Ετικέτες

Τετάρτη 4 Ιανουαρίου 2017

Engineering hepatitis B virus core particles for targeting HER2 receptors in vitro and in vivo

S01429612.gif

Publication date: March 2017
Source:Biomaterials, Volume 120
Author(s): Izzat Fahimuddin Bin Mohamed Suffian, Julie Tzu-Wen Wang, Naomi O. Hodgins, Rebecca Klippstein, Mitla Garcia-Maya, Paul Brown, Yuya Nishimura, Hamed Heidari, Sara Bals, Jane K. Sosabowski, Chiaki Ogino, Akihiko Kondo, Khuloud T. Al-Jamal
Hepatitis B Virus core (HBc) particles have been studied for their potential as drug delivery vehicles for cancer therapy. HBc particles are hollow nano-particles of 30–34 nm diameter and 7 nm thick envelopes, consisting of 180–240 units of 21 kDa core monomers. They have the capacity to assemble/dis-assemble in a controlled manner allowing encapsulation of various drugs and other biomolecules. Moreover, other functional motifs, i.e. receptors, receptor binding sequences, peptides and proteins can be expressed. This study focuses on the development of genetically modified HBc particles to specifically recognise and target human epidermal growth factor receptor-2 (HER2)-expressing cancer cells, in vitro and in vivo, for future cancer therapy. The non-specific binding capacity of wild type HBc particles was reduced by genetic deletion of the sequence encoding arginine-rich domains. A specific HER2-targeting was achieved by expressing the ZHER2 affibodies on the HBc particles surface. In vitro studies showed specific uptake of ZHER2-ΔHBc particles in HER2 expressing cancer cells. In vivo studies confirmed positive uptake of ZHER2-ΔHBc particles in HER2-expressing tumours, compared to non-targeted ΔHBc particles in intraperitoneal tumour-bearing mice models. The present results highlight the potential of these nanocarriers in targeting HER2-positive metastatic abdominal cancer following intra-peritoneal administration.



http://ift.tt/2j85I56

Disparities in hospitalization outcomes among African-American and White prostate cancer patients

S18777821.gif

Publication date: February 2017
Source:Cancer Epidemiology, Volume 46
Author(s): Gurudatta Naik, Tomi Akinyemiju
ObjectivesThis paper aims to determine whether racial disparities exist in hospitalization outcomes among African-American and White hospitalized prostate cancer patients in the United States. We evaluated racial differences among matched groups of patients in post-operative complications, hospital length of stay and in-hospital mortality.MethodsWe identified a total of 183,856 men aged 40 years and older with a primary diagnosis of prostate cancer, of which 58,701 underwent prostatectomy, through the Nationwide Inpatient Sample, and matched all African-American patients with White patients on: 1) Demographics, 2) Demographics+Clinical presentation and 3) Demographics+Clinical presentation+Treatment. Multivariable regression analyses were conducted in SAS and estimates were reported with 95% confidence intervals.ResultsAfrican-American patients were more likely to be admitted with metastatic disease (24.8%) compared with White patients matched on demographics (17.9%), and demographics+presentation (23.6%). However, 23.9% of African-American patients received surgery compared with 38.2% and 34.2% of Whites matched on demographics and demographics+presentation, respectively. White patients had lower in-hospital mortality compared with African-American patients matched on demographics (OR: 0.72, 95% CI: 0.66-0.79), demographics+presentation (OR: 0.88, 95% CI: 0.81-0.96), but was no longer significantly lower when matched on demographics, presentation and treatment (OR: 0.92, 95% CI: 0.85–1.00).ConclusionThere were significant racial differences in outcomes among prostate cancer patients within the inpatient setting, even after accounting for demographic and presentation differences.



http://ift.tt/2iAbkUF

Piecewise-linear criterion functions in oblique survival tree induction

S09333657.gif

Publication date: Available online 3 January 2017
Source:Artificial Intelligence in Medicine
Author(s): Malgorzata Kretowska
ObjectiveRecursive partitioning is a common, assumption-free method of survival data analysis. It focuses mainly on univariate trees, which use splits based on a single variable in each internal node. In this paper, I provide an extension of an oblique survival tree induction technique, in which axis-parallel splits are replaced by hyperplanes, dividing the feature space into areas with a homogeneous survival experience.Method and materialsThe proposed tree induction algorithm consists of two steps. The first covers the induction of a large tree with internal nodes represented by hyperplanes, whose positions are calculated by the minimization of a piecewise-linear criterion function, the dipolar criterion. The other phase uses a split-complexity algorithm to prune unnecessary tree branches and a 10-fold cross-validation technique to choose the best tree. The terminal nodes of the final tree are characterised by Kaplan–Meier survival functions. A synthetic data set was used to test the performance, while seven real data sets were exploited to validate the proposed method.ResultsThe evaluation of the method was focused on two features: predictive ability and tree size. These were compared with two univariate tree models: the conditional inference tree and recursive partitioning for survival trees, respectively. The comparison of the predictive ability, expressed as an integrated Brier score, showed no statistically significant differences (p=0.486) among the three methods. Similar results were obtained for the tree size (p=0.11), which was calculated as a median value over 20 runs of a 10-fold cross-validation.ConclusionsThe predictive ability of trees generated using piecewise-linear criterion functions is comparable to that of univariate tree-based models. Although a similar conclusion may be drawn from the analysis of the tree size, in the majority of the studied cases, the number of nodes of the dipolar tree is one of the smallest among all the methods.



http://ift.tt/2iDuBm4

Proton beam therapy for olfactory neuroblastoma

S01678140.gif

Publication date: Available online 3 January 2017
Source:Radiotherapy and Oncology
Author(s): Naoki Nakamura, Sadamoto Zenda, Makoto Tahara, Susumu Okano, Ryuichi Hayashi, Hidehiro Hojo, Kenji Hotta, Satoe Kito, Atsushi Motegi, Satoko Arahira, Hidenobu Tachibana, Tetsuo Akimoto
PurposeTo clarify the efficacy and feasibility of proton beam therapy (PBT) for olfactory neuroblastoma (ONB).Methods and materialsWe retrospectively reviewed 42 consecutive patients who received PBT with curative intent for ONB at National Cancer Center Hospital East from November 1999 to March 2012.ResultsFive patients (12%) had Kadish A disease, nine (21%) had Kadish B, and twenty-eight (67%) had Kadish C. All patients except one received a total dose of 65Gy (relative biological effectiveness: RBE) in 26 fractions. Twenty-four patients (57%) received induction and/or concurrent chemotherapy. The median follow-up for all eligible patients was 69months (7–186). The 5-year overall survival (OS) and progression-free survival (PFS) rates were 100% and 80% for Kadish A, 86 and 65% for Kadish B, and 76% and 39% for Kadish C, respectively. The sites of the first progression were local in six patients (30%), regional in eight (40%), distant in two (10%), local and regional in two (10%), and local and distant in two (10%). Late adverse events of grade 3–4 were seen in six patients (ipsilateral visual impairment, 3; bilateral visual impairment, 1; liquorrhea, 1; cataract, 1).ConclusionPBT was a safe and effective modality for ONB.



http://ift.tt/2izNlF0

Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial

S01678140.gif

Publication date: Available online 3 January 2017
Source:Radiotherapy and Oncology
Author(s): Leen Paelinck, Akos Gulyban, Ferenc Lakosi, Tom Vercauteren, Werner De Gersem, Bruno Speleers, Christel Monten, Thomas Mulliez, Patrick Berkovic, Annick van Greveling, Frederik Decoster, Philippe Coucke, Wilfried De Neve, Liv Veldeman
Background and purposeThe safety of a simultaneous integrated boost (SIB) in combination with prone hypofractionated whole-breast irradiation (WBI) was investigated.Materials and methods167 patients were randomized between WBI with a sequential boost (SeB) or SIB. All patients were treated in prone position to 40.05Gy in 15 fractions to the whole breast. In the control arm, a SeB of 10Gy in 4 fractions (negative surgical margins) or 14.88Gy in 6 fractions (transsection) was prescribed. In the experimental arm a SIB of 46.8 or 49.95Gy (negative and positive surgical margins, respectively) was prescribed.ResultsPatient age was the only significantly different parameter between treatment arms with patients in the SIB arm being slightly older. In both arms, 6/83 patients developed moist desquamation. Grade 2/3 dermatitis was significantly more frequent in the SeB arm (38/83vs 24/83 patients, p=0.037). In the SIB and SeB arm, respectively, 36 patients (43%) and 51 patients (61%) developed pruritus (p=0.015). The incidence of oedema was lower in the SIB arm (59vs 68 patients), but not statistically significant (p=0.071).ConclusionsThe primary endpoint, moist desquamation, was not significantly different between treatment arms.



http://ift.tt/2hQchUx

Plural Pleural Problems

alertIcon.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): David A. Palma




http://ift.tt/2iP7xQV

In Regard to Arthurs et al

alertIcon.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): Pierre Blanchard, Adam S. Garden




http://ift.tt/2hQZxSw

Induction Chemotherapy with Surgery and Post-operative Radiation Therapy

alertIcon.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): Daniel Gomez




http://ift.tt/2iPfeGK

18F-Fluorodeoxyglucose/Positron Emission Tomography Predicts Patterns of Failure After Definitive Chemoradiation Therapy for Locally Advanced Non-Small Cell Lung Cancer

1-s2.0-S0360301616X00181-cov150h.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): Nitin Ohri, William R. Bodner, Balazs Halmos, Haiying Cheng, Roman Perez-Soler, Steven M. Keller, Shalom Kalnicki, Madhur Garg
BackgroundWe previously reported that pretreatment positron emission tomography (PET) identifies lesions at high risk for progression after concurrent chemoradiation therapy (CRT) for locally advanced non-small cell lung cancer (NSCLC). Here we validate those findings and generate tumor control probability (TCP) models.MethodsWe identified patients treated with definitive, concurrent CRT for locally advanced NSCLC who underwent staging 18F-fluorodeoxyglucose/PET/computed tomography. Visible hypermetabolic lesions (primary tumors and lymph nodes) were delineated on each patient's pretreatment PET scan. Posttreatment imaging was reviewed to identify locations of disease progression. Competing risks analyses were performed to examine metabolic tumor volume (MTV) and radiation therapy dose as predictors of local disease progression. TCP modeling was performed to describe the likelihood of local disease control as a function of lesion size.ResultsEighty-nine patients with 259 hypermetabolic lesions (83 primary tumors and 176 regional lymph nodes) met the inclusion criteria. Twenty-eight patients were included in our previous report, and the remaining 61 constituted our validation cohort. The median follow-up time was 22.7 months for living patients. In 20 patients, the first site of progression was a primary tumor or lymph node treated with radiation therapy. The median time to progression for those patients was 11.5 months. Data from our validation cohort confirmed that lesion MTV predicts local progression, with a 30-month cumulative incidence rate of 23% for lesions above 25 cc compared with 4% for lesions below 25 cc (P=.008). We found no evidence that radiation therapy dose was associated with local progression risk. TCP modeling yielded predicted 30-month local control rates of 98% for a 1-cc lesion, 94% for a 10-cc lesion, and 74% for a 50-cc lesion.ConclusionPretreatment FDG-PET identifies lesions at risk for progression after CRT for locally advanced NSCLC. Strategies to improve local control should be tested on high-risk lesions, and treatment deintensification for low-risk lesions should be explored.



http://ift.tt/2hQPNrk

Pre-operative Radiation Therapy with Surgery

alertIcon.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): B.C. John Cho




http://ift.tt/2iP8Tel

In Regard to Lee et al

alertIcon.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): Puneet Pareek




http://ift.tt/2hR08U8

Remember Pleurodesis!

alertIcon.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): Tom Treasure




http://ift.tt/2iPbSDF

Role of Stereotactic Body Radiotherapy Prior to Orthotopic Liver Transplantation: Retrospective Evaluation of Pathologic Response and Outcomes

alertIcon.gif

Publication date: Available online 4 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): E.M. Mannina, H.R. Cardenes, F.D. Lasley, B. Goodman, J. Zook, S. Althouse, J.A. Cox, R. Saxena, J. Tector, M. Maluccio
IntroductionStereotactic body radiotherapy (SBRT) applied to early stage, localized hepatocellular carcinoma in our institutional Phase I-II trial showed acceptable toxicities and exceptional local control. The results of SBRT in patients who underwent definitive orthotopic liver transplantation (OLT) was analyzed herein.Materials & MethodsThe subjects of this retrospective report are 38 patients diagnosed with hepatocellular carcinoma who underwent SBRT per institutional Phase I-II eligibility criteria, prior to definitive OLT. Pre-OLT radiographs were compared with pathologic gold standard. Analysis of treatment failures and deaths was undertaken.ResultsWith median follow-up of 4.8 years from OLT, 9/38 patients (24%) recurred while 10/38 patients (26%) died. Kaplan-Meier estimates of 3-year overall survival (OS) and disease-free survival (DFS) are 77 and 74%, respectively. Sum longest dimension of tumors was significantly associated with DFS (HR 1.93, p=0.026). Pathologic response rate (complete + partial response) was 68%. Radiographic scoring criteria performed poorly; mRECIST produced highest concordance (kappa=0.224). Explants revealed viable tumor in 74% of evaluable patients. Treatment failures had statistically larger sum longest dimension of tumors (4.0 cm vs 2.8 cm, p=0.014) and non-statistically significant higher rates of lymphovascular space invasion (44% vs. 17%), cT2 disease (44% vs 21%), ≥ pT2 disease (67% vs 34%), multifocal tumors at time of SBRT (44% vs 21%) and less robust mean AFP response (-25 IU/mL vs -162 IU/mL).ConclusionsSBRT prior to OLT is a well-tolerated treatment providing 68% pathologic response though 74% of explants ultimately contained viable tumor. Radiographic response criteria poorly approximate pathology. Our data suggest further stratification of patients based on initial disease burden and treatment response.



http://ift.tt/2hQQFMW

Humbling Advances in Technology: Protons, Brainstem Necrosis, and the Self-Driving Car

alertIcon.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): Shannon M. MacDonald, Nadia N. Laack, Stephanie Terezakis




http://ift.tt/2iPbUeL

Issue Highlights

alertIcon.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2





http://ift.tt/2hQYOk9

The Red Beam: Past, Present, and Future of Radiation Oncology in Russia

alertIcon.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): Anna Likhacheva, Timur Mitin, Evgeni Khmelevsky




http://ift.tt/2iPaHnR

Supply and Demand for Radiation Oncology in the United States: A Resident Perspective

alertIcon.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): Lindsay M. Burt, Daniel M. Trifiletti, Nima Nabavizadeh, Leah M. Katz, Zachary S. Morris, Trevor J. Royce




http://ift.tt/2hQQDVk

Clinical Implementation of Dual-energy CT for Proton Treatment Planning on Pseudo-monoenergetic CT scans

grey_pxl.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): Patrick Wohlfahrt, Christian Möhler, Volker Hietschold, Stefan Menkel, Steffen Greilich, Mechthild Krause, Michael Baumann, Wolfgang Enghardt, Christian Richter
PurposeTo determine whether a standardized clinical application of dual-energy computed tomography (DECT) for proton treatment planning based on pseudomonoenergetic CT scans (MonoCTs) is feasible and increases the precision of proton therapy in comparison with single-energy CT (SECT).Methods and MaterialsTo define an optimized DECT protocol, CT scan settings were analyzed experimentally concerning beam hardening, image quality, and influence on the heuristic conversion of CT numbers into stopping-power ratios (SPRs) and were compared with SECT scans with identical CT dose. Differences in range prediction and dose distribution between SECT and MonoCT were quantified for phantoms and a patient.ResultsDose distributions planned on SECT and MonoCT datasets revealed mean range deviations of 0.3 mm, γ passing rates (1%, 1 mm) greater than 99.9%, and no clinically relevant changes in dose-volume histograms. However, image noise and CT-related uncertainties could be reduced by MonoCT compared with SECT, which resulted in a slightly decreased dependence of SPR prediction on beam hardening. Consequently, DECT was clinically implemented at the University Proton Therapy Dresden in 2015. Until October 2016, 150 patients were treated based on MonoCTs, and more than 950 DECT scans of 351 patients were acquired during radiation therapy.ConclusionsA standardized clinical use of MonoCT for treatment planning is feasible, leads to improved image quality and SPR prediction, extends diagnostic variety, and enables a stepwise clinical implementation of DECT toward a physics-based, patient-specific, nonheuristic SPR determination. Further reductions of CT-related uncertainties, as expected from such SPR approaches, can be evaluated on the resulting DECT patient database.



http://ift.tt/2iP9sF0

In Regard to Pisansky et al

alertIcon.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): Pirus Ghadjar, Stefanie Hayoz, Daniel R. Zwahlen, George N. Thalmann, Daniel M. Aebersold




http://ift.tt/2iPi8eE

Analysis of the Factors Contributing to Vertebral Compression Fractures After Spine Stereotactic Radiosurgery

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): David Boyce-Fappiano, Erinma Elibe, Lonni Schultz, Samuel Ryu, M. Salim Siddiqui, Indrin Chetty, Ian Lee, Jack Rock, Benjamin Movsas, Farzan Siddiqui
PurposeTo determine our institutional vertebral compression fracture (VCF) rate after spine stereotactic radiosurgery (SRS) and determine contributory factors.Methods and MaterialsRetrospective analysis from 2001 to 2013 at a single institution was performed. With institutional review board approval, electronic medical records of 1905 vertebral bodies from 791 patients who were treated with SRS for the management of primary or metastatic spinal lesions were reviewed. A total of 448 patients (1070 vertebral bodies) with adequate follow-up imaging studies available were analyzed. Doses ranging from 10 Gy in 1 fraction to 60 Gy in 5 fractions were delivered. Computed tomography and magnetic resonance imaging were used to evaluate the primary endpoints of this study: development of a new VCF, progression of an existing VCF, and requirement of stabilization surgery after SRS.ResultsA total of 127 VCFs (11.9%; 95% confidence interval [CI] 9.5%-14.2%) in 97 patients were potentially SRS induced: 46 (36%) were de novo, 44 (35%) VCFs progressed, and 37 (29%) required stabilization surgery after SRS. Our rate for radiologic VCF development/progression (excluding patients who underwent surgery) was 8.4%. Upon further exclusion of patients with hematologic malignancies the VCF rate was 7.6%. In the univariate analyses, females (hazard ratio [HR] 1.54, 95% CI 1.01-2.33, P=.04), prior VCF (HR 1.99, 95% CI 1.30-3.06, P=.001), primary hematologic malignancies (HR 2.68, 95% CI 1.68-4.28, P<.001), thoracic spine lesions (HR 1.46, 95% CI 1.02-2.10, P=.02), and lytic lesions had a significantly increased risk for VCF after SRS. On multivariate analyses, prior VCF and lesion type remained contributory.ConclusionsSingle-fraction SRS doses of 16 to 18 Gy to the spine seem to be associated with a low rate of VCFs. To the best of our knowledge, this is the largest reported experience analyzing SRS-induced VCFs, with one of the lowest event rates reported.



http://ift.tt/2hR086A

Meetings

alertIcon.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2





http://ift.tt/2iPmGl5

Multi-institutional Nomogram Predicting Survival Free From Salvage Whole Brain Radiation After Radiosurgery in Patients With Brain Metastases

alertIcon.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): Daniel Gorovets, Diandra Ayala-Peacock, David J. Tybor, Paul Rava, Daniel Ebner, Deus Cielo, Georg Norén, David E. Wazer, Michael Chan, Jaroslaw T. Hepel
PurposeOptimal patient selection for stereotactic radiosurgery (SRS) as the initial treatment for brain metastases is complicated and controversial. This study aimed to develop a nomogram that predicts survival without salvage whole brain radiation therapy (WBRT) after upfront SRS.Methods and MaterialsMulti-institutional data were analyzed from 895 patients with 2095 lesions treated with SRS without prior or planned WBRT. Cox proportional hazards regression model was used to identify independent pre-SRS predictors of WBRT-free survival, which were integrated to build a nomogram that was subjected to bootstrap validation.ResultsMedian WBRT-free survival was 8 months (range, 0.1-139 months). Significant independent predictors for inferior WBRT-free survival were age (hazard ratio [HR] 1.1 for each 10-year increase), HER2(−) breast cancer (HR 1.6 relative to other histologic features), colorectal cancer (HR 1.4 relative to other histologic features), increasing number of brain metastases (HR 1.09, 1.32, 1.37, and 1.87 for 2, 3, 4, and 5+ lesions, respectively), presence of neurologic symptoms (HR 1.26), progressive systemic disease (HR 1.35), and increasing extracranial disease burden (HR 1.31 for oligometastatic and HR 1.56 for widespread). Additionally, HER2(+) breast cancer (HR 0.81) and melanoma (HR 1.11) trended toward significance. The independently weighted hazard ratios were used to create a nomogram to display estimated probabilities of 6-month and 12-month WBRT-free survival with a corrected Harrell's C concordance statistic of 0.62.ConclusionsOur nomogram can be used at initial evaluation to help select patients best suited for upfront SRS for brain metastases while reducing expense and morbidity in patients who derive minimal or no benefit.



http://ift.tt/2j4ipcT

Radiation Dose–Dependent Hippocampal Atrophy Detected With Longitudinal Volumetric Magnetic Resonance Imaging

alertIcon.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): Tyler M. Seibert, Roshan Karunamuni, Hauke Bartsch, Samar Kaifi, Anitha Priya Krishnan, Yoseph Dalia, Jeffrey Burkeen, Vyacheslav Murzin, Vitali Moiseenko, Joshua Kuperman, Nathan S. White, James B. Brewer, Nikdokht Farid, Carrie R. McDonald, Jona A. Hattangadi-Gluth
PurposeAfter radiation therapy (RT) to the brain, patients often experience memory impairment, which may be partially mediated by damage to the hippocampus. Hippocampal sparing in RT planning is the subject of recent and ongoing clinical trials. Calculating appropriate hippocampal dose constraints would be improved by efficient in vivo measurements of hippocampal damage. In this study we sought to determine whether brain RT was associated with dose-dependent hippocampal atrophy.Methods and MaterialsHippocampal volume was measured with magnetic resonance imaging (MRI) in 52 patients who underwent fractionated, partial brain RT for primary brain tumors. Study patients had high-resolution, 3-dimensional volumetric MRI before and 1 year after RT. Images were processed using software with clearance from the US Food and Drug Administration and Conformité Européene marking for automated measurement of hippocampal volume. Automated results were inspected visually for accuracy. Tumor and surgical changes were censored. Mean hippocampal dose was tested for correlation with hippocampal atrophy 1 year after RT. Average hippocampal volume change was also calculated for hippocampi receiving high (>40 Gy) or low (<10 Gy) mean RT dose. A multivariate analysis was conducted with linear mixed-effects modeling to evaluate other potential predictors of hippocampal volume change, including patient (random effect), age, hemisphere, sex, seizure history, and baseline volume. Statistical significance was evaluated at α = 0.05.ResultsMean hippocampal dose was significantly correlated with hippocampal volume loss (r=−0.24, P=.03). Mean hippocampal volume was significantly reduced 1 year after high-dose RT (mean −6%, P=.009) but not after low-dose RT. In multivariate analysis, both RT dose and patient age were significant predictors of hippocampal atrophy (P<.01).ConclusionsThe hippocampus demonstrates radiation dose–dependent atrophy after treatment for brain tumors. Quantitative MRI is a noninvasive imaging technique capable of measuring radiation effects on intracranial structures. This technique could be investigated as a potential biomarker for development of reliable dose constraints for improved cognitive outcomes.



http://ift.tt/2iHYdRJ

Ku70, Ku80, and sClusterin: A Cluster of Predicting Factors for Response to Neoadjuvant Chemoradiation Therapy in Patients With Locally Advanced Rectal Cancer

1-s2.0-S0360301616X00181-cov150h.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): Sabina Pucci, Chiara Polidoro, Alessandro Joubert, Francesca Mastrangeli, Barbara Tolu, Michaela Benassi, Valeria Fiaschetti, Laura Greco, Roberto Miceli, Roberto Floris, Giuseppe Novelli, Augusto Orlandi, Riccardo Santoni
PurposeThe identification of predictive biomarkers for neoadjuvant chemoradiation therapy (CRT) is a current clinical need. The heterodimer Ku70/80 plays a critical role in DNA repair and cell death induction after damage. The aberrant expression and localization of these proteins fail to control DNA repair and apoptosis. sClusterin is the Ku70 partner that sterically inhibits Bax-dependent cell death after damage in some pathologic conditions. This study sought to evaluate the molecular relevance of Ku70-Ku80-Clu as a molecular cluster predicting the response to neoadjuvant CRT in patients with locally advanced rectal cancer (LARC).Methods and MaterialsPatients enrolled in this study underwent preoperative CRT followed by surgical excision. A retrospective study based on individual response, evaluated by computed tomography and diffusion-weighted magnetic resonance imaging, identified responder (56%) and no-responder patients (44%). Ku70/80 and Clu expression were observed in biopsy specimens obtained before and after treatment with neoadjuvant CRT from the same LARC patients. In vitro studies before and after irradiation were also performed on radioresistant (SW480) and radiosensitive (SW620) colorectal cancer cell lines, mimicking sensitive or resistant tumor behavior.ResultsWe found a conventional nuclear localization of Ku70/80 in pretherapeutic tumor biopsies of responder patients, in agreement with their role in DNA repair and regulating apoptosis. By contrast, in the no-responder population we observed an unconventional overexpression of Ku70 in the cytoplasm (P<.001). In this context we also overexpression of sClu in the cytoplasm, which accorded with its role in stabilizing of Bax-Ku70 complex, inhibiting Bax-dependent apoptosis. Strikingly, Ku80 in these tumor tissues was lost (P<.005). In vitro testing of colon cancer cells finally confirmed the results observed in tumor biopsy specimens, proving that Ku70/80-Clu deregulation is extensively involved in the resistance mechanism.ConclusionThese results strongly suggest a potential role of these proteins as a new prognostic tool to predict the response to chemoradiation in LARC.



http://ift.tt/2j4reDJ

Cerebrovascular Diseases in Childhood Cancer Survivors: Role of the Radiation Dose to Willis Circle Arteries

1-s2.0-S0360301616X00181-cov150h.gif

Publication date: 1 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 2
Author(s): Chiraz El-Fayech, Nadia Haddy, Rodrigue Sètchéou Allodji, Cristina Veres, Fara Diop, Amar Kahlouche, Damien Llanas, Angela Jackson, Carole Rubino, Catherine Guibout, Hélène Pacquement, Odile Oberlin, Cécile Thomas-Teinturier, Pierre-Yves Scarabin, Jean Chavaudra, Dimitry Lefkopoulos, Maurice Giroud, Yannick Bejot, Valérie Bernier, Christian Carrie, Ibrahima Diallo, Florent de Vathaire
Background and PurposeThe aim of this study was to investigate the role of radiation dose received to the circle of Willis (WC) during radiation therapy (RT) and of potential dose-response modifiers on the risk of stroke after treatment of childhood cancer.MethodsWe evaluated the risk factors for stroke in a cohort of 3172 5-year survivors of childhood cancer who were followed up for a median time of 26 years. Radiation doses to the WC and brain structures were estimated for each of the 2202 children who received RT.ResultsFifty-four patients experienced a confirmed stroke; 39 were ischemic. Patients not receiving RT had a stroke risk similar to that of the general population, whereas those who received RT had an 8.5-fold increased risk (95% confidence interval [CI]: 6.3-11.0). The excess of incidence of stroke increased yearly. The dose of radiation to the WC, rather than to other brain structures, was found to be the best predictor of stroke. The relative risk was 15.7 (95% CI: 4.9-50.2) for doses of 40 Gy or more. At 45 years of age, the cumulative stroke incidence was 11.3% (95% CI: 7.1%-17.7%) in patients who received 10 Gy or more to the WC, compared with 1% expected from general population data. Radiation doses received to the heart and neck also increased the risk. Surgery for childhood brain cancer was linked to hemorrhagic strokes in these patients.ConclusionThe WC should be considered as a major organ at risk during RT for childhood brain cancers. The incidence of radiation-induced ischemic stroke strongly increases with long-term follow-up.



http://ift.tt/2iI0Rqt

A comprehensive analysis and immunobiology of autoimmune neurological syndromes during the Zika virus outbreak in Cúcuta, Colombia

Publication date: Available online 3 January 2017
Source:Journal of Autoimmunity
Author(s): Juan-Manuel Anaya, Yhojan Rodríguez, Diana M. Monsalve, Daniel Vega, Ernesto Ojeda, Diana González-Bravo, Mónica Rodríguez-Jiménez, Carlos A. Pinto-Díaz, Pablo Chaparro, María L. Gunturiz, Aftab A. Ansari, M. Eric Gershwin, Nicolás Molano-González, Carolina Ramírez-Santana, Yeny Acosta-Ampudia
We have focused on the epidemiology and immunobiology of Zika virus (ZIKV) infection and factors associated with the development of Guillain-Barré syndrome (GBS) and other neurological syndromes in Cúcuta, the capital of North Santander department, Colombia. Data of patients with ZIKV disease reported to the national population-based surveillance system were used to calculate the basic reproduction number (R0) and the attack rates (ARs) as well as to develop epidemiological maps. Patients with neurological syndromes were contacted and their diagnoses were confirmed. A case-control study in which 29 patients with GBS associated with ZIKV compared with 74-matched control patients with ZIKV infection alone was undertaken. Antibodies against arboviruses and other infections that may trigger GBS were evaluated. The estimated value of R0 ranged between 2.68 (95% CI 2.54–2.67) to 4.57 (95% CI 4.18–5.01). The sex-specific ARs were 1306 per 100,000 females, and 552 per 100,000 males. A non-linear interaction between age and gender on the ARs was observed. The incidence of GBS in Cúcuta increased 4.41 times secondary to ZIKV infection. The lag time between ZIKV infection and neurological symptoms was 7 days (interquartile range 2–14.5). Patients with GBS appeared to represent a lower socioeconomic status and were living near to environmentally contaminated areas. All GBS patients were positive for IgG antibodies against both ZIKV and Dengue virus, and 69% were positive for Chikungunya virus. Noteworthy, GBS was associated with a previous infection with M. pneumoniae (OR: 3.95; 95% CI 1.44–13.01; p = 0.006). No differences in antibody levels against C. jejuni, Epstein-Barr virus and cytomegalovirus were observed. High rates of cranial nerves involvement and dysautonomia were present in 82% and 75.9%, respectively. Intensive care unit (ICU) admission was necessary in 69% of the GBS patients. Most of the patients disclosed a high disability condition (Hughes grade 4). Dysautonomia was the main risk factor of poor GBS prognosis (i.e., ICU admission and disability). Thirteen patients were diagnosed with other neurological syndromes different to GBS (6 with transverse myelitis, 3 with encephalitis, 3 with peripheral facial palsy and one with thoraco-lumbosacral myelopathy). Our data confirm an increased transmission of ZIKV in Cúcuta, and provide support to the view that severe neurological syndromes are related to ZIKV disease. The complex ways by which previous infections and socioeconomic status interact to increase the risk of GBS in people infected by ZIKV should be further investigated.



http://ift.tt/2iP2fVG

Masthead

Publication date: December 2016
Source:Seminars in Oncology, Volume 43, Issue 6





http://ift.tt/2hQaiQp

Modeling Adherence to Preventive Swallowing Exercises in Head and Neck Cancer

Conditions:   Malignant Neoplasms of Lip Oral Cavity and Pharynx;   Head and Neck Cancer
Interventions:   Behavioral: Questionnaire;   Procedure: Blood Draw
Sponsors:   M.D. Anderson Cancer Center;   National Institute of Dental and Craniofacial Research (NIDCR)
Recruiting - verified January 2017

http://ift.tt/2iHVpUz

Editorial Board

Publication date: December 2016
Source:Seminars in Oncology, Volume 43, Issue 6





http://ift.tt/2iA8oHA

High-activity Natural Killer Immunotherapy for Small Metastases of Nasopharyngeal Cancer

Condition:   Metastatic Nasopharyngeal Cancer
Intervention:   Biological: High-activity natural killer
Sponsors:   Fuda Cancer Hospital, Guangzhou;   Shenzhen Hank Bioengineering Institute
Recruiting - verified December 2016

http://ift.tt/2iOZgfP

Table of Contents

Publication date: December 2016
Source:Seminars in Oncology, Volume 43, Issue 6





http://ift.tt/2hQiArs

Olaparib and Ramucirumab in Treating Patients With Metastatic or Locally Recurrent Gastric or Gastroesophageal Junction Cancer That Cannot Be Removed by Surgery

Conditions:   Adenocarcinoma of the Gastroesophageal Junction;   Metastatic Malignant Neoplasm in the Lymph Nodes;   Recurrent Gastric Carcinoma;   Stage IV Gastric Cancer
Interventions:   Other: Laboratory Biomarker Analysis;   Drug: Olaparib;   Other: Quality-of-Life Assessment;   Biological: Ramucirumab
Sponsor:   National Cancer Institute (NCI)
Not yet recruiting - verified December 2016

http://ift.tt/2hQJt3l

outside front cover

Publication date: December 2016
Source:Seminars in Oncology, Volume 43, Issue 6





http://ift.tt/2izYaH8

High-activity Natural Killer Immunotherapy for Small Metastases of Tongue Cancer

Condition:   Tongue Cancer
Intervention:   Biological: High-activity natural killer
Sponsors:   Fuda Cancer Hospital, Guangzhou;   Shenzhen Hank Bioengineering Institute
Recruiting - verified December 2016

http://ift.tt/2iP0nw8

Relationship of Metabolic Syndrome and Its Components With Thyroid Nodule(s)

Conditions:   Metabolic Syndrome;   Thyroid Nodule
Intervention:  
Sponsor:   Lin Liao
Not yet recruiting - verified December 2016

http://ift.tt/2hQOXLv

Effect of FDG-PET/CT for Simulation and Radiation Treatment Planning in Oral Cancer Patients

Conditions:   Oral Cancer;   Radiotherapy; Complications
Intervention:   Device: PET/CT
Sponsor:   Zhongnan Hospital
Not yet recruiting - verified December 2016

http://ift.tt/2iP3rIv

A Prospective Controlled Treatment Trial for Post-Traumatic Headaches

Condition:   Post-Traumatic Headaches
Interventions:   Drug: Amitriptyline;   Procedure: Occipital Nerve Block and Cervical Medial Branch Blocks;   Other: Placebo
Sponsors:   Boston Children's Hospital;   Beth Israel Deaconess Medical Center;   Harvard University
Not yet recruiting - verified December 2016

http://ift.tt/2hQLcFK

Diffuse angiomatosis with severe facial disfigurement



http://ift.tt/2hQKWGK

Acantholytic dermatosis of the vagina: the diagnostic challenge of acantholytic disease in the genital region

Summary

We report the case of a 24-year-old woman with an 8-month history of deep pelvic pain and postcoital bleeding. Examination revealed desquamation of the vaginal epithelium with tender fissured plaques in the vagina, initially thought to be vaginal intraepithelial neoplasia. Histology showed squamous mucosa with suprabasal acantholysis and hyperkeratosis, and no evidence of viral infection, dysplasia or malignancy. These findings were consistent with acantholytic dermatosis (AD), a rare lesion that resembles Hailey–Hailey and Darier disease histopathologically, but can be distinguished on a clinical basis. Vulval cases of AD are well recognized, but to our knowledge, this is the first reported case involving the vaginal epithelium alone.



http://ift.tt/2iOJp0C

Nodular Lymphocyte Predominant Hodgkin Lymphoma of the Thyroid.

Related Articles

Nodular Lymphocyte Predominant Hodgkin Lymphoma of the Thyroid.

Case Rep Endocrinol. 2016;2016:8756723

Authors: Tavares Bello C, Cassis J, Simões H, Sequeira Duarte J

Abstract
Thyroid lymphomas are rare clinical entities that may result from either the primary intrathyroid de novo or secondary thyroid gland involvement of a lymphoma. Among these, the Hodgkin's subtype is quite uncommon, accounting for 0.6-5% of all thyroid malignancies. The authors report on a 76-year-old female presenting with a thyroid nodule that, upon surgical excision, was found to be a nodular lymphocyte predominant Hodgkin lymphoma of the thyroid. So far, thyroid involvement by this variant has never been reported. Upon reporting on this clinical case, the authors emphasize the difficulties usually found in establishing the diagnosis and in defining the best management strategy. A thorough review of the available literature is done.

PMID: 28044111 [PubMed]



http://ift.tt/2j3SHoX

Unusual Cushing's Syndrome and Hypercalcitoninaemia due to a Small Cell Prostate Carcinoma.

Related Articles

Unusual Cushing's Syndrome and Hypercalcitoninaemia due to a Small Cell Prostate Carcinoma.

Case Rep Endocrinol. 2016;2016:6308058

Authors: Balestrieri A, Magnani E, Nuzzo F

Abstract
A 75-year-old man was hospitalized because of severe hypokalaemia due to ACTH dependent Cushing's syndrome. Total body computed tomography (TBCT) and 68 Gallium DOTATATE PET/CT localized a voluminous prostate tumour. A subsequent transurethral prostate biopsy documented a small cell carcinoma positive for ACTH and calcitonin and negative for prostatic specific antigen (PSA) at immunocytochemical study; serum prostatic specific antigen (PSA) was normal. Despite medical treatments, Cushing's syndrome was not controlled and the patient's clinical condition progressively worsened. Surgical resection was excluded; the patient underwent a cycle of chemotherapy followed by febrile neutropenia and fatal intestinal perforation. This case report describes a rare case of Cushing's syndrome and hypercalcitoninaemia due to a small cell carcinoma of the prostate, a rare tumour with very few therapeutic options and negative prognosis.

PMID: 28044110 [PubMed]



http://ift.tt/2j8EfjI

A 33-Year-Old Man with Gynaecomastia and Galactorrhea as the First Symptoms of Graves Hyperthyroidism.

Related Articles

A 33-Year-Old Man with Gynaecomastia and Galactorrhea as the First Symptoms of Graves Hyperthyroidism.

Case Rep Endocrinol. 2016;2016:1946824

Authors: Khoohaphatthanakul S, Sriwijitkamol A

Abstract
Graves' hyperthyroidism has a various number of well-recognized manifestations. Galactorrhea is a rare manifestation in this disease. We describe a 33-year-old man who presented with the symptoms of hyperthyroidism, gynaecomastia, and galactorrhea for 2 months. Physical examination revealed goitre, gynaecomastia, and galactorrhea, bilaterally. Laboratory investigations demonstrated high free thyroxine with suppressed thyroid-stimulating hormone level together with elevated anti-TSH receptor; therefore, the diagnosis of Graves' disease was confirmed. Other investigations to elucidate the etiology of galactorrhea were normal, so the galactorrhea was hypothesized to be caused by Graves' disease. The gynaecomastia and galactorrhea resolved with the successful treatment of hyperthyroidism. Although the galactorrhea is extremely rare in thyrotoxicosis male patients, to the best of our knowledge, this is the third case which reported gynaecomastia and galactorrhea in male patient who presented with thyrotoxicosis.

PMID: 28044109 [PubMed]



http://ift.tt/2iHCrgI

Skin Surface Topography and Texture Analysis of Sun-Exposed Body Sites in View of Sunscreen Application

Background/Aims: To determine the roughness of the surface of human skin at highly sun-exposed anatomical sites in a wide age range in order to derive consequences for sunscreen application. Methods: The forehead, cheek, nose, shoulder, and dorsal hand of 4 age groups (0-9, 20-39, 40-59, and >60 years) were investigated by replica formation, and areal topography was determined by confocal chromatic imaging. The arithmetic mean height as a roughness parameter and the void volume of the surface profile were calculated. Results: Age and site had a significant effect on roughness. Both the dorsal hand and nose exhibited the greatest roughness over the age of 40, and the forehead of the youngest age group exhibited the smallest roughness. Differentiation between sites progressed with age, whereas roughness increased significantly with age for the dorsal hand and nose but not for the other sites. The void volume was smaller than the volume corresponding to the typically recommended amount of sunscreen application except for the cases of largest roughness. Conclusions: Different site-age combinations show significant variation of skin surface roughness. The application of sunscreen may in some instances need to be adjusted to take into account the increased roughness of highly sun-exposed anatomical sites.
Skin Pharmacol Physiol 2016;29:291-299

http://ift.tt/2j8HMyp

In vitro Dermal Absorption of Hydroquinone: Protocol Validation and Applicability on Illegal Skin-Whitening Cosmetics

In Europe, hydroquinone is a forbidden cosmetic ingredient. It is, however, still abundantly used because of its effective skin-whitening properties. The question arises as to whether the quantities of hydroquinone used become systemically available and may cause damage to human health. Dermal absorption studies can provide this information. In the EU, dermal absorption has to be assessed in vitro since the Cosmetic Regulation 1223/2009/EC forbids the use of animals. To obtain human-relevant data, a Franz diffusion cell protocol was validated using human skin. The results obtained were comparable to those from a multicentre validation study. The protocol was applied to hydroquinone and the dermal absorption ranged between 31 and 44%, which is within the range of published in vivo human values. This shows that a well-validated in vitro dermal absorption study using human skin provides relevant human data. The validated protocol was used to determine the dermal absorption of illegal skin-whitening cosmetics containing hydroquinone. All samples gave high dermal absorption values, rendering them all unsafe for human health. These results add to our knowledge of illegal cosmetics on the EU market, namely that they exhibit a negative toxicological profile and are likely to induce health problems.
Skin Pharmacol Physiol 2016;29:300-308

http://ift.tt/2j8QMUk

Axial Traction Magnetic Resonance Imaging (MRI) of the Glenohumeral Joint in Healthy Volunteers: Initial Experience

Publication date: Available online 3 January 2017
Source:Clinical Imaging
Author(s): Elisabeth R. Garwood, Richard B. Souza, Amy Zhang, Alan L. Zhang, C. Benjamin Ma, Thomas M. Link, Daria Motamedi
ObjectiveEvaluate technical feasibility and potential applications of glenohumeral (GH) joint axial traction magnetic resonance imaging (MRI) in healthy volunteers.Materials and MethodsEleven shoulders were imaged in neutral and with 4 kg axial traction at 3 Tesla. Quantitative measurements were assessed.ResultsAxial traction was well tolerated. There was statistically significant widening of the superior GH joint space (p=0.002) and acromial angle (p=0.017) with traction. Inter-rater agreement was high.ConclusionGH joint axial traction MRI is technically feasible and well tolerated in volunteers. Traction of the capsule, widening of the superior GH joint space and acromial angle were observed.



http://ift.tt/2hRXg87

Interventional radiology in the management of thoracic duct injuries: Anatomy, techniques and results

Publication date: Available online 3 January 2017
Source:Clinical Imaging
Author(s): Mohammad Toliyat, Kanwar Singh, Robert C. Sibley, Murthy Chamarthy, Sanjeeva P. Kalva, Anil K. Pillai
Disruption of the thoracic duct can have devastating consequences and be associated with a high morbidity and mortality. Conservative therapies have been attempted to treat chylothorax without much success. Surgical management has traditionally been necessary to provide definitive treatment at the expense of increased morbidity. Lymphatic interventions have recently emerged as a new frontier for interventional radiologists to add value and provide minimally invasive therapies for debilitating conditions. The goal of this manuscript is to review the anatomy of the thoracic duct, describe various percutaneous techniques for accessing the duct, and briefly discuss outcomes as reported in the literature.



http://ift.tt/2iCVKFu

Lavage Redux

alertIcon.gif

Publication date: Available online 3 January 2017
Source:The Journal of Emergency Medicine
Author(s): Ken Kulig, Peter Rosen




http://ift.tt/2j8Auuv

Bilateral Pneumothoraces as a Complication of Endoscopic Retrograde Cholangiopancreatography

alertIcon.gif

Publication date: Available online 3 January 2017
Source:The Journal of Emergency Medicine
Author(s): Douglas E. Rappaport, Joshua J. Solano, Jonathan A. Edlow




http://ift.tt/2j47oID

Purinergic P2X7 receptor mediates acetaldehyde-induced hepatic stellate cells activation via PKC-dependent GSK3β pathway

Publication date: February 2017
Source:International Immunopharmacology, Volume 43
Author(s): Xiaojuan Wu, Yuhui Wang, Sheng Wang, Rixiang Xu, Xiongwen Lv
The activation of hepatic stellate cells (HSCs) is an essential part in the development of alcoholic liver fibrosis (ALF). In this study, stimulated HSCs with 200μM acetaldehyde for 48h was used to imitate alcoholic liver fibrosis in vitro. The western blot and qRT-PCR results showed that P2X7R expression was significantly increased in the activation of HSCs after acetaldehyde treatment. Interestingly, activation of P2X7R by stimulating with P2X7R agonist BzATP significantly promoted acetaldehyde-induced CyclinD1 expression, cell proportion in S phase, inflammatory response, and the protein and mRNA levels of α-SMA, collagen I. In contrast, blockage of P2X7R by stimulating with the inhibitor A438079 or transfecting with specific siRNA dramatically suppressed acetaldehyde-induced HSCs activation. Furthermore, PKC activation treated with PMA could obviously up-regulate the expression of α-SMA and collagen I and the phosphorylation of GSK3β, while inhibition of PKC significantly reduced GSK3β activation. Moreover, GSK3β inhibition harvested a dramatic decrease of the mRNA and protein levels of α-SMA and collagen I by suppressing GSK3β phosphorylation. Taken together, these results suggested that purinergic P2X7R mediated acetaldehyde-induced activation of HSCs via PKC-dependent GSK3β pathway, which maybe a novel target for limiting HSCs activation.

Graphical abstract

image


http://ift.tt/2iOyNPk

Malignant peritoneal mesothelioma, clear cell variant, in a female and its differentiation from clear cell carcinoma

Publication date: Available online 3 January 2017
Source:Pathology - Research and Practice
Author(s): Hiroko Hayashi, Takuya Kawata, Isao Shimokawa
Epithelial type malignant mesothelioma with a clear cell morphology is rare, and no case arising in the peritoneum of a female patient has been reported. Here we report a case of clear cell mesothelioma that developed in the peritoneum of a 61-year-old female. The patient died from massive ascites and respiratory failure 11days after her hospital admission. The autopsy demonstrated marked thickening of the omentum and a yellowish-whitish tumor diffusely covering the abdominal organs. The predominantly solid tumor was characterized microscopically by the growth of atypical cells with an abundant clear cytoplasm. The immunohistochemical study suggested mesothelioma rather than carcinoma. Electron microscopy showed the long and slender villi of the tumor cells, confirming the diagnosis. Primary clear cell carcinoma of the peritoneum, like clear cell mesothelioma, is rare and was also a diagnostic consideration in this patient. The differentiation between these two tumors is discussed herein.



http://ift.tt/2iHzdKp

Tuberous Sclerosis Complex and Polycystic Kidney Disease Contiguous Gene Syndrome with Moyamoya Disease

Publication date: Available online 3 January 2017
Source:Pathology - Research and Practice
Author(s): Jonathan Lai, Lopa Modi, Daryl Ramai, Matthew Tortora
Tuberous sclerosis complex (TSC) and autosomal dominant polycystic kidney disease (ADPKD) are two diseases sharing close genetic loci on chromosome 16. Due to contiguous gene syndrome, also known as contiguous gene deletion syndrome, the proximity of TSC2 and PKD1 genes increases the risk of co-deletion resulting in a shared clinical presentation. Furthermore, Moyamoya disease (MMD) is a rare vaso-occlusive disease in the circle of Willis. We present the first case of TSC2/PKD1 contiguous gene syndrome in a patient with MMD along with detailed histopathologic, radiologic, and cytogenetic analyses. We also highlight the clinical presentation and surgical complications in this case.



http://ift.tt/2j3Q8Dw

Absent in Melanoma 2 proteins in SLE

S15216616.gif

Publication date: Available online 3 January 2017
Source:Clinical Immunology
Author(s): Divaker Choubey, Ravichandran Panchanathan
Type I interferons (IFN-α/β)-inducible PYRIN and HIN domain-containing protein family includes Absent in Melanoma 2 (murine Aim2 and human AIM2), murine p202, and human PYRIN-only protein 3 (POP3). The generation of Aim2-deficient mice indicated that the Aim2 protein is essential for inflammasome activation, resulting in the secretion of interleukin-1β (IL-1β) and IL-18 and cell death by pyroptosis. Further, Aim2-deficiency also increased constitutive expression of the IFN-β and expression of the p202 protein. Notably, an increased expression of p202 protein in female mice associated with the development of systemic lupus erythematosus (SLE). SLE in patients is characterized by a constitutive increase in serum levels of IFN-α and an increase in the expression IFN-stimulated genes. Recent studies indicate that p202 and POP3 proteins inhibit activation of the Aim2/AIM2 inflammasome and promote IFN-β expression. Therefore, we discuss the role of Aim2/AIM2 proteins in the suppression of type I IFNs production and lupus susceptibility.



http://ift.tt/2iOO2bg

Harnessing H-bonds stretches electronics

alertIcon.gif

Publication date: Available online 3 January 2017
Source:Nano Today





http://ift.tt/2hRFSk1

CNT terahertz scanner goes round the bend

alertIcon.gif

Publication date: Available online 3 January 2017
Source:Nano Today





http://ift.tt/2iCEaBA

Gold nanoparticles for regulation of cell function and behavior

Publication date: Available online 3 January 2017
Source:Nano Today
Author(s): Gustavo Bodelón, Celina Costas, Jorge Pérez-Juste, Isabel Pastoriza-Santos, Luis M. Liz-Marzán
The cell possesses the remarkable ability to perceive and process chemical and physical stimuli, which in turn modulate cellular behavior. One of the great wonders about nanotechnology is that it enables the fabrication of tools on the same length scale as biomolecules, thereby providing us with a unique handle for characterizing and controlling basic cellular processes. Owing to their tunable size and shape dependent physical properties, biocompatibility and facile surface modification, gold nanoparticles become potentially powerful tools to probe fundamental aspects of cell biology. Consequently, innovative approaches based on gold nanoparticles are under development toward the manipulation of cell function and improvement of techniques currently used in biomedicine and biotechnology. In this review we provide an overview of recent applications based on gold nanoparticles and nanostructured materials for the modulation of cellular activity and behavior, mediated by their interactions with cell surface receptors.

Graphical abstract

image


http://ift.tt/2hRCPYW

Evaluation of a Web Course on the Basics of Gynecological Laparoscopy in Resident Training

Publication date: Available online 3 January 2017
Source:Journal of Surgical Education
Author(s): Ewa Jokinen, Tomi S. Mikkola, Päivi Härkki
ObjectivesReduction in the number of gynecological operations has made resident training more difficult in gynecological surgery. We used electronic educational material to supplement traditional apprentice model in resident surgical education. Our aim was to evaluate effectiveness of a web-based course in knowledge gaining among residents with various levels of clinical experience.DesignIn prospective interventional study, the level of knowledge was assessed before and after taking the course.SettingAll Finnish residents in obstetrics and gynecology were invited to participate.ParticipantsFifty-eight voluntary residents from all 5 University districts were allocated in 3 groups according to the experience.ResultsFifty-eight residents replied to the precourse questionnaire, and 33 (57%) of them filled in the postcourse questionnaire. Significant knowledge gain was detected in each experience group. In the less experienced group, the mean score (max: 110) increased from 81.9 to 89.3 (p = 0.009), in the middle group from 90.4 to 97.9 (p = 0.003), and in the most experienced group from 94.8 to 100.0 (p = 0.017). The participants rated the usefulness of the course as 4.8 in the Likert scale 1 to 5, and all intended to return to the course.ConclusionsWe found a significant increase in scores in every level of clinical experience. Thus, the course could be used as an educational tool.



http://ift.tt/2hPu7qN

Quality of Life and Psychosocial Implications in Patients with Hidradenitis Suppurativa

Background: Hidradenitis suppurativa (HS) is a long-term skin disorder associated with high levels of psychological distress and significant life impact. Objective: To evaluate the quality of life, depression, anxiety, loneliness, and self-esteem in patients with HS. Methods: Ninety-four patients with HS were enrolled in the study. The quality of life, depression, anxiety, loneliness, and self-esteem of the patients were assessed using the Dermatology Life Quality Index (DLQI), the Hospital Anxiety and Depression Scale (HADS), the UCLA Loneliness Scale (UCLA-Version 3), and the Rosenberg Self-Esteem Scale (RSES), respectively. Results: The DLQI mean score was 11.43 ± 6.61 in patients with HS. The patients with HS presented statistically significantly higher anxiety (6.41 ± 3.31 vs. 5.00 ± 1.59, p p p p = 0.008) than the healthy controls. Conclusions: HS is a distressing, recurrent disease that impairs quality of life. We can suggest services that allow an integrated approach, which includes psychosocial support, offering the patients relief from isolation and an opportunity to share common experiences.
Dermatology

http://ift.tt/2j81Cd0

Unknown Primary Melanoma: Worldwide Survey on Clinical Management

Background: How to deal with melanoma of unknown primary (MUP) origin is a debated topic in the literature. Objective: We performed a worldwide survey to inquire what clinical and investigational workup is performed as well as the physicians' perception of this disease. Methods: A questionnaire was sent via mail to clinicians involved in melanoma care from December 2015 to April 2016 using the International Dermoscopy Society website. Results: 119 physicians from 47 different countries answered the questionnaire. The most reported examination was skin examination followed by CT and/or PET scans. All the participants declared asking about previous excisions of skin lesions with 81% of them asking for a histopathological slide review of previous biopsies. Half of the participants checked for a possible vitiligo phenomenon that may explain regression of the primary lesion. BRAF, cKIT, and GNAQ mutations were screened by 32% of participants. The majority of participants (76%) applied the same treatment protocols for MUP as patients with known primary melanomas of the same AJCC stage. Conclusion: Strong heterogeneity was found between physicians dealing with MUP. Thus, a consensus document should be strongly encouraged.
Dermatology

http://ift.tt/2i9j4ts

Optimism and Cause-Specific Mortality: A Prospective Cohort Study

Growing evidence has linked positive psychological attributes like optimism to a lower risk of poor health outcomes, especially cardiovascular disease. It has been demonstrated in randomized trials that optimism can be learned. If associations between optimism and broader health outcomes are established, it may lead to novel interventions that improve public health and longevity. In the present study, we evaluated the association between optimism and cause-specific mortality in women after considering the role of potential confounding (sociodemographic characteristics, depression) and intermediary (health behaviors, health conditions) variables. We used prospective data from the Nurses' Health Study (n = 70,021). Dispositional optimism was measured in 2004; all-cause and cause-specific mortality rates were assessed from 2006 to 2012. Using Cox proportional hazard models, we found that a higher degree of optimism was associated with a lower mortality risk. After adjustment for sociodemographic confounders, compared with women in the lowest quartile of optimism, women in the highest quartile had a hazard ratio of 0.71 (95% confidence interval: 0.66, 0.76) for all-cause mortality. Adding health behaviors, health conditions, and depression attenuated but did not eliminate the associations (hazard ratio = 0.91, 95% confidence interval: 0.85, 0.97). Associations were maintained for various causes of death, including cancer, heart disease, stroke, respiratory disease, and infection. Given that optimism was associated with numerous causes of mortality, it may provide a valuable target for new research on strategies to improve health.



http://ift.tt/2iHcC0h

Contents Page



http://ift.tt/2j3xnzY

Fetuin-A and Risk of Diabetes Independent of Liver Fat Content: The Multi-Ethnic Study of Atherosclerosis

Fetuin-A is a hepatic secretory protein and a novel risk factor for diabetes. However, it remains unclear whether the association between high levels of fetuin-A and diabetes can be attributed to nonalcoholic fatty liver disease. We conducted a case-cohort study among 1,957 subcohort members and 455 incident diabetes cases in the Multi-Ethnic Study of Atherosclerosis, a multicenter US study of Caucasian, African-American, Hispanic, and Chinese-American adults aged 45–84 years. Serum fetuin-A and computed tomography-determined liver fat content were measured from samples collected at baseline (2000–2002). In multivariable Cox proportional hazards models with follow-up through 2012, a higher fetuin-A level was associated with a higher risk of diabetes, with a stronger association among women (for top quartile vs. bottom, hazard ratio (HR) = 3.36, 95% confidence interval (CI): 2.08, 5.44) than among men (HR = 1.47, 95% CI: 0.93, 2.35) (P-heterogeneity = 0.001). Adjustment for liver fat content attenuated these associations slightly (women: HR = 2.61, 95% CI: 1.59, 4.26; men: HR = 1.32, 95% CI: 0.84, 2.08). In this study, we observed a particularly strong association of fetuin-A with diabetes risk in women that could not be explained by liver fat.



http://ift.tt/2iGZHM6

Editorial Board



http://ift.tt/2j3uYoZ

Duration of Analgesic Use and Risk of Hearing Loss in Women

Aspirin, nonsteroidal antiinflammatory drugs (NSAID), and acetaminophen are commonly used. Frequent use of analgesics has been associated with a higher risk of hearing loss. However, the association between duration of analgesic use and the risk of hearing loss is unclear. We investigated the relationship between duration of analgesic use and self-reported hearing loss among 55,850 women in the Nurses' Health Study. Cox proportional hazards regression was used to adjust for potential confounders. During 873,376 person-years of follow-up (1990–2012), longer durations of NSAID use (for >6 years of use compared with <1 year, multivariable-adjusted relative risk = 1.10, 95% confidence interval: 1.06, 1.15; P for trend < 0.001) and acetaminophen use (for >6 years of use compared with <1 year, multivariable-adjusted relative risk = 1.09, 95% confidence interval: 1.04, 1.14; P for trend < 0.001) were associated with higher risks of hearing loss. Duration of aspirin use was not associated with hearing loss (for >6 years of use compared with <1 year, multivariable-adjusted relative risk = 1.01, 95% confidence interval: 0.97, 1.05; P for trend = 0.35). In this cohort of women, longer durations of NSAID and acetaminophen use were associated with slightly higher risks of hearing loss, but duration of aspirin use was not. Considering the high prevalence of analgesic use, this may be an important modifiable contributor to hearing loss.



http://ift.tt/2iHghv5

Subscription Page



http://ift.tt/2j3pDxQ

Cover Page



http://ift.tt/2iH5kdd

Ambient Fine Particulate Matter, Outdoor Temperature, and Risk of Metabolic Syndrome

Ambient air pollution and temperature have been linked with cardiovascular morbidity and mortality. Metabolic syndrome and its components—abdominal obesity, elevated fasting blood glucose concentration, low high-density lipoprotein cholesterol concentration, hypertension, and hypertriglyceridemia—predict cardiovascular disease, but the environmental causes are understudied. In this study, we prospectively examined the long-term associations of air pollution, defined as particulate matter with an aerodynamic diameter less than or equal to 2.5 µm (PM2.5), and temperature with the development of metabolic syndrome and its components. Using covariate-adjustment Cox proportional hazards models, we estimated associations of mean annual PM2.5 concentration and temperature with risk of incident metabolic dysfunctions between 1993 and 2011 in 587 elderly (mean = 70 (standard deviation, 7) years of age) male participants in the Normative Aging Study. A 1-μg/m3 increase in mean annual PM2.5 concentration was associated with a higher risk of developing metabolic syndrome (hazard ratio (HR) = 1.27, 95% confidence interval (CI): 1.06, 1.52), an elevated fasting blood glucose level (HR = 1.20, 95% CI: 1.03, 1.39), and hypertriglyceridemia (HR = 1.14, 95% CI: 1.00, 1.30). Our findings for metabolic syndrome and high fasting blood glucose remained significant for PM2.5 levels below the Environmental Protection Agency's health-safety limit (12 μg/m3). A 1°C increase in mean annual temperature was associated with a higher risk of developing elevated fasting blood glucose (HR = 1.33, 95% CI: 1.14, 1.56). Men living in neighborhoods with worse air quality—with higher PM2.5 levels and/or temperatures than average—showed increased risk of developing metabolic dysfunctions.



http://ift.tt/2iH861T

Residential Proximity to Gasoline Stations and Risk of Childhood Leukemia

Significant elevations in the risk of childhood leukemia have been associated with environmental exposure to gasoline; aromatic hydrocarbons from refinery pollution, petroleum waste sites, and mobile sources (automobile exhaust); paints, paint products, and thinners; and secondary cigarette smoke in the home. These higher risks have also been associated with parental exposure to benzene, gasoline, motor vehicle–related jobs, painting, and rubber solvents. These exposures and jobs have 1 common chemical exposure—benzene, a recognized cause of acute leukemia in adults—and raise the question of whether children represent a subpopulation in which a higher risk of leukemia is associated with very low level exposure to environmental benzene.



http://ift.tt/2j3xVFP

Steinmaus and Smith Respond to "Proximity to Gasoline Stations and Childhood Leukemia"

Benzene is an established cause of adult leukemia, but its role in childhood leukemia is less clear. In a recent meta-analysis, we identified associations of childhood leukemia with occupational and household product benzene exposure and traffic-related pollution. Residential proximity to gasoline stations or automobile repair facilities may be another source of benzene, and in 3 studies assessing these sources, we identified a summary relative risk of 1.59 (95% confidence interval: 0.70, 3.62). Although not statistically significant, this summary relative risk was of a magnitude similar to that of our other positive findings. In this issue of the Journal (Am J Epidemiol. 2017;185(1):5–7), Dr. Infante suggested that meta-analyses of studies on childhood leukemia and proximity to gasoline stations should involve some criteria that differ from those we used. These suggested criteria involved combining leukemia subtypes, excluding automobile repair facilities, and using nonleukemia cancers as control subjects. We redid our meta-analysis using these new criteria and obtained a summary relative risk of 2.42 (95% confidence interval: 1.51, 3.89). Overall, although this result should be interpreted in light of the relatively small sample size (3 studies) and its post-hoc nature, it provides additional new evidence for associations of childhood leukemia with both residential proximity to gasoline stations and exposure to benzene.



http://ift.tt/2j3zpjB

Association Between Preterm Birth and Lower Adult Height in Women

We examined whether being born preterm was associated with changes in adult anthropometry in women. We assessed data on 201,382 women (born in 1973–1988) from the Swedish Birth Register. The mean age was 26.0 years. Of the women in our cohort, 663 were born very preterm (<32 weeks of gestation), 8,247 were born moderately preterm (at least 32 weeks but <37 weeks), and 192,472 were born at term (37–41 weeks). Subgroup analyses were carried out among siblings and also after adjustment for maternal anthropometric data. Statistical tests were 2-sided. Decreasing gestational age was associated with lower height (–1.1 mm per week of gestation; P < 0.0001), so that women who were born very preterm were on average 12 mm shorter than women who were born moderately preterm (P < 0.0001) and 17 mm shorter than women born at term (P < 0.0001). Compared with women who were born at term, those who were born very preterm had 2.9 times higher odds of short stature (<155.4 cm), and those born moderately preterm had 1.43 times higher odds. Subgroup analyses showed no differences between women born moderately preterm and those born at term but accentuated differences from women born very preterm. Among siblings (n = 2,388), very preterm women were 23 mm shorter than those born at term (P = 0.003), with a 20-mm difference observed in subgroup analyses (n = 27,395) that were adjusted for maternal stature (P < 0.001). A shorter final height was associated with decreasing gestational age, and this association was particularly marked in women born very preterm.



http://ift.tt/2iH9SA6

Pelvic Inflammatory Disease and the Risk of Ovarian Cancer and Borderline Ovarian Tumors: A Pooled Analysis of 13 Case-Control Studies

Inflammation has been implicated in ovarian carcinogenesis. However, studies investigating the association between pelvic inflammatory disease (PID) and ovarian cancer risk are few and inconsistent. We investigated the association between PID and the risk of epithelial ovarian cancer according to tumor behavior and histotype. We pooled data from 13 case-control studies, conducted between 1989 and 2009, from the Ovarian Cancer Association Consortium (OCAC), including 9,162 women with ovarian cancers, 2,354 women with borderline tumors, and 14,736 control participants. Study-specific odds ratios were estimated and subsequently combined into a pooled odds ratio using a random-effects model. A history of PID was associated with an increased risk of borderline tumors (pooled odds ratio (pOR) = 1.32, 95% confidence interval (CI): 1.10, 1.58). Women with at least 2 episodes of PID had a 2-fold increased risk of borderline tumors (pOR = 2.14, 95% CI: 1.08, 4.24). No association was observed between PID and ovarian cancer risk overall (pOR = 0.99, 95% CI: 0.83, 1.19); however, a statistically nonsignificantly increased risk of low-grade serous tumors (pOR = 1.48, 95% CI: 0.92, 2.38) was noted. In conclusion, PID was associated with an increased risk of borderline ovarian tumors, particularly among women who had had multiple episodes of PID. Although our results indicated a histotype-specific association with PID, the association of PID with ovarian cancer risk is still somewhat uncertain and requires further investigation.



http://ift.tt/2j3vmDW

Targeted Maximum Likelihood Estimation for Causal Inference in Observational Studies

Estimation of causal effects using observational data continues to grow in popularity in the epidemiologic literature. While many applications of causal effect estimation use propensity score methods or G-computation, targeted maximum likelihood estimation (TMLE) is a well-established alternative method with desirable statistical properties. TMLE is a doubly robust maximum-likelihood–based approach that includes a secondary "targeting" step that optimizes the bias-variance tradeoff for the target parameter. Under standard causal assumptions, estimates can be interpreted as causal effects. Because TMLE has not been as widely implemented in epidemiologic research, we aim to provide an accessible presentation of TMLE for applied researchers. We give step-by-step instructions for using TMLE to estimate the average treatment effect in the context of an observational study. We discuss conceptual similarities and differences between TMLE and 2 common estimation approaches (G-computation and inverse probability weighting) and present findings on their relative performance using simulated data. Our simulation study compares methods under parametric regression misspecification; our results highlight TMLE's property of double robustness. Additionally, we discuss best practices for TMLE implementation, particularly the use of ensembled machine learning algorithms. Our simulation study demonstrates all methods using super learning, highlighting that incorporation of machine learning may outperform parametric regression in observational data settings.



http://ift.tt/2iHaPZ2

Understanding How to Prevent and Treat Adverse Events of Fillers and Neuromodulators

Summary: Experience teaches cosmetic surgeons to become good, but avoiding and treating adverse events make them great. In no area is this more true than in cosmetic procedures involving fillers and neuromodulators. By utilizing knowledge of materials and anatomy involved, specialists seek to avoid complications. A well-trained physician is able to reduce the sequelae from an adverse event by acting promptly using algorithms and a methodical approach to treatments. In this article I discuss the difference between perceived and true complications from fillers and neuromodulators, how to avoid, what to look for and how to treat to provide patients with the best possible outcomes, and make the physicians life less stressful. Copyright (C) 2016 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

http://ift.tt/2hReiTQ

Anti-angiogenic treatment in breast cancer: facts, successes, failures and future perspectives

S03057372.gif

Publication date: Available online 3 January 2017
Source:Cancer Treatment Reviews
Author(s): Kim C. Aalders, Konstantinos Tryfonidis, Elżbieta Senkus, Fatima Cardoso
Angiogenesis is one of the hallmarks of cancer and a crucial requisite in the development of tumors. Interrupting this process by blocking the vascular endothelial growth factor (VEGF) with the monoclonal antibody bevacizumab has been considered a possible breakthrough in the treatment of various types of cancer, especially for advanced disease. However in breast cancer, studies have shown ambivalent results causing debate about the value of this drug. In this article, we review the evidence for anti-angiogenic treatment options for breast cancer, as well as discuss the possible factors limiting the effectiveness of anti-angiogenic agents and offer a recommendation regarding the future research on these therapies for the treatment of breast cancer.



http://ift.tt/2iz09v9

A three-lncRNA signature derived from the Atlas of ncRNA in cancer (TANRIC) database predicts the survival of patients with head and neck squamous cell carcinoma

Publication date: February 2017
Source:Oral Oncology, Volume 65
Author(s): Wei Cao, Jian-nan Liu, Zeqi Liu, Xu Wang, Ze-Guang Han, Tong Ji, Wan-tao Chen, Xin Zou
ObjectiveLong non-coding RNAs (lncRNAs) have important biological functions and can be used as prognostic biomarkers in cancer. To identify a lncRNA prognostic signature for head and neck squamous cell carcinoma (HNSCC).MethodWe analysed RNA-seq data derived from the TANRIC database to identify a lncRNA prognostic signature model using the orthogonal partial least squares discrimination analysis (OPLS-DA) and 1.5-fold expression change criterion methods. The prognosis prediction model based on the lncRNA signatures and clinical parameters were evaluated using the 5-fold cross validation method.ResultsA total of 84 out of 3199 lncRNAs were significantly associated with the survival of patients with HNSCC (log-rank test P<0.01). Using the OPLS-DA and 1.5-fold change selection criterion, 5 lncRNAs (KTN1-AS1, LINC00460, GUSBP11, LINC00923 and RP5-894A10.6) were further selected. The prediction power of each combination of the 5 lncRNAs was evaluated through the receiver operating characteristic (ROC) curve and a three-lncRNA panel (KTN1-AS1, LINC00460 and RP5-894A10.6) achieved the highest prognostic prediction power (AUC 0.68, 95% CI 0.60–0.76, P<0.0001) in the cohort. The patients were categorized into high- and low-risk groups based on their three-lncRNA profiles. Patients with high-risk scores had worse overall survival than those with low risk scores in the cohort (log-rank test P=0.0003). Multivariable Cox regression analyses showed that the lncRNA signature and tumour grade were independent prognostic factors for patients with HNSCC.ConclusionsOur findings showed that the three-lncRNA signature might be a novel biomarker for the accurate prognosis prediction of patients with HNSCC.



http://ift.tt/2j2SrGH

Reply to: the small details that influence postoperative pain

imageNo abstract available

http://ift.tt/2hQcM5U

Minimally invasive analgesia after cardiac surgery

wk-health-logo.gif

No abstract available

http://ift.tt/2iOcklD

Reply to: association of increased N terminal B-type natriuretic propeptide levels with short-term adverse outcomes after noncardiac surgery

wk-health-logo.gif

No abstract available

http://ift.tt/2hQ7bMU

Bilateral sternal infusion of ropivacaine and length of stay in ICU after cardiac surgery with increased respiratory risk: A randomised controlled trial

imageBACKGROUND: The continuous bilateral infusion of a local anaesthetic solution around the sternotomy wound (bilateral sternal) is an innovative technique for reducing pain after sternotomy. OBJECTIVE: To assess the effects of the technique on the need for intensive care in cardiac patients at increased risk of respiratory complications. DESIGN: Randomised, observer-blind controlled trial. SETTING: Single centre, French University Hospital. PATIENTS: In total, 120 adults scheduled for open-heart surgery, with one of the following conditions: age more than 75 years, BMI >30 kg m−2, chronic obstructive pulmonary disease, active smoking habit. INTERVENTION: Either a bilateral sternal infusion of 0.2% ropivacaine (3 ml h−1 through each catheter; 'intervention' group), or standardised care only ('control' group). Analgesia was provided with paracetamol and self-administered intravenous morphine. MAIN OUTCOME MEASURES: The length of time to readiness for discharge from ICU, blindly assessed by a committee of experts. RESULTS: No effect was found between groups for the primary outcome (P = 0.680, intention to treat); the median values were 42.4 and 37.7 h, respectively for the control and intervention groups (P = 0.873). Similar nonsignificant trends were noted for other postoperative delays. Significant effects favouring the intervention were noted for dynamic pain, patient satisfaction, occurrence of nausea and vomiting, occurrence of delirium or mental confusion and occurrence of pulmonary complications. In 12 patients, although no symptoms actually occurred, the total ropivacaine plasma level exceeded the lowest value for which neurological symptoms have been observed in healthy volunteers. CONCLUSION: Because of a small size effect, and despite significant analgesic effects, this strategy failed to reduce the time spent in ICU. TRIAL REGISTRATION: EudraCT (N°: 2012-005225-69); ClinicalTrials.gov (NCT01828788).

http://ift.tt/2hQ1MFW

Reply to: posterior wall puncture during ultrasound-guided arterial cannulation suggests inadequate operator skills

wk-health-logo.gif

No abstract available

http://ift.tt/2iO1gVs

Lung recruitment improves right ventricular performance after cardiopulmonary bypass: A randomised controlled trial

imageBACKGROUND: Atelectasis after cardiopulmonary bypass (CPB) can affect right ventricular (RV) performance by increasing its outflow impedance. OBJECTIVE: The aim of this study was to determine whether a lung recruitment manoeuvre improves RV function by re-aerating the lung after CPB. DESIGN: Randomised controlled study. SETTING: Single-institution study, community hospital, Córdoba, Argentina. PATIENTS: Forty anaesthetised patients with New York Heart Association class I or II, preoperative left ventricular ejection fraction at least 50% and Euroscore 6 or less scheduled for cardiac surgery with CPB. INTERVENTIONS: Patients were assigned to receive either standard ventilation with 6 cmH2O of positive end-expiratory pressure (PEEP; group C, n = 20) or standard ventilation with a recruitment manoeuvre and 10 cmH2O of PEEP after surgery (group RM, n = 20). RV function, left ventricular cardiac index (CI) and lung aeration were assessed by transoesophageal echocardiography (TOE) before, at the end of surgery and 30 min after surgery. MAIN OUTCOME MEASURES: RV function parameters and atelectasis assessed by TOE. RESULTS: Haemodynamic data and atelectasis were similar between groups before surgery. At the end of surgery, CI had decreased from 2.9 ± 1.1 to 2.6 ± 0.9 l min−1 m−2 in group C (P = 0.24) and from 2.8 ± 1.0 to 2.6 ± 0.8 l min−1 m−2 in group RM (P = 0.32). TOE-derived RV function parameters confirmed a mild decrease in RV performance in 95% of patients, without significant differences between groups (multivariate Hotelling t-test P = 0.16). Atelectasis was present in 18 patients in group C and 19 patients in group RM (P = 0.88). After surgery, CI decreased further from 2.6 to 2.4 l min−1 m−2 in group C (P = 0.17) but increased from 2.6 to 3.7 l min−1 m−2 in group RM (P 

http://ift.tt/2iOdXj2

Reply to: volume therapy in obstetrics

wk-health-logo.gif

No abstract available

http://ift.tt/2hQ2bYZ

Assessment of a smartphone app (Capstesia) for measuring pulse pressure variation: agreement between two methods: A Cross-sectional study

imageBACKGROUND: Less invasive and noninvasive methods are emerging for haemodynamic monitoring. Among them is Capstesia, a smartphone app that, from photographs of a patient monitor showing invasive arterial pressure, estimates advanced haemodynamic variables after digitising and analysing the pressure curves. OBJECTIVE: The aim of this study was to compare the level of agreement between the analysis of the signals obtained from the patient monitor and a photograph of the same images using the Capstesia app. DESIGN: Cross-sectional study. SETTING: Araba University hospital (Txagorritxu), Vitoria-Gasteiz, Alava, Spain, from January to February 2015. PATIENTS: Twenty patients (229 images) who had an arterial catheter (radial or femoral artery) inserted for haemodynamic monitoring. INTERVENTION: Snapshots obtained from the patient monitor and a photograph of these same snapshots using the Capstesia application were assessed with the same software (MATLAB, Mathworks, Natick, Massachusetats, USA) for evaluating the level of concordance of the following variables: pulse pressure variation (PPV), cardiac output (CO) and maximum slope of the pressure curve (dP/dt). Comparison was made using interclass correlation coefficients with corresponding 95% confidence intervals, and Bland–Altman plots with the corresponding percentages of error. MAIN OUTCOME MEASURES: (PPV). Secondary outcome: CO and maximum slope of the pressure curve [dP/dt]. RESULTS: The interclass correlation coefficients for PPV, CO and max dP/dt were 0.991 (95% confidence interval 0.988 to 0.993), 0.966 (95% confidence interval 0.956 to 0.974) and 0.962 (95% confidence interval 0.950 to 0.970), respectively. In the Bland–Altman analysis, bias and limits of agreement of PPV were (0.50% ± 1.42) resulting in a percentage of error of 20% for PPV. For CO they were 0.19 ± 0.341, with a 13.8% of error. Finally bias and limits of agreement for max dP/dt were 1.33 ± 77.71, resulting in an error of 14.20% CONCLUSIONS: Photograph of the screenshots obtained with the Capstesia app show a good concordance with analysis of the original screenshots. Either approach could be used to monitor the haemodynamic variables assessed.

http://ift.tt/2hQ5GOS

Developing standardised advanced training in neuroanaesthesia: Results of a Europe-wide survey

imageNo abstract available

http://ift.tt/2hPYFO1

Myoelectric activation pattern changes in the involved limb of individuals with transtibial amputation during locomotor state transitions

Publication date: Available online 3 January 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Bryson H. Nakamura, Michael E. Hahn
ObjectiveTo investigate whether lower extremity muscle activation patterns differ in the strides leading to locomotive state transitions in the involved limb of individuals with transtibial amputation. It was hypothesized that all transitions would elicit activation differences between strides as the subjects moved toward the transition event.DesignA single sample, observational study.SettingThe study was conducted in the hallways, ramps and stairs of a university building.ParticipantsA volunteer sample of nine persons with unilateral transtibial amputation (48.8±12.1years; 1.74±0.09m; 86.1±24.7kg) were recruited by posting flyers in local prosthetics clinics.InterventionsNot applicable.Main Outcome MeasuresSurface electromyography was used to measure muscle activation from seven muscles of the involved limb. Subjects walked across eight different terrain conditions transitioning from level-ground to ramp/stair locomotion and vice versa. Statistical Parametric Mapping Analysis of Variance (α<0.05) was used to assess muscle activation differences in the three pre-transition gait cycles as subjects moved toward the terrain change.ResultsNo muscle activation changes were observed in ramp transitions. All stair transitions elicited a myoelectric difference in at least two muscles. The transition from stair descent to level ground elicited change in the greatest number of muscles. Tibialis anterior activation was unchanged in all transitions.ConclusionsMuscle activation differences were observed in the involved limb of individuals with transtibial amputation during stair transitions, suggesting that those patterns may be successfully used in transition detection algorithms. It remains unknown whether ramp transitions can be successfully identified pre-transition using electromyography.



http://ift.tt/2hRdVsA

External validation of predictive models for acute kidney injury following cardiac surgery: A prospective multicentre cohort study

imageBACKGROUND: Four predictive models for acute kidney injury associated with cardiac surgery were developed by Demirjian in the United States in 2012. However, the usefulness of these models in clinical practice needs to be established in different populations independent of that used to develop the models. OBJECTIVES: Our aim was to evaluate the predictive performance of these models in a Spanish population. DESIGN: A multicentre, prospective observational study. DATA SOURCES: Twenty-three Spanish hospitals in 2012 and 2013. ELIGIBILITY CRITERIA: Of 1067 consecutive cardiac patients recruited for the study, 1014 patients remained suitable for the final analysis. MAIN OUTCOME MEASURES: Dialysis therapy, and a composite outcome of either a doubling of the serum creatinine level or dialysis therapy, in the 2 weeks (or until discharge, if sooner) after cardiac surgery. RESULTS: Of the 1014 patients analysed, 34 (3.4%) required dialysis and 95 (9.4%) had either dialysis or doubled their serum creatinine level. The areas under the receiver operating characteristic curves of the two predictive models for dialysis therapy, which include either presurgical variables only, or combined presurgical and intrasurgical variables, were 0.79 and 0.80, respectively. The model for the composite endpoint that combined presurgical and intrasurgical variables showed better discriminatory ability than the model that included only presurgical variables: the areas under the receiver operating characteristic curves were 0.76 and 0.70, respectively. All four models lacked calibration for their respective outcomes in our Spanish population. CONCLUSION: Overall, the lack of calibration of these models and the difficulty in using the models clinically because of the large number of variables limit their applicability.

http://ift.tt/2hQ6ZNS

Association of increased N terminal B-type natriuretic propeptide levels with short-term adverse outcomes after noncardiac surgery

wk-health-logo.gif

No abstract available

http://ift.tt/2iOffL2

Comparative analysis of resuscitation using human serum albumin and crystalloids or 130/0.4 hydroxyethyl starch and crystalloids on skeletal muscle metabolic profile during experimental haemorrhagic shock in swine: A randomised experimental study

imageBACKGROUND: Protection against acute skeletal muscle metabolic dysfunction and oxidative stress could be a therapeutic target in volume expansion for severely bleeding patients. OBJECTIVES: This experimental pilot study in swine aims at comparing 130/0.4 hydroxyethyl starch (HES) with 4% albumin along with crystalloid perfusion for first-line volume expansion in haemorrhagic shock with a particular emphasis on oxidative stress and muscular mitochondrial function. DESIGN: Randomised experimental study. SETTING: Digestive Cancer Research Institute Preclinical Laboratory, Strasbourg University Hospital, France, from February 2012 to June 2013. ANIMALS: Twenty large white pigs. INTERVENTION: Pressure-controlled haemorrhagic shock and volume resuscitation using either 4% human serum albumin or 130/0.4 HES along with crystalloid perfusion were performed in 20 large white pigs. MAIN OUTCOME MEASURES: Muscular biopsy of gastrocnemius muscle was performed for metabolomics screening, mitochondrial respiratory chain assessment and electron spin resonance reactive oxygen species production along with arterial and venous reactive oxygen species production at baseline, at the completion of shock, at 90 min and at 180 min after volume expansion. RESULTS: There was no difference between the two groups in measurements of skeletal muscle superoxide production. In a pooled analysis, there was a statistically significant decrease in gastrocnemius muscle creatine content from baseline to 90 min (P 

http://ift.tt/2iOmkvg

Volume therapy in obstetrics

wk-health-logo.gif

No abstract available

http://ift.tt/2hQ3eYQ

Does permissive hypoxaemia during extracorporeal membrane oxygenation cause long-term neurological impairment?: A study in patients with H1N1-induced severe respiratory failure

imageBACKGROUND: The Extracorporeal Life Support Organisation accepts permissive hypoxaemia in adult patients during extracorporeal membrane oxygenation (ECMO). The neurological long-term outcome of this approach has not yet been studied. OBJECTIVES: We investigated the prevalence of brain lesions and cognitive dysfunction in survivors from the Influenza A/H1N1 2009 pandemic treated with permissive hypoxaemia during ECMO for severe acute respiratory distress syndrome (ARDS). Our hypothesis was that this method is reasonable if tissue hypoxia is avoided. DESIGN: Long-term follow-up study after ECMO. SETTING: Karolinska University Hospital, Sweden, from October 2012 to July 2013. PATIENTS: Seven patients treated with ECMO for severe influenza A/H1N1-induced ARDS were studied 3.2 years after treatment. Blood lactate concentrations were used as a surrogate for tissue oxygenation. INTERVENTIONS: Neurocognitive outcome was studied with standardised cognitive tests and MRI of the brain. MAIN OUTCOME MEASURES: Cognitive functioning and hypoxic brain lesions after permissive hypoxaemia during ECMO. The observation period was the first 10 days of ECMO or the entire treatment period if shorter than 10 days. RESULTS: Eleven of 13 patients were still alive 3 years after ECMO. We were able to contact seven of these patients (mean age 31 years), who all agreed to participate in this study. Mean ± SD peripherally measured arterial saturation during the observation period was 79 ± 10%. Full-scale Intelligence Quotient was within one standard deviation or above from the mean of a healthy population in five patients, and was 1.5 SD below the mean in one patient. In one other patient, it could not be determined because of a lack of formal education. Memory functioning was normal in all patients. MRI showed no changes related to cerebral hypoxia. CONCLUSIONS: Permissive hypoxaemia during ECMO might not negatively affect long-term cognitive outcome if adequate organ perfusion is maintained. TRIAL REGISTRATION: at Clinicaltrials.gov NCT01763060

http://ift.tt/2iOcd9H

The small details that influence postoperative pain

wk-health-logo.gif

No abstract available

http://ift.tt/2hQeiVJ

Posterior wall puncture during ultrasound-guided arterial cannulation suggests inadequate operator skills

wk-health-logo.gif

No abstract available

http://ift.tt/2iO1fkm

Complications in Neuroanesthesia

wk-health-logo.gif

No abstract available

http://ift.tt/2iOr0kz

Τρίτη 3 Ιανουαρίου 2017

Image Sharing in Radiology—A Primer

alertIcon.gif

Publication date: Available online 3 January 2017
Source:Academic Radiology
Author(s): Arindam R. Chatterjee, Seth Stalcup, Arjun Sharma, T. Shawn Sato, Pushpender Gupta, Yueh Z. Lee, Christopher Malone, Morgan McBee, Elise L. Hotaling, Akash P. Kansagra
By virtue of its information technology-oriented infrastructure, the specialty of radiology is uniquely positioned to be at the forefront of efforts to promote data sharing across the healthcare enterprise, including particularly image sharing. The potential benefits of image sharing for clinical, research, and educational applications in radiology are immense. In this work, our group—the Association of University Radiologists (AUR) Radiology Research Alliance Task Force on Image Sharing—reviews the benefits of implementing image sharing capability, introduces current image sharing platforms and details their unique requirements, and presents emerging platforms that may see greater adoption in the future. By understanding this complex ecosystem of image sharing solutions, radiologists can become important advocates for the successful implementation of these powerful image sharing resources.



http://ift.tt/2i99tTJ

Αναζήτηση αυτού του ιστολογίου