Expedited partner therapy (EPT) may reduce Chlamydia trachomatis reinfection. This pilot study was conducted to determine if female adolescents with C. trachomatis accept and deliver EPT to male sexual partners and whether it is associated with decreased C. trachomatis reinfection rates at 3 and 6 months.
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Σάββατο 9 Φεβρουαρίου 2019
Patient-Delivered Expedited Partner Therapy for Chlamydia trachomatis Infection Among Female Adolescents Using School-Based Health Centers
Challenges in the Treatment of Iron Deficiency Anemia in a Child With Autism Spectrum Disorder: A Case Study
Children with autism spectrum disorder (ASD) face many challenges, including feeding problems due to behavioral issues and food aversions. Therefore, pediatric nurse practitioners need to assess for different mineral deficiencies, including iron deficiency anemia (IDA). The following case study describes a 4-year-old with ASD with persistent IDA despite typical recommendation of oral iron supplementation. Other potential etiologies of IDA are reviewed. Finally, different management approaches for managing IDA in children with ASD are described.
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A Job Task Analysis of the Expanding Role of the Pediatric Mental Health Specialist and the Nurse Practitioner in Pediatric Mental Health
Lack of access to support, services, and providers for children and adolescents with mental health conditions is a serious problem in the United States. Fewer than half of the children who need services obtain them. To meet this demand, the Pediatric Nursing Certification Board launched a new specialty certification in 2011 for advanced practice registered nurses called the pediatric primary care mental health specialist (PMHS). In 2016, a job task analysis of the role of the PMHS and nurse practitioners practicing in pediatric mental health and developmental/behavioral pediatrics was conducted.
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Associations Between Maternal Caregiving and Child Indicators of Toxic Stress Among Multiethnic, Urban Families
Our purpose was to examine associations between maternal caregiving and child indicators of toxic stress among multiethnic, urban families with children of early school age.
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Problematic Sexual Behavior in Children
It is important for health care professionals to have a strong knowledge base of childhood sexual development, to know how to differentiate between problematic and normative sexual behaviors, and counsel parents accordingly given their assessment of the behaviors. A review of the literature suggests that sexual behaviors are a common occurrence in childhood, though some behaviors are rare regardless of age. Frequency of the behavior, developmental considerations, and the level of harm may help health care professionals assess whether the sexual behavior is typical or problematic.
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Parent- and Child-Reported Asthma Responsibility in School-Age Children: Examining Agreement, Disagreement, and Family Functioning
The school-age years represent a critical time for children to begin assuming shared asthma management responsibility. This study aimed to describe parent- and child-reported asthma responsibility, examine agreement and disagreement, and explore family functioning as a predictor of agreement/disagreement.
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Beyond Eligibility: Access to Federal Public Benefit Programs for Immigrant Families in the United States
Federal benefit programs assist individuals and low-income families with basic expenses like food, housing, and health care. The eligibility rules associated with these programs impact access to health care and the health of immigrants, as well as natural-born citizens in the United States (Salami, 2017). In 2016, about 44 million immigrants resided in the United States and accounted for 13.5% of the total U.S. population (Gambino, 2017). California has the largest population of legal permanent residents (LPRs); of the 38 million people in California, 27% are immigrants, and an estimated 3.3 million are LPRs (Ponce et al., 2018).
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A Rare Cause of Recurrent Abdominal Pain in a 5-Year-Old
A healthy 5-year-old boy of Indian and Caucasian descent presented to his pediatrician after three intermittent monthly bouts of cramping diffuse abdominal pain. His mother described these episodes as waves of writhing pain that would incapacitate her son for approximately 10 to 20 minutes before remitting briefly, only to start over again in a repetitive manner. These recurrent episodes of pain continued for 3 to 9 hours and occurred in the evening or at night. Associated symptoms included nonbloody, nonbilious episodes of vomiting with loose stools.
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Hepatic portal venous gas associated with Klebsiella oxytoca infection in the absence of preceding antibiotic treatment
Abstract
Klebsiella oxytoca (K. oxytoca) is a causative organism for hemorrhagic antibiotic-associated colitis. K. oxytoca infection is a typical example of microbial substitution diseases caused by exposure to antibiotics prior to the onset of diarrhea. Here, we repot a case with ileitis associated with K. oxytoca infection in the absence of preceding antibiotic treatment. Interestingly, abdominal computed tomography revealed wall thickening of the ileum and hepatic portal venous gas (HPVG). K. oxytoca was isolated from the stool. This very elderly patient had been treated with azathioprine for long-standing history of ulcerative colitis. Immuno-compromised state of this patient was considered to allow overgrowth of K. oxytoca in the small bowel to cause not only ileitis but also HPVG.
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Obstructive pancreatitis secondary to a pancreatic metastasis from lung cancer treated with nasopancreatic drainage
Abstract
A 44- and a 66-year-old woman underwent nasopancreatic drainage (NPD) to treat obstructive pancreatitis secondary to a pancreatic metastasis from lung cancer. Both patients were diagnosed with stage IV lung cancer and underwent chemotherapy for 17 and 15 months, respectively. Abdominal ultrasonography and computed tomography revealed a solid pancreatic tail tumor measuring 2.5 cm and 1.3 cm in diameter, respectively. Additionally, we observed dilatation of the upstream main pancreatic duct (MPD) and edematous parenchyma with peripancreatic inflammatory changes limited to the pancreatic tail. Both patients were diagnosed with moderately severe acute pancreatitis and received fluid resuscitation, an opioid analgesic, antibiotics, and a protease inhibitor. However, owing to unrelenting pain, we performed endoscopic retrograde cholangiopancreatography (ERCP) for pancreatic duct drainage in both patients. ERCP showed a stricture in the MPD in the pancreatic tail with upstream dilatation. A 5-Fr NPD tube was inserted to drain the dilated MPD, and cloudy pancreatic juice was drained. NPD tube placement led to pain relief in both patients. Pancreatic juice cultures grew Enterococcus faecium and Enterobacter cloacae, respectively. The NPD tube was later cut in both cases using a pair of scissor forceps.
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Pancreatic granular cell tumor diagnosed by endoscopic ultrasound-guided fine needle aspiration biopsy
Abstract
Pancreatic granular cell tumors (GCTs) are rare and making an imaging diagnosis of pancreatic GCT is difficult because it has no definite characteristics on contrast-enhanced computed tomography (CE-CT) or magnetic resonance imaging (MRI) owing to varying findings. We report about a 32-year-old woman who presented with an incidental finding of a pancreatic tumor with a past history of excision of a right forearm GCT nodule 12 years ago. CE-CT revealed a 23-mm-sized homogeneous low enhancement tumor in the arterial phase in the pancreatic body. Abdominal MRI revealed a lobulated hypointense mass in T1WI and high signal in DWI. Endoscopic ultrasonography (EUS) revealed that the tumor was oval, hypoechoic with posterior echo enhancement, and had a well-defined border. Although EUS-guided fine needle aspiration revealed benign granular cells of the pancreas, she underwent laparoscopic surgery because the metastatic tumor from the past lesion was not excluded. The pathological finding was benign GCT of the pancreas and it was considered as an original lesion. In the previous reports, most of the resected cases were considered to be pancreatic cancer or neuroendocrine tumor preoperatively. Compared to CE-CT and MRI, EUS imaging and EUS-FNA are more reliable diagnosis tools for pancreatic GCT. Although malignant GCT accounts for approximately 1–2% of all cases, surgical resection or strict follow-up should be considered because it is difficult to predict its biological behavior.
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Curative endoscopic treatment of intussusception due to a giant colonic lipoma using a wedged balloon and ligation with detachable snares
Abstract
A 67-year-old woman presented with symptoms of bowel obstruction. Radiographic and ultrasonographic findings suggested colo-colonic intussusception caused by a colonic lipoma. Colonoscopy with an endoscope tip balloon was performed for reduction. The intussusception was partially reduced by injecting dilute contrast media with a wedged inflated balloon at the endoscope tip. For definitive treatment of the polyp, ischemia was induced using a detachable snare. The abdominal pain well improved after endoscopic treatment. However, ultrasonography suggested a residual lesion. Another detachable snare was applied to the stalk on day 6. A large amount of dark-red necrotic tissue was passed per anus the following day. One month later, complete scarring of the site was confirmed colonoscopically. This is the first report of curative endoscopic treatment of an intussusception due to a giant colonic lipoma with detachable snares after the reduction with a wedged balloon of colonoscope tip.
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Videos: Verizon honors first responders with Super Bowl commercials
Verizon's "The Team that Wouldn't Be Here" series consists of 12 commercials and a documentary featuring NFL stars who owe their lives to first responders
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Newly-released EMS Agenda 2050 focuses on ‘people-centered vision’
EMS Agenda 2050 calls for an evidence-based, data driven industry that is integrated with the rest of the nation's healthcare system
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How Pittsburgh’s ‘Freedom House’ shaped modern EMS systems
During a time of racial tension and social upheaval, the movement helped form the foundations of the pre-hospital care we're used to today
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NYC mayor on FDNY EMS pay gap: ‘The work is different’
When asked how the FDNY EMT pay gap compared to his campaign for "equity and social justice," Mayor Bill de Blasio said he thinks "the work is different"
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NY EMS agency initiative works to implement 'Stop the Bleed' in schools
The Canandaigua Emergency Squad, led by Chief Matt Sproul, is distributing Stop the Bleed kits and providing staff with the training on how to use them
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Praetorian Digital and Lexipol Merge, Creating Comprehensive Content, Training and Policy Platform for Public Safety
DALLAS, TX – Lexipol and Praetorian Digital, leaders in the public safety industry, today announced the merger of the two companies to offer a single, comprehensive platform addressing critical education, training and policy needs among public safety and local government agencies. The combined company will offer a range of content and solutions unequaled in the public sector, including a...
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How to get grant money for opioid overdose treatment
Consider a variety of funding sources and make your case for why you need it, how you plan to use it and who will benefit
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Trending topics: Should paramedics have a degree?
The idea of requiring paramedics to earn a college degree is a hot topic among industry personnel, with national organizations weighing in
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Tyler Technologies to acquire MicroPact from Arlington Capital Partners
Acquisition to augment Tyler's solution offerings and broaden addressable market. PLANO, Texas — Tyler Technologies Inc. announced it has signed a definitive agreement to acquire MicroPact, Inc., a leading provider of specialized, vertically oriented case management and business process management (BPM) applications for government, for approximately $185 million in cash. The...
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NY resident fights to have AEDs required at large retail outlets
Justin Beyer was motivated to take action after no AED was available at the Walmart where he worked when a customer went unconscious
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Maine bill would require cameras in ambulances
Sen. Dave Miramant said the bill, which would require transports to be recorded, is aiming to improve patient care
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Pulsara and iSchemaView unveil new RAPID integration
Best-in-class partners collaborate to dynamically share critical images in real time with stroke teams. BOZEMAN, Mont. — Pulsara has expanded its integration strategy by partnering with iSchemaView, the worldwide leader in advanced imaging for stroke. By leveraging Pulsara's open API infrastructure, iSchemaView now streamlines the sharing of its RAPID imaging platform for stroke care...
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Braun Ambulances to attend EMS Today 2019
The Premier Ambulance Manufacturer will showcase four ambulances at the conference. VAN WERT, Ohio — Each year, JEMS (The Journal of Emergency Medical Services) produces EMS Today, also known as The JEMS Conference and Exposition. This year's event will be held February 20-22, 2019 at the Gaylord National Resort and Convention Center in National Harbor, Maryland. EMS Today is one of...
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Pulmodyne acquiring Innovative Products
INDIANAPOLIS, IN — Pulmodyne, a global manufacturer of high quality respiratory, and emergency airway products, has taken on new innovative products by Inventor, Steve Islava. With Steve's background as a firefighter/paramedic for 30 years, he's gained the valuable field experience necessary to invent several products to aid in patient comfort, as well as save lives. While...
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EMT / Paramedic - Spectrum Healthcare Resources
Spectrum Healthcare Resources has an opportunity for a civilian **Emergency department Paramedics (EMT-P)** at **Keller Army Hospital in West Point, NY**. **This EMT / Paramedic position offers:** - Full-time, Part-time and PRN positions available - 12 hour shifts - Competitive salary
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Paramedic - National EMS
**JOB TITLE: PARAMEDIC (EMT-P)** **COMPANY: National EMS** **LOCATION: Rockdale County, Georgia** **CITY: Conyers, GA** **POSITION PURPOSE:** The Paramedic is responsible for providing patient care and customer service that meets or exceeds the National Standard of Care for Advanced Life Support Personnel and for the safe driving of the ambulance. The paramedic is ultimately responsible for all actions ...
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EMT - Central EMS
**Position: EMT (Basic - Advanced)** **Company: Central EMS** **Location: Roswell, GA** **Summary:** Provides patient care in both the emergency and non-emergency environment. Ensures compliance with all State of Georgia EMS rules and regulations. Checks and maintains all ambulance equipment and vehicle to insure it is clean and in proper working condition. Maintains all company required licenses and ...
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Paramedic - Dorchester County Maryland
Paramedic Full time with Benefits Annual Compensation $48,377.59 Includes Built-in Overtime & 11 Paid Holidays Shift work, Nights & Holidays Skilled technical and responsible position as Maryland certified Paramedic. Requires a valid Driver's License and current certifications. You may be assigned to various locations within the County. High School diploma or equivalent required; criminal background ...
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Paramedic Critical Intensive Care - Community Care Ambulance
**POSITION PURPOSE**: The Advanced EMT-P (CICP) is primarily responsible for providing patient care and customer service that meets or exceeds the National Standard of Care for Advanced Life Support personnel and all CCAN standards. The Advanced EMT-P will provide transportation of higher acuity patients between facilities and to the Tertiary Care centers. The paramedic is ultimately responsible for ...
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Low-Income Children with Neonatal Hypothyroidism Are at Increased Risk for Intellectual Disability
Clinical Thyroidology, Volume 31, Issue 1, Page 14-16, January 2019.
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How Can Levothyroxine Overuse Be Reduced?
Clinical Thyroidology, Volume 31, Issue 1, Page 5-7, January 2019.
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An Increased Relative but Small Absolute Risk of Leukemia Can Be Attributed to I-131 Ablation
Clinical Thyroidology, Volume 31, Issue 1, Page 30-32, January 2019.
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New miRNA-Based Classifier Test Uses FNA Cytology to Evaluate Cytologically Indeterminate Thyroid Nodules
Clinical Thyroidology, Volume 31, Issue 1, Page 23-26, January 2019.
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Fear of Recurrence Affects Health-Related Quality of Life in Thyroid Cancer Patients
Clinical Thyroidology, Volume 31, Issue 1, Page 27-29, January 2019.
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Clinical Validation of ThyroSeq V3 Shows High Sensitivity and Specificity
Clinical Thyroidology, Volume 31, Issue 1, Page 20-22, January 2019.
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A Mild Risk of Neonatal Hyperthyroidism Follows Preconception Radioactive Iodine Treatment for Graves’ Disease
Clinical Thyroidology, Volume 31, Issue 1, Page 11-13, January 2019.
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More Hürthle-Cell Aspirations Will Be Identified as Benign by the New Afirma GSC Test
Clinical Thyroidology, Volume 31, Issue 1, Page 17-19, January 2019.
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Dyslipidemia Is Common in Patients with Hypothyroidism Despite Correction of Abnormal TSH: A Systematic Review and Meta-Analysis
Clinical Thyroidology, Volume 31, Issue 1, Page 8-10, January 2019.
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The Difficult to Access “Right-To-Try” U.S. Health Care Law
Clinical Thyroidology, Volume 31, Issue 1, Page 33-36, January 2019.
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Greetings From the New Editor of Clinical Thyroidology
Clinical Thyroidology, Volume 31, Issue 1, Page 4-4, January 2019.
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Long Noncoding RNA-ATB Impairs the Function of Tumor Suppressor miR-126-Mediated Signals in Endometrial Cancer for Tumor Growth and Metastasis
Cancer Biotherapy and Radiopharmaceuticals, Volume 34, Issue 1, Page 47-55, February 2019.
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Lentivirus-Based Virus-Like Particles Mediate Delivery of Caspase 8 into Breast Cancer Cells and Inhibit Tumor Growth
Cancer Biotherapy and Radiopharmaceuticals, Volume 34, Issue 1, Page 33-41, February 2019.
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Expressions of Matrix Metalloproteinases-9 and Tissue Inhibitor of Metalloproteinase-1 in Pituitary Adenomas and Their Relationships with Prognosis
Cancer Biotherapy and Radiopharmaceuticals, Volume 34, Issue 1, Page 1-6, February 2019.
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Elevated Expressions of Survivin and Endoglin in Patients with Hepatic Carcinoma
Cancer Biotherapy and Radiopharmaceuticals, Volume 34, Issue 1, Page 7-12, February 2019.
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Correlation Between HER-2 Gene Amplification or Protein Expression and Clinical Pathological Features of Breast Cancer
Cancer Biotherapy and Radiopharmaceuticals, Volume 34, Issue 1, Page 42-46, February 2019.
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In Vitro Characterization of a Potent p53-MDM2 Inhibitor, RG7112 in Neuroblastoma Cancer Cell Lines
Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.
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miR-424-5p Regulates Hepatoma Cell Proliferation and Apoptosis
Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.
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Imaging of HER2 with [89Zr]pertuzumab in Response to T-DM1 Therapy
Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.
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Identification of Further Components of an Anticancer Defense System Composed of Small Molecules Present in the Serum
Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.
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Combination treatment with highly bioavailable curcumin and NQO1 inhibitor exhibits potent antitumor effects on esophageal squamous cell carcinoma
Abstract
Background
Esophageal squamous cell carcinoma (ESCC) is one of the most intractable cancers, so the development of novel therapeutics has been required to improve patient outcomes. Curcumin, a polyphenol from Curcuma longa, exhibits various health benefits including antitumor effects, but its clinical utility is limited because of low bioavailability. Theracurmin® (THC) is a highly bioavailable curcumin dispersed with colloidal submicron particles.
Methods
We examined antitumor effects of THC on ESCC cells by cell viability assay, colony and spheroid formation assay, and xenograft models. To reveal its mechanisms, we investigated the levels of reactive oxygen species (ROS) and performed microarray gene expression analysis. According to those analyses, we focused on NQO1, which involved in the removal of ROS, and examined the effects of NQO1-knockdown or overexpression on THC treatment. Moreover, the therapeutic effect of THC and NQO1 inhibitor on ESCC patient-derived xenografts (PDX) was investigated.
Results
THC caused cytotoxicity in ESCC cells, and suppressed the growth of xenografted tumors more efficiently than curcumin. THC increased ROS levels and activated the NRF2–NMRAL2P–NQO1 expressions. Inhibition of NQO1 in ESCC cells by shRNA or NQO1 inhibitor resulted in an increased sensitivity of cells to THC, whereas overexpression of NQO1 antagonized it. Notably, NQO1 inhibitor significantly enhanced the antitumor effects of THC in ESCC PDX tumors.
Conclusions
These findings suggest the potential usefulness of THC and its combination with NQO1 inhibitor as a therapeutic option for ESCC.
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Serum aldo–keto reductase family 1 member B10 predicts advanced liver fibrosis and fatal complications of nonalcoholic steatohepatitis
Abstract
Background
Nonalcoholic steatohepatitis (NASH) is associated with liver inflammation in patients with nonalcoholic fatty liver disease, and it can progress to liver fibrosis at an advanced stage, as well as hepatocellular carcinoma (HCC) and portal hypertension. Although liver fibrosis is accurately diagnosed via biopsy, noninvasive methods are preferable. Aldo–keto reductase family 1 member B10 (AKR1B10) is associated with HCC and is secreted into the blood by liver cells via a lysosome-mediated nonclassical pathway. Accordingly, we analyzed whether secretion of AKR1B10 protein is associated with advanced NASH.
Methods
We performed histological staging in 85 Matteoni classification type III and IV NASH patients and evaluated the incidence of HCC, formation of gastroesophageal varices, and prognosis according to serum AKR1B10 and Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA(+)-M2BP)(M2BPGi) and by comparison with conventional markers of fibrosis.
Results
A positive correlation was found between the Brunt classification and serum AKR1B10 level. In Brunt stage 4 patients, AKR1B10 levels were higher than those of other liver fibrosis markers, with higher specificity. The cutoff values for AKR1B10 and WFA(+)-M2BP for stage 4 fibrosis were 1.03 and 3.11, respectively. The rates of stage 4 fibrosis, HCC incidence, and gastroesophageal varix formation were significantly different between the two groups subdivided according to these cutoff levels. Moreover, the patients in the higher value group had significantly worse prognosis after NASH diagnosis
Conclusion
AKR1B10 is a useful serum biomarker for advanced liver fibrosis in NASH and, combined with serum WFA(+)-M2BP, can predict HCC development, gastroesophageal varix formation, and poor prognosis.
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Increase in the skeletal muscle mass to body fat mass ratio predicts the decline in transaminase in patients with nonalcoholic fatty liver disease
Abstract
Background
The aim of this retrospective study was to determine the effect of skeletal muscle and body fat on liver function in patients with nonalcoholic fatty liver disease (NAFLD) diagnosed by liver biopsy.
Methods
Among the 219 patients with NAFLD enrolled in this study was a cohort of 139 patients who had their body composition measured with Inbody720 at baseline and at ≥ 1 year postbaseline, to elucidate the relationship between liver function and changes in skeletal muscle and body fat mass. Multivariate analysis was used to identify factors influencing low skeletal muscle mass index (SMI, defined as 7 kg/m2 in men, and 5.7 kg/m2 in women) and the skeletal muscle mass to body fat mass ratio (SF ratio).
Results
Of the 219 patients enrolled, 27 (12.3%) had a low SMI. Patient age (> 70 years) and female gender were identified as risk factors for low SMI. Hepatic fibrosis was not associated with SMI. In the cohort followed up at baseline and 12 months later, transaminase activity, body fat mass, and SMI significantly decreased over time. Changes in the SF ratio were significantly associated with changes in liver function. An increase in the SF ratio [hazard ratio (HR) 10.99 in men, 6.849 in women] was a predictor of reduced ALT, independent of age and other backgrounds.
Conclusions
In the patients with NAFLD, SMI was decreased, even in the early stages of NAFLD. Therapeutic strategies for NAFLD require a reduction in body fat mass and the maintenance of skeletal muscle is also needed.
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Combinations of two drugs among NS3/4A inhibitors, NS5B inhibitors and non-selective antiviral agents are effective for hepatitis C virus with NS5A-P32 deletion in humanized-liver mice
Abstract
Background
The emergence of a deletion mutant at hepatitis C virus (HCV) NS5A-P32 (P32del) has recently been reported in a subset of chronic hepatitis C patients who experience virologic failure after direct-acting antiviral drug (DAA) treatment. This mutation confers extremely high resistance to NS5A inhibitors. No effective treatment has been established for cases with this mutation.
Methods
We used a JFH1-based recombinant virus with NS5A from a genotype 1b strain to introduce a P32del mutation. We inoculated human hepatocyte chimeric mice with sera from a patient with ledipasvir/sofosbuvir therapy failure carrying a genotype 1b HCV with NS5A L31M and P32del or from a DAA-naïve patient carrying wild-type virus.
Results
JFH1-based chimeric viruses with P32del showed sufficient levels of replication for in vitro assay despite the suppression of viral growth and infectious virus production. Variants with P32del exhibited severe resistance to all tested NS5A inhibitors, including daclatasvir, ledipasvir, elbasvir and velpatasvir, but were as susceptible to NS3/4A inhibitors, NS5B inhibitors, interferon alfa-2b, and ribavirin as wild-type viruses in the in vitro assay. The P32del mutant virus caused persistent infection in all inoculated chimeric mice with high viral titer and frequency. The virus was resistant to the ledipasvir/GS-558093 (a nucleotide analog inhibitor of NS5B polymerase) regimen but susceptible to either simeprevir plus GS-558093 or peg-interferon alfa-2b, compared to the wild-type virus.
Conclusion
Therapies combining at least two drugs among NS3/4A inhibitors, NS5B inhibitors and non-selective antiviral agents may be effective for HCV-infected patients with NS5A-P32del.
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Liver disease in adults with severe alpha-1-antitrypsin deficiency
Abstract
Background
The proportion of adults with liver disease due to severe alpha-1-antitrypsin deficiency (AATD), with PiZZ phenotype, is not clear. The markers of the AATD liver disease, how it progresses, and measures for its prevention have not been established. The aim of this study was to analyze the risk of liver disease in individuals with severe AAT deficiency (PiZZ).
Methods
Longitudinal clinical and laboratory data were obtained from the Swedish National registers, by cross-linkage between the Swedish national AATD register, the Swedish National Patient Register, the National Cancer Register and the National Causes of Death Register.
Results
A total of 1595 PiZZ individuals were included in the analyses. The mean follow-up time was 12 years (range 0.3–24). The mean number of follow-ups was 5 (range 2–15). Two or more liver function tests (LFTs) were available in 1123 individuals, and 26% of them (n = 290) had repeated elevated LFTs during the follow-up. The prevalence of any liver disease was 10% (n = 155). Liver cirrhosis was found in 7% of the individuals (n = 116) and hepatocellular carcinoma in 2% (n = 29). The mean age at the onset of liver disease was 61 (SD 15) years. In multivariate analyses, the male gender, age over 50 years, repeated elevated LFTs, hepatitis virus infection, and a diagnosis of diabetes were associated with increased risk of developing liver disease in adulthood (p < 0.01).
Conclusion
The prevalence of liver disease in adult PiZZ individuals is 10%. Age over 50 years, the male gender, repeated elevated liver enzymes, hepatitis, and the presence of diabetes mellitus are risk factors for developing liver disease.
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Proton pump inhibitor monotherapy is effective to attenuate dyspepsia symptoms associated with gastroesophageal reflux disease: a multicenter prospective observational study
Abstract
Background and aim
Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) are frequently overlapped. However, no treatment strategies have been established yet for such patients. This study compared the effects of proton pump inhibitor (PPI) treatment in patients with GERD-associated FD among three groups with varying severity levels of GERD symptoms.
Methods
The patients with GERD and FD symptoms received PPI treatment for 4 weeks after endoscopy, and the severity of the symptoms and responses to treatment were evaluated at before and after 4 weeks of treatment using the Gastroesophageal Reflux and Dyspepsia Therapeutic Efficacy and Satisfaction Test (GERD-TEST). The patients were divided into three groups in accordance with the severity of the GERD symptoms as assessed by the GERD symptom subscale (SS) scores of pre-treatment.
Results
Data from 233 cases of 40 mild, 151 moderate and 42 severe symptoms were analyzed. Analysis of the pre-treatment scores for each symptom revealed that a higher GERD-SS score was significantly associated with higher scores on any kind of FD score. Four weeks of PPI treatment significantly and markedly alleviated any of GERD/FD symptoms. Most importantly, change in the score for each symptom after 4 weeks of treatment relative to the pre-treatment score was significantly greater in the groups with more severe GERD-SS.
Conclusion
FD symptoms associated with more severe GERD symptoms are supposed to be acid-related dyspepsia, and PPI monotherapy is recommended as the treatment of first choice in such patients.
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Molecular subtype switching in early-stage gastric cancers with multiple occurrences
Abstract
Background
Multiple gastric cancers at the same time (synchronous) or recurrence after 1 year (metachronous) are frequently encountered. Since their genetic profiles were not well elucidated, we molecularly subtyped the genetic events of synchronous and metachronous early-stage gastric cancers.
Methods
We studied mismatch repair (MMR) genes in 84 tumors from 31 patients (15 synchronous and 16 metachronous) by immunohistochemistry. We performed microsatellite instability analysis and targeted sequencing of 58 significantly mutated genes (SMGs) in 35 tumors from thirteen patients. Genomic data from TCGA were used for comparisons with advanced-stage cancers.
Results
Among the 31 patients, at least one deficient-MMR (dMMR) tumor was observed in eight (26%). Of eight patients, seven showed a mixture of proficient-MMR (pMMR) and dMMR tumors. The one case with only dMMR had six recurrent tumors within 2 years. To further subtype, we sequenced 58 SMGs in 35 samples (25 pMMR and 10 dMMR) from thirteen patients. In 35 samples, 163 mutations were identified, but none matched in almost cases, strongly indicating different clonal origins, whether synchronous or metachronous occurrences. Of the 25 pMMR cases, 1 belonged to Epstein–Barr virus (EBV), 24 belonged to chromosomal instability (CIN) subtypes. Of the thirteen cases, repetitive CIN, a mixture of CIN and MSI, a mixture of CIN and EBV, and repetitive MSI were observed in nine (70%), two (15%), one (8%) and one (8%), respectively.
Conclusions
Despite multiple tumors occurring in the same patient simultaneously or several years apart, clonal origin was totally different. 'Switching' or 'mixing' of dMMR and pMMR, EBV or CIN occurred, which had clinical relevance with regard to immunotherapy.
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Alcoholic and non-alcoholic steatohepatitis: global perspective and emerging science
Abstract
Alcohol and high-fat diet are two major risk factors responsible for metabolic diseases, which are manifested as steatohepatitis and liver cancer in the liver, and chronic pancreatitis and pancreatic adenocarcinoma (PDAC) in the pancreas. These metabolic diseases are becoming increasingly prevalent around the globe, and more importantly, their two major etiologies commonly coexist to precipitate the disease processes. To highlight the importance of these metabolic diseases, Japanese Society of Gastroenterology (JSGE) and National Institute on Alcoholism and Alcohol Abuse of National Institute of Health cosponsored the JSGE's 7th International Forum jointly held with the 12th International Symposium on ALPD and Cirrhosis. Toward the main theme of "Frontiers in ASH, NASH, NBNC-HCC and PDAC", this platform showcased presentations by 12 invited international and Japanese speakers on brain–gut–liver interactions, emerging mechanisms of ASH and NASH, metabolic reprogramming, and new therapeutic targets for cirrhosis, HCC, and PDAC. This editorial discusses the most recent data on global statistics on how alcohol and obesity impact health and longevity as a prelude to a brief summary of the symposium presentations and discussions, primarily focusing on the first two session themes.
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The Role of EUS in Liver Biopsy
Abstract
Purpose of Review
EUS-guided liver biopsy (EUS-LB) is being used with increased frequency to perform parenchymal liver biopsy. Evolution of the technique can now achieve excellent liver tissue cores. This review covers important developments in this procedure.
Recent Findings
Clinical studies have recently demonstrated that the 19G EUS core biopsy needle is superior to non-core needles for liver tissue acquisition. In addition, wet suction provides more robust tissue samples than dry suction. Heparin priming of the needle (instead of saline) can prevent blood clogging within the needle lumen. A 1-hour recovery time after the EUS-LB is sufficient in almost all cases. The EUS-LB can deliver bilobar biopsies, which can decrease sampling error. Patients who need a liver biopsy in addition to an endoscopy or EUS are best served by the EUS-LB, as the combination procedure saves time and cost.
Summary
The EUS-LB is a safe and effective means for procuring good liver core biopsies. Incremental improvements in technique have increased quality of the resulting specimen. Future directions of this technique are discussed.
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Back to the Colorectal Cancer Consensus Molecular Subtype Future
Abstract
Purpose of Review
This review seeks to provide an informed prospective on the advances in molecular profiling and analysis of colorectal cancer (CRC). The goal is to provide a historical context and current summary on how advances in gene and protein sequencing technology along with computer capabilities led to our current bioinformatic advances in the field.
Recent Findings
An explosion of knowledge has occurred regarding genetic, epigenetic, and biochemical alterations associated with the evolution of colorectal cancer. This has led to the realization that CRC is a heterogeneous disease with molecular alterations often dictating natural history, response to treatment, and outcome. The consensus molecular subtypes (CMS) classification classifies CRC into four molecular subtypes with distinct biological characteristics, which may form the basis for clinical stratification and subtype-based targeted intervention.
Summary
This review summarizes new developments of a field moving "Back to the Future." CRC molecular subtyping will better identify key subtype specific therapeutic targets and responses to therapy.
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The Microbiome-Host Interaction as a Potential Driver of Anastomotic Leak
Abstract
Purpose of Review
The goal of this paper is to review current literature on the gut microbiome within the context of host response to surgery and subsequent risk of developing complications, particularly anastomotic leak. We provide background on the relationship between host and gut microbiota with description of the role of the intestinal mucus layer as an important regulator of host health.
Recent Findings
Despite improvements in surgical technique and adherence to the tenets of creating a tension-free anastomosis with adequate blood flow, the surgical community has been unable to decrease rates of anastomotic leak using the current paradigm. Rather than adhere to empirical strategies of decontamination, it is imperative to focus on the interaction between the human host and the gut microbiota that live within us. The gut microbiome has been found to play a potential role in development of post-operative complications, including but not limited to anastomotic leak. Evidence suggests that peri-operative interventions may have a role in instigating or mitigating the impact of the gut microbiota via disruption of the protective mucus layer, use of multiple medications, and activation of virulence factors.
Summary
The microbiome plays a potential role in the development of surgical complications and can be modulated by peri-operative interventions. As such, further research into this relationship is urgently needed.
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The Spectrum of Small Intestinal Bacterial Overgrowth (SIBO)
Abstract
Purpose of Review
To critically review recent (past 3 years) literature on the definition, diagnosis, and management of small intestinal bacterial overgrowth (SIBO).
Recent Findings
While various series continue to illustrate the occurrence of SIBO in disease states where well-known risk factors for its occurrence are present (hypochlorhydria, disorders of intestinal structure or motor function, pancreatic insufficiency, and chronic liver disease, for example), the current challenge is in defining the limits of SIBO. Is SIBO truly common among those with "functional" gastrointestinal symptoms where there is no evidence of maldigestion or malabsorption; the original hallmarks of SIBO? Our attempts to address this question continue to be hampered by the limitations of our diagnostic tool kit. There is hope—the application of modern molecular techniques to the study of the small intestinal microbiome, together with some innovative sampling techniques, such as real-time intestinal gas sampling, may soon allow us to truly define the spectrum of SIBO.
Summary
SIBO, once removed from its original confines as a cause of malabsorption syndrome, has proven to be an elusive and moving target. Only the most rigorous studies employing validated methodologies will finally corral this mysterious entity.
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The size of well differentiated pancreatic neuroendocrine tumors correlates with Ki67 proliferative index and is not associated with age
Digestive and Liver Diseases
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The association between adherence to the Mediterranean diet and hepatic steatosis: Cross-sectional analysis of two independent studies, the UK Fenland Study and the Swiss CoLaus Study
BMC Medicine
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Jumbo biopsy forceps vs cold snares for removing diminutive colorectal polyps: A prospective randomized controlled trial
Gastrointestinal Endoscopy
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A phase 3, multicenter, prospective, single-blinded, noninferiority, randomized controlled trial on the performance of a novel esophageal stent with an anti-reflux valve (with video)
Gastrointestinal Endoscopy
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Small dense low-density lipoprotein cholesterol predicts cardiovascular events in liver transplant recipients
Hepatology
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Underutilization of aspirin in patients with advanced colorectal polyps
American Journal of Medicine
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A large-scale multicenter study validates AKR1B10 as a new prevalent serum marker for detection of hepatocellular carcinoma
Hepatology
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Q&A: How to encourage employee growth and maintain high standards
Eve Grau, co-founder of Royal Ambulance, shares the company's philosophy for cultivating highly-motivated employees and how it positively impacts their agency
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6 ways to defend yourself against verbal abuse
A verbal attack can be personal; here's how to deflect the blow
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4 tips for airway management mastery
Successful airway management is the culmination of preparation, practice and technique mastery
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NAEMT president addresses paramedic education questions
Our co-hosts discuss NAEMT's position on paramedic education requirements with President Matt Zavadsky
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EMS Pioneers: Wisconsin paramedic still active after 45 years in EMS
Steve Teale discusses the peculiarities of small-town practice and life after EMS
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Now is the age of EMS: It is time to revolutionize our practice
Advances in prehospital treatments and community paramedicine require a new paradigm of training and education for EMS
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MRSA, fentanyl, bed bugs: What are you bringing home with you?
Limit your exposure and clean the ambulance and your clothing before heading home after shift to avoid contaminating your home and loved ones
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7 things public safety officials need to know about Safe Haven laws
These state laws are designed to prevent infanticide and offer parents a safe place to surrender their child without fear of being prosecuted
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Is concealed carry a good option for EMS providers?
Our co-hosts discuss a new bill that recently passed Virginia's Senate to allow EMS providers the option to conceal carry on the job
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What should EMS providers consider before carrying a concealed weapon on duty?
EMS1 columnists react to a Kansas law that prohibits public employers from preventing their employees from carrying a concealed weapon while on duty
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Research Analysis: Using continuous feedback to drive cardiac arrest care improvements
There is no silver bullet for cardiac arrest care, just silver buckshot
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Do lights and sirens make an already distracted driver more dangerous?
An ambulance and vehicle collision immediately transforms an incident from the patient's emergency to an emergency shared with the EMS crew
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How to avoid, survive an ambulance collision
Ambulance collisions, which happen with frightening regularity, often result in injury and are occasionally fatal, especially for private vehicle drivers
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How Pittsburgh’s ‘Freedom House’ shaped modern EMS systems
During a time of racial tension and social upheaval, the movement helped form the foundations of the pre-hospital care we're used to today
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Stabbed on duty: A medic's lessons learned on the long road back
Ben Vernon dug deep to work through years of emotional trauma that surged to the front of his mind after he was attacked
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Why a personal connection opens your mind to the patient as a person
EMS providers are more than personal space invaders. The connections we form with the patient can be the key to creating an environment of healing
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EMS quality improvement through clinical specialty teams
Harness a passion for care to identify improvement opportunities in clinical specialty areas and propose change
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Increasing your career options with more education
Due to on-the-job injury, family demands or burnout, many EMS professionals eventually need to find work outside of EMS
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Thoracoscopic rib resection and reconstruction of chest wall: Our clinical experience
Chest wall resection is traditionally performed via open thoracotomy, a procedure that increases surgical morbidity and reduces postoperative quality of life. Conversely, thoracoscopic chest wall resection may minimize invasiveness but the optimal procedure remains uncertain. We previously reported rib resection using a pneumatic high‐speed power drill during video‐assisted thoracoscopic surgery for selected lung cancer patients. In this report, we present two cases of chest wall tumor resected using the drill via the thoracoscopic approach. We also report thoracoscopic chest wall reconstruction in one patient using a patch sheet.
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Laparoscopic distal gastrectomy for gastric cancer with simultaneous resection of para‐aortic schwannoma
An asymptomatic 74‐year‐old man was diagnosed with early gastric cancer during screening. Preoperative CT revealed a 25‐mm tumor surrounded by the abdominal aorta, inferior vena cava, and left renal vein. Based on the primary tumor stage, para‐aortic lymph node metastasis was considered to be unlikely but could not be ruled out. For this reason, we planned a concurrent diagnostic and therapeutic laparoscopic resection with gastrectomy. The gastric cancer and para‐aortic tumor were successfully resected laparoscopically. The tumor was diagnosed as a schwannoma. With care and skill, we were able to resect the para‐aortic schwannoma and gastric cancer simultaneously and safely by using laparoscopic techniques.
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Laparoscopic dissection for pelvic lymph node recurrence of thymic carcinoma: A case report
Thymic carcinoma, a rare mediastinal neoplasm, is characterized by extensive local invasion and distant metastasis. To our knowledge, this is the first case report demonstrating the efficacy of laparoscopic dissection for pelvic lymph node metastases from thymic carcinoma. A 64‐year‐old man was found to have a mediastinal mass by CT and underwent radical resection. Six months after resection of his thymic carcinoma, follow‐up CT revealed a gluteal tumor and enlarged pelvic lymph nodes. The gluteal tumor was resected percutaneously. Two months after this procedure, PET showed that the three pelvic lymph nodes had abnormal uptake of 18F‐fluorodeoxyglucose and had enlarged further. The patient accordingly underwent laparoscopic dissection of these lymph nodes. Pathological examination of all resected specimens showed metastatic thymic carcinoma. We recommend laparoscopic dissection of pelvic lymph node metastases because it provides a clear intraoperative view and is minimally invasive.
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Initial learning curve for robot‐assisted partial nephrectomy performed by a single experienced robotic surgeon
Introduction
The objective of this study was to evaluate the initial learning curve for robot‐assisted partial nephrectomy (RAPN) using the da Vinci Xi Surgical System (Intuitive Surgical, Sunnyvale, California).
Methods
This study included the initial 65 consecutive patients with small renal tumors who had undergone RAPN at our institution. A single trained surgeon with extensive experience in robot‐assisted radical prostatectomy, but not in laparoscopic partial nephrectomy, performed RAPN for all patients using the da Vinci Xi. The learning curve was analyzed by examining the perioperative outcomes among five groups each consisting of 13 consecutive patients.
Results
In this series, the median tumor size and R.E.N.A.L. nephrometry score were 23 mm and 7, respectively, and the median console time and warm ischemia time (WIT) were 116 and 15 minutes, respectively. Fifty‐eight patients (89.2%) achieved trifecta outcomes, meaning that the ischemic time was ≤25 minutes, there was a negative surgical margin, and no major postoperative complications occurred. Although there were no significant changes in R.E.N.A.L. nephrometry scores over time, increased surgeon experience was significantly associated with a shorter console time and WIT. Drawing logarithmic approximation curves enabled the achievement of a console time ≤150 minutes and WIT ≤20 minutes at the sixth and fourth procedures, respectively. Furthermore, multivariate analysis identified an independent correlation between surgeon experience with WIT, but not with console time.
Conclusion
These findings suggest that regardless of a surgeon's prior experience in laparoscopic partial nephrectomy, an experienced robotic surgeon can perform RAPN using the da Vinci Xi with acceptable perioperative outcomes after a small number of procedures.
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Dual‐hemostat port closure technique with customized surgical suture after laparoscopic cholecystectomy: Single‐center experience
Introduction
Dual‐hemostat techniques for port closure have previously been reported, but their safety and efficacy have not been evaluated. Here, we describe the dual‐hemostat port closure technique employed at our institution, which uses a customized surgical suture for safe and certain port closure, and we assess the incidence rate of trocar‐site hernia (TSH) after laparoscopic cholecystectomy.
Methods
From March 1999 to March 2017 at our institution, 316 patients underwent elective laparoscopic cholecystectomy performed by a single experienced surgeon. We routinely used a dual‐hemostat technique with a customized surgical suture to achieve safe and certain port closure. We assessed the incidence rate of TSH after laparoscopic cholecystectomy (defined as a reoperation for a TSH or clinical hernia at the port site) based on follow‐up data from patient questionnaires and clinical examinations.
Results
After 67 patients were excluded because of death, unknown address, or conversion to open cholecystectomy, 249 eligible patients received questionnaires, of which 173 were returned (response rate, 69.5%). From these responses, TSH was suspected in three patients, but only one underwent reoperation for TSH after laparoscopic cholecystectomy. Thus, the incidence rate of TSH after laparoscopic cholecystectomy was 0.6% (1/173).
Conclusions
Our single‐center experience demonstrated that our port closure technique using a dual‐hemostat technique with customized surgical suture provides an appropriate option for laparoscopic cholecystectomy, especially given its ease and low incidence of TSH.
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Recent advances in thoracoscopic esophagectomy for esophageal cancer
Abstract
Technical advances and developments in endoscopic equipment and thoracoscopic surgery have increased the popularity of minimally invasive esophagectomy (MIE). However, there is currently no established scientific evidence supporting the use of MIE as an alternative to open esophagectomy (OE). To date, a number of single‐institution studies and several meta‐analyses have demonstrated acceptable short‐term outcomes of thoracoscopic esophagectomy for esophageal cancer, and we recently reported one of the largest propensity score‐matched comparison studies between MIE and OE for esophageal cancer, based on a nationwide Japanese database. We found that, in general, MIE had a longer operative time and less blood loss than OE. Moreover, compared to OE, MIE was associated with a lower rate of pulmonary complications such as pneumonia, and both methods had similar mortality rates. Although MIE may reduce the occurrence of postoperative respiratory complications, MIE and OE seem to have comparable short‐term outcomes. However, the oncological benefit to patients undergoing MIE remains to be scientifically proven, as no randomized controlled trials have been conducted to verify each method's impact on the long‐term survival of cancer patients. An ongoing randomized phase III study (JCOG1409) is expected to determine the impact of each method with regard to short‐ and long‐term outcomes.
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Endoscopic surgery in Japan: The 13th national survey (2014‐2015) by the Japan Society for Endoscopic Surgery
Abstract
In Japan, the first endoscopic surgery, a laparoscopic cholecystectomy, was performed in 1990. Since then, the operative procedure has been standardized, and the safety and usefulness of endoscopic surgery have been evaluated. In accordance with the social acceptance of endoscopic surgery as a less‐invasive surgery, the number of endoscopic procedures has been increasing in all surgical domains. The Japan Society for Endoscopic Surgery (JSES) has played an important role in the development of endoscopic surgery in Japan. For example, JSES established a technical skills certification system for surgeons to train instructors how to teach safe endoscopic surgery, and the organization performs a national survey every 2 years. In 2015, a total of 211 953 patients underwent endoscopic surgery in all surgical domains, including abdominal, thoracic, mammary and thyroid gland, cardiovascular, obstetrics and gynecology, urologic, orthopedic, and plastic surgery. The course of laparoscopic surgery's development and its current status are reported here based on the results of the most recent questionnaire survey conducted by JSES.
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Transmediastinal approach for esophageal cancer: A new trend toward radical surgery
Esophageal squamous cell carcinoma (ESCC), the most common histology of esophageal cancer in Japan and Asia, shows extensive mediastinal spread from an early stage. Therefore, transthoracic esophagectomy with extensive mediastinal lymphadenectomy, including in the upper mediastinum along the recurrent laryngeal nerves, is the gold standard of radical surgery for ESCC. Minimally invasive thoracoscopic esophagectomy has now become a standard option for ESCC. However, transhiatal esophagectomy is regarded as less invasive because it avoids thoracotomy. Yet, it is also considered less curative because it offers a limited surgical view and insufficient mediastinal lymphadenectomy even when conventional specialized mediastinoscopy is used. Recent clinical studies on radical esophagectomy without thoracotomy for ESCC have been reported from Japan. The introduction of novel minimally invasive techniques for the transcervical or transhiatal approach, such as single‐port or robotic surgical devices, have enabled transmediastinal radical esophagectomy for ESCC. This review focuses on the transmediastinal approach for esophageal cancer surgery, which employs minimally invasive techniques to reduce morbidity, and its application to radical surgery for ESCC.
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Modified laparoscopic keyhole plus repair to manage a parastomal hernia: A single‐center experience
Abstract
Introduction
Parastomal hernia (PH) is a common late complication of stoma formation for which laparoscopic repair is a well‐accepted modality of treatment. Keyhole repair has been frequently reported with recurrence, but our modification in surgical technique have lesser and acceptable recurrence rates. The present study aimed to assess the results of modified laparoscopic keyhole plus repair in the treatment of symptomatic PH.
Methods
We reviewed our prospectively maintained database to search for patients who had undergone laparoscopic modified keyhole repair between January 2008 and April 2018. All 23 symptomatic patients who had undergone this procedure were included in the present study.
Results
A total of 23 patients were studied. The median age was 37 years (range, 22‐54 years). Two patients with large PHs underwent open excision of the redundant skin and then laparoscopic modified keyhole repair. There was one conversion to open repair because of dense adhesions. The mean operative time was 112 ± 37 minutes. The mean postoperative hospital stay was 3 ± 2 days. There were no significant intraoperative or postoperative complications. During follow‐up, three patients had a seroma, which was managed conservatively. One morbidly obese patient who had an ileal conduit‐related stomal hernia had a symptomatic recurrence 3 years after surgery.
Conclusion
The modified laparoscopic keyhole plus repair is a safe, feasible, and effective technique for PH repair; it has an acceptable recurrence rate and offers good cosmesis and functional outcomes.
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Novel approach to intraoperative peritoneal lavage with an extracorporeal stirring method in laparoscopic surgery for generalized peritonitis: Preliminary results
Introduction
The primary concern with laparoscopic intraoperative peritoneal lavage (IOPL) for generalized peritonitis relates to the difficulty and uncertainty in ensuring adequate washout of contaminated fluid. Here, we describe a new method of laparoscopy‐assisted IOPL.
Methods
We performed emergency surgery in 10 patients with generalized peritonitis necessitating IOPL. A small wound retractor was inserted into the abdominal cavity through an incision and elevated to raise the abdominal wall. More than 3‐L saline was injected via the retractor at one time. The abdomen was manually shaken by pressure from outside the body. Contaminated fluid was removed with a long suction device through the retractor. This procedure was repeated until the fluid was confirmed to be transparent by laparoscopy, and then drains were placed.
Results
Median lavage time was 23.5 minutes (range, 15‐34 minutes), and volume of lavage fluid was 19 L (range, 10‐20 L). Median time to resumption of fluid intake was 3 days (range, 1‐12 days), time to food intake was 6 days (range, 3‐14 days), and time to first bowel movement was 5 days (range, 3‐10 days). Median duration of antibiotic use was 8.5 days (range, 5‐15 days). Complications were one case of antibiotic‐induced rash, two cases of paralytic ileus, and one case of pelvic abscess. All patients recovered well without additional surgical intervention.
Conclusions
This new approach to laparoscopy‐assisted IOPL was feasible for these patients with generalized peritonitis. This procedure enabled corpus lavage to be performed in a similarly short time to open surgery but with less invasiveness. Further research is needed to confirm indications and long‐term outcomes.
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Video‐assisted esophagectomy using a port‐free organ retractor for the prevention of laryngeal nerve paralysis
Introduction
Recurrent laryngeal nerve (RLN) paralysis is a major complication of esophageal cancer surgery. The free jaw clip (FJ clip) was developed as an organ‐retracting device, and it can also reduce the number of ports required during surgery. Here, we describe a new technique for lymphadenectomy along the left RLN using the FJ clip.
Materials and Surgical Technique
After the middle and lower mediastinal lymph nodes were dissected, the upper esophagus and other tissues, including the lymph nodes and left RLN, were retracted by cutting the tracheal arteries between the esophagus and trachea and then pulling the upper esophagus to the dorsal side with the FJ clip. The esophagus was transected at the upper mediastinum, and the proximal esophagus was drawn by the FJ clip. This technique helped provide a good field of view during lymphadenectomy along the left RLN. The data of nine consecutive patients who underwent video‐assisted esophagectomy in the left lateral decubitus position by the same surgeon were reviewed. Postoperative left RLN paralysis occurred in only one patient in whom the RLN could not be preserved.
Discussion
Given the excellent short‐term outcomes with respect to left RLN paralysis, lymphadenectomy along the left RLN using the FJ clip was safe and feasible.
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NADPH oxidases derived ROS: Dosis facit venenum
New Findings
What is the topic of this review? Within this review, the role of reactive oxygen species in cellular homeostasis, physiology and pathophysiology is discussed. What advances does it highlight? The review provides new concepts of how reactive oxygen species influence gene expression, energy consumption and other aspects in a cells life. Further a model is provided, how reactive oxygen species elicit specific oxidation of target molecules.
Abstract
Reactive oxygen species have a long history of bad reputation. They are needed and quite effective in host defense, but on the other hand may induce situations of oxidative stress.
Besides that, within the last years, several soft functions of NADPH oxidases have been discovered, which slowly erode the image of the solely dangerous ROS. NADPH oxidase derived ROS serve to ease or enable signal transduction and to maintain homeostasis. However, there is still an enormous lag of knowledge concerning target proteins and how ROS may elicit specific signaling in different cells and tissue. The present review summarizes some important functions of Nox2 and Nox4. Further, although highly speculative, a model is provided of how those NADPH oxidases may be able to oxidize target proteins in a specific way. Many concepts mentioned in this review, represent my personal view and are only partially supported by published studies.
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Cardiovascular response of postmenopausal women to 8 weeks of sprint interval training
Abstract
Introduction
Menopause is accompanied by decreased aerobic fitness and increased risk of cardiovascular disease. Sprint interval training (SIT) is a time-efficient intervention for improving cardiovascular function and aerobic fitness of young adults.
Aim
To determine the effect of an 8-week SIT program on the cardiovascular function and aerobic fitness of overweight postmenopausal women.
Method
Thirty overweight postmenopausal women were randomized into exercise (n = 15) or control (n = 15) groups. The intervention group completed three SIT sessions a week for 8 weeks. Each session consisted of 20 min of 8-s sprints and 12 s of light pedalling. Participants also completed 8 min of light aerobic cycle exercise, before and after the SIT intervention. Cardiovascular function including heart rate, stroke volume (SV), and diastolic filling time (DFT) was assessed before and after the intervention and during 8 min of light aerobic exercise. Estimated maximal oxygen uptake ( \(\dot {V}_{2{\text{max}}}}\) ) was also assessed.
Results
Resting SV was increased (p = 0.001) from pre- (77.5 ± 17.0 mL) to post-SIT (81.3 ± 17.0 mL), whereas SV during 8 min of light aerobic exercise was increased (p = 0.000), from pre- (97.8 ± 1.6 mL) to post-test (103.5 ± 17.8 mL). Resting DFT was increased, (p = 0.010), at pre- (333.4 ± 94.4 mL) to post-SIT (357.4 ± 88.2 mL), whereas DFT during 8 min of aerobic exercise was increased, (p = 0.000), from pre- (480.1 ± 99.5 mL) to posttest (527.2 ± 123.0 mL). Predicted \(\dot {V}_{2{\text{max}}}}\) was increased, (p = 0.016), from pre- (19.5 ± 5.87 mL kg−1 min−1) to post-SIT (21.4 ± 7.02 mL kg−1 min−1).
Conclusion
SIT improved cardiovascular function and aerobic fitness of overweight postmenopausal women after 8 weeks of exercise.
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Diagnostic accuracy of interictal source imaging in presurgical epilepsy evaluation: A systematic review from the E-PILEPSY consortium
Publication date: Available online 8 February 2019
Source: Clinical Neurophysiology
Author(s): Brian E Mouthaan, Matea Rados, Paul Boon, Evelien Carrette, Beate Diehl, Julien Jung, Vasilios Kimiskidis, Teia Kobulashvili, Giorgi Kuchukhidze, Pål G Larsson, Markus Leitinger, Philippe Ryvlin, Fergus Rugg-Gunn, Margitta Seeck, Serge Vulliémoz, Geertjan Huiskamp, Frans SS Leijten, Pieter Van Eijsden, Eugen Trinka, Kees PJ Braun
Abstract
Objective
Interictal high resolution (HR-) electric source imaging (ESI) and magnetic source imaging (MSI) are non-invasive tools to aid epileptogenic zone localization in epilepsy surgery candidates. We carried out a systematic review on the diagnostic accuracy and quality of evidence of these modalities.
Methods
Embase, Pubmed and the Cochrane database were searched on 13 February 2017. Diagnostic accuracy studies taking post-surgical seizure outcome as reference standard were selected. Quality appraisal was based on the QUADAS-2 framework.
Results
Eleven studies were included: eight MSI (n=267), three HR-ESI (n=127) studies. None was free of bias. This mostly involved: selection of operated patients only, interference of source imaging with surgical decision, and exclusion of indeterminate results. Summary sensitivity and specificity estimates were 82% (95% CI: 75-88%) and 53% (95% CI: 37-68%) for overall source imaging, with no statistical difference between MSI and HR-ESI. Specificity is higher when partially concordant results were included as non-concordant (p<0.05). Inclusion of indeterminate test results as non-concordant lowered sensitivity (p<0.05).
Conclusions
Source imaging has a relatively high sensitivity but low specificity for identification of the epileptogenic zone.
Significance
We need higher quality studies allowing unbiased test evaluation to determine the added value and diagnostic accuracy of source imaging in the presurgical workup of refractory focal epilepsy.
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Ardipithecus ramidus postcrania from the Gona Project area, Afar Regional State, Ethiopia
Publication date: April 2019
Source: Journal of Human Evolution, Volume 129
Author(s): Scott W. Simpson, Naomi E. Levin, Jay Quade, Michael J. Rogers, Sileshi Semaw
Abstract
Functional analyses of the 4.4 Ma hominin Ardipithecus ramidus postcrania revealed a previously unknown and unpredicted locomotor pattern combining arboreal clambering and a form of terrestrial bipedality. To date, all of the fossil evidence of Ar. ramidus locomotion has been collected from the Aramis area of the Middle Awash Research Project in Ethiopia. Here, we present the results of an analysis of additional early Pliocene Ar. ramidus fossils from the Gona Project study area, Ethiopia, that includes a fragmentary but informative partial skeleton (GWM67/P2) and additional isolated manual remains. While we reinforce the original functional interpretations of Ar. ramidus of having a mixed locomotor adaptation of terrestrial bipedality and arboreal clambering, we broaden our understanding of the nature of its locomotor pattern by documenting better the function of the hip, ankle, and foot. The newly recovered fossils document a greater adaptation to bipedality in the Ar. ramidus ankle and hallux than previously recognized. In addition, a newly discovered scaphoid bone with a fusing os centrale provides further evidence about the nature of hominin hand evolution.
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Proboscidea from Kanapoi, Kenya
Publication date: Available online 8 February 2019
Source: Journal of Human Evolution
Author(s): William J. Sanders
Abstract
The early Pliocene site of Kanapoi (Turkana Basin, Kenya) has a large, diverse vertebrate sample that contains the earliest representatives of the hominin genus Australopithecus. Included in this sample is an impressive assemblage of fossil proboscideans, comprised of deinotheres (Deinotherium bozasi), anancine gomphotheres (Anancus ultimus), and at least three species of elephant (Loxodonta adaurora, a primitive morph of Loxodonta exoptata, and Elephas ekorensis). A single specimen from high in the sequence could plausibly belong to a primitive stage of Elephas recki. A review of dental carbon isotope analyses indicates a range of dietary habits for these taxa, from dedicated browsing (deinotheres) to mixed feeding/grazing (elephants and gomphotheres), which in early Pliocene elephants corresponds to molars with greater crown height and more plates than in late Miocene confamilials, bringing their morphology more in phase with feeding behavior than was the case in their earlier relatives. Variation in feeding preferences among Kanapoi proboscideans corresponds to evidence for habitat heterogeny, including inferred substantial presence of grasses; the occurrence of multiple megaherbivores may have contributed to the fragmentation of ecosystems, positively affecting early hominin success and aiding diversification of other ungulate groups.
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Confirmation of a new phenotype in an individual with a variant in the last part of exon 30 of CREBBP
We report here a novel de novo missense variant affecting the last amino acid of exon 30 of CREBBP [NM_004380, c.5170G>A; p.(Glu1724Lys)] in a 17‐year‐old boy presenting mild intellectual disability and dysmorphisms but not resembling the phenotype of classical Rubinstein–Taybi syndrome. The patient showed a marked overweight from early infancy on and had cortical heterotopias. Recently, 22 individuals have been reported with missense mutations in the last part of exon 30 and the beginning of exon 31 of CREBBP, showing this new phenotype. This additional case further delineates the genotype–phenotype correlations within the molecular and phenotypic spectrum of variants in CREBBP and EP300.
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Substantial pain burden in frequency, intensity, interference and chronicity among children and adults with neurofibromatosis Type 1
Tumor growths, migraine headaches, and other health‐related complications reported in patients with neurofibromatosis type 1 (NF1) are often associated with pain. Thus, this study sought to describe and quantify the pain experience in children and young adults with NF1. Surveys were administered to 49 participants (28 children and 21 adults), ages 8 through 40 years. The survey included the Numeric Rating Scale 11 (NRS11) to assess pain intensity and the Patient Reported Outcomes Measurement Information System (PROMIS) to assess pain interference. A supplemental survey was created to measure pain frequency, chronicity, quality, and location. Results suggest pain is not only present in 55% of the cohort, but that it can begin at early ages. Pain was chronic in 35% of participants, with 41% reporting the use of medication to manage pain symptoms. Common sources of pain included migraine headaches and NF‐related tumors. Pain was described as having neuropathic features (i.e., burning, tingling, numbness, or itching), and was localized to the head, back, and extremities. Further, subsets of participants reported moderate‐to‐severe pain intensity, high frequency of pain, and interference of pain in daily activities. Continued investigation of the pain experience in a multisystem disorder, such as NF1, remains essential to providing guidance in the setting of complex pain management.
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Xq22.3q23 microdeletion harboring TMEM164 and AMMECR1 genes: Two case reports confirming a recognizable phenotype with short stature, midface hypoplasia, intellectual delay, and elliptocytosis
The AMME syndrome defined as the combination of Alport syndrome, intellectual disability, midface hypoplasia, and elliptocytosis (AMME) is known to be a contiguous gene syndrome associated with microdeletions in the region Xq22.3q23. Recently, using exome sequencing, missense pathogenic variants in AMMECR1 have been associated with intellectual disability, midface hypoplasia, and elliptocytosis. In these cases, AMMECR1 gene appears to be responsible for most of the clinical features of the AMME syndrome except for Alport syndrome. In this article, we present two unrelated male patients with short stature, mild intellectual disability or neurodevelopmental delay, sensorineural hearing loss, and elliptocytosis harboring small microdeletions identified by array‐CGH involving TMEM164 and AMMECR1 genes and SNORD96B small nucleolar RNA for one patient, inherited from their mothers. These original cases further confirm that most specific AMME features are ascribed to AMMECR1 haploinsufficiency. These cases reporting the smallest microdeletions encompassing AMMECR1 gene provide new evidence for involvement of AMMECR1 in the AMME phenotype and permit to discuss a phenotype related to AMMECR1 haploinsufficiency: developmental delay/intellectual deficiency, midface hypoplasia, midline defect, deafness, and short stature.
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Carbohydrate consumption and variable-intensity exercise responses in boys and men
Abstract
Purpose
The effect of carbohydrate (CHO) supplementation on physiological and perceptual responses to steady-state exercise has been studied in children. However, little is known about these responses to variable-intensity exercise (VIE) and how these responses might differ from adults. This study examined the physiological and perceptual effects of CHO on VIE in boys and men.
Methods
Eight boys (11.1 ± 0.9 years) and 11 men (23.8 ± 2.1 years) consumed CHO or a placebo (PL) beverage before and throughout VIE (three 12-min cycling bouts with intensity varying every 20–30 s between 25, 50, 75, and 125% peak work rate). Pulmonary gas exchange was assessed during the second 12-min bout. RPE was assessed twice per bout.
Results
In CHO, blood glucose increased and then decreased more from pre-exercise to 12 min and was higher in this trial at the end of exercise in men versus boys. In boys, blood glucose in CHO was higher at 24 and 36 min of exercise than in PL. RER during the CHO trial was higher in both groups; the other physiological responses were unaffected by CHO. All RPE measures (whole body, legs and chest) increased over time, but were not different between groups or trials.
Conclusion
Blood glucose patterns during VIE were differentially affected by CHO in boys and men, but most physiological and perceptual responses to VIE were unaffected by CHO in either group. Knowledge of the underlying mechanisms of glucose regulation and effects on physical performance during this type of exercise in children is warranted.
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Ultrasound-Guided Steroid Injections for Lateral Antebrachial Cutaneous Nerve Entrapment Within Post-Surgical Scar
No abstract available
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The effect of CT-guided botulinum toxin injection on cervical dystonia, confirmed by nine-month follow-up using 18F-FDG PET/CT : A case report
Although accurate targeting of the causative muscles is of paramount importance in the treatment of focal dystonia, this is often challenging due to distortion of the affected anatomical structures and difficulty in proper positioning of injections. We report a case of idiopathic cervical dystonia that was treated by CT-guided injection of botulinum toxin (BTX) into multiple deep muscles. Based on clinical presentation of combined torticollis and retrocollis, and needle electromyography (EMG) results, BTX was injected under EMG guidance. This treatment resulted in no improvement. Subsequently, target muscles were identified using fludeoxyglucose (18F-FDG) fusion positron emission tomography/computed tomography (18F-FDG PET/CT). BTX was injected into the hypermetabolic muscles. This injection successfully relieved the symptoms, and nine months of follow-up using PET/CT confirmed that hypermetabolic muscles had been normalized. This case indicated that CT guidance may facilitate accurate targeting of BTX injection. To the authors' knowledge, this is the first case reporting a positive effect of BTX on cervical dystonia symptoms that lasted nine months, confirmed by follow-up PET/CT. Address for Correspondence: Byung-Mo Oh, MD, PhD, Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea. Fax:+82-2-2072-2561. Phone:+82-10-9944-4481. E-mail: keepwiz@gmail.com Disclosure: The authors have no conflicts of interest, provided funding, financial benefits, and details of any previoius presentation of this report Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
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Ergonomic latex pillows as a part of a multimodal intervention or as an adjunct to rehabilitation programs in cervical spondylosis: Is it useful? A randomized controlled trial
Objective This study evaluated the effectiveness of ergonomic latex pillows in terms of clinical and biomechanical (cervical range of motion) outcome measures in patients with cervical spondylosis. Design This parallel-group randomized controlled trial randomly assigned 42 patients with cervical spondylosis to the experimental and control groups. Both groups received 12 sessions of routine physical therapy for four weeks. While the experimental group received an ergonomic latex pillow, the control group slept on their own usual pillow during the mentioned four-week period. Pain intensity, functional disability, medication use, and cervical range of motion were measured before and after four weeks of intervention. Results After four weeks of intervention, the experimental group showed pain relief, decreased disability, and significantly increased range of motion in all directions. The simultaneous use of an ergonomic latex pillow and physical therapy could more successfully decrease pain intensity compared to routine physical therapy alone. In addition, extension and right lateral flexion variables significantly increased in the experimental group compared to the control group. Conclusion The adminsitration of an ergonomic latex pillow can ameliorate treatment outcome in patients with cervical spondylosis. Corresponding author: Behshid Farahmand PhD candidate, Instructor at Department of Orthotics and Prosthetics, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq, Mirdamad Blv, Tehran, Iran. Farahmandb1@yahoo.com, +982122228051 Conflicts of Interest Disclosure: The authors have no conflicts of interest to declare with respect to the research, authorship, and/or publication of this article. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Previous presentation: The authors disclose that the results of this study have not been presented elsewhere. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
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Reply to Haydar, Bishr; Holman, Ashlee; Galante, Dario, regarding their comment ‘ESPA Pain Management Ladder: Caudal Clonidine and Cost/Benefit Considerations
Abstract
we thank Dr Haydar and colleagues for their comments on our article and we appreciate their interest and expertise in this field. We note their support for the concept of providing a framework for improvement in care. They make specific points about caudal epidural clonidine, outcomes, risk‐benefit balance, use of ultrasound guidance, and the possibility that pain assessment has caused overuse of opioids. We feel that they may have misunderstood some aspects of the nature and purpose of the ESPA Pain Management Ladder initiative and also have extrapolated unreasonably from experiences in adult practice and problems in the USA with inappropriate use of opioids.
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The angle Range of Leg Abduction with External Hip Rotation Which Can Minimize Femoral Artery and Vein Overlap in Pediatric Patients
Summary
Background
Since the femoral artery frequently overlaps the femoral vein, femoral central venous catheterization carries the risk of arterial puncture in pediatric patients.
Aim
We evaluated the angle range of leg abduction with external hip rotation to minimize the overlap between the femoral artery and vein in pediatric patients undergoing general anesthesia.
Methods
Eighty‐two pediatric patients who underwent elective surgery with general anesthesia were enrolled in this study. Using ultrasonography, patients were divided into groups N (patients with non‐overlap) and O (patients with continuing overlap) based on the presence of non‐overlap range between the femoral artery and vein. The range minimizing the overlap was defined as the range without overlap in group N and as the range presenting the overlap that was less‐than‐half of the radius of the femoral vein in group O. By increasing the angle of leg abduction with external hip rotation, the starting and ending angles minimizing the overlap were found using ultrasonographic images.
Results
The angle range of leg abduction with external hip rotation minimizing the overlap between the femoral artery and vein was defined as the range from the maximum 99% confidence interval of starting angles to the minimum 99% confidence interval of ending angles, which was between 45° and 65° in group N and between 48° and 58° in group O, respectively.
Conclusion
Positioning patients in a range of 48° and 58° leg abduction with external hip rotation can minimize the overlap between the femoral artery and vein. However, the clinical usefulness of this positioning for femoral venous catheterization remains to be seen.
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Neuronal Ca2+ signalling at rest and during spontaneous neurotransmission
Abstract
Action potential driven neuronal signaling drives several electrical and biochemical processes in the nervous system. However, neurons can maintain synaptic communication and signaling under resting conditions independent of activity. Importantly, these processes are regulated by Ca2+ signals that occur at rest. Several studies have suggested that opening of voltage‐gated Ca2+ channels near resting membrane potentials, activation of NMDA receptors in the absence of depolarization or Ca2+ release from intracellular stores can drive neurotransmitter release as well as subsequent signalling in the absence of action potentials. Interestingly, recent studies have demonstrated that manipulation of resting neuronal Ca2+ signalling yielded pronounced homeostatic synaptic plasticity suggesting a critical role for this resting form of signalling in regulation of synaptic efficacy and neuronal homeostasis. Given their robust impact on synaptic efficacy and neuronal signalling, neuronal resting Ca2+ signals warrant further mechanistic analysis that include the potential role of store‐operated Ca2+ entry in these processes.
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