Purpose of review: Our review of current literature within the past 12-24 months for the treatment of lumbar spinals stenosis (LSS) serves to update providers on recent advances and comparisons regarding therapy spanning lifestyle modification, pharmacologic therapy, minimally invasive interventions, and surgical interventions. Recent findings: Current literature supporting the inclusion of physical therapy and gabapentin/pregabalin within an initial treatment regimen have been positive. A recent randomized, double-blinded clinical trial of adding calcitonin to epidural steroid injections have shown improvement in pain and function up to 1 year. The minimally invasive lumbar decompression (mild) procedure is showing ongoing beneficial results in pain and function. Spinal cord stimulation (SCS) may have a role for select patients with lumbar spinal stenosis. Finally, the benefits of surgical treatment versus nonsurgical treatment is ultimately inconclusive because of the nature of data collection, inconsistencies with the clinical definition of LSS, and a lack of standardized treatment guidelines. Summary: Our review of current research demonstrates there is a positive role for the current conservative therapies, with favorable results for interventions such as minimally invasive decompression and SCS. Pharmacologic interventions such as systemic prostaglandin analogues and epidural agents such as calcitonin demonstrate early promise, but need to undergo additional safety testing and confirmatory trials. Further long-term research with validated, objective measurements for the aforementioned treatments are needed to draw any definitive conclusions for clinical practice. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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Τρίτη 11 Ιουλίου 2017
Regional blocks carried out during general anesthesia or deep sedation: myths and facts.
Purpose of review: More patients will accept regional blocks if these are performed during sedation or general anesthesia. This review discusses regional anesthesia in sedated or anesthetized patients. Recent findings: As complications of regional blocks are rare, regional anesthesia can be considered aswell-tolerated. Awake patients will notice only a minority of needle-to-nerve contacts, that renders the notion of a 'live monitor' obsolete. Using high-resolution ultrasound, the needle can be advanced to an extraepineural position for injection, thus strictly avoiding needle-to-nerve contact or intraepineural injection of local anesthetic. Rare cases of intoxication manifest more immediately when the patient is awake but some general anesthesia drugs reduce the seizure-inducing potency of local anesthetics, and hemodynamic signs of intoxication are also detectable under general anesthesia, allowing for faster cardiopulmonary resuscitation as the patient is anesthetized already. Summary: With the use of ultrasound guidance in skilled hands, it is a reasonable option to perform neuraxial and peripheral regional blocks in sedated or anesthetized patients. Performing the procedure safely and effectively requires an adequate level of experience with the specific block technique in question. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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Oregon’s Coordinated Care Organizations and Their Effect on Prenatal Care Utilization Among Medicaid Enrollees
Abstract
Introduction Previous studies indicate that inadequate prenatal care is more common among women covered by Medicaid compared with private insurance. Increasing the proportion of pregnant women who receive early and adequate prenatal care is a Healthy People 2020 goal. We examined the impact of the implementation of Oregon's accountable care organizations, Coordinated Care Organizations (CCOs), for Medicaid enrollees, on prenatal care utilization among Oregon women of reproductive age enrolled in Medicaid. Methods Using Medicaid eligibility data linked to unique birth records for 2011–2013, we used a pre-posttest treatment–control design that compared prenatal care utilization for women on Medicaid before and after CCO implementation to women never enrolled in Medicaid. Additional stratified analyses were conducted to explore differences in the effect of CCO implementation based on rurality, race, and ethnicity. Results After CCO implementation, mothers on Medicaid had a 13% increase in the odds of receiving first trimester care (OR 1.13, CI 1.04, 1.23). Non-Hispanic (OR 1.20, CI 1.09, 1.32), White (OR 1.20, CI 1.08, 1.33) and Asian (OR 2.03, CI 1.26, 3.27) women on Medicaid were more likely to receive initial prenatal care in the first trimester after CCO implementation and only Medicaid women in urban areas were more likely (OR 1.14, CI 1.05, 1.25) to initiate prenatal care in the first trimester. Conclusion Following Oregon's implementation of an innovative Medicaid coordinated care model, we found that women on Medicaid experienced a significant increase in receiving timely prenatal care.
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Effects of a 2014 Statewide Policy Change on Cash-Value Voucher Redemptions for Fruits/Vegetables Among Participants in the Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Abstract
Purpose In 2014, the New Jersey Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began requiring WIC-authorized stores to stock at least two fresh fruits and two fresh vegetables. We aimed to evaluate the effect of this policy change on fruit and vegetable purchases among WIC-participating households and to assess variation by household access to a healthy food store such as a supermarket or large grocery store. Description Households with continuous WIC enrollment from June 2013 to May 2015 were included (n = 16,415). Participants receive monthly cash-value vouchers (CVVs) to purchase fruits and vegetables. For each household, the CVV redemption proportion was calculated for the period before and after the policy by dividing the total dollar amount redeemed by the total dollar amount issued. Complete redemption was defined as a proportion ≥90% and the change in complete redemption odds was assessed after adjusting for Supplemental Nutrition Assistance Program participation. Assessment We observed a small increase following the policy change [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.04–1.17]; however, the effect varied by healthy food access (p = 0.03). The odds increased for households with access to at least one healthy food store (OR 1.13, 95% CI 1.06–1.20) while no effect was observed for households without such access (OR 0.91, 95% CI 0.76–1.10). Conclusion Policy change was associated with a small increase in purchasing, but only among households with healthy food access. The state is addressing this gap through technical assistance interventions targeting WIC-authorized small stores in communities with limited access.
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CNVbase: Batch identification of novel and rare copy number variations based on multi-ethnic population data
Source:Journal of Genetics and Genomics
Author(s): Cheng Zhang, Jianqi Lu, Haiyi Lou, Renqian Du, Shuhua Xu, Yiping Shen, Feng Zhang, Haiyi Lou, Li Jin
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The Role of Occupational Voice Demand and Patient-Rated Impairment in Predicting Voice Therapy Adherence
Source:Journal of Voice
Author(s): Barbara Ebersole, Resha S. Soni, Kathleen Moran, Miriam Lango, Karthik Devarajan, Nausheen Jamal
ObjectiveExamine the relationship among the severity of patient-perceived voice impairment, perceptual dysphonia severity, occupational voice demand, and voice therapy adherence. Identify clinical predictors of increased risk for therapy nonadherence.MethodsA retrospective cohort study of patients presenting with a chief complaint of persistent dysphonia at an interdisciplinary voice center was done. The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (V-RQOL) survey scores, clinician rating of dysphonia severity using the Grade score from the Grade, Roughness Breathiness, Asthenia, and Strain scale, occupational voice demand, and patient demographics were tested for associations with therapy adherence, defined as completion of the treatment plan. Classification and Regression Tree (CART) analysis was performed to establish thresholds for nonadherence risk.ResultsOf 166 patients evaluated, 111 were recommended for voice therapy. The therapy nonadherence rate was 56%. Occupational voice demand category, VHI-10, and V-RQOL scores were the only factors significantly correlated with therapy adherence (P < 0.0001, P = 0.018, and P = 0.008, respectively). CART analysis found that patients with low or no occupational voice demand are significantly more likely to be nonadherent with therapy than those with high occupational voice demand (P < 0.001). Furthermore, a VHI-10 score of ≤29 or a V-RQOL score of >40 is a significant cutoff point for predicting therapy nonadherence (P < 0.011 and P < 0.004, respectively).ConclusionOccupational voice demand and patient perception of impairment are significantly and independently correlated with therapy adherence. A VHI-10 score of ≤9 or a V-RQOL score of >40 is a significant cutoff point for predicting nonadherence risk.
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Determinants of short and long term outcomes in patients undergoing immediate breast reconstruction following neoadjuvant chemotherapy
Background
We evaluated oncologic outcomes and complications of skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) with immediate reconstruction (IR) after neoadjuvant chemotherapy (NAC) in patients with early-stage and locally advanced breast cancer (BC).
Methods
BC patients from 2000 to 2014 treated with NAC followed by SSM/NSM and IR were reviewed. Patient demographics, tumor characteristics, NAC response, complications, and recurrence were analyzed.
Results
Two hundred sixty-nine patients with 280 BCs were treated with NAC followed by SSM (94%) or NSM (6%) with IR. Median age was 47 (26-72) years with a median follow-up of 45 months. Pathologic complete response (pCR) was noted in 49 (17.5%) cases. Overall 30-day complication rate was 13.2%. Variables associated with complications included BMI (P < 0.0001), tobacco use (P = 0.015), and adjuvant radiation (P = 0.025). Local-regional recurrence was 3.2% and metastatic recurrence was 13.2%. Variables predicting recurrence risk were pre-NAC tumor size (P < 0.001), residual tumor size (P = 0.002), Grade III (P = 0.002), HER-2 negative (P = 0.025), pre-NAC nodal disease (P = 0.05), and lack of pCR (P = 0.045).
Conclusion
Following NAC, risk factors for complications in patients undergoing SSM/NSM with IR are high BMI, smoking, and adjuvant XRT. SSM/NSM following NAC is associated with excellent local control. These data support expanding the indications for NSM/SSM to include patients receiving NAC.
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Cholinergic neurotransmission and olfactory function in obstructive sleep apnea syndrome: a TMS study
/Objective: Odor identification and discrimination are reduced in subjects with obstructive sleep apnea syndrome (OSAS), but the pathophysiology of the olfactory dysfunction in OSAS is still poorly understood. Experimental evidence suggests that olfactory impairment could be related to central cholinergic dysfunction. Short latency afferent inhibition (SAI) is a paired-pulse transcranial magnetic stimulation (TMS) protocol that gives the opportunity to test an inhibitory cholinergic circuit in the human cerebral motor cortex.
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Improved prosthetic hand control with concurrent use of myoelectric and inertial measurements
Myoelectric pattern recognition systems can decode movement intention to drive upper-limb prostheses. Despite recent advances in academic research, the commercial adoption of such systems remains low. This lim...
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Using Receiver Operating Characteristic Curve to Define the Cutoff Points of Voice Handicap Index Applied to Young Adult Male Smokers
Voice performance is an inextricable key factor of everyday life. Obviously, the deterioration of voice quality can cause various problems to human communication and can therefore reduce the performance of social skills (relevant to voice). The deterioration could be originated from changes inside the system of the vocal tract and larynx. Various prognostic methods exist, and among them is the Voice Handicap Index (VHI). This tool includes self-reported questionnaires, used for determining the cutoff points of total score and of its three domains relevant to young male Greek smokers.
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The Role of Occupational Voice Demand and Patient-Rated Impairment in Predicting Voice Therapy Adherence
Examine the relationship among the severity of patient-perceived voice impairment, perceptual dysphonia severity, occupational voice demand, and voice therapy adherence. Identify clinical predictors of increased risk for therapy nonadherence.
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Acoustic and Perceived Measurements Certifying Tango as Voice Treatment Method
Voice disorders are affecting everyday life in many levels, and their prevalence has been studied extensively in certain and general populations. Notably, several factors have a cohesive influence on voice disorders and voice characteristics. Several studies report that health and environmental and psychological etiologies can serve as risk factors for voice disorders. Many diagnostic protocols, in the literature, evaluate voice and its parameters leading to direct or indirect treatment intervention.
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Human anatomy in the paintings of Dominikos Theotokopoulos - El Greco (1541-1614)
The peculiar style of Dominikos Theotokopoulos’ paintings of his last period, with the special characteristic of the elongated human figures, has raised a heated debate which has lasted more than a century. Many scholars tried to identify an ocular pathology and especially astigmatism in this painter in order to interpret his style, and also other pathologies have been proposed as the reason for this elongation, such as a mental disease expressing the symptoms of graphomania and ecography, hashish addiction and Marfan’s syndrome. On the other hand art historians reject any ‘medical’ theories, believing that in his works there are many elements of mannerism and one of them is this elongation, but many physicians insist to find a pathology beneath this deformation, which is discussed in this paper.
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Noxious effect of Moringa oleifera leave extract on the developing brain, morphology and behaviour of Wistar rat
The effects of Moringa oleifera leave extracts on the morphology and behaviour of the postnatal developing rat brain was studied. Twenty pregnant rats of Wistar strain weighing between 160 g and 180 g were used in the study. The pregnant rats were divided into two groups of ten animals per group. Group I animals received distilled water and served as control animals, while group II animals received 200 mg/kg body weight of Moringa oleifera leave extract orally. All the animals were provided with rat cubes and water ad libitum during pregnancy and lactation. After birth, five pups of day 21 were weighed and subjected to behavioural study. Animals of days 1, 7, 14, 21 and 28 of age were sacrificed by cervical dislocation, the brain dissected out, weighed and fixed in 10% formol-saline for microscopic studies. Some congenital malformations such as meromelia, phocomelia and amelia were observed in the Moringa oleifera group only. There was a significant increase in body weight of the Moringa oleifera animals on days 7, 14 and 21, in brain weight on days 1 and 7, and in cerebral weight on days 1, 7 and 21 (p<0.05). The behaviour of the rats was significantly worse in the Moringa oleifera group, especially in the area of motor function. Microscopically, there was significant reduction in the cerebral cortical thickness of Moringa oleifera group on days 21 and 28. Immunohistochemical studies revealed poor myelination in the Moringa oleifera group. The results indicate that maternal consumption of Moringa oleifera significantly affected the general morphology as well as behaviour of their pups, therefore it should be consumed with caution in pregnancy until better knowledge on humans is available.
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Anatomy, histology and histochemistry of accessory sex glands in male Persian squirrel (Sciurus anomalus)
Persian squirrel (Sciurus anomalus) is a species of squirrels in the Middle East. There is little information about the anatomy and histology of various organs of this species. Moreover, there are no practical data about the accessory male sex glands of this species of squirrel. In this study the anatomical, histological and histochemical properties of the male reproductive system accessory glands of Persian Squirrel was evaluated. Eight adult male squirrels were anesthetized and euthanized. The pelvic area was dissected and the male reproductive system was separated. The accessory sex glands were investigated for gross anatomical aspect. Samples were fixed in formaldehyde for histological and histochemical studies. The coagulating glands, prostate and bulbourethral glands were observed at gross anatomical level. A single heart-shape and compact prostate gland was situated on the dorsal side of pelvic urethra. Two small coagulating glands were observed on the cranio-dorsal side of prostate. Two large spiral shape bulbourethral glands were situated out of the pelvic cavity near the root of penis on both sides of anal area. Histologic studies revealed that all accessory sex glands were alveolar glands with cuboidal to columnar epithelium. The most positive reaction for PAS stain was observed in the trabeculae of glands. There was no positive reaction for lipids in glands stained with Oil red O and Sudan Black. Some anatomical differences were observed in the accessory sex glands of Persian Squirrel in comparison to other rodents, however the histology of glands was almost similar to other rodents.
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Double transverse foramen in cervical vertebrae in a Spanish rural population of the late 17th and 18th centuries
Double transverse foramen is an anatomical variant often observed in the inferior cervical rachis. It consists in the presence of the main transverse foramen and an accessory transverse foramen, which is smaller. Since the vertebral artery runs through the transverse foramen, this anatomical variant may suggest clinical considerations regarding the vertebral artery. In this context, our objective was to study the prevalence of double transverse foramen in a sample of 88 complete cervical sets of vertebrae dating from the late 17th and early 18th centuries and exhumed from a common grave in the “Nuestra Señora de los Ángeles” church, in Castielfabib (Ademuz, Valencia, Spain). We also wanted to analyze the possible correlation between the presence of double transverse foramen and the size of the main transverse foramen. The anteroposterior and lateral diameters of the transverse foramen and the accessory foramen were measured using digital calipers. Double transverse foramen was found in 96 (15.5%) cervical vertebrae, mostly in C6, but also in C4, C5 and C7. Our results show that double transverse foramen can cause the transverse foramen to be smaller when compared with normal vertebrae. Therefore, a thorough study should be performed to analyze the prevalence of double transverse foramen in the current population, as well as its clinical implications on the vertebral artery physiology.
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A morphometric and radiological study of the distal end of femur in West Bengal population
The distal end of the femur has immense importance from the anatomical, functional and clinical point of view. The present study was carried out to assess the individual condylar dimension, maximum bicondylar width, size of intercondylar notch and bicondylar angle on dry femurs and on digital radiographic plates among the population of eastern India. The study was carried out bilaterally on seventy adult dry femurs of unknown sex and also on fifty digital radiographic plates of known age and sex by using Martin’s sliding calipers, diaptograph and sigma view software. Among the different parameters, transverse and vertical dimensions of medial condyle and intercondylar width showed significant bilateral asymmetry. From radiologic evaluation, it has been observed that only bicondylar width showed sexual dimorphism on both sides. The present study also reported significant asymmetry in bicondylar width between the two sides in males but not in females, whereas comparison of bicondylar angle between right and left sides revealed significant difference in females in contrast to males. The present study may help in manufacturing a properly sized implant and also help the surgeons during instrumentation of lower end of femur.
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Morphometric study of cervical vertebrae C3-C7 in South Indian population –A clinico-anatomical approach
Knowledge about the dimensions of the vertebral elements is necessary for the development of instrumentation related to cervical spine. Ethnic variations have been reported in these dimensions. This study included 350 dry cervical vertebras (C3-C7) of unknown age and sex, collected from the department of Anatomy, Mahathma Gandhi Medical College and Research Institute, Puducherry and other medical colleges in and around Puducherry. The dimensions of vertebral bodies, pedicles, laminae, spinous process, superior and inferior articular processes were measured and compared. No significant difference was noted between the measurements taken on the right and left side. The dimensions of the vertebral bodies were seen to be larger at lower levels. The larger dimensions of the pedicle were seen in C3 and thereafter decreased at lower levels. Height and length of lamina progressively increased from C3 to C7. The spinous process length was greatest at C7. The height of pedicle, superior and inferior articular processes decreased towards the lower cervical level.
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A rare instance of fused pelvic kidney without other associated congenital anomalies
Much of the fused pelvic kidney (pancake kidney) described in the literature are complicated by coexisting anomalies of other organ system and vasculature. During a routine anatomical dissection of a 69 year-old male we found a fused pelvic kidney without vascular or other organ system defects. A detailed dissection of the entire body showed normal anatomical features except pancreatic cancer and related lymph nodes. Further dissection of the pelvic kidney showed presence of right and left accessory renal arteries; however the remaining vasculature was normal. Possible embryological causes of pelvic kidney and clinical consequences of this anomaly are discussed.
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Q7 e-tron: The new Hybrid-car for Oslo Fire Chef:
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Q7 e-tron: The new Hybrid-car for Oslo Fire Chef:
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Combination of whole spine lateral radiograph and lateral scanogram in the assessment of global sagittal balance
Global balance of human standing is analyzed as the geometric sum of the individual alignments extending from the spinal column to the pelvis, and to the lower limbs. The innovative EOS system has opened new perspectives for the global analysis of whole body alignment, but its use is very limited due to its high cost. An alternative may be to combine the whole spine lateral radiograph and the lateral scanogram in the global sagittal analysis of whole body alignment.
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Frailty and sarcopenia do not predict adverse events in an elderly population undergoing non-complex primary elective surgery for degenerative conditions of the lumbar spine
Sarcopenia measured by normalized total psoas area (NTPA) has been shown to predict mortality and adverse events (AE) in numerous surgical populations. The relationship between sarcopenia and postoperative outcomes after surgery for degenerative spine disease (DSD) has not been investigated.
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Giovanni Battista Della Porta’s (1535?-1615) study on ocular anatomy
Giovanni Battista Della Porta (1535?-1615) was a polymath who dealt with many scientific fields. Among his studies very important are those concerning optics and the physiology of vision. Due to his interest in optics it was inevitable to deal also with ocular anatomy. His anatomical description of the eye gives us a lot of information about the development of the knowledge concerning ocular anatomy of his time.
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The pharyngeal contractile integral is a useful indicator of pharyngeal swallowing impairment
Abstract
Background
A limitation to the expanded use of high-resolution pharyngeal manometry (HRPM) in clinical practice is the lack of useful pharyngeal parameters that are easy to interpret, generalizable between patients, and do not require specialized software. In this study, we sought to test the relationship between the pharyngeal contractile integral (PhCI) with videofluoroscopic abnormalities as assessed with the Modified Barium Swallow Impairment Profile©™.
Methods
Adult dysphagic patients were recruited to undergo simultaneous HRPM and videofluoroscopy during a standardized swallowing protocol.
Key Results
Thirty-six patients were included in the study. The mean PhCI was 247 mm Hg·cm·s (range 2-488 mm Hg·cm·s). The lower pharyngeal total (PT) group (N=20; mean PT=3.9) had a mean PhCI of 299 mm Hg·cm·s, while the higher PT group (N=16; mean PT=12.7) had a mean PhCI score of 188 mm Hg·cm·s (P=.01). There was also a significant negative correlation between normalized PhCI to PT scores (r=−.47; P=.004). Patients with higher PhCIs exhibited less severe penetration-aspiration scores on thin liquids (1.44 vs 3.78; P=.03) and all consistencies combined (1.21 vs 1.99; P=.03).
Conclusions & Inferences
The PhCI is a useful indicator of the presence of pharyngeal swallowing impairment and is technically simple to calculate with currently available software programs. Advancement of software is necessary to refine the clinical value of this parameter. High-resolution pharyngeal manometry has the potential to be a valuable adjunct procedure for the evaluation and treatment of dysphagic individuals.
In this study, we sought to test the relationship between a clinically practical high-resolution pharyngeal manometry parameter, the pharyngeal contractile integral, with videofluoroscopic observations. Lower pharyngeal contractile integral scores correlated with higher degrees of impairment and increased risk for aspiration or penetration. Our data support the potential utility for incorporation of high-resolution pharyngeal manometry to aid in assessment of pharyngeal swallowing and to identify physiologic targets for behavioral or surgical interventions.
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Alar cartilage—an alternative for spreader graft in primary rhinoplasty
Abstract
Background
Alar cartilage can be very useful for tip and dorsum grafts. Depending on its size and thickness, it can be an important alternative for spreader grafts to improve endonasal functional deficiencies, correct deviated noses, and prevent inverted “V” deformities. Caucasian patients with bulbous tips are the most common candidates to achieve such benefits. It is easy to obtain and to frame into a desired graft.
Methods
The authors describe a surgical technique using the alar cartilages as spreader grafts. All Caucasian patients with bulbous tips who underwent primary rhinoplasty were included. All patients have been evaluated after 3 to 4 months and after 1 and 2 years by aesthetical and functional criteria.
Results
Thirty-four patients (28 female and 6 male) underwent this procedure between 2001 and 2015: 94% reported a better airflow, 91% reported very good aesthetic results and were very satisfied 2 years postoperatively, and 12% had nasal deviations that were corrected with a one side double-layered spreader grafts. Two patients presented supra-tip deformities and one patient had a columella scar that was revised surgically. No cases of inverted “V” deformity were reported 2 years postoperatively.
Conclusions
Patients with functional satisfaction and with a straight and smooth dorsum seem to be the most important benefits that were achieved with this technique using alar cartilage spreader grafts, an alternative that can be offered to improve airflow and to prevent deviated and inverted “V” deformities.
Level of Evidence: IV, therapeutic study.
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Expression patterns of claudins in patients with triple-negative breast cancer are associated with nodal metastasis and worse outcome
Claudins (CLDNs) are key cell adhesion molecules, which compose tight junctions (TJs), and the disruption of TJs is associated with cancer development. Here we immunohistochemically studied expression patterns of CLDNs in 222 primary invasive breast cancers including 68 triple-negative breast cancers (TNBCs), and examined their correlation with epithelial-to-mesenchymal transition (EMT)-related markers, breast cancer stem cell (BCSC) markers, and clinicopathological features including patients’ clinical outcome. Tumor margins were classified as three infiltrating growth patterns (expanding, intermediate and infiltrating). For CLDN1, 3, 4, and 7, their expression rates were more frequent in TNBCs than in other subtypes (11.8% vs 0.7%, 26.5% vs 2.0%, 48.5% vs 11.1%, and 32.4% vs 8.7%, respectively; P ≤ 0.001). In 68 TNBCs, we identified high Ki67 labeling index (LI) and the combination of CLDN4 high/CLDN7 low expression as independent predictors of axillary nodal metastasis (P = 0.019; OR, 4.36; 95%CI, 1.28–14.90 and P = 0.007; OR, 5.33; 95%CI, 1.58–17.90). Moreover, the combination of CLDN1 low/CLDN7 low/E-cadherin negative as well as tumor infiltrating patterns were predictors for worse recurrence-free survival by univariate analyses in TNBCs (P = 0.005 and P = 0.011). Our analyses provide further evidence that CLDNs would be valuable prognostic markers in TNBCs.
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Entinostat neutralizes myeloid derived suppressor cells and enhances the antitumor effect of PD-1 inhibition in murine models of lung and renal cell carcinoma
Purpose: Recent advances in immunotherapy highlight the antitumor effects of immune- checkpoint inhibition despite a relatively limited subset of patients receiving clinical benefit. The selective class I histone deacetylase inhibitor (HDACi) entinostat has been reported to have immunomodulatory activity including targeting of immune suppressor cells in the tumor microenvironment. Thus, we decided to assess whether entinostat could enhance anti-PD-1 treatment and investigate those alterations in the immunosuppressive tumor microenvironment that contribute to the combined anti-tumor activity. <p>Experimental design: We utilized syngeneic mouse models of lung (LLC) and renal cell (RENCA) carcinoma, and assessed immune correlates, tumor growth and survival following treatment with entinostat (5 or 10 mg/kg, P.O.) and a PD-1 inhibitor (10 and 20 mg/kg, s.c.).</p> <p>Results: Entinostat enhanced the antitumor effect of PD-1 inhibition in two syngeneic mouse tumor models by reducing tumor growth and increasing survival. Entinostat inhibited the immunosuppressive function of both PMN- and M-MDSC populations. Analysis of MDSC response to entinostat revealed significantly reduced arginase-1, iNOS and COX-2 levels, suggesting potential mechanisms for the altered function. We also observed significant alterations in cytokine/chemokine release in vivo with a shift towards a tumor suppressive microenvironment.</p> <p>Conclusions: Our results demonstrate that entinostat enhances the antitumor effect of PD-1 targeting through functional inhibition of MDSCs, and a transition away from an immune suppressive tumor microenvironment. These data provide a mechanistic rationale for the clinical testing and potential markers of response of this novel combination in solid tumor patients.
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Sorafenib in patients with hepatocellular carcinoma - results of the observational INSIGHT study
Purpose: Sorafenib is the only currently approved systemic therapy for advanced hepatocellular carcinoma (HCC). We aimed to evaluate the safety and efficacy of sorafenib therapy in patients with HCC under real-life conditions regarding patient, tumor characteristics and any adverse events at study entry and at follow-up visits every 2-4 months. <br /><br />Experimental Design: The present INSIGHT study is a non-interventional, prospective, multicenter, observational study performed in 124 sites across Austria and Germany between 2008 and 2014.<br /><br />Results: Median overall survival and time to progression (RECIST) were found to be dependent on baseline Barcelona Clinic Liver Cancer (BCLC) tumor stage (A: 29.2, B: 19.6, C: 13.6, D: 3.1 and A: 6.0, B: 5.5, C: 3.9, and D: 1.7 months respectively), Child-Pugh liver function (A: 17.6, B: 8.1, C: 5.6 and A: 5.3, B: 3.3, C: 2.5 months, respectively), and performance status of the patient; however, age did not affect prognosis. Sorafenib-related adverse events at any grade occurred in 64.9% of patients, with diarrhea (35.4%), hand-foot-skin reaction (HFSR) (16.6%), nausea (10.3%), and fatigue (11.2%) occurring most frequently. <br /><br />Conclusions: Sorafenib treatment was shown to be effective in a real-life setting, in agreement with previously reported clinical trial data. The therapy was found to have an acceptable safety profile, with predominantly mild to moderate side effects.
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Targeting AXL and mTOR pathway overcomes primary and acquired resistance to WEE1 inhibition in small cell lung cancer
Purpose: Drugs targeting DNA repair and cell cycle checkpoints have emerged as promising therapies for small cell lung cancer (SCLC). Among these, the WEE1 inhibitor AZD1775 has shown clinical activity in a subset of SCLC patients, but resistance is common. Understanding primary and acquired resistance mechanisms will be critical for developing effective WEE1 inhibitor combinations. <p>Experimental Design: AZD1775 sensitivity in SCLC cell lines was correlated with baseline expression level of 200 total or phosphorylated proteins measured by reverse phase protein array (RPPA) to identify predictive markers of primary resistance. We further established AZD1775 acquired-resistant models to identify mechanism of acquired resistance. Combination regimens were tested to overcome primary and acquired resistance to AZD1775 in in vitro and in vivo SCLC models.</p> <p>Results: High-throughput proteomic profiling demonstrate that SCLC models with primary resistance to AZD1775 express high levels of AXL and phosphorylated S6 and that WEE1/AXL or WEE1/mTOR inhibitor combinations overcome resistance in vitro and in vivo. Furthermore, AXL, independently and via mTOR, activates the ERK pathway, leading to recruitment and activation of another G2-checkpoint protein, CHK1. AZD1775 acquired-resistant models demonstrated upregulation of AXL, pS6, and MET, and resistance was overcome with the addition of AXL (TP0903), dual-AXL/MET (cabozantinib), or mTOR (RAD001) inhibitors.</p> <p>Conclusions: AXL promotes resistance to WEE1 inhibition via downstream mTOR signaling and resulting activation of a parallel DNA damage repair pathway, CHK1. These findings suggest rational combinations to enhance the clinical efficacy of AZD1775, which is currently in clinical trials for SCLC and other malignancies.
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Evaluation of serum microRNA biomarkers for gastric cancer based on blood and tissue pools profiling: the importance of miR-21 and miR-331
Evaluation of serum microRNA biomarkers for gastric cancer based on blood and tissue pools profiling: the importance of miR-21 and miR-331
British Journal of Cancer 117, 266 (11 July 2017). doi:10.1038/bjc.2017.190
Authors: Marek Sierzega, Marcin Kaczor, Piotr Kolodziejczyk, Jan Kulig, Marek Sanak & Piotr Richter
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Sequential versus concurrent chemotherapy for adjuvant breast cancer: does dose intensity matter?
Sequential versus concurrent chemotherapy for adjuvant breast cancer: does dose intensity matter?
British Journal of Cancer 117, 157 (11 July 2017). doi:10.1038/bjc.2017.176
Authors: N LeVasseur & S K Chia
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Akt as a target for cancer therapy: more is not always better (lessons from studies in mice)
Akt as a target for cancer therapy: more is not always better (lessons from studies in mice)
British Journal of Cancer 117, 159 (11 July 2017). doi:10.1038/bjc.2017.153
Authors: Qi Wang, Xinyu Chen & Nissim Hay
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Comment on ‘Renewed interest in the progesterone receptor in breast cancer’
Comment on ‘Renewed interest in the progesterone receptor in breast cancer’
British Journal of Cancer 117, e1 (11 July 2017). doi:10.1038/bjc.2017.90
Authors: Giovanni Simone, Sergio Diotaiuti, Maria Digennaro, Domenico Sambiasi, Simona De Summa, Stefania Tommasi, Rosanna Altieri, Annita Mangia, Caterina Dantona & Angelo Paradiso
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Mutations in TP53 and JAK2 are independent prognostic biomarkers in B-cell precursor acute lymphoblastic leukaemia
Mutations in TP53 and JAK2 are independent prognostic biomarkers in B-cell precursor acute lymphoblastic leukaemia
British Journal of Cancer 117, 256 (11 July 2017). doi:10.1038/bjc.2017.152
Authors: Maribel Forero-Castro, Cristina Robledo, Rocío Benito, Irene Bodega-Mayor, Inmaculada Rapado, María Hernández-Sánchez, María Abáigar, Jesús Maria Hernández-Sánchez, Miguel Quijada-Álamo, José María Sánchez-Pina, Mónica Sala-Valdés, Fernanda Araujo-Silva, Alexander Kohlmann, José Luis Fuster, Maryam Arefi, Natalia de las Heras, Susana Riesco, Juan N Rodríguez, Lourdes Hermosín, Jordi Ribera, Mireia Camos Guijosa, Manuel Ramírez, Cristina Díaz de Heredia Rubio, Eva Barragán, Joaquín Martínez, José M Ribera, Elena Fernández-Ruiz & Jesús-María Hernández-Rivas
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Molecular profiling of signet ring cell colorectal cancer provides a strong rationale for genomic targeted and immune checkpoint inhibitor therapies
Molecular profiling of signet ring cell colorectal cancer provides a strong rationale for genomic targeted and immune checkpoint inhibitor therapies
British Journal of Cancer 117, 203 (11 July 2017). doi:10.1038/bjc.2017.168
Authors: Muhammad A Alvi, Maurice B Loughrey, Philip Dunne, Stephen McQuaid, Richard Turkington, Marc-Aurel Fuchs, Claire McGready, Victoria Bingham, Brendan Pang, Wendy Moore, Perry Maxwell, Mark Lawler, Jacqueline A James, Graeme I Murray, Richard H Wilson & Manuel Salto-Tellez
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Reduced Protein Expression in a Virus Attenuated by Codon Deoptimization
A general means of viral attenuation involves the extensive recoding of synonymous codons in the viral genome. The mechanistic underpinnings of this approach remain unclear, however. Using quantitative proteomics and RNA sequencing, we explore the molecular basis of attenuation in a strain of bacteriophage T7 whose major capsid gene was engineered to carry 182 suboptimal codons. We do not detect transcriptional effects from recoding. Proteomic observations reveal that translation is halved for the recoded major capsid gene, and a more modest reduction applies to several co-expressed downstream genes. We observe no changes in protein abundances of other co-expressed genes that are encoded upstream. Viral burst size, like capsid protein abundance, is also decreased by half. Together, these observations suggest that, in this virus, reduced translation of an essential polycistronic transcript and diminished virion assembly form the molecular basis of attenuation.
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Genome-Wide Sequence and Expression Analysis of the NAC Transcription Factor Family in Polyploid Wheat
Many important genes in agriculture correspond to transcription factors which regulate a wide range of pathways from flowering to responses to disease and abiotic stresses. In this study, we identified 5,776 transcription factors in hexaploid wheat (Triticum aestivum) and classified them into gene families. We further investigated the NAC family exploring the phylogeny, C-terminal domain conservation and expression profiles across 308 RNA-seq samples. Phylogenetic trees of NAC domains indicated that wheat NACs divided into eight groups similar to rice (Oryza sativa) and barley (Hordeum vulgare). C-terminal domain motifs were frequently conserved between wheat, rice and barley within phylogenetic groups, however this conservation was not maintained across phylogenetic groups. Three homoeologous copies were present for 58% of NACs, whereas evidence of single homoeolog gene loss was found for 33% of NACs. We explored gene expression patterns across a wide range of developmental stages, tissues, and abiotic stresses. We found that more phylogenetically related NACs shared more similar expression patterns compared to more distant NACs. However, within each phylogenetic group there were clades with diverse expression profiles. We carried out a co-expression analysis on all wheat genes and identified 37 modules of co-expressed genes of which 23 contained NACs. Using GO term enrichment we obtained putative functions for NACs within co-expressed modules including responses to heat and abiotic stress and responses to water: these NACs may represent targets for breeding or biotechnological applications. This study provides a framework and data for hypothesis generation for future studies on NAC transcription factors in wheat.
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Prioritising action on occupational carcinogens in Europe: a socioeconomic and health impact assessment
Prioritising action on occupational carcinogens in Europe: a socioeconomic and health impact assessment
British Journal of Cancer 117, 274 (11 July 2017). doi:10.1038/bjc.2017.161
Authors: J W Cherrie, S Hutchings, M Gorman Ng, R Mistry, C Corden, J Lamb, A Sánchez Jiménez, A Shafrir, M Sobey, M van Tongeren & L Rushton
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Potentiating the effects of radiotherapy in rectal cancer: the role of aspirin, statins and metformin as adjuncts to therapy
Potentiating the effects of radiotherapy in rectal cancer: the role of aspirin, statins and metformin as adjuncts to therapy
British Journal of Cancer 117, 210 (11 July 2017). doi:10.1038/bjc.2017.175
Authors: K J Gash, A C Chambers, D E Cotton, A C Williams & M G Thomas
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Radiation-associated breast cancer and gonadal hormone exposure: a report from the Childhood Cancer Survivor Study
Radiation-associated breast cancer and gonadal hormone exposure: a report from the Childhood Cancer Survivor Study
British Journal of Cancer 117, 290 (11 July 2017). doi:10.1038/bjc.2017.169
Authors: Chaya S Moskowitz, Joanne F Chou, Charles A Sklar, Dana Barnea, Cécile M Ronckers, Danielle Novetsky Friedman, Joseph P Neglia, Lucie Turcotte, Rebecca M Howell, Tara O Henderson, Gregory T Armstrong, Wendy M Leisenring, Leslie L Robison, Flora E van Leeuwen, Malcolm C Pike & Kevin C Oeffinger
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Prevalence of somatic mitochondrial mutations and spatial distribution of mitochondria in non-small cell lung cancer
Prevalence of somatic mitochondrial mutations and spatial distribution of mitochondria in non-small cell lung cancer
British Journal of Cancer 117, 220 (11 July 2017). doi:10.1038/bjc.2017.155
Authors: Daniel Kazdal, Alexander Harms, Volker Endris, Roland Penzel, Mark Kriegsmann, Florian Eichhorn, Thomas Muley, Albrecht Stenzinger, Nicole Pfarr, Wilko Weichert & Arne Warth
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Comment on ‘Effect of population breast screening on breast cancer mortality up to 2005 in England and Wales: an individual-level cohort study’
Comment on ‘Effect of population breast screening on breast cancer mortality up to 2005 in England and Wales: an individual-level cohort study’
British Journal of Cancer 117, e2 (11 July 2017). doi:10.1038/bjc.2017.101
Author: Anthony B Miller
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Water vapor variation and the effect of aerosols in China
Source:Atmospheric Environment, Volume 165
Author(s): Ke Gui, Huizheng Che, Quanliang Chen, Zhaoliang Zeng, Yu Zheng, Qichao Long, Tianze Sun, Xinyu Liu, Yaqiang Wang, Tingting Liao, Jie Yu, Hong Wang, Xiaoye Zhang
This study analyzes the annual and seasonal trends in precipitable water vapor (PWV) and surface temperature (Ts) over China from 1979 to 2015, and the relationships between PWV and Ts and between PWV and aerosol absorption optical depth (AAOD), using data from radiosonde stations, weather stations and multiple satellite observations. The results revealed a positive PWV trend between 1979 and 1999, and a negative PWV trend between 2000 and 2015. Analysis of the differences in the PWV trend among different stations types showed that the magnitude of the trends were in the order main urban stations > provincial capital stations > suburb stations, suggesting that anthropogenic activities have a strong influence on the PWV trend. The AAOD exhibited a significant positive trend in most regions of China from 2005 to 2015 (confidence level 95%). Using spatial correlation analysis, we showed that PWV trend derived from Moderate Resolution Imaging Spectroradiometer (MODIS) satellite observations is correlated with Ts, with an annual correlation coefficient of 0.596. In addition, the spatial correlation between PWV and AAOD showed a negative relationship, with the highest correlation coefficients of −0.76 and −0.71 observed in mid-eastern China and central northwest China, respectively, suggesting that the increase in AAOD in recent years may be one of the reasons for the decrease in PWV since the 2000s in China.
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Oligomerization reactions for precursors to secondary organic aerosol: Comparison between two formation mechanisms for the oligomeric hydroxyalkyl hydroperoxides
Publication date: October 2017
Source:Atmospheric Environment, Volume 166
Author(s): Qiangli Zhao, Weina Wang, Fengyi Liu, Jian Lü, Wenliang Wang
To better understand the formation mechanism of oligomeric hydroxyalkyl hydroperoxides HOROO(SCI)nH composed of stabilized Criegee intermediate (SCI) as a chain unit, the reactions of SCI with hydroxyalkyl hydroperoxides (HOROOH) and hydroxyalkylperoxy radical (HORO2) as well as HO2 radical were investigated. For the reactions of HORO2 + SCI, two preferred pathways involving a SCI insertion in HOROOH hydroperoxide bond can be found, and the formation of HOROO(SCI)H is the dominant pathway in the reaction of HOCH2(CH3)2COOH + (CH3)2COO. The structures of the HORO2, HOROOH as well as the SCIs play a crucial role in determining the reactivity of the oligomerization. Both the reactions of HORO2 + SCI + HO2 and HOROOH + SCI could be the source of the processors to the formation of secondary organic aerosol (SOA). But from the point of free energy barriers, the formation of HOROO(SCI)H prefers to follow the mechanism involving initiation by the reaction of a HORO2 and a SCI, sequential addition of SCIs, and termination by reaction with the HO2 radical. The rate coefficients show negative temperature dependence and vary in different systems depending on the reactants. The reaction process and constituents of the products can be regulated by temperature and reactants.
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Source:Atmospheric Environment, Volume 166
Author(s): Qiangli Zhao, Weina Wang, Fengyi Liu, Jian Lü, Wenliang Wang
To better understand the formation mechanism of oligomeric hydroxyalkyl hydroperoxides HOROO(SCI)nH composed of stabilized Criegee intermediate (SCI) as a chain unit, the reactions of SCI with hydroxyalkyl hydroperoxides (HOROOH) and hydroxyalkylperoxy radical (HORO2) as well as HO2 radical were investigated. For the reactions of HORO2 + SCI, two preferred pathways involving a SCI insertion in HOROOH hydroperoxide bond can be found, and the formation of HOROO(SCI)H is the dominant pathway in the reaction of HOCH2(CH3)2COOH + (CH3)2COO. The structures of the HORO2, HOROOH as well as the SCIs play a crucial role in determining the reactivity of the oligomerization. Both the reactions of HORO2 + SCI + HO2 and HOROOH + SCI could be the source of the processors to the formation of secondary organic aerosol (SOA). But from the point of free energy barriers, the formation of HOROO(SCI)H prefers to follow the mechanism involving initiation by the reaction of a HORO2 and a SCI, sequential addition of SCIs, and termination by reaction with the HO2 radical. The rate coefficients show negative temperature dependence and vary in different systems depending on the reactants. The reaction process and constituents of the products can be regulated by temperature and reactants.
Graphical abstract
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Q7 e-tron: The new Hybrid-car for Oslo Fire Chef:
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Q7 e-tron: The new Hybrid-car for Oslo Fire Chef:
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Aerosol black carbon at an urban site-Srinagar, Northwestern Himalaya, India: Seasonality, sources, meteorology and radiative forcing
Source:Atmospheric Environment, Volume 165
Author(s): Mudasir Ahmad Bhat, Shakil Ahmad Romshoo, Gufran Beig
Black carbon (BC) mass concentration was measured first-time at a high altitude urban site-Srinagar (1600 m asl), in northwestern Himalaya, India using an Aethalometer during 2013 to study temporal variations (monthly, diurnal and seasonal), meteorological influences, source and its radiative forcing. Diurnal variations with two peaks (at 8–10 h and 20–23 h) and two dips (at 13–17 h and 0–3 h) were observed throughout the year with varying magnitude. November and April showed the highest (13.6 μg/m3) and the lowest (3.4 μg/m3) mean monthly BC concentration respectively. Seasonally, autumn displayed the highest (9.2 μg/m3) and spring the lowest (3.5 μg/m3) mean BC concentration. Annual average BC concentration was quite higher (6 μg/m3) than those reported for other high altitude stations. Wind speed, Minimum temperature and total precipitation showed a clear negative correlation with BC (r = −0.63, −0.51 and −0.55 respectively), while as, the evening relative humidity showed positive correlation (r = 0.56). During autumn, spring and winter seasons, the main source of BC at Srinagar is the biomass burning, while during summer season, equal contribution of BC is from fossil fuel and biomass burning. Back trajectory simulations revealed that, except summer, westerly air masses are the dominant winds, transporting BC from central Asia, west Asia, south Asia, Africa and some parts of Europe to Srinagar adding to its local sources. Clear-sky short wave radiative forcing of atmosphere due to BC was highest (58.2 W m-2) during autumn which leads to the increase in lower atmospheric heating rate by 1.6 K/d. The high concentration of BC observed over the high-altitude Himalayan Kashmir region has serious implications for the regional climate, hydrology and cryosphere which needs to be investigated.
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EM Nerd-The Case of the Tarnished Standard
Anyone who has spent some time in a cardiac intensive care unit understands the physiologic appeal of the intra-aortic balloon pump (IABP). Anecdotally its use improves multiple clinical endpoints that for years have been considered surrogates for patient important outcomes. And yet, despite these physiologic advantages when examined in a rigorous fashion, IABPs have failed […]
EMCrit by Rory Spiegel.
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Rezidivierende Sialadenitis der Gl. parotis beidseitig in der Adoleszenz
Laryngo-Rhino-Otol 2017; 96: 390-393
DOI: 10.1055/s-0043-104772
© Georg Thieme Verlag KG Stuttgart · New York
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Akute Otitis Media: wie lange Antibiotika einsetzen?
Laryngo-Rhino-Otol 2017; 96: 347-348
DOI: 10.1055/s-0043-105201
Hoberman A et al. Shortened Antimicrobial Treatment for Acute Otitis Media in Young Children. N Engl J Med. 2016; 375: 2446–2456 Führt bei Kindern mit akuter Otitis media die Begrenzung der antimikrobiellen Behandlung auf 5 Tage im Vergleich zur Standardtherapie über 10 Tage zum gleichen Ergebnis? Kann durch die gleiche Strategie in darauffolgenden Episoden der Gesamtantibiotikaverbrauch und damit das Auftreten von Resistenzen reduziert werden? Diese Fragen wollten amerikanische Kinderärzte in einer Vergleichsuntersuchung klären.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
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Chirurgie der inneren Nase
Laryngo-Rhino-Otol 2017; 96: 422-427
DOI: 10.1055/s-0043-104074
© Georg Thieme Verlag KG Stuttgart · New York
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Nasale Obstruktion wie operativ behandeln?
Laryngo-Rhino-Otol 2017; 96: 348-350
DOI: 10.1055/s-0043-105196
Standlee AG et al. Evaluating the Effect of Spreader Grafting on Nasal Obstruction Using the NOSE Scale. Ann Otol Rhinol Laryngol. 2017; 126: 219–223 Die Nasenobstruktion ist das am häufigsten auftretende Symptom bei Erkrankungen von Nase und Nebenhöhlen. Der Therapieerfolg eines operativen Eingriffs lässt sich anhand der Nasal Obstruction Symptom Evaluation (NOSE)-Scale beurteilen. Amerikanische Ärzte bewerteten nun die NOSE-Scores, um Wirksamkeit von Dehnungsimplantaten auf die postoperative nasale Funktion zu bestimmen.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
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Kochleaimplantatversorgung von Kindern und Erwachsenen
Laryngo-Rhino-Otol 2017; 96: 396-419
DOI: 10.1055/s-0043-104067
In Deutschland werden jährlich etwa 4000 Patienten mit einem Kochleaimplantat versorgt. Während noch vor Jahren schwerhörige ältere Menschen mit konventionellen Hörgeräten und progredientem Hörverlust bei unzureichendem Sprachverständnis mit dem Risiko der sozialen Isolation leben mussten, können heute Cochleaimplantate als Folgeglied in der Hörsystemversorgung mit hoffnungsvollen Ergebnissen auch bei im fortgeschrittenen Alter angesehen werden. Auch bei Kindern ergeben sich neue Indikationen, mit besonderen Anforderungen in der Rehabilitation.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
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CI: bei Innenohr-Anomalien oft aberranter Facialis-Verlauf
Laryngo-Rhino-Otol 2017; 96: 350-351
DOI: 10.1055/s-0043-105197
Palabiyik FB et al.; Facial nerve anomalies in paediatric cochlear implant candidates: radiological evaluation; J Laryngol Otol (2017); 131: 26–31 Eine Verletzung des N. facialis mit nachfolgender Facialisparese ist eine der möglichen Komplikationen einer Cochlea-Implantation bei Kindern mit sensorineuralem Hörverlust (SNHL). Türkische Radiologen untersuchten jetzt, welche Rolle Facialis-Anomalien in diesem Zusammenhang spielen und inwieweit sie mit Innenohr-Anomalien assoziiert sind.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
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Zur Bewertung spontaner Atemänderungen bei der Respirations-Olfaktometrie
Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-111239
Einleitung Durch Gerüche evozierte Atemänderungen werden zum objektivierenden Nachweis der Intaktheit des Riechsystems im Sinne einer Respirations-Olfaktometrie genutzt. Spontane Atemänderungen lassen sich in der Regel nicht von evozierten unterscheiden. Es müssen deshalb wiederholt Reize mit reinen Riechstoffen randomisiert mit Leerreizen in die Ruheatmung appliziert werden, um mehrheitliche Atemänderungen bei olfaktorischer Reizung darzustellen. Methodik Bei 26 erwachsenen Normosmikern wurden mit Hilfe eines Fluss-Olfaktometers 15 überschwellige H2S- und 15 Neutralluft-Reize (Dauer: 2 s) randomisiert mit einem Interstimulusintervall von mindestens 1 Minute inspirationssynchron appliziert. Vor der Reizung durfte die Ruheatmung nicht sehr streuen (Variationskoeffizient der Dauer der Inspiration und der Exspiration ≤0,1). Eine respiratorische Reaktion im Reizatemzug lag vor, wenn die Dauer der Inspiration (DIN) bzw. der Exspiration (DEX) des Reizatemzuges jenseits der doppelten Standardabweichung dieser Atemparameter vom Mittelwert der fünf vorausgehenden Ruheatemzüge lag. Die Anzahl der Reaktionen wurde auf die Anzahl der Reize und der off-line als regelmäßig ermittelten Ruheatemkomplexe normiert und Reaktionsindizes gebildet. Ergebnisse H2S-Reize evozierten deutlich mehr Atemänderungen als Neutralluftreize. DIN und DEX verringerten sich bei olfaktorischer Reizung häufiger als bei einer Applikation von Neutralluft. Verlängerungen von DIN und DEX waren zwischen den beiden Reizqualitäten nicht different. Schlussfolgerungen Nur die randomisierte nasale Reizung mit einem Riechstoff und einem Leerreiz machen die Respirations-Olfaktometrie aussagefähig.
[...]
Georg Thieme Verlag KG Stuttgart · New York
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Kontaktgranulom
Laryngo-Rhino-Otol 2017; 96: 352-353
DOI: 10.1055/s-0043-104066
Erhöhte Stimmbelastung kann zu Kontaktgranulomen führen, wobei Stimmklangveränderungen meist kein Teil der Beschwerden sind. Sollten sie allerdings auftreten, dann ist eine chirurgische Therapie neben der Stimmtherapie indiziert.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
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Wie ein Tritt in den Hintern zur Verjährung führte
Laryngo-Rhino-Otol 2017; 96: 394-395
DOI: 10.1055/s-0042-118286
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Prävalenz, Risikofaktoren und Diagnostik von Hörstörungen bei Frühgeborenen
Laryngo-Rhino-Otol 2017; 96: 354-360
DOI: 10.1055/s-0043-109512
Einleitung: Die Frühgeburt bringt ein deutlich gesteigertes Risiko der Ausbildung einer konnatalen Hörstörung mit sich. Der postnatalen Kontrolle der Hörfunktion muss daher bei allen Frühgeborenen besondere Aufmerksamkeit zuteil werden. Die vorgestellte Arbeit untersucht, inwieweit die aktuellen wissenschaftlichen Erkenntnisse hinsichtlich Prävalenz, Diagnostik, Therapie und in Bezug auf die Risikofaktoren von Hörstörungen bei Frühgeborenen praktische Anwendung finden. Material und Methoden: Die Behandlungsdaten von 126 im Arbeitsbereich Phoniatrie und Pädaudiologie der HNO-Universitätsklinik Magdeburg in den Jahren 2006–2011 untersuchten und behandelten ehemaligen Frühgeborenen wurden retrospektiv ausgewertet. Die zusätzliche Analyse aller Datensätze der Screeningzentrale (n=67 640) aus diesem Zeitraum ermöglicht Rückschlüsse auf die Gesamtanzahl und Prävalenz von Hörstörungen bei Frühgeborenen in Sachsen-Anhalt. Ergebnisse: Nahezu alle Frühgeborene erhalten, wie Reifgeborene, ein beidseitiges postnatales Hörscreening. Die Datenauswertung zeigt jedoch, dass die praktische Umsetzung im Detail oft nicht den in der G-BA-Richtlinie festgelegten Qualitätszielen entspricht. Bspw. erfolgt je nach Geburtsklinik keine regelhafte Anwendung der bei Frühgeborenen empfohlenen Screeningmethode (AABR) oder der richtliniengemäße Screening-und Therapiezeitpunkt wird nicht eingehalten. Diskussion: Die Evaluation der praktischen Umsetzung des universellen Neugeborenenhörscreenings wurde bereits zum Zeitpunkt der Einführung des Screeningprogrammes durch den G-BA geplant. Im Rahmen dieser Untersuchung sollte der praktischen Versorgung von Risikogruppen wie Frühgeborenen besondere Beobachtung gewidmet werden, um auf Basis der erhobenen Daten das Hörscreening – sowie die anschließende Diagnostik und Therapie-weiter zu vereinheitlichen. Unabhängig von der Geburtsklinik sollte gleichermaßen die Chance auf rechtzeitige Diagnostik und damit auf frühzeitige, prognostisch günstigere Therapie einer konnatalen Hörstörung bestehen. Durch schnelle postnatale Hörgerätversorgung können die Hörbahnreifung stimuliert und so potentiell Entwicklungsprobleme hinsichtlich der Hör-und Sprachentwicklung vermieden werden.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Fragen für die Facharztprüfung
Laryngo-Rhino-Otol 2017; 96: 420-421
DOI: 10.1055/s-0043-110071
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Hirnnervenlähmung nach endonasaler, endoskopischer Nasennebenhöhlenoperation. Fallbericht
Laryngo-Rhino-Otol 2017; 96: 388-389
DOI: 10.1055/s-0043-105796
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Kommentar der Schriftleitung
Laryngo-Rhino-Otol 2017; 96: 345-345
DOI: 10.1055/s-0043-104080
Liebe Leserinnen und Leser,in Referiert + Diskutiert starten wir mit einer wegweisenden Arbeit aus dem New England Journal of Medicine, dass es bei einer Antibiotikatherapie der kindlichen Otitis media acuta wichtig ist auch konsequent über 10 Tage zu behandeln 1; eine Kurzzeittherapie ist dem eindeutig unterlegen. Dann geht es um die Effektivität von Dehnungsimplantaten bei Septorhinoplastiken und dann um radiologische Befundung von Fazialisanomalien bei Innenohranomalien, was auch für CI Implantationen relevant ist, siehe weiter unten 2.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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The Anterior SMAS Approach for Facelifting and for Buccal Fat Pad Removal
Abstract
Having performed numerous varieties of SMAS advancement including: plication, resection, flap elevation with variable anterior deep dissection, the author has developed a direct approach to the mobile anterior SMAS which allows correction of midface descent, modest elevation of the modiolus, jawline correction, and, where indicated, direct access for buccal fat pad resection.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
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Systematic Review of Quality of Patient Information on Phalloplasty in the Internet
Abstract
Background
An increasing number of patients, considering aesthetic surgery, use Internet health information as their first source of information. However, the quality of information available in the Internet on phalloplasty is currently unknown. This study aimed to assess the quality of patient information on phalloplasty available in the Internet.
Methods
The assessment of the Web sites was based on the modified Ensuring Quality Information for Patients (EQIP) instrument (36 items). Three hundred Web sites were identified by the most popular Web search engines.
Results
Ninety Web sites were assessed after, duplicates, irrelevant sources and Web sites in other languages rather than English were excluded. Only 16 (18%) Web sites addressed >21 items, and scores tended to be higher for Web sites developed by academic centers and the industry than for Web sites developed by private practicing surgeons. The EQIP score achieved by Web sites ranged between 4 and 29 of the total 36 points, with a median value of 17.5 points (interquartile range, 13–21). The top 5 Web sites with the highest scores were identified.
Conclusions
The quality of patient information on phalloplasty in the Internet is substandard, and the existing Web sites present inadequate information. There is a dire need to improve the quality of Internet phalloplasty resources for potential patients who might consider this procedure.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
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Anesthesia for Kidney and Pancreas Transplantation
Source:Anesthesiology Clinics
Author(s): Aaron M. Mittel, Gebhard Wagener
Teaser
Kidney transplants are the most common solid organ abdominal transplant and are occasionally performed simultaneously with pancreas transplants in diabetic patients. Preoperative evaluation of potential transplant recipients should focus on the potential for occult cardiovascular disease while also screening for other signs of end-organ dysfunction. Intraoperatively, it is of utmost importance to ensure adequate graft perfusion to limit the risk of postoperative graft dysfunction or rejection. Postoperative care of the kidney or pancreas transplant patient should focus on ensuring normalization of volume status, electrolyte concentrations, and glycemic control.from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2tL95RC
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Anesthetic Management of Pediatric Liver and Kidney Transplantation
Source:Anesthesiology Clinics
Author(s): Nicholas R. Wasson, Jeremy D. Deer, Santhanam Suresh
Teaser
Pediatric patients with liver dysfunction and renal failure may exhibit many comorbidities. There are often associated congenital syndromes to be taken into account. Liver and renal transplantation offer a solution and substantial improvement in quality of life. Anesthetic management of pediatric liver and renal transplantation has not been well-described. There are key differences between adults and children undergoing these procedures, and acknowledgment of some key principles provide a solid foundation to optimize perioperative outcomes. This article provides an overview of the perioperative management and considerations in pediatric patients undergoing liver and renal transplantation.from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2t1K8nU
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Anesthesia for Liver Transplantation
Source:Anesthesiology Clinics
Author(s): Dieter Adelmann, Kate Kronish, Michael A. Ramsay
Teaser
The provision of anesthesia for a liver transplant program requires a dedicated team of anesthesiologists. Liver transplant anesthesiologists must have an understanding of liver physiology and anatomy; the spectrum of clinical disease associated with liver dysfunction; the impact of warm and cold ischemia times, surgical techniques in liver transplantation, the impact of ischemia–reperfusion syndrome; and optimal practices to protect the liver. The team must provide a 24-hour service, be actively involved in the selection committee process, and stay current with advances in the subspecialty.from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2tL7Fqu
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Transfusion Medicine and Coagulation Management in Organ Transplantation
Source:Anesthesiology Clinics
Author(s): Jaswanth Madisetty, Cynthia Wang
Teaser
Organ transplantation recipients present unusual challenges with regard to blood transfusion. Although this patient population requires a larger proportion of blood product resources, liberal transfusion of allogeneic blood products can lead to a plethora of complications. Recent trends suggest that efforts to minimize bleeding, conserve products, and target transfusion to specific deficits and needs are increasingly becoming the standard practice. This must all occur with optimization of graft function and preservation in mind. With newer monitoring modalities and factor concentrates, the approach toward transfusion and bleeding in organ transplantation has rapidly improved in recent years.from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2t1Wtsn
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Organ Transplantation: A Systematic Review
Source:Anesthesiology Clinics
Author(s): Aman Mahajan, Christopher Wray
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Anesthesia for Kidney and Pancreas Transplantation
Publication date: Available online 10 July 2017
Source:Anesthesiology Clinics
Author(s): Aaron M. Mittel, Gebhard Wagener
Teaser
Kidney transplants are the most common solid organ abdominal transplant and are occasionally performed simultaneously with pancreas transplants in diabetic patients. Preoperative evaluation of potential transplant recipients should focus on the potential for occult cardiovascular disease while also screening for other signs of end-organ dysfunction. Intraoperatively, it is of utmost importance to ensure adequate graft perfusion to limit the risk of postoperative graft dysfunction or rejection. Postoperative care of the kidney or pancreas transplant patient should focus on ensuring normalization of volume status, electrolyte concentrations, and glycemic control.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2tL95RC
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Anesthetic Management of Pediatric Liver and Kidney Transplantation
Publication date: Available online 10 July 2017
Source:Anesthesiology Clinics
Author(s): Nicholas R. Wasson, Jeremy D. Deer, Santhanam Suresh
Teaser
Pediatric patients with liver dysfunction and renal failure may exhibit many comorbidities. There are often associated congenital syndromes to be taken into account. Liver and renal transplantation offer a solution and substantial improvement in quality of life. Anesthetic management of pediatric liver and renal transplantation has not been well-described. There are key differences between adults and children undergoing these procedures, and acknowledgment of some key principles provide a solid foundation to optimize perioperative outcomes. This article provides an overview of the perioperative management and considerations in pediatric patients undergoing liver and renal transplantation.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2t1K8nU
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Anesthesia for Liver Transplantation
Publication date: Available online 10 July 2017
Source:Anesthesiology Clinics
Author(s): Dieter Adelmann, Kate Kronish, Michael A. Ramsay
Teaser
The provision of anesthesia for a liver transplant program requires a dedicated team of anesthesiologists. Liver transplant anesthesiologists must have an understanding of liver physiology and anatomy; the spectrum of clinical disease associated with liver dysfunction; the impact of warm and cold ischemia times, surgical techniques in liver transplantation, the impact of ischemia–reperfusion syndrome; and optimal practices to protect the liver. The team must provide a 24-hour service, be actively involved in the selection committee process, and stay current with advances in the subspecialty.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2tL7Fqu
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Transfusion Medicine and Coagulation Management in Organ Transplantation
Publication date: Available online 10 July 2017
Source:Anesthesiology Clinics
Author(s): Jaswanth Madisetty, Cynthia Wang
Teaser
Organ transplantation recipients present unusual challenges with regard to blood transfusion. Although this patient population requires a larger proportion of blood product resources, liberal transfusion of allogeneic blood products can lead to a plethora of complications. Recent trends suggest that efforts to minimize bleeding, conserve products, and target transfusion to specific deficits and needs are increasingly becoming the standard practice. This must all occur with optimization of graft function and preservation in mind. With newer monitoring modalities and factor concentrates, the approach toward transfusion and bleeding in organ transplantation has rapidly improved in recent years.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2t1Wtsn
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Organ Transplantation: A Systematic Review
Publication date: Available online 10 July 2017
Source:Anesthesiology Clinics
Author(s): Aman Mahajan, Christopher Wray
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Using anatomical landmark to avoid phrenic nerve injury during balloon-based procedures in atrial fibrillation patients
Abstract
Purpose
Atrial fibrillation (AF) is an arrhythmia which affects as many as 2.7 million Americans. AF should be treated, because it can lead to a four-to-fivefold increased risk of experiencing a stroke. The American College of Cardiology/American Heart Association guidelines for the treatment of drug refractory and symptomatic paroxysmal AF denote catheter ablation as the standard of care. The newest ablation treatment, cryoballoon, uses a cold balloon tip. The biggest risk factor associated with the cryoballoon ablation is phrenic nerve injury (PNI). The purpose of this study is to measure relevant distances from specific landmarks to the right phrenic nerve (RPN) to create a safe zone for physicians.
Methods
Using 30 cadaveric specimens, we measured laterally from the right superior pulmonary vein orifice (RSPV) to the RPN at the level of the sixth thoracic vertebra and laterally from the lateral border of the sixth thoracic vertebral body (T6) to the RPN. The depth and width of the left atrium (LA) were also measured to establish a cross-sectional area of the LA. The cross-sectional area of the LA was then correlated with the averaged measurements to see if the area of the LA could be a predictor of the location of the RPN.
Results
The average distance from the RPN–RSPV was 9.6 mm (range 4.3–18.8 mm). The average RPN-T6 distance was 30.6 mm (range 13.7–49.9 mm). There was a non-significant trend that suggests as the size of the LA increases, the measured distances also increased.
Conclusion
Using the lateral border of the sixth thoracic vertebra as a landmark, which can be viewed under fluoroscopy during the procedure, physicians can triangulate the distance to the RSPV and determine the approximate position of the RPN. Furthermore, physicians can perform a preoperative echocardiogram to determine the size of the LA to assist in determining the position of the RPN with the hopes of avoiding injury to the RPN.
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Fetal Tobacco Smoke Exposure in the Third Trimester of Pregnancy Is Associated with Atopic Eczema/Dermatitis Syndrome in Infancy
Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.
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Creation of an Aesthetic Male Nipple Areolar Complex in Female-to-Male Transgender Chest Reconstruction
Abstract
Background
Female-to-male chest wall reconstruction is becoming more common, but while there is a growing body of the literature describing technique and algorithms, little detail is written on methods for creating a male appearing nipple areolar complex (NAC) from a female NAC utilizing free nipple graft techniques. Incorrect positioning of the NAC on the chest wall and suboptimal shaping and sizing of the NAC are common pitfalls in male NAC creation.
Methods
With this paper, we present techniques for nipple grafting to achieve improved male appearing NACs, as well as a simple, reproducible method for appropriate placement of the NAC relative to the borders of the pectoralis muscle. To validate our technique, we performed photographic analysis of 64 NACs in 32 volunteers with BMI of 25 or less.
Results
The anatomic study determined the cis-male nipple to be positioned on average 2.5 cm medial to the lateral border of the pectoralis muscle and 2.4 cm above the inferior pectoralis insertion. This supports our surgical technique of positioning the NAC in relation to the pectoralis borders rather than previously advocated anatomic landmarks. We also present reliable techniques for creating a round or horizontally oval final NAC shape as well as a composite grafting technique for cases of large papillae.
Conclusions
Our anatomic study supports placement of the male NAC relative to lateral and inferior borders of the pectoralis muscle. Nipple grafting techniques presented allow for a simple and reproducible method of creating an aesthetic male NAC shape in female-to-male transgender chest reconstruction.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
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Combination of Würinger’s Horizontal Septum and Inferior Pedicle Techniques to Increase Nipple-Areolar Complex Viability During Breast Reduction Surgery
Abstract
Background
Breast reduction techniques depend on the vascularity of the pedicle. Preserving vascularity of the nipple-areolar complex (NAC) is mandatory for reduction mammoplasties, as the NAC is the most important aesthetic and functional unit of the breast. The inferior pedicle technique is the most common method for breast reduction; however, pedicle length may increase after using this technique and cause problems related to NAC viability in gigantomastic and hypertrophic breasts. In this study, we present our technical approach to preserve NAC viability by combining Würinger’s horizontal septum and inferior pedicle techniques.
Methods
This study included 60 women (mean age 39.71 ± 10.52 years) who underwent a breast reduction combining Würinger’s horizontal septum and inferior pedicle procedures from April 2012 to January 2016. All patients were marked preoperatively in a standing upright position using a prefabricated Wise-pattern template. The base of the pedicle was marked at the level of the inframammary ridge at a width of 8 cm.
Results
The patients were followed up for a mean of 5.6 ± 3.3 months. The resection weights of the right and left sides were 1406 ± 566 and 1340 ± 563 g, respectively. Venous insufficiency was encountered in five cases (8.3%) and caused partial NAC necrosis in one case (1.6%). No cases of total NAC necrosis were encountered. Fifteen breasts (12.5%) were described as gigantomastic (resection weight >2000 g).
Conclusions
This combined method may promote safer and more satisfying outcomes from inferior pedicle breast reduction.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
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The Anterior SMAS Approach for Facelifting and for Buccal Fat Pad Removal
Abstract
Having performed numerous varieties of SMAS advancement including: plication, resection, flap elevation with variable anterior deep dissection, the author has developed a direct approach to the mobile anterior SMAS which allows correction of midface descent, modest elevation of the modiolus, jawline correction, and, where indicated, direct access for buccal fat pad resection.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
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Systematic Review of Quality of Patient Information on Phalloplasty in the Internet
Abstract
Background
An increasing number of patients, considering aesthetic surgery, use Internet health information as their first source of information. However, the quality of information available in the Internet on phalloplasty is currently unknown. This study aimed to assess the quality of patient information on phalloplasty available in the Internet.
Methods
The assessment of the Web sites was based on the modified Ensuring Quality Information for Patients (EQIP) instrument (36 items). Three hundred Web sites were identified by the most popular Web search engines.
Results
Ninety Web sites were assessed after, duplicates, irrelevant sources and Web sites in other languages rather than English were excluded. Only 16 (18%) Web sites addressed >21 items, and scores tended to be higher for Web sites developed by academic centers and the industry than for Web sites developed by private practicing surgeons. The EQIP score achieved by Web sites ranged between 4 and 29 of the total 36 points, with a median value of 17.5 points (interquartile range, 13–21). The top 5 Web sites with the highest scores were identified.
Conclusions
The quality of patient information on phalloplasty in the Internet is substandard, and the existing Web sites present inadequate information. There is a dire need to improve the quality of Internet phalloplasty resources for potential patients who might consider this procedure.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
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Fetal Tobacco Smoke Exposure in the Third Trimester of Pregnancy Is Associated with Atopic Eczema/Dermatitis Syndrome in Infancy
Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.
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TERT Promoter Mutations Were Not Found in Papillary Thyroid Microcarcinomas That Showed Disease Progression on Active Surveillance
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Using P16 Immunohistochemistry to Classify Morphologic Cervical Intraepithelial Neoplasia 2: Correlation of Ambiguous Staining Patterns with HPV Subtypes and Clinical Outcome
Publication date: Available online 11 July 2017
Source:Human Pathology
Author(s): Yuxin Liu, Mahfood Alqatari, Kieran Sultan, Fei Ye, Dana Gao, Keith Sigel, David Zhang, Tamara Kalir
P16INK4a immunohistochemistry (IHC) is widely used to facilitate the diagnosis of human papillomavirus (HPV)-associated cervical precancerous lesions. While most p16 results are distinctly positive or negative, certain ones are ambiguous: they meet some but not all requirements for the “block-positive” pattern. It is unclear whether ambiguous p16 immunoreactivity indicates oncogenic HPV infection or risk of progression. Herein, we compared HPV genotypes and subsequent High-grade Squamous Intraepithelial Lesion (HSIL) outcomes among 220 cervical biopsies with a differential diagnosis of Cervical Intraepithelial Neoplasia 2 (CIN 2) based on hematoxylin and eosin morphology and varying degrees of p16 immunoreactivity. P16 results were classified as block-positive (n=40, 18%), negative (n=130, 59%), or ambiguous (n=50, 23%), a category we further grouped into three patterns: strong/basal (n=18), strong/focal (n=15), and weak/diffuse (n=17). 70% of ambiguous p16 lesions were negative for the most common low- and high-risk HPV types; the remaining 30% were positive for HPV 16, 18, 45, 58, 59, or 66. Three patterns revealed comparably low HPV detection rates (28%, 27% and 35%). During 12-month surveillance, HSILs were detected in 35% of the p16 block-positive group, 1.5% of negative group, and 16% of the ambiguous group. The accuracy of ambiguous p16 immunoreactivity in predicting oncogenic HPV and HSIL outcome is significantly lower than that of the block-positive pattern but greater than negative staining. Specific guidelines for this intermediate category should prevent diagnostic errors and help implement p16 IHC in general practice.
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Source:Human Pathology
Author(s): Yuxin Liu, Mahfood Alqatari, Kieran Sultan, Fei Ye, Dana Gao, Keith Sigel, David Zhang, Tamara Kalir
P16INK4a immunohistochemistry (IHC) is widely used to facilitate the diagnosis of human papillomavirus (HPV)-associated cervical precancerous lesions. While most p16 results are distinctly positive or negative, certain ones are ambiguous: they meet some but not all requirements for the “block-positive” pattern. It is unclear whether ambiguous p16 immunoreactivity indicates oncogenic HPV infection or risk of progression. Herein, we compared HPV genotypes and subsequent High-grade Squamous Intraepithelial Lesion (HSIL) outcomes among 220 cervical biopsies with a differential diagnosis of Cervical Intraepithelial Neoplasia 2 (CIN 2) based on hematoxylin and eosin morphology and varying degrees of p16 immunoreactivity. P16 results were classified as block-positive (n=40, 18%), negative (n=130, 59%), or ambiguous (n=50, 23%), a category we further grouped into three patterns: strong/basal (n=18), strong/focal (n=15), and weak/diffuse (n=17). 70% of ambiguous p16 lesions were negative for the most common low- and high-risk HPV types; the remaining 30% were positive for HPV 16, 18, 45, 58, 59, or 66. Three patterns revealed comparably low HPV detection rates (28%, 27% and 35%). During 12-month surveillance, HSILs were detected in 35% of the p16 block-positive group, 1.5% of negative group, and 16% of the ambiguous group. The accuracy of ambiguous p16 immunoreactivity in predicting oncogenic HPV and HSIL outcome is significantly lower than that of the block-positive pattern but greater than negative staining. Specific guidelines for this intermediate category should prevent diagnostic errors and help implement p16 IHC in general practice.
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Perineural Invasion by Prostate Cancer on MR/US Fusion Targeted Biopsy is Associated with Extraprostatic Extension and Early Biochemical Recurrence after Radical Prostatectomy
Publication date: Available online 11 July 2017
Source:Human Pathology
Author(s): Matthew Truong, Soroush Rais-Bahrami, Jeffrey W. Nix, Edward M. Messing, Hiroshi Miyamoto, Jennifer B. Gordetsky
In recent years, multiparametric magnetic resonance imaging (MRI) and MR/ultrasound (US) fusion targeted biopsy (TB) have become more widely adopted to aid in prostate cancer (PCa) detection. Previously, TB has been found to increase the yield of clinically significant PCa and is more likely to sample the index tumor compared to traditional 12-core extended sextant biopsies. Currently the prognostic significance of perineural invasion (PNI) when identified on TB (PNI-TB) is unknown. We identified 95 men at two tertiary referral centers who underwent TB followed by radical prostatectomy between January 2014 and January 2017. Clinical, radiological, and pathological variables were retrospectively reviewed. PNI was identified on TB in 27/95 (28.4%) patients. On multivariable logistic regression, independent predictors of extraprostatic extension were prostate specific antigen (PSA), TB maximum % core involvement, and PNI-TB (all P<.05). Furthermore, Kaplan–Meier analysis demonstrated that PNI-TB was associated with early biochemical recurrence events within 12months after prostatectomy (log rank P=.049). Given the increasing adoption of TB for PCa detection in clinical practice, PNI-TB may be useful for PCa risk stratification.
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Source:Human Pathology
Author(s): Matthew Truong, Soroush Rais-Bahrami, Jeffrey W. Nix, Edward M. Messing, Hiroshi Miyamoto, Jennifer B. Gordetsky
In recent years, multiparametric magnetic resonance imaging (MRI) and MR/ultrasound (US) fusion targeted biopsy (TB) have become more widely adopted to aid in prostate cancer (PCa) detection. Previously, TB has been found to increase the yield of clinically significant PCa and is more likely to sample the index tumor compared to traditional 12-core extended sextant biopsies. Currently the prognostic significance of perineural invasion (PNI) when identified on TB (PNI-TB) is unknown. We identified 95 men at two tertiary referral centers who underwent TB followed by radical prostatectomy between January 2014 and January 2017. Clinical, radiological, and pathological variables were retrospectively reviewed. PNI was identified on TB in 27/95 (28.4%) patients. On multivariable logistic regression, independent predictors of extraprostatic extension were prostate specific antigen (PSA), TB maximum % core involvement, and PNI-TB (all P<.05). Furthermore, Kaplan–Meier analysis demonstrated that PNI-TB was associated with early biochemical recurrence events within 12months after prostatectomy (log rank P=.049). Given the increasing adoption of TB for PCa detection in clinical practice, PNI-TB may be useful for PCa risk stratification.
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