Comparative study of safety and efficacy of synthetic surgical glue for mesh fixation in ventral rectopexy

Abstract

Background

Ventral mesh rectopexy (VMR) is a surgical option to treat rectal prolapse with pelvic floor dysfunction (PFD). Using synthetic surgical glue to fix the mesh to the anterior rectal wall after ventral dissection could be advantageous in comparison with sutured or stapled fixation. This study aimed to evaluate the safety and efficacy of synthetic surgical glue for mesh fixation compared with suture mesh fixation in VMR.

Methods

This observational cohort study is a retrospective analysis conducted in a University Hospital Pelvic Surgery Center. All consecutive female patients (n = 176) who underwent laparoscopic or laparotomic VMR between January 2009 and December 2014 were included. Two groups were defined based on mesh fixation technique of the rectal wall: VMR with synthetic glue (n = 66) and VMR with suture (n = 110). The recurrence-free survival after VMR was determined by Kaplan–Meier method and multivariate analysis by Cox regression. Short-term postoperative complications, postoperative symptom improvement, the need for complementary treatment postoperatively, and procedure length were evaluated.

Results

A total of 176 females patients (mean age, 58.6 ± 13.7 years) underwent VMR with synthetic mesh. Mean recurrence-free survivals after VMR were 17.16 (CI 95% 16.54–17.80) and 17.33 (CI 95% 16.89–17.77) months in the glue group and the suture group, respectively (p > 0.05). Cox regression identified an independent effect on the recurrence risk of the external rectal prolapse, alone, or in combination with other anatomical abnormalities (HR = 0.37; CI 95% 0.14–0.93; p = 0.03). There was no significant difference of short-term postoperative morbidity, procedure length, postoperative symptom improvement, or need for complementary treatment postoperatively between suture versus glue groups (all p > 0.05).

Conclusions.

Use of glue to fix the mesh in VMR was safe and had no impact on outcomes. External prolapse was the unique significant predictive factor for recurrence.

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The optimal treatment of patients with mild and moderate acute cholecystitis: time for a revision of the Tokyo Guidelines

Abstract

Introduction

According to the Tokyo Guidelines, severity of acute cholecystitis is divided into three grades based on the degree of inflammation and the presence of organ dysfunction. These guidelines recommend grade I (mild) acute cholecystitis to be treated with early laparoscopic cholecystectomy and grade II (moderate) acute cholecystitis with delayed cholecystectomy. Yet, several studies have shown that, for acute cholecystitis in general, early cholecystectomy is superior to delayed cholecystectomy in terms of complication rate, duration of hospital stay and costs. The aim of this study was to determine the clinical outcomes of emergency cholecystectomy in patients with grade II acute cholecystitis. Based on our findings, we propose a revision of the Tokyo Guidelines.

Methods

We performed a retrospective observational cohort study of 589 consecutive patients undergoing emergency cholecystectomy for acute calculous cholecystitis in a large teaching hospital between January 2002 and January 2015. Patients were classified according to the severity assessment criteria of the Tokyo Guidelines. Patients with grade I and grade II acute cholecystitis were compared for perioperative outcomes.

Results

Emergency cholecystectomy was performed in 270 patients with grade I acute cholecystitis and 187 patients with grade II acute cholecystitis. There was no difference in conversion rate (6 vs. 6%, p = 0.985) and operating time (60 min [25–255] vs. 70 min [30–255], p = 0.421). Also the perioperative complication rate (7 vs. 9%, p = 0.517), 30-day mortality (1 vs. 1%, p = 0.648) and length of hospital stay (4 days [1–42] vs. 4 days [1–62], p = 0.327) were similar between grade I and grade II acute cholecystitis.

Conclusion

The clinical outcomes of emergency cholecystectomy did not differ between patients with grade I and grade II acute cholecystitis. The findings support a revision of the Tokyo Guidelines with respect to the recommendation of performing emergency cholecystectomy in both grade I and grade II acute cholecystitis.

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A novel laparoscopic technique for anorectal malformation with low recto-bulbar fistulae

Abstract

Background

The repair of anorectal malformation (ARM) with low recto-bulbar fistula (bowel-to-skin distance: 1–1.5 cm) is contraindicated for laparoscopy due to the difficulty in exposing the fistulae. Posterior or anterior sagittal anorectoplasty is thus conventionally carried out for low recto-bulbar fistula repair. However, these procedures carry the potential risk of wound infection/dehiscence and incontinence. We have developed a single-incision laparoscopic-assisted perineal anorectoplasty (SILPARP) technique. The current study aims to evaluate the safety and efficacy of this novel procedure.

Methods

Fifteen infants with ARMs and low recto-bulbar fistulae who underwent a SILPARP between November 2013 and March 2016 were reviewed.

Results

The mean distance between the rectal pouch and the perineal skin was 1.15 cm. The mean age at the time of surgery was 3.92 months. The average operative time was 1.60 h. All patients resumed feeding on postoperative day 1. The median follow-up duration was 7 months. No injury to blood vessels, the urethra or vas deferens was encountered in our series. No mortality, morbidity of wound infection, rectal retraction, anal stenosis, or rectal prolapse was encountered. The postoperative voiding cystourethrogram verified that there was no urethral diverticulum or recurrent fistula. Postoperative pelvic magnetic resonance imaging demonstrated that the distal rectum was located in the center of the pelvic muscle complex.

Conclusions

SILPARP is a feasible alternative treatment for ARM infants with low recto-bulbar fistulae.

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Endoscopic mucosal resection versus esophagectomy for intramucosal adenocarcinoma in the setting of barrett’s esophagus

Abstract

Background

Esophagectomy has been the standard of care for patients with intramucosal adenocarcinoma (IMC) in the setting of Barrett's esophagus. It is, however, associated with significant post-operative morbidity and mortality. Endoscopic mucosal resection (EMR) offers a minimally invasive approach with lesser morbidity. This study investigates the transition from esophagectomy to EMR for IMC with respect to eradication rates, post-operative morbidity, and long-term survival.

Methods

Patients diagnosed with IMC from 2005 to 2013 were identified retrospectively. Beginning in 2009, preferred initial therapy for IMC transitioned from esophagectomy to EMR. Esophagectomy was performed either through a transthoracic or transhiatal technique. EMR was repeated until resolution of IMC on pathology or progression of disease. Continuous data are expressed as mean (SD) and analyzed using Student's t test. Categorical data are presented as number (%) and analyzed using Fisher's exact test.

Results

We identified 23 patients; 12 patients underwent esophagectomy and 11 patients underwent EMR as initial therapy. Patients were similar with respects to age, gender, and comorbidity index. Most tumors arose from short segment (vs long segment) Barrett's (esophagectomy: 9 (75%) vs. EMR: 10 (91%), p = 0.59) and one patient in each group had superficial invasion into the submucosa (T1sm1), the remainder having mucosal disease. Esophagectomy was associated with 7 (58%) minor complications and 2 (17%) major complications (respiratory failure, anastomotic leak), whereas there were no complications related to EMR (p < 0.01). EMR successfully eradicated IMC in 10 patients (91%) with one progressing to esophagectomy. Patients required 2 (1) endoscopies to achieve eradication. There was one mortality in each group on long-term follow-up (log-rank test, p = 0.62).

Conclusions

EMR was successful in eradicating IMC in 10/11 patients with similar long-term recurrence and mortality to esophagectomy patients. Patients with IMC may benefit from EMR as initial therapy by obviating the need for a complex and morbid operation.

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SAGES endoluminal treatments for GERD

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Erratum to: Robotic versus laparoscopic rectal resection for sphincter-saving surgery: pathological and short-term outcomes in a single-center analysis of 130 consecutive patients

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Impact of continuous training through distributed practice for acquisition of minimally invasive surgical skills

Abstract

Background

Minimally invasive surgery (MIS) requires the mastery of manual skills and a specific training is required. Apart from residencies and fellowships in MIS, other learning opportunities utilize massive training, mainly with use of simulators in short courses. A long-term postgraduate course represents an opportunity to learn through training using distributed practice.

Objective

The objective of this study is to assess the use of distributed practice for acquisition of basic minimally invasive skills in surgeons who participated in a long-term MIS postgraduate course.

Methods

A prospective, longitudinal and quantitative study was conducted among surgeons who attended a 1-year postgraduate course of MIS in Brazil, from 2012 to 2014. They were tested through five different exercises in box trainers (peg-transfer, passing, cutting, intracorporeal knot, and suture) in the first (t0), fourth (t1) and last, eighth, (t2) meetings of this course. The time and penalties of each exercise were collected for each participant. Participant skills were assessed based on time and accuracy on a previously tested score.

Results

Fifty-seven surgeons (participants) from three consecutive groups participated in this study. There was a significant improvement in scores in all exercises. The average increase in scores between t0 and t2 was 88% for peg-transfer, 174% for passing, 149% for cutting, 130% for intracorporeal knot, and 120% for suture (p < 0.001 for all exercises).

Conclusion

Learning through distributed practice is effective and should be integrated into a MIS postgraduate course curriculum for acquisition of core skills.

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Laparoscopic proximal gastrectomy with double tract reconstruction is superior to laparoscopic total gastrectomy for proximal early gastric cancer

Abstract

Background

Laparoscopic proximal gastrectomy (LPG) with double tract reconstruction (DTR) is known to reduce reflux symptoms, which is a major concern after proximal gastrectomy. The aim of this study is to compare retrospectively the clinical outcomes of patients undergoing LPG with DTR with those treated by laparoscopic total gastrectomy (LTG).

Methods

Ninety-two and 156 patients undergoing LPG with DTR and LTG for proximal stage I gastric cancer were retrospectively analyzed for short- and long-term clinical outcomes.

Results

There were no significant differences in the demographics, T-stage, N-stage, and complications between the groups. The LPG with DTR group had a shorter operative time and lower estimated blood loss than the LTG group (198.3 vs. 225.4 min, p < 0.001; and 84.7 vs. 128.3 mL p = 0.001). The incidence of reflux symptoms ≥ Visick grade II did not significantly differ between the groups during a mean follow-up period of 37.2 months (1.1 vs. 1.9%, p = 0.999). The hemoglobin change was significantly lower in the LPG with DTR group compared to in the LTG group in the first and second postoperative years (5.03 vs. 9.18% p = 0.004; and 3.45 vs. 8.30%, p = 0.002, respectively), as was the mean amount of vitamin B₁₂ supplements 2 years after operation (0.1 vs. 3.1 mg, p < 0.001). The overall survival rate was similar between the groups.

Conclusions

LPG with DTR maintained comparable oncological safety and anastomosis-related late complications compared to LTG and is preferred over LTG in terms of preventing postoperative anemia and vitamin B₁₂ deficiency.

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Specific computed virtual chromoendoscopy for detection of peritoneal carcinomatosis: an animal study

Abstract

Background

Detection of an incipient Peritoneal Carcinomatosis (PC) is still challenging, and there is a crucial need for technological improvements in order to diagnose and to treat early this condition. The aim of this study was to create a murine model of incipient PC and to explore the PC with Fujinon Intelligent Chromo Endoscopy (FICE) in order to determine the wavelengths of the white light (WL) spectre that offer the highest contrast between PC nodules and surrounding peritoneum.

Methods

Eighteen BALB/c mice had intraperitoneal injection of murine colonic cancer CT26 cells. Peritoneal exploration with FICE was performed at different times. For each PC nodule, 1 WL and 10 FICE images were recorded. Each image was then divided into its elementary red, green and blue band images. Depending on the FICE channel, each elementary image corresponds to a specific wavelength of the WL spectre. Through numerical analysis of these images, the value of the nodule and the background peritoneum were obtained, and the contrast value was calculated. Contrast values obtained with the different wavelengths were then compared.

Results

PC grew in all the mice. The number as well as the size of PC nodules was increasingly high depending on the day of exploration. Mean PCI was 1.6 ± 1.2 at day 5, 7.7 ± 2.6 at day 8 and 15.0 ± 7.3 at day 10. A total number of 1805 elementary images of PC nodules were analysed. The wavelength that offered the best contrast between PC nodules and background peritoneum was 460 nm with a mean contrast value of 0.240 ± 0.151 (p < 0.0001).

Conclusion

This murine model of incipient PC is effective, reliable and reproducible. A monochromatic light with a wavelength at 460 nm offers the highest contrast between PC nodules and background peritoneum, allowing a better detection of PC.

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Needlescopic sleeve gastrectomy: pushing the boundaries of the standard technique

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric surgery performed worldwide. Improvements in LSG have been suggested to achieve better weight loss or to lessen the complications rates. We propose a change in the standard technique to privilege the use of thinner instruments, the needlescopic sleeve gastrectomy (NSG).

Methods

A 40-year-old female, BMI 40, with no previous abdominal surgery was selected for a NSG. She was placed in a semi-sitting position with the surgeon standing between the legs. Pneumoperitoneum was created through open laparoscopy; 5 trocars were inserted in standard position for laparoscopic gastric surgery. We have used one 12 mm trocar in the navel for a 5 mm scope and for stapling the stomach; one 5 mm trocar for impedance coagulator and also for the scope during the stapling process, and three 3 mm trocars for liver retraction, left hand manipulation, and greater curve exposition. Surgical techniques are basically the same as for a standard LSG until the moment of stapling the stomach, when the 5 mm scope is changed to the right hand trocar. Stapling can be done trough the umbilical port, parallel to the lesser curvature, in contact with the calibration tube. After stapling, hemostasis was achieved by bipolar coagulation, application of titanium clips, and absorbable suture. The 12 mm umbilical orifice is closed after extraction of the resected stomach.

Results

Operative time was 76 min. There was no per-operative complication. Recovery was uneventful and patient was discharged at post operative day 2. Pain was considered minor by the patient. One month after surgery, cosmetic results were very convincing.

Discussion

There are several proposed technical modifications in LSG. They can influence complication rates or weight loss like the length of antrum resection, the size of Fouchet tube, or the reinforcement of staple line [1–4]. Besides that other concepts regarding reduction of size or number of trocars have also been applied. LSG has been performed with fewer trocars, using for example special designed internal retractors or even the posterior part of the dissected stomach to replace the liver retractor and its trocar [5, 6]. Single port is another well-known possibility [7, 8], but mini-laparoscopy or needlescopic SG is still not well explored in our opinion. We believe that this technical alternative proposed in this video keeps the standards of care and safety of conventional LSG. There is no change in the position of the surgeon, not even the trocars. Specially designed needlescopic instruments show enough strength to be used in bariatrics and allow the surgeon to perform all the routine maneuvers from dissection to suturing. LSG can be done by mini-laparoscopy with a short adaptation period, previewing a short learning curve with no increase in the complications rate.

Conclusion

NSG is feasible in selected patients and with few modifications in the standard technique. There might be a benefit in terms of pain. Further studies with large series are necessary to observe these potential benefits.

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Efficacy and safety of endoscopic submucosal dissection in elderly patients with esophageal squamous cell carcinoma

Abstract

Background

Endoscopic submucosal dissection (ESD) has been widely applied in superficial esophageal squamous cell carcinoma (SESCC) as a minimally invasive treatment, which has advantages over surgery, especially in the elderly who have high risk of surgery. This study elucidated the efficacy and safety of ESD for SESCC in the elderly.

Methods

Between April 2007 and June 2016, a total of 176 patients with SESCC treated with ESD were analyzed. Clinical outcomes including En bloc, complete, and curative resection rates, procedure-related complication rates, and cumulative recurrence rates were compared between the elderly (n = 46, ≥70 years of age) and the non-elderly groups (n = 130, <70 years of age).

Results

Between the two groups, sex, past medical history (hypertension and diabetes), body mass index, tumor characteristics (number, location, shape, maximal and circumferential size of the tumor and the resected specimen, and depth), and use of stricture prevention except for age (elderly vs non-elderly; 74.1 ± 2.78 vs. 61.1 ± 6.06 years, p < 0.001) did not differ. En bloc resection (elderly vs. non-elderly; 93.5 vs. 93.8%, p = 1.000), complete resection (elderly vs. non-elderly; 69.6 vs. 76.2%, p = 0.433), and curative resection rates (elderly vs. non-elderly; 54.3 vs. 60.0%, p = 0.602) did not differ significantly between the two groups. Procedure time and hospital stay were also similar between the two groups. Complications of ESD such as stricture (17.4 vs. 10.8%, p = 0.299) and perforation (13.0 vs. 6.2%, p = 0.083) occurred at a similar rate in the elderly and non-elderly groups. After curative ESD, cumulative recurrence rate of the elderly group (0%) did not differ significantly to that of the non-elderly group (5.1%) by the log-rank test (p = 0.307).

Conclusion

ESD for SESCC is effective and safe in elderly patients as in non-elderly patients.

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Imaging in Rheumatology: An Update

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5
Author(s): Giuseppe Guglielmi




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Practical Pediatric Imaging

Publication date: July 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 4
Author(s): Edward Y. Lee




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Copyright

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6





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Computed Tomography and MR Imaging in Crystalline-Induced Arthropathies

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5
Author(s): Constantinus Franciscus Buckens, Maaike P. Terra, Mario Maas

Teaser

Crystalline-induced arthropathies impose substantial morbidity but can be challenging to diagnose, especially in early phases. The most common crystalline arthropathies are gout (monosodium urate deposition), calcium pyrophosphate dihydrate deposition, and hydroxyapatite deposition disease. Computed tomography (CT) and MR imaging provide 3-dimensional information on osseous structures, periarticular soft tissue, and tophi with superior spatial resolution. Dual-source CT (dual-energy CT [DECT]) offers the further advantage of selectively identifying crystalline deposits. CT, MR imaging, and DECT can be of value in problematic cases and can potentially be used for disease monitoring. Further research is necessary to elucidate their added value.


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Contributors

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6





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Contributors

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5





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Contents

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6





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Conventional Radiology in Crystal Arthritis

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5
Author(s): Thibaut Jacques, Paul Michelin, Sammy Badr, Michelangelo Nasuto, Guillaume Lefebvre, Neal Larkman, Anne Cotten

Teaser

This article reviews the main radiographic features of crystal deposition diseases. Gout is linked to monosodium urate crystals. Classic radiographic features include subcutaneous tophi, large and well-circumscribed paraarticular bone erosions, and exuberant bone hyperostosis. Calcium pyrophosphate deposition (CPPD) can involve numerous structures, such as hyaline cartilages, fibrocartilages, or tendons. CPPD arthropathy involves joints usually spared by osteoarthritis. Basic calcium phosphate deposits are periarticular or intraarticular. Periarticular calcifications are amorphous, dense, and round or oval with well-limited borders, and most are asymptomatic. When resorbing, they become cloudy and less dense with an ill-defined shape and can migrate into adjacent structures.


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CME Accreditation Page

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6





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Imaging in Osteoarthritis

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5
Author(s): Daichi Hayashi, Frank W. Roemer, Mohamed Jarraya, Ali Guermazi

Teaser

With technologic advances and the availability of sophisticated computer software and analytical strategies, imaging plays an increasingly important role in understanding the disease process of osteoarthritis (OA). Radiography has limitations in that it can visualize only limited features of OA, such as osteophytes and joint space narrowing, but remains the most commonly used modality for establishing an imaging-based diagnosis of OA. This article describes the roles and limitations of different imaging modalities and discusses the optimum imaging protocol, imaging diagnostic criteria of OA, differential diagnoses, and what the referring physician needs to know.


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Forthcoming Issues

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6





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Imaging and Cancer Screening

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6
Author(s): Dushyant V. Sahani




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Imaging and Cancer Screening

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6
Author(s): Dushyant V. Sahani




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CME Accreditation Page

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5





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Screening for Breast Cancer

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6
Author(s): Bethany L. Niell, Phoebe E. Freer, Robert Jared Weinfurtner, Elizabeth Kagan Arleo, Jennifer S. Drukteinis

Teaser

The goal of screening is to detect breast cancers when still curable to decrease breast cancer–specific mortality. Breast cancer screening in the United States is routinely performed with mammography, supplemental digital breast tomosynthesis, ultrasound, and/or MR imaging. This article aims to review the most commonly used breast imaging modalities for screening, discuss how often and when to begin screening with specific imaging modalities, and examine the pros and cons of screening. By the article's end, the reader will be better equipped to have informed discussions with patients and medical professionals regarding the benefits and disadvantages of breast cancer screening.


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Conventional Radiology in Rheumatoid Arthritis

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5
Author(s): Eva Llopis, Herman M. Kroon, Jose Acosta, Johan L. Bloem

Teaser

In clinical practice, the conventional radiography is still the radiologic method for the diagnosis of rheumatoid arthritis (RA). Moreover, it provides a quick overview of the symptomatic joints to narrow the differential diagnosis and to evaluate progression. RA is a polyarticular disease with bilateral and symmetric involvement of the peripheral joints, especially small joints, and less frequently, the cervical spine. The radiologic features are soft tissue swelling, periarticular osteoporosis, erosions, loss of joint space, and in advanced disease, osteolysis and typical subluxations or deformities, such as ulnar deviation.


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Lung Cancer Screening

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6
Author(s): Florian J. Fintelmann, Ravi V. Gottumukkala, Shaunagh McDermott, Matthew D. Gilman, Inga T. Lennes, Jo-Anne O. Shepard

Teaser

This article explains the rationale of lung cancer screening with low-dose computed tomography and provides a practical approach to all relevant aspects of a lung cancer screening program. Imaging protocols, patient eligibility criteria, facility readiness, and reimbursement criteria are addressed step by step. Diagnostic criteria and Lung-RADS (Lung Computed Tomography Screening Reporting and Data System) nodule management pathways are illustrated with examples. Pearls and pitfalls for interpretation of lung cancer screening low-dose chest computed tomography are discussed.


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Computed Tomography and MR Imaging in Rheumatoid Arthritis

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5
Author(s): Antonio Barile, Francesco Arrigoni, Federico Bruno, Giuseppe Guglielmi, Marcello Zappia, Alfonso Reginelli, Piero Ruscitti, Paola Cipriani, Roberto Giacomelli, Luca Brunese, Carlo Masciocchi

Teaser

The clinical diagnosis of rheumatoid arthritis is supported by imaging findings. MR imaging, in particular, can allow an early diagnosis to determine a target therapy that can stop or at least slow the disease progression.


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Imaging and Screening for Colorectal Cancer with CT Colonography

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6
Author(s): Perry J. Pickhardt

Teaser

Despite being readily preventable, colorectal cancer ranks second behind only lung cancer in overall mortality. However, this situation could be reversed if screening tests that effectively detect advanced adenomas and early cancers were broadly applied. Computed tomographic colonography (CTC) reflects an ideal balance of minimal invasiveness with high-level performance, assuming all facets of the examination are appropriately addressed. Unfortunately, this promising screening test remains grossly underused. This article details the technical and interpretive approaches used by one successful CTC screening program.


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Imaging of Myopathies

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5
Author(s): Lukas Filli, Sebastian Winklhofer, Gustav Andreisek, Filippo Del Grande

Teaser

This article clarifies the current role of MR imaging in the assessment of myopathies. Typical MR imaging findings are discussed for different forms of myopathies, including idiopathic inflammatory myopathies, muscular dystrophies, and congenital myopathies. The last section deals with advanced MR imaging techniques and their potential role in further characterization of muscular disease.


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Single-unit activity of the anterior globus pallidus internus in Tourette patients and posterior globus pallidus internus in Dystonic patients

Dystonia is a movement disorder characterised by involuntary sustained muscle contractions that lead to twisting, repetitive movements and abnormal postures. Two types of Dystonia can be distinguished: Primary Dystonia has no evidence of other pathological abnormalities, and secondary Dystonia which is associated with neurological lesions, either degenerative or traumatic (Albanese et al. 2013). Tourette's Syndrome (TS) is a neuropsychiatric disorder that is chronic and typically characterised by motor and vocal tics.

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Local changes in computational non-rapid eye movement sleep depth in infants

Newborns and young infants spend most of their time sleeping, and the quality of sleep has been found to be important for their development. Although the contribution of each sleep stage is different, both REM and NREM sleep have important functional roles in brain maturation and in normal synaptic development (Graven, 2006). As for NREM, deep NREM is considered to be the most important sleep stage for infants. In adults, slow wave sleep and slow wave activity (SWA) of NREM sleep are homeostatically regulated and considered a measure of sleep pressure (Borbély and Achermann, 1999).

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The complete mitochondrial genomes of Tarsiger cyanurus and Phoenicurus auroreus : a phylogenetic analysis of Passeriformes

Abstract

Passeriformes is the largest group within aves and the phylogenetic relationships between Passeriformes have caused major disagreement in ornithology. Particularly, the phylogenetic relationships between muscicapoidea and sylvioidea are complex, and their taxonomic boundaries have not been clearly defined. Our aim was to study the status of two bird species: Tarsiger cyanurus and Phoenicurus auroreus. Furthermore, we analyzed the phylogenetic relationships of Passeriformes. Complete mitochondrial DNA (mtDNA) sequences of both species were determined and the lengths were 16,803 (T. cyanurus) and 16,772 bp (P. auroreus), respectively. Thirteen protein-coding genes, 22 tRNA genes, two rRNA genes, and one control region were identified in these mtDNAs. The contents of A and T at the base compositions was significantly higher than the content of G and C, and this AT skew was positive, while the GC skew was negative. The monophyly of Passeriformes is divided into four major clades: Corvoidea, Sylvioidea, Passeroidea, and Musicicapoidea. Paridae should be separated from the superfamily Sylvioidea and placed within the superfamily Muscicapoidea. The family Muscicapidae and Corvida were paraphyly, while Carduelis and Emberiza were grouped as a sister taxon. The relationships between some species of the order passeriformes may remain difficult to resolve despite an effort to collect additional characters for phylogenetic analysis. Current research of avian phylogeny should focus on adding characters and taxa and use both effectively to obtain a better resolution for deeper and shallow nodes.

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Cell-free DNA noninvasive prenatal screening for aneuploidy versus conventional screening: a systematic review of economic evaluations

Abstract

Although non-invasive prenatal testing (NIPT) for aneuploidies using cell free fetal DNA in maternal blood has been reported to have a high accuracy, only little evidence about its cost effectiveness is available. We systematically reviewed and assessed quality of economic evaluation studies published between 1st January 2009 and 1st January 2016 where NIPT was compared to the current screening practices consisting of biochemical markers with or without nuchal translucency (NT) and/or maternal age). We included 16 studies and we found that, at current level of NIPT prices, contingent NIPT provide the best value for money, especially for publicly funded screening programs. NIPT as first-line test was found not cost-effective in the majority of studies. The NIPT unit cost, the risk cut-offs for current screening practice, the screening uptake rates (first and second line screening) as well as the costs and uptake rates of invasive diagnostic screening were the most common uncertain variables. The overall quality of included studies was fair. Considering a possible drop in prices and an ongoing NIPT expansion to include other chromosomes abnormalities other than T21, T18, T13 and sex chromosomes aneuploidies, future research are needed to examine the potential cost effectiveness of implementing NIPT as first-line test.

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Diets of mammalian fossil fauna from Kanapoi, northwestern Kenya

Publication date: Available online 13 October 2017
Source:Journal of Human Evolution
Author(s): Fredrick K. Manthi, Thure E. Cerling, Kendra L. Chritz, Scott A. Blumenthal
Carbon isotope ratios of mammalian teeth from the Kanapoi site in northern Kenya are interpreted in the context of C3 and C4 derived resources to investigate the paleoecology of Australopithecus anamensis. δ¹³C values of large mammals, when compared at the taxon level, show an ecosystem that is strongly biased towards mixed feeders and browsers. However, sufficient C4 resources were present such that some C4 dominated grazers were also present in the large mammal fauna. Analyses of micromammals shows that their diets were C3 dominated or C3–C4 mixed. Carbon isotope studies of primates shows that the major primate tribes—Colobini, Papioini, Hominini—all made some use of C4 resources in their respective diets; the Hominini had a higher fraction of C3 diet resources than the other primate tribes represented in the fossil record.



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Laser-evoked potentials in painful radiculopathy

Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): P. Hüllemann, C. von der Brelie, G. Manthey, J. Düsterhöft, A.K. Helmers, M. Synowitz, J. Gierthmühlen, R. Baron
ObjectiveThe aims of this exploratory study were (1) to develop a standardized objective electrophysiological technique with laser-evoked potentials to assess dorsal root damage quantitatively and (2) to correlate these LEP measures with clinical parameters and sensory abnormalities (QST) in the affected dermatome.MethodsThirty-eight patients with painful radiculopathy and 20 healthy subjects were investigated with LEP recorded from the affected dermatome and control areas as well as with quantitative sensory testing. Questionnaires evaluating severity and functionality were applied.ResultsOn average, LEP amplitudes and latencies from the affected dermatomes did not differ from the contralateral control side. In patients with left L5 radiculopathy (more severely affected) the N2 latency was longer and the amplitudes reduced.ConclusionsThe N2P2 amplitude correlated with pinprick evoked sensations in QST. The N2 latency from the affected dermatome correlates with pain intensity, chronicity, clinical severity and with a decrease of physical function.SignificanceAn increase in N2-latency indicates a more pronounced nerve root damage, which is associated with a decrease of function and an increase of severity and pain. LEP amplitudes are associated with the functional status of the nociceptive system and may distinguish between degeneration of neuronal systems and central sensitization processes.



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Intraoperative direct cortical stimulation motor evoked potentials: Stimulus parameter recommendations based on rheobase and chronaxie

Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): Tariq M. Abalkhail, David B. MacDonald, Ibrahim AlThubaiti, Faisal A. AlOtaibi, Bent Stigsby, Amal A. Mokeem, Iftetah A. AlHamoud, Maher I. Hassounah, Salah M. Baz, Abdulaziz AlSemari, Hesham M. AlDhalaan, Sameena Khan
ObjectiveTo determine optimal interstimulus interval (ISI) and pulse duration (D) for direct cortical stimulation (DCS) motor evoked potentials (MEPs) based on rheobase and chronaxie derived with two techniques.MethodsIn 20 patients under propofol/remifentanil anesthesia, 5-pulse DCS thenar MEP rheobase and chronaxie with 2, 3, 4 and 5ms ISI were measured by linear regression of five charge thresholds at 0.05, 0.1, 0.2, 0.5 and 1msD, and estimated from two charge thresholds at 0.1 and 1msD using simple arithmetic. Optimal parameters were defined by minimum threshold energy: the ISI with lowest rheobase2×chronaxie, and D at its chronaxie. Near-optimal was defined as threshold energy <25% above minimum.ResultsThe optimal ISI was 3 or 4 (n=7 each), 2 (n=4), or 5ms (n=2), but only 4ms was always either optimal or near-optimal. The optimal D was ∼0.2 (n=12), ∼0.1 (n=7) or ∼0.3ms (n=1). Two-point estimates closely approximated five-point measurements.ConclusionsOptimal ISI/D varies, with 4ms/0.2ms being most consistently optimal or near-optimal. Two-point estimation is sufficiently accurate.SignificanceThe results endorse 4ms ISI and 0.2msD for general use. Two-point estimation could enable quick individual optimization.



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Wavelet coherence analysis: a new approach to distinguish organic and functional tremor types

Publication date: Available online 14 October 2017
Source:Clinical Neurophysiology
Author(s): G. Kramer, A.M.M. Van der Stouwe, N.M. Maurits, M.A.J. Tijssen, J.W.J. Elting
ObjectiveTo distinguish tremor subtypes using wavelet coherence analysis (WCA). WCA enables to detect variations in coherence and phase difference between two signals over time and might be especially useful in distinguishing functional from organic tremor.MethodsIn this pilot study, polymyography recordings were studied retrospectively of 26 Parkinsonian (PT), 26 functional (FT), 26 essential (ET), and 20 enhanced physiological (EPT) tremor patients. Per patient one segment of 20 seconds in duration, in which tremor was present continuously in the same posture, was selected. We studied several coherence and phase related parameters, and analysed all possible muscle combinations of the flexor and extensor muscles of the upper and fore arm. The area under the receiver operating characteristic curve (AUC-ROC) was applied to compare WCA and standard coherence analysis to distinguish tremor subtypes.ResultsThe percentage of time with significant coherence (PTSC) and the number of periods without significant coherence (NOV) proved the most discriminative parameters. FT could be discriminated from organic (PT, ET, EPT) tremor by high NOV (31.88 vs 21.58, 23.12 and 10.20 respectively) with an AUC-ROC of 0.809, while standard coherence analysis resulted in an AUC-ROC of 0.552.ConclusionsEMG-EMG WCA analysis might provide additional variables to distinguish functional from organic tremor.SignificanceWCA might prove to be of additional value to discriminate between tremor types.



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