequently, we retrospectively compared sequential fluoroscopy-monitored pneumatic intussusception reduction procedures performed in patients younger than 18 years using either the standard or modified devices, evaluating technical procedure parameters (i.e. median procedure time length, fluoroscopy time length and radiation dose) and patient outcomes (i.e. number of complete intussusception reductions, number of incomplete intussusception reductions, number of intussusception recurrences within 3 days of the procedure, number of procedures followed by surgery).

Results

We found no statistically significant differences between procedures performed with the standard and modified techniques.

Conclusion

The device modification allows for increased operator comfort. Evaluated procedure parameters and patient outcomes appear similar to those of the standard technique.

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Facial race and sex cues have a comparable influence on emotion recognition in Chinese and Australian participants

Abstract

The magnitude of the happy categorisation advantage, the faster recognition of happiness than negative expressions, is influenced by facial race and sex cues. Previous studies have investigated these relationships using racial outgroups stereotypically associated with physical threat in predominantly Caucasian samples. To determine whether these influences generalise to stimuli representing other ethnic groups and to participants of different ethnicities, Caucasian Australian (Experiments 1 and 2) and Chinese participants (Experiment 2) categorised happy and angry expressions displayed on own-race male faces presented with emotional other-race male, own-race female, and other-race female faces in separate tasks. The influence of social category cues on the happy categorisation advantage was similar in the Australian and Chinese samples. In both samples, the happy categorisation advantage was present for own-race male faces when they were encountered with other-race male faces but reduced when own-race male faces were categorised along with female faces. The happy categorisation advantage was present for own-race and other-race female faces when they were encountered with own-race male faces in both samples. Results suggest similarity in the influence of social category cues on emotion categorisation.

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The automaticity of face perception is influenced by familiarity

Abstract

In this study, we explore the automaticity of encoding for different facial characteristics and ask whether it is influenced by face familiarity. We used a matching task in which participants had to report whether the gender, identity, race, or expression of two briefly presented faces was the same or different. The task was made challenging by allowing nonrelevant dimensions to vary across trials. To test for automaticity, we compared performance on trials in which the task instruction was given at the beginning of the trial, with trials in which the task instruction was given at the end of the trial. As a strong criterion for automatic processing, we reasoned that if perception of a given characteristic (gender, race, identity, or emotion) is fully automatic, the timing of the instruction should not influence performance. We compared automaticity for the perception of familiar and unfamiliar faces. Performance with unfamiliar faces was higher for all tasks when the instruction was given at the beginning of the trial. However, we found a significant interaction between instruction and task with familiar faces. Accuracy of gender and identity judgments to familiar faces was the same regardless of whether the instruction was given before or after the trial, suggesting automatic processing of these properties. In contrast, there was an effect of instruction for judgments of expression and race to familiar faces. These results show that familiarity enhances the automatic processing of some types of facial information more than others.

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Attentional requirements in perceptual grouping depend on the processes involved in the organization

Abstract

Previous studies on the role of attention in perceptual grouping have yielded contradicting findings, some suggesting that grouping requires attention and others indicating that it does not. Kimchi and Razpurker-Apfeld (Psychonomic Bulletin and Review, 11(4), 687–696, 2004) showed that attentional demands in grouping could vary according to the processes involved. The current study expanded on this, examining whether attentional demands vary for (a) different grouping principles and (b) as a function of contingent processing of element segregation and shape formation. We used the inattention paradigm with an online measure, in which participants engaged in an attentionally demanding change-detection task on a small matrix presented on a task-irrelevant backdrop of grouped elements. The backdrop grouping changed or stayed the same independently of any change in the target. Congruency effects produced by changes in backdrop grouping on target-change judgments indicate that the backdrop grouping was accomplished under inattention. The results showed congruency effects when grouping formed columns/rows by proximity but not by shape similarity, and when grouping into a distinct shape by collinearity did not involve element segregation. No congruency effects were found when grouping into a shape by collinearity or connectedness involved element segregation, except when connectedness was combined with color similarity. These results suggest that attentional demands depend on the combination of grouping principles and the complexity of the processes involved in the organization. These findings provide further support for the view that perceptual organization is a multiplicity of processes that vary in attentional demands.

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