Inguinoscrotal hernia in infants: Three case reports in ultrasound diagnosis

Dharmraj Meena, Richa Jhuria, Sangeeta Saxena, Umesh Saini

Indian Journal of Radiology and Imaging 2017 27(1):78-81

An inguinal hernia occurs when an intestinal loop or part of the omentum or genital organs passes into the scrotal cavity or labia through an incompletely obliterated processus vaginalis. Inguinal hernias are most common in preterm neonates, especially at 32-weeks gestation. Content of hernia is mostly bowel and ovary/testicles. Presence of uterus in herniated sac is rare, and only few cases are reported in literature. Hernia is more frequently located on the right side because the right processus vaginalis closes later than the left. Physical examination is sufficient to enable diagnosis in most cases. Ultrasound examination is indicated in patients with inconclusive physical findings, in patients with acute scrotum, and to investigate contralateral involvement in patients in whom only a unilateral hernia is clinically evident. Routinely, color or power Doppler imaging is used in inguinal-scrotal hernia to investigate intestinal and testicular/ovarian perfusion. Urgent surgery is indicated in patients with an akinetic dilated bowel loop (a sign of strangulation) or impaired testicular/ovarian perfusion.

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Evaluation of 1-way valves used in medical devices for prevention of cross-contamination

Publication date: Available online 27 March 2017
Source:American Journal of Infection Control
Author(s): Poulomi Nandy, Megan Young, Shanil P. Haugen, Kristy Katzenmeyer-Pleuss, Edward A. Gordon, Stephen M. Retta, Steven C. Wood, Anne D. Lucas
BackgroundOne-way valves used in day use devices (used on multiple patients throughout a day without reprocessing between patients) are intended to reduce the potential for cross-contamination between patients resulting from the backflow of patient fluids. One-way valves are typically designed to withstand high levels of back pressure before failure; however, they may not be explicitly designed as a means of infection control as used in medical device applications.MethodsFive different medical grade 1-way valves were placed in low pressure configurations. After flushing in the intended direction of flow, bacteriophage, bacteria, or dye was placed patient side for 24 hours. The upstream device side of the valve was then evaluated for microbial growth or presence of visible dye.ResultsLeakage (ie, backflow) of the microorganisms occurred with a variety of 1-way valve designs across a range of fluid properties tested.ConclusionsThis study describes testing of the 1-way valves (component-level testing) for the potential of cross-contamination. Although day use medical device systems may use numerous other factors to prevent patient cross-contamination, this work demonstrates that 1-way valves themselves may not prevent leakage of contaminated fluid if the fluid is able to reach the upstream side of the 1-way valve.



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Calcification of the submandibular gland in a patient with chickenpox

Cetin Celenk, Peruze Celenk

Indian Journal of Radiology and Imaging 2017 27(1):49-51

The pneumonia virus of chickenpox is now known to cause scattered calcified foci in the lungs, however to our knowledge, recent literature has not discussed calcification in the salivary glands. A 15-year-old boy consulted the department of radiology because of a swelling on the right side of the submandibular area. Radiological assessment included an ultrasonography and computerized tomography scan of the neck area, which demonstrated intraparenchymal amorph calcification, with approximately 13 mm diameter in the right submandibular gland. General condition and oral intake was good without distress in the patient, and hence he was discharged on the seventh day of follow-up treatment.

http://ift.tt/2naGDUk

Risk factors, characteristics, and outcomes of candidemia in an adult intensive care unit in Turkey

Publication date: Available online 27 March 2017
Source:American Journal of Infection Control
Author(s): Elif Tukenmez Tigen, Huseyin Bilgin, Hande Perk Gurun, Arzu Dogru, Beste Ozben, Nilgun Cerikcioglu, Volkan Korten
Thirty-six patients with candidemia and 37 control patients were included consecutively to determine the characteristics of candidemia episodes. The patients with candidemia had higher mortality with higher Sequential Organ Failure Assessment scores and frequency of use of a central venous catheter, total parenteral nutrition, and broad-spectrum antibiotics; chronic renal failure with replacement therapy; and longer stay in an intensive care unit. Candida albicans was the predominant species followed by Candida glabrata, Candida tropicalis, and Candida parapsilosis. All isolates of C glabrata were itraconazole-resistant.



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Radiofrequency ablation of osteoid osteoma in common and technically challenging locations in pediatric population

Shaileshkumar Garge, Shyamkumar N Keshava, Vinu Moses, George K Chiramel, Munawwar Ahmed, Suraj Mammen, Vrisha Madhuri

Indian Journal of Radiology and Imaging 2017 27(1):88-91

Context: Percutaneous radiofrequency ablation (RFA) of osteoid osteoma has a high technical and clinical success rate. However, there is limited data on its use in the pediatric population, especially in technically challenging locations. Objective: To assess the safety and efficacy of computed tomography (CT)-guided percutaneous RFA of osteoid osteoma in pediatric population. Patients and Methods: From June 2009 to May 2014, 30 patients with osteoid osteoma were treated with CT-guided RFA in common (25 cases) and technically challenging (five cases: four near articular surface and one in sacrum) locations. Therapy was performed under general anesthesia with a three-array expandable RF probe for 6 min at 90°C and power of 60–100 W. The patients were discharged next day under instruction. The treatment success was evaluated in terms of pain relief before and after (1 day, 1 month, and 6 months) treatment. Results: Technical success was achieved in all patients (100%). Primary clinical success was 96.66% (29 of total 30 patients), despite the pediatric population and atypical location. One patient had persistent pain after 1 month and was treated successfully with a second procedure (secondary success rate was 100%). One patient had immediate complication of weakness of right hand and fingers extension. No delayed complications were observed. Conclusions: CT-guided RFA is relatively safe and highly effective for treatment of osteoid osteoma in pediatric population, even in technically difficult locations.

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Methicillin-resistant Staphylococcus aureus nasal carriage between healthy students of medical and nonmedical universities

Publication date: Available online 27 March 2017
Source:American Journal of Infection Control
Author(s): Soleiman Abroo, Nima Hosseini Jazani, Yaeghob Sharifi
BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is a challenge for public health, and community-acquired (CA) infections seem to be increasing among people in different areas.MethodsA total of 700 healthy student volunteers residing in dormitories of universities in Urmia, Iran, were enrolled in this study. After identification of the isolates, antibiotic susceptibility, presence of mecA and pvl genes, and staphylococcal cassette chromosome mec (SCCmec) typing were evaluated.ResultsNasal screening identified 137 (19.6%) carriers of S aureus, and 18 (13.14%) were MRSA isolates. The antimicrobial susceptibility patterns of isolates revealed high resistance to penicillin (93.4%). All isolates were sensitive to vancomycin. The SCCmec typing showed that most MRSA strains belonged to SCCmec type IV (n = 14; 77.8%). Only 1 (5.56%) MRSA isolates carried the pvl gene.ConclusionsOur findings revealed the relatively high frequency of S aureus nasal carriers and the advent of multidrug resistance among these isolates. Most MRSA isolates were SCCmec type IV; the transfer of such MRSA strains from carriers to other individuals in crowded living conditions such as dormitories can act as a risk factor for outbreak of CA MRSA and is a serious threat for the study groups.



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Utility of supplemental screening with breast ultrasound in asymptomatic women with dense breast tissue who are not at high risk for breast cancer

Geetika A Klevos, Fernando Collado-Mesa, Jose M Net, Monica M Yepes

Indian Journal of Radiology and Imaging 2017 27(1):52-58

Objective: To assess the results of an initial round of supplemental screening with hand-held bilateral breast ultrasound following a negative screening mammogram in asymptomatic women with dense breast tissue who are not at high risk for breast cancer. Materials and Methods: A retrospective, Health Insurance Portability and Accountability Act compliant, Institutional Research Board approved study was performed at a single academic tertiary breast center. Informed consent was waived. A systematic review of the breast imaging center database was conducted to identify and retrieve data for all asymptomatic women, who were found to have heterogeneously dense or extremely dense breast tissue on screening bilateral mammograms performed from July 1, 2010 through June 30, 2012 and who received a mammographic final assessment American College of Radiology's (ACR) Breast Imaging Reporting and Data System (BI-RADS) category 1 or BI-RADS category 2. Hand-held screening ultrasound was performed initially by a technologist followed by a radiologist. Chi-square and t-test were used and statistical significance was considered at P< 0.05. Results: A total of 1210 women were identified. Of these, 394 underwent the offered supplemental screening ultrasound. BI-RADS category 1 or 2 was assigned to 323 women (81.9%). BI-RADS category 3 was assigned to 50 women (12.9%). A total of 26 biopsies/aspirations were recommended and performed in 26 women (6.6%). The most common finding for which biopsy was recommended was a solid mass (88.5%) with an average size of 0.9 cm (0.5–1.7 cm). Most frequent pathology result was fibroadenoma (60.8%). No carcinoma was found. Conclusion: Our data support the reported occurrence of a relatively high number of false positives at supplemental screening with breast ultrasound following a negative screening mammogram in asymptomatic women with dense breast tissue, who are not at a high risk of developing breast cancer, and suggests that caution is necessary in establishing wide implementation of this type of supplemental screening for all women with dense breast tissue without considering other risk factors for breast cancer.

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Extinction memory is facilitated by methylphenidate and regulated by dopamine and noradrenaline receptors

Publication date: 30 May 2017
Source:Behavioural Brain Research, Volume 326
Author(s): Cristiane R.G. Furini, Jonny A.K. Behling, Carolina G. Zinn, Mara Lise Zanini, Eduardo Assis Brasil, Luiza Doro Pereira, Ivan Izquierdo, Jociane de Carvalho Myskiw
Extinction is defined as the learned inhibition of retrieval and is the mainstay of exposure therapy, which is widely used to treat drug addiction, phobias and fear disorders. The psychostimulant, methylphenidate (MPH) is known to increase extracellular levels of noradrenaline and dopamine by blocking their reuptake and studies have demonstrated that MPH can modulate hippocampal physiology and/or functions including long-term potentiation (LTP), learning and memory. However, the influence of MPH on fear extinction memory has been insufficiently studied. Here we investigate the effect of MPH infused into the CA1 region of the hippocampus on extinction memory in animals normally incapable of showing contextual fear conditioning (CFC) extinction because of weak training, and the possible mechanisms through which it acts during this process. For this, male Wistar rats with infusion cannulae stereotaxically implanted in the CA1 region were submitted to a weak extinction protocol in a CFC apparatus. Animals that received intra-CA1 infusion of MPH (12.5μg/side) 20min before the extinction training (Ext Tr) expressed less freezing behavior than Veh-treated animals during both Ext Tr and extinction retention Test (Ext Test). Additionally, the administration of MPH+Timolol (1μg/side) or MPH+SCH23390 (1.5μg/side) intra-CA1 20min before the Ext Tr blocked the enhancing effect of the MPH on extinction learning. These results suggest that MPH in the CA1 region of the hippocampus is able to induce the consolidation of extinction memory and this process occurs through both β-adrenergic and D1/D5 dopaminergic receptors.



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Generalized verrucosis and abnormal T cell activation due to homozygous TAOK2 mutation

Publication date: Available online 27 March 2017
Source:Journal of Dermatological Science
Author(s): Vered Molho-Pessach, Yuval Ramot, Maxim Mogilevsky, Leonor Cohen-Daniel, Eli M. Eisenstein, Abu-Libdeh Abdulsala, Ihab Siam, Michael Berger, Rotem Karni, Abraham Zlotogorski
BackgroundGeneralized verrucosis (GV) is a chronic and progressive cutaneous human papillomavirus (HPV) infection resulting in multiple warts and associated with acquired or genetic immune defects. We identified a consanguineous Arab family manifesting GV and recurrent bacterial and viral infections, in association with inflammatory bowel disease (IBD).ObjectiveTo identify the mutated gene responsible for GV, recurrent infections and IBD, in this family.MethodsFlow cytometry of peripheral blood mononuclear cells was performed, as well as proliferation and cell cycle assays of T cells. Whole exome sequencing was utilized to detect candidate mutated genes, assuming an autosomal recessive mode of inheritance. Skin fibroblasts from a patient, the mother and control were incubated with sorbitol to detect the phosphorylation ability of TAOK2, and a clonogenic assay was performed to assess the survival and proliferative capacity of fibroblasts' colonies.ResultsDespite normal immunophenotyping of T and B cells, T cell proliferation upon activation was impaired in a patient compared to a heterozygous family member and a control. Genetic analyses identified a rare homozygous missense variant, c.2098C>T (p.R700C) in the TAOK2 gene, segregating with the disease phenotype in the family. TAOK2 encodes the TAO2 kinase, a mitogen activated protein kinase kinase kinase (MAP3K) in the p38-MAPK cascade. The mutation is predicted to disrupt its normal folding and molecular interaction; however, no impairment was observed in TAOK2 kinase activity toward its downstream target, MEK3/6, in patient's fibroblasts. Despite this normal kinase activity, a noticeably higher survival/proliferation of patient's skin fibroblasts was found.ConclusionsA mutation in TAOK2 appears to cause a novel form of primary immunodeficiency, characterized by an impaired T cell proliferation upon activation. This novel cause of GV gives further support to the importance of the p38-MAPK pathway in the immune response against HPV, and possibly also in the pathogenesis of IBD.



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Podoplanin expression in peritumoral keratinocytes predicts aggressive behavior in extramammary Paget's disease

Publication date: Available online 27 March 2017
Source:Journal of Dermatological Science
Author(s): Zaigen Cho, Eiichi Konishi, Mai Kanemaru, Taro Isohisa, Takahiro Arita, Minako Kawai, Miho Tsutsumi, Hiromi Mizutani, Hideya Takenaka, Toshiyuki Ozawa, Daisuke Tsuruta, Norito Katoh, Jun Asai
BackgroundRecent studies have demonstrated podoplanin expression in several tumors, which has been associated with lymph node metastasis and poor prognosis. Podoplanin expression in peritumoral cells such as cancer-associated fibroblasts also correlates with tumor progression in several cancers. However, podoplanin expression and its association with extramammary Paget's disease (EMPD) remain unclear.ObjectiveIn this study, we examined whether the presence of podoplanin expression in tumor cells or peritumoral basal keratinocytes correlated with aggressive behavior in patients with EMPD and investigated the mechanisms of podoplanin-mediated tumor invasion in this disorder.MethodsSkin samples of 37 patients with EMPD were investigated by immunohistochemical analysis. The functions of podoplanin in keratinoctes were examined in vitro by RT-PCR and with invadopodia gelatin-degradation assays using HaCaT cells.ResultsPodoplanin was not identified in tumor cells in all cases. Podoplanin expression in peritumoral basal keratinocytes was observed in 25 patients (67.6%). In in situ EMPD, 50% of cases (9 in 18) exhibited podoplanin-positive keratinocytes, whereas 84.2% (16 in 19) demonstrated positive staining in invasive EMPD (P<0.05). Podoplanin expression in peritumoral keratinocytes was also associated with tumor thickness (P<0.005). By immunohistochemical analysis, podoplanin-positive peritumoral keratinocytes were found to be negative for E-cadherin, one of the major adhesion molecules of keratinocytes, which might contribute to tumor invasion into the dermis through a crack in the basal cell layer induced by down-regulation of cell adhesion therein. We further found that podoplanin-positive keratinocytes exhibited invadopodia, which are thought to function in the migration of cancer cells through tissue barriers, indicating that podoplanin-positive peritumoral basal keratinocytes might assist tumor invasion by degrading the extracellular matrix.ConclusionThe presence of podoplanin expression in peritumoral keratinocytes correlates with aggressive behavior in EMPD and might therefore serve as a useful prognostic marker for patients with EMPD.



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Serum peptides as putative modulators of inflammation in psoriasis

Publication date: Available online 27 March 2017
Source:Journal of Dermatological Science
Author(s): Tetsuhiko Matsuura, Masaaki Sato, Kouhei Nagai, Toshiyuki Sato, Mitsumi Arito, Kazuki Omoteyama, Naoya Suematsu, Kazuki Okamoto, Tomohiro Kato, Yoshinao Soma, Manae S. Kurokawa
BackgroundPsoriasis is a refractory inflammatory disease, however, its pathophysiology is still not fully understood.ObjectiveWe tried to identify novel serum peptides associated with the pathophysiology of psoriasis.MethodsSerum peptides from 24 patients with psoriasis vulgaris (PV), 10 patients with psoriatic arthritis (PsA), 14 patients with atopic dermatitis (AD), and 23 healthy control (HC) subjects were analyzed by mass spectrometry. The effects of some peptides on the secretion of humoral factors from dermal cells were investigated by cytokine arrays and ELISAs.ResultsA total of 93 peptides was detected. 24, 20, 23, and 2 peptides showed at least 1.2-fold difference in ion intensity between the psoriasis (PV+PsA) and HC groups, between the PV+PsA and AD groups, between the PV and PsA groups, and between patients with severe-to-moderate PV (n=6) and those with mild PV (n=18), respectively (p<0.05). 13 out of 27 peptides that showed at least 1.5-fold ion intensity difference in the abovementioned 4 comparisons were identified. The parent proteins of the identified peptides included a coagulation factor, proteins involved in the maintenance of skin, and a protein relating to cytoskeleton. We focused on 2 peptides that were increased in the PV+PsA group: a fibrinogen α chain-derived peptide (1462m/z), the unmodified form of which was fibrinopeptide A-des-alanine (FPAdA), and a filaggrin (FLG)-derived peptide (1977m/z), a modified form of FLG2099-2118 (Q2099pE, Q2115E; FLG-pEE). FPAdA stimulation increased the secretion of GROα from dermal microvascular endothelial cells (dMVECs) and decreased the secretion of lipocalin-2 from keratinocytes in comparison to FPAdA-resequenced peptide stimulation (GROα, 280.9±7.3pg/mL vs. 229.6±5.0pg/mL, p<0.001; lipocalin-2, 273±13pg/mL vs. 350±10pg/mL, p<0.01). Interestingly, FLG-pEE stimulation decreased the secretion of GROα, IL-8, and MCP-1 from dMVECs in comparison to FLG-derived control peptide stimulation (GROα, 844.3±47.5pg/mL vs. 1038.5±96.9pg/mL, p<0.05; IL-8, 2240.1±172.6pg/mL vs. 3221.8±523.7pg/mL, p<0.05; MCP-1, 4057.8±157.2pg/mL vs. 4619.1±213.4pg/mL, p<0.05).ConclusionsThe results suggested that some serum peptides are involved in the pathophysiology of psoriasis, regulating the secretion of inflammatory chemokines and an antimicrobial protein. The modulation of serum peptides may be a potential therapeutic strategy for psoriasis.



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Selective photoinactivation of Histoplasma capsulatum by water-soluble derivatives chalcones

Publication date: Available online 27 March 2017
Source:Photodiagnosis and Photodynamic Therapy
Author(s): Wanessa C.M.A. Melo, Mariana Bastos dos Santos, Beatriz de Carvalho Marques, Luis Octávio Regasini, Maria José Soares Mendes Giannini, Ana Marisa Fusco Almeida




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Pilot study on laser propagation in maxillary and mandibular bone: Grey level image analysis for optical measurements

Publication date: Available online 27 March 2017
Source:Photodiagnosis and Photodynamic Therapy
Author(s): Monalisa Jacob Guiselini, Alessandro Melo Deana, Daniela de Fátima Teixeira da Silva, Nelson Hideyoshi Koshoji, Raquel Agnelli Mesquita-Ferrari, Katia Llanos do Vale, Marcelo Betti Mascaro, Simone Aleksandra de Moraes, Sandra Kalil Bussadori, Kristianne Porta Santos Fernandes
BackgroundBone tissue anatomy, density and porosity vary among subjects in different phases of life and even within areas of a single specimen. The optical characteristics of changes in bone tissue are analyzed based on these properties. Photobiomodulation has been used to improve bone healing after surgery or fractures. Thus, knowledge on light propagation is of considerable importance to the obtainment of successful clinical outcomes.ObjectiveThis study determines light penetration and distribution in human maxillary and mandibular bones in three different regions (anterior, middle, and posterior).MethodsA HeNe laser (633nm) irradiated maxillary and mandibular bones in the cervical-apical direction. The light propagation and scattering pattern were acquired and the grey level of the images was analyzed. Three-dimensional plots of the intensity profile and attenuation profiles were created.ResultsDifferences in optical properties were found between the mandibular and maxillary bones. The maxilla attenuated more light than the mandible at all sites, leading to a shallower penetration depth.ConclusionOur results provide initial information on the behavior of the propagation of red laser on alveolar bone using an optical method.



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Effect of antimicrobial photodynamic therapy on the counts of salivary streptococcus mutans in children with severe early childhood caries

Publication date: Available online 27 March 2017
Source:Photodiagnosis and Photodynamic Therapy
Author(s): Reza Fekrazad, Bahman Seraj, Nasim Chiniforush, Mehrak Rokouei, Niloofar Mousavi, Sara Ghadimi
BackgroundAntimicrobial photodynamic therapy (aPDT) is a novel technique for reduction of pathogenic microorganisms in dentistry. The aim of this study was to evaluate the effects of aPDT on Streptococcus mutans reduction in children with severe early childhood caries.MethodsTwenty-two children with severe early childhood caries aged 3 to 6 years were treated with toluoidine blue O (TBO) for 1 minute and irradiated by a Light Emitting Diode (LED; FotoSan, CMS Dental, Denmark) with the exposure time of 150seconds. Saliva samples were collected at baseline, 1hour and 7 days after treatment. Streptococcus mutans counts were determined using the Dentocult SM Strip mutans.ResultsThe counts of Streptococcus mutans in saliva decreased significantly after 1hour (P<0.001). However, the difference in reduction of Streptococcus mutans counts in saliva was not significant between the baseline and 7 days after treatment (P>0.05).ConclusionaPDT seems to be efficient to reduce salivary Streptococcus mutans immediately after treatment in children with severe early childhood caries. However, further researches are needed to evaluate different doses and frequency of irradiation in combination with restoring carious teeth to find more durable results.



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Variation in Patients' Travel Times among Imaging Examination Types at a Large Academic Health System

Publication date: Available online 27 March 2017
Source:Academic Radiology
Author(s): Andrew B. Rosenkrantz, Yu Liang, Richard Duszak, Michael P. Recht
Rationale and ObjectivesPatients' willingness to travel farther distances for certain imaging services may reflect their perceptions of the degree of differentiation of such services. We compare patients' travel times for a range of imaging examinations performed across a large academic health system.Materials and MethodsWe searched the NYU Langone Medical Center Enterprise Data Warehouse to identify 442,990 adult outpatient imaging examinations performed over a recent 3.5-year period. Geocoding software was used to estimate typical driving times from patients' residences to imaging facilities. Variation in travel times was assessed among examination types.ResultsThe mean expected travel time was 29.2 ± 20.6 minutes, but this varied significantly (p < 0.001) among examination types. By modality, travel times were shortest for ultrasound (26.8 ± 18.9) and longest for positron emission tomography-computed tomography (31.9 ± 21.5). For magnetic resonance imaging, travel times were shortest for musculoskeletal extremity (26.4 ± 19.2) and spine (28.6 ± 21.0) examinations and longest for prostate (35.9 ± 25.6) and breast (32.4 ± 22.3) examinations. For computed tomography, travel times were shortest for a range of screening examinations [colonography (25.5 ± 20.8), coronary artery calcium scoring (26.1 ± 19.2), and lung cancer screening (26.4 ± 14.9)] and longest for angiography (32.0 ± 22.6). For ultrasound, travel times were shortest for aortic aneurysm screening (22.3 ± 18.4) and longest for breast (30.1 ± 19.2) examinations. Overall, men (29.9 ± 21.6) had longer (p < 0.001) travel times than women (27.8 ± 20.3); this difference persisted for each modality individually (p ≤ 0.006).ConclusionsPatients' willingness to travel longer times for certain imaging examination types (particularly breast and prostate imaging) supports the role of specialized services in combating potential commoditization of imaging services. Disparities in travel times by gender warrant further investigation.



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Showcasing Our Profession to the Future Physician Workforce

Publication date: Available online 27 March 2017
Source:Academic Radiology
Author(s): Sravanthi Reddy, Yoshimi Anzai, Gary J. Whitman, Tudor Hughes, Smyrna Tuburan, Alison L. Chetlen, Alexander Norbash, Bibb Allen, William Thorwarth, James A. Brink, Stephanie Taylor, Christopher M. Straus
Rationale and ObjectivesThere has been waxing and waning of popularity of radiology as a career choice over the last few years. These fluctuations may in part be due to misconceptions such as the perceived lack of patient contact, as well as the perception of decreasing numbers of entry-level jobs. To address such misconceptions, it is important to reach medical students early in their training, both to give them a comprehensive and balanced understanding of radiology practice, and to appropriately frame radiologists as clinicians. Realizing the benefits of direct student outreach, a number of medical specialties are moving toward more direct recruitment efforts often through student interest groups and career fairs. The Medical Student Radiology Expo (MSRE) was proposed and executed by the Alliance of Medical Students Educators in Radiology, which was supported by the Association of University Radiologists (AUR) and the American College of Radiology. The MSRE was held immediately after the 2016 AUR annual meeting and hosted at the Moores Cancer Center at the University of California, San Diego. The goals of the MSRE were threefold: (1) to showcase radiology as a distinct and exciting specialty to all medical students, (2) to foster an interest in pursuing a career in radiology among medical students, and (3) to create a distributable and customizable combined symposium and workshop that could be easily replicated elsewhere.MethodsThe activities of this 1-day expo started with a morning of didactic elements, including a session identifying inaccurate myths surrounding radiology, specific details of interest pertaining to diagnostic radiology and interventional radiology residency programs, followed by interactive imaging diagnosis games, and question and answer sessions. A casual lunch with faculty members and attendees provided for more sustained direct and informal interactions between the students and the faculty. During the afternoon sessions, students participated in hands-on workshops, including ultrasound, imaging-guided biopsies, catheter manipulation, and post-processing image analysis, as well as roundtable discussions about radiology with the faculty.ResultsThe results from the post-program survey of the medical students were overall positive.ConclusionsThe MSRE, with the combined efforts of multiple organizations, was successful. A customizable, modular toolkit has been posted on the AUR website. Using this toolkit as a template, this recruitment and informational activity can be replicated at individual institutions, local radiology chapters, multidisciplinary meetings, and radiology meetings.



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The difference in association between aspirin use and other thrombocyte aggregation inhibitors and survival in patients with colorectal cancer

Publication date: May 2017
Source:European Journal of Cancer, Volume 77
Author(s): M.A. Frouws, E. Rademaker, E. Bastiaannet, M.P.P. van Herk-Sukel, V.E. Lemmens, C.J.H. Van de Velde, J.E.A. Portielje, G.J. Liefers
BackgroundSeveral studies have suggested that the association between aspirin and improved cancer survival is mediated through the mechanism of aspirin as thrombocyte aggregation inhibitors (TAI). The aim of this study was to provide epidemiological evidence for this mechanism assessing the association between overall survival and the use of aspirin and non-aspirin TAI in patients with colorectal cancer.MethodsIn this observational study, data from the Netherlands Comprehensive Cancer Organisation were linked to PHARMO Database Network. Patients using aspirin or aspirin in combination with non-aspirin TAI (dual users) were selected and compared with non-users. The association between overall survival and the use of (non-)aspirin TAI was analysed using Cox regression models with the use of (non-)aspirin TAI as a time-varying covariate.ResultsIn total, 9196 patients were identified with colorectal cancer and 1766 patients used TAI after diagnosis. Non-aspirin TAI were mostly clopidogrel and dipyridamole. Aspirin use was associated with a significant increased overall survival and hazard ratio (HR) 0.41 (95% confidence interval [CI] 0.37–0.47), and the use of non-aspirin TAI was not associated with survival of HR 0.92 (95% CI 0.70–1.22). Dual users did not have an improved overall survival when compared with patients using solely aspirin.ConclusionsAspirin use after diagnosis of colorectal cancer was associated with significantly lower mortality rates and this effect remained significant after adjusting for potential confounders. No additional survival benefit was observed in patients using both aspirin and another TAI.



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Baicalin against obesity and insulin resistance through activation of AKT/AS160/GLUT4 pathway

Publication date: Available online 27 March 2017
Source:Molecular and Cellular Endocrinology
Author(s): Penghua Fang, Mei Yu, Lei Zhang, Dan Wan, Mingyi Shi, Yan Zhu, Ping Bo, Zhenwen Zhang
Obesity may cause several metabolic complications, including insulin resistance and type 2 diabetes mellitus. Despite great advances in medicine, people still keep exploring novel and effective drugs for treatment of obesity and insulin resistance. The aim of this study was to survey if baicalin might ameliorate obesity-induced insulin resistance and to explore its signal mechanisms in skeletal muscles of mice. Diet-induced obese (DIO) mice were given 50 mg/kg baicalin intraperitoneally (i.p.) once a day for 21 days, and C2C12 myotubes were treated with 100, 200, 400 μM baicalin for 12 h in this study. Then insulin resistance indexes and insulin signal protein levels in skeletal muscles were examined. We discovered that administration of baicalin decreased food intake, body weight, HOMA-IR and NT-PGC-1α levels, but enhanced GLUT4, PGC-1α, pP38MAPK, pAKT and pAS160 contents, as well as GLUT4 mRNA, PGC-1α mRNA, PPARγ mRNA, GLUT1 mRNA expression in skeletal muscles of obese mice and myotubes of C2C12 cells, and reversed high fat diet-induced glucose and insulin intolerance, hyperglycemia and insulin resistance in the mice. These results suggest that baicalin is a powerful and promising agent for treatment of obesity and insulin resistance via Akt/AS160/GLUT4 and P38MAPK/PGC1α/GLUT4 pathway.



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Capecitabine in early breast cancer: A meta-analysis of randomised controlled trials

Publication date: May 2017
Source:European Journal of Cancer, Volume 77
Author(s): Akina Natori, Josee-Lyne Ethier, Eitan Amir, David W. Cescon
PurposeCapecitabine is an effective therapy for metastatic breast cancer. Its role in early breast cancer is uncertain due to conflicting data from randomised controlled trials (RCTs).MethodsPubMed and major conference proceedings were searched to identify RCTs comparing standard chemotherapy with or without capecitabine in the neoadjuvant or adjuvant setting. Hazard ratios (HRs) for disease-free survival (DFS) and overall survival (OS), as well as odds ratios (ORs) for toxicities were extracted or calculated and pooled in a meta-analysis. Subgroup analysis compared triple-negative breast cancer (TNBC) to non-TNBC and whether capecitabine was given in addition to or in place of standard chemotherapy. Meta-regression was used to explore the influence of TNBC on OS.ResultsEight studies comprising 9302 patients were included. In unselected patients, capecitabine did not influence DFS (hazard ratio [HR] 0.99, p = 0.93) or OS (HR 0.90, p = 0.36). There was a significant difference in DFS when capecitabine was given in addition to standard treatment compared with in place of standard treatment (HR 0.92 versus 1.62, interaction p = 0.002). Addition of capecitabine to standard chemotherapy was associated with significantly improved DFS in TNBC versus non-TNBC (HR 0.72 versus 1.01, interaction p = 0.02). Meta-regression showed that adding capecitabine to standard chemotherapy was associated with improved OS in studies with higher proportions of patients with TNBC (R = −0.967, p = 0.007). Capecitabine increased grade 3/4 diarrhoea (odds ratio [OR] 2.33, p < 0.001) and hand-foot syndrome (OR 8.08, p < 0.001), and resulted in more frequent treatment discontinuation (OR 3.80, p < 0.001).ConclusionAdding capecitabine to standard chemotherapy appears to improve DFS and OS in TNBC, but increases adverse events in keeping with its known toxicity profile.



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Autophagy-related polymorphisms predict hypertension in patients with metastatic colorectal cancer treated with FOLFIRI and bevacizumab: Results from TRIBE and FIRE-3 trials

Publication date: May 2017
Source:European Journal of Cancer, Volume 77
Author(s): Martin D. Berger, Shinichi Yamauchi, Shu Cao, Diana L. Hanna, Yu Sunakawa, Marta Schirripa, Satoshi Matsusaka, Dongyun Yang, Susan Groshen, Wu Zhang, Yan Ning, Satoshi Okazaki, Yuji Miyamoto, Mitsukuni Suenaga, Sara Lonardi, Chiara Cremolini, Alfredo Falcone, Volker Heinemann, Fotios Loupakis, Sebastian Stintzing, Heinz-Josef Lenz
PurposeThe most frequent bevacizumab-related side-effects are hypertension, proteinuria, bleeding and thromboembolism. To date, there is no biomarker that predicts anti-VEGF–associated toxicity. As autophagy inhibits angiogenesis, we hypothesised that single-nucleotide polymorphisms (SNPs) within autophagy-related genes may predict bevacizumab-mediated toxicity in patients with metastatic colorectal cancer (mCRC).Patients and methodsPatients with mCRC treated with first-line FOLFIRI and bevacizumab in two phase III randomised trials, namely the TRIBE trial (n = 219, discovery cohort) and the FIRE-3 trial (n = 234, validation cohort) were included in this study. Patients receiving treatment with FOLFIRI and cetuximab (FIRE-3, n = 204) served as a negative control. 12 SNPs in eight autophagy-related genes (ATG3/5/8/13, beclin 1, FIP200, unc-51-like kinase 1, UVRAG) were analysed by PCR-based direct sequencing.ResultsThe FIP200 rs1129660 variant showed significant associations with hypertension in the TRIBE cohort. Patients harbouring any G allele of the FIP200 rs1129660 SNP showed a significantly lower rate of grade 2–3 hypertension compared with the A/A genotype (3% versus 15%, odds ratio [OR] 0.17; 95% confidence interval [CI], 0.02–0.73; P = 0.009). Similarly, G allele carriers of the FIP200 rs1129660 SNP were less likely to develop grade 2–3 hypertension than patients with an A/A genotype in the FIRE-3 validation cohort (9% versus 20%, OR 0.43; 95% CI, 0.14–1.11; P = 0.077), whereas this association could not be observed in the control cohort (12% versus 9%, OR 1.40; 95% CI, 0.45–4.04; P = 0.60).ConclusionThis is the first report demonstrating that polymorphisms in the autophagy-related FIP200 gene may predict hypertension in patients with mCRC treated with FOLFIRI and bevacizumab.



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MiR-200b and miR-155 as predictive biomarkers for the efficacy of chemoradiation in locally advanced head and neck squamous cell carcinoma

Publication date: May 2017
Source:European Journal of Cancer, Volume 77
Author(s): Anne-Katrin Hess, Annika Müer, Fabian Dominik Mairinger, Wilko Weichert, Albrecht Stenzinger, Michael Hummel, Volker Budach, Ingeborg Tinhofer
BackgroundThe predictive value of microRNAs (miRNAs) in tumour cells and infiltrating immune cells for the efficacy of chemoradiation (CRTX) in locally advanced head and neck squamous cell carcinoma (HNSCC) was evaluated.MethodsFormalin-fixed, paraffin-embedded tumour material was collected from patients with locally advanced HNSCC treated within the ARO-0401 phase III trial with radiotherapy in combination with either 5-fluorouracil/cisplatin (CDDP-CRTX) or 5-fluorouracil/mitomycin C (MMC-CRTX). MiRNA and immune profiles were established in a test cohort of 48 oropharyngeal carcinoma (OPSCC) cases by Affymetrix miRNA microarrays and the nanoString PanCancer Immune Panel, respectively. Expression of miRNA candidates was measured in 149 HNSCC patients by real-time PCR. Interference of miRNA profiles with CRTX efficacy was determined by Kaplan–Meier and Cox regression analysis.ResultsExpression levels of five miRNAs (miR-27b, -130b, -200b, -451 and -532-5p) were significantly associated with overall survival after MMC-CRTX. Six different miRNAs (miR-125b, -146a, -150, -155, -187 and -342-5p) were correlated with overall survival after CDDP-CRTX. Validation by real-time PCR confirmed the predictive value of miR-200b and miR-155 in OPSCC, which was absent in hypopharyngeal carcinomas. MiR-146a was revealed as a prognostic marker for both CRTX regimens. MiR-200b expression was mainly associated with distant metastasis, whereas miR-155 correlated with local recurrence. MiR-155 and miR-146a were identified as surrogate markers for tumour-infiltrating lymphocytes.ConclusionsMiR-200b and miR-155 were established as potential markers for personalised treatment selection of two standard regimens of CRTX. The predictive role of miR-155 deserves further investigation, especially within the framework of clinical trials of CRTX/immune checkpoint inhibitor combinations.



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Quality measures of the population-based Finnish Cancer Registry indicate sound data quality for solid malignant tumours

Publication date: May 2017
Source:European Journal of Cancer, Volume 77
Author(s): Maarit K. Leinonen, Joonas Miettinen, Sanna Heikkinen, Janne Pitkäniemi, Nea Malila
BackgroundThe Finnish Cancer Registry (FCR) has collected population-based data on cancer incidence for scientific research and statistical purposes since 1953. Our aim was to provide a comprehensive quality assessment of the current cancer registry data in Finland.MethodsWe used established quantitative and semi-quantitative techniques to address four main dimensions of data quality: completeness, comparability, validity and timeliness for the period 1953–2013, with a special focus on cancers diagnosed in 2009–2013. For completeness, hospital admissions and outpatient visits were used as an independent data source.ResultsIn 2009–2013, 153 147 incident tumours were registered in the FCR. Of them, 91% were solid tumours. The completeness for all solid tumours was estimated at 96%, and for non-solid tumours at 86%. Potential underreporting was most prominent for tumours which are not typically histologically verified such as haematological malignancies and non-malignant tumours of the central nervous system. Of all cancers, 93% were morphologically verified, with variation by primary site. The proportion of cancers with uncertain or ill-defined primary site and the proportion of death certificate only registrations were both low at 1.9% and 2.6%, respectively.ConclusionsThe FCR provides overall accurate and close to complete national cancer data for solid malignant tumours. Registration of tumours with no histology is still compromised. This warrants continuous communication with clinicians to ensure undisturbed data flow, and active trace-back using external data sources such as hospital administrative data. In addition, broad diagnosis categories would be less sensitive to diversity of input and data quality when international comparisons are made.



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RE: Incidence and risk factors for secondary malignancy in patients with neuroblastoma after treatment with 131-I-metaiodobenzylguanidine. Huibregtse K et al. European Journal of Cancer 2016. 66:144–152

Publication date: May 2017
Source:European Journal of Cancer, Volume 77
Author(s): Cecile M. Ronckers, Lieve Tytgat, Marry M. van den Heuvel-Eibrink, Jop Teepen, Leontine C.M. Kremer, Sarah Clement, Hanneke M. van Santen




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Health-related quality of life in patients with locally recurrent or metastatic breast cancer treated with etirinotecan pegol versus treatment of physician's choice: Results from the randomised phase III BEACON trial

Publication date: May 2017
Source:European Journal of Cancer, Volume 76
Author(s): Chris Twelves, Javier Cortés, Joyce O'Shaughnessy, Ahmad Awada, Edith A. Perez, Seock–Ah Im, Patricia Gómez-Pardo, Lee S. Schwartzberg, Véronique Diéras, Denise A. Yardley, David A. Potter, Audrey Mailliez, Alvaro Moreno-Aspitia, Jin-Seok Ahn, Carol Zhao, Ute Hoch, Mary Tagliaferri, Alison L. Hannah, Hope S. Rugo
BackgroundHealth-related quality of life (HRQoL) enhances understanding of treatment effects that impact clinical decision-making. Although the primary end-point was not achieved, the BEACON (BrEAst Cancer Outcomes with NKTR-102) trial established etirinotecan pegol, a long-acting topoisomerase-1 (TOP1) inhibitor, as a promising therapeutic for patients with advanced/metastatic breast cancer (MBC) achieving clinically meaningful benefits in median overall survival (OS) for patients with stable brain metastases, with liver metastases or ≥ 2 sites of metastatic disease compared to treatment of physician's choice (TPC). Reported herein are the findings from the preplanned secondary end-point of HRQoL.Patients and methodsHRQoL, assessed by European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) (version 3.0) supplemented by the breast cancer-specific Quality of Life Questionnaire (QLQ-BR23), was evaluated post randomisation in 733 of 852 patients with either anthracycline-, taxane- and capecitabine-pretreated locally recurrent or MBC randomised to etirinotecan pegol (n = 378; 145 mg/m² every 3 weeks (q3wk)) or single-agent TPC (n = 355). Patients completed assessments at screening, every 8 weeks (q8wk) during treatment, and end-of-treatment. Changes from baseline were analysed, and the proportions of patients achieving differences (≥5 points) in HRQoL scores were compared.ResultsDifferences were seen favouring etirinotecan pegol up to 32 weeks for global health status (GHS) and physical functioning scales (P < 0.02); numerical improvement was reported in other functional scales. The findings from HRQoL symptom scales were consistent with adverse event profiles; etirinotecan pegol was associated with worsening gastrointestinal symptoms whereas TPC was associated with worsened dyspnoea and other systemic side-effects. Analysis of GHS and physical functioning at disease progression showed a decline in HRQoL in both treatment arms, with a mean change from baseline of −9.4 and −10.8 points, respectively.ConclusionThere was evidence of benefit associated with etirinotecan pegol compared with current standard of care agents in multiple HRQoL measurements, including global health status and physical functioning, despite worse gastrointestinal symptoms (e.g. diarrhoea). Patients in both arms had a decline in HRQoL at disease progression.Study numberNCT01492101.



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Thyroid Cancer Surgery Guidelines in an Era of De-Escalation

Publication date: Available online 16 March 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Kevin J. Kovatch, Connor W. Hoban, Andrew G. Shuman
Well-differentiated thyroid carcinoma has seen a tremendous rise in global incidence over the past three decades, largely owing to widespread screening and identification of small, incidentally detected tumors. With this increased incidence has emerged a movement questioning whether all cases of thyroid cancer merit a treatment approach focused on oncologic completeness. Such trends towards thoughtful, evidence-based treatment de-escalation paradigms reflect better risk stratification of thyroid cancers, and recognition that not all detected disease poses a threat to health or survival. Thus, national and professional guidelines are evolving to incorporate higher thresholds for surgery, acceptance of less than total thyroidectomy in specific circumstances, higher thresholds for adjuvant therapy, and introducing the role of active surveillance for selected cases of low risk disease. Despite these common themes, there are significant differences among guidelines. This lack of consensus in guidelines persists due to variation in clinical practice patterns, differences in consideration and interpretation of existing evidence, cultural and geographical considerations, and resources available for both diagnosis and treatment.



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Editorial Board

Publication date: April 2017
Source:European Journal of Surgical Oncology (EJSO), Volume 43, Issue 4





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Impact of time to surgery after neoadjuvant chemotherapy in operable breast cancer patients

Publication date: April 2017
Source:European Journal of Surgical Oncology (EJSO), Volume 43, Issue 4
Author(s): C. Omarini, G. Guaitoli, S. Noventa, A. Andreotti, A. Gambini, E. Palma, S. Papi, G. Tazzioli, S. Balduzzi, M. Dominici, S. Cascinu, F. Piacentini
BackgroundThe optimal time interval between the end of neoadjuvant systemic therapy (NST) and breast surgery is still unclear. It is not known if a delay in surgery might influence the benefit of primary chemotherapy. The aim of this study is to evaluate the relationship between time to surgery (TTS) and survival outcomes.Patients and methodsAccording to TTS, women with diagnosis of BC treated with NST were divided into two cohorts: group A = 21 days or fewer and group B = longer than 21 days. OS and RFS were estimated and compared according to TTS and known prognostic factors.ResultsA total of 319 patients were included in the study: 61 in group A and 258 in group B. Median TTS was 34 days. No association between clinical stage, nuclear grade, type of chemotherapy, type of surgery and TTS was detected. OS and RFS were significantly worse for group B compared with group A, with a hazard ratio of 3.1 (95% CI, 1.1–8.6 p = 0.03) and 3.1 (95% CI, 1.3–7.1 p = 0.008) respectively. Multivariate analysis confirmed that TTS was an independent prognostic factor in term of OS (p = 0.03) and RFS (p = 0.01). Even in the subgroup of patients with pCR, TTS continued to be an independent prognostic factor for both OS and RFS (p = 0.05 and p = 0.03).ConclusionsTTS after NST seems to influence survival outcomes. BC patients underwent surgery within 21 days experienced maximal benefit from previous treatment: this advantage is consistent and maintained over time.



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The harmful impact of the rhetoric “ War on Cancer”

Publication date: Available online 27 March 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): S. Kruijff, C. Van Zweden




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PET/CT with 18F-FDG predicts short-term outcome in stage II/III breast cancer patients upstaged to N2/3 nodal disease

Publication date: April 2017
Source:European Journal of Surgical Oncology (EJSO), Volume 43, Issue 4
Author(s): S.C. Teixeira, B.B. Koolen, P.H.M. Elkhuizen, M.-J.T.F.D. Vrancken Peeters, M.P.M. Stokkel, S. Rodenhuis, V. van der Noort, E.J.T. Rutgers, R.A. Valdés Olmos
Introduction¹⁸F-FDG PET/CT has high positive predictive value for the detection of avid lymph node metastases in breast cancer patients. We analysed the effect of upstaging lymph nodes by PET/CT on short-term outcome in stage II/III breast cancer patients.Patients and methodsA total of 278 stage II/III primary breast cancer patients (mean age 48.9 years, range 19–75 years) were re-staged with ¹⁸F-FDG PET/CT before start of pre-operative systemic treatment (PST). Patients were divided in three groups based on risk for local recurrence: a low – (T2N0), intermediate – (T0-2N1 and T3N0) and a high-risk group (T0-3N2–3, T3N1 and T4). Within these groups we looked at local recurrence-free survival (LRFS), recurrence-free survival (RFS) and overall survival (OS) within the first 3 years of follow-up.ResultsWith a median follow-up (FU) of 50 months the RFS, LRFS and OS were 87%, 88% and 92% respectively for the whole group. PET/CT upstaged 43 patients from the low- and intermediate risk group to the high-risk group, based on detection of ≥4 avid axillary nodes or occult N2/3-disease. Patients upstaged with PET/CT had more events for all three analyses compared to the original risk groups, which resulted in a significantly worse RFS (69.8%; p = 0.03) a nearly significantly worse LRFS (p = 0.052) and no effect in OS (p = 0.433).DiscussionAdditional PET/CT staging allows breast cancer patients to be treated according to the true stage, still stage II/III breast cancer patients upstaged to N2/3 by PET/CT have worse short-term outcome, despite adjustment of treatment, than patients staged high-risk with conventional imaging.



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Diffusion-weighted magnetic resonance imaging in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy

Publication date: Available online 23 March 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): De Felice Francesca, Magnante Anna Lisa, Musio Daniela, Ciolina Maria, De Cecco Carlo Nicola, Rengo Marco, Laghi Andrea, Tombolini Vincenzo
PurposeTo analyze diffusion-weighted magnetic resonance imaging (DW-MRI) for treatment response assessment in locally advanced rectal cancer (LARC).Patients and methodsPatients with histologically proven rectal adenocarcinoma, stage II-III disease, were enrolled and underwent surgery following neoadjuvant chemoradiotherapy (nCRT). All patients were referred for a DW-MRI protocol on a 3 Tesla MR-system, consisting of axial T2-weighted and DWI sequences prior (I), during (II) and after (III) nCRT. Corresponding apparent diffusion coefficient (ADC) values were calculated.ResultsBetween February 2011 and June 2015, 37 patients participated in the study. All patients completed programmed treatment. Overall, 11 patients (29.7%) had pathologic complete response (pCR). No correlation between the mean pre- (ADC-I), during (ADC-II), post- (ADC-III) ADC and the reduction in tumor size after nCRT was recorded. No substantial difference in the ADC distribution was found between pCR and no-pCR patients. The ADC-II level significantly increased in the pCR cases (T= 1.675; p < 0.05).ConclusionADC value could be useful for discriminating between the pCR patients and the no-pCR patients. Further studies are necessary to identify the optimal MRI parameters combination to predict tumor response to nCRT. It is hoped that these data will provide the basis for a more solid scientific evidence.



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The surgical management of patients with clinical stage T4 bladder cancer: A single institution experience

Publication date: April 2017
Source:European Journal of Surgical Oncology (EJSO), Volume 43, Issue 4
Author(s): M. Moschini, S. Luzzago, E. Zaffuto, P. Dell'Oglio, G. Gandaglia, A. Mattei, R. Damiano, F. Soria, T. Klatte, S.F. Shariat, A. Salonia, F. Montorsi, A. Briganti, A. Gallina, R. Colombo
IntroductionPatients with clinical T4 (cT4) bladder cancer (BCa) infrequently undergo radical cystectomy (RC). We investigated the reliability of preoperative clinical staging, perioperative and survival outcomes in patients treated with RC due to cT4a-b BCa disease at a single tertiary care institution.MethodsThe study relied on 917 BCa patients treated with RC and pelvic lymph node dissection (PLND) at a single institution between January 1995 and December 2012. We compared the accuracy of the clinical assessment with final pathology results. Moreover, we evaluated perioperative outcomes, complication rates and survival after surgery.ResultsThe median follow-up was 62 months. Overall, 74 (8.1%) patients presented cT4 stage at preoperative evaluation. Conversely, a pathological T4 disease was confirmed only in 68.9% patients staged initially as cT4. No differences were recorded in complications, 30 days readmission or 30 days death rates between cT1–T3 vs. cT4a vs. cT4b (p > 0.1). At multivariable Cox regression analyses predicting cancer specific mortality, clinical T4 stage vs. clinical T1–2, clinical T3 stage vs. clinical T1–2 and age were predictors of worst survival after RC (all p < 0.04).ConclusionsWe recorded poor concordance between preoperative imaging and pathology in cT4 patients. No differences in major perioperative outcomes and acceptable survival expectancies were reported in patients treated for cT4 disease.



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Calendar

Publication date: April 2017
Source:European Journal of Surgical Oncology (EJSO), Volume 43, Issue 4





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Immediate Lipofilling in Breast Conserving Surgery

Publication date: Available online 27 March 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): L.R. Khan, C.R. Raine, J.M. Dixon
BackgroundThe aim of breast conserving surgery (BCS) is to excise the cancer with clear margins whilst at the same time leaving a good or excellent cosmetic result. A significant percentage of women, who have large cancers or have limited breast volumes, achieve poor cosmetic outcomes. BCS with immediate volume replacement using lipofilling or autologous fat transfer is a new technique. The aim of this study was to evaluate the cosmetic outcomes of a pilot study of patients having BCS and immediate lipofilling performed in The Edinburgh Breast Unit.MethodsQuestionnaires were mailed to 35 women who had BCS with immediate lipofilling and completed by 32 and results compared with those from a contemporary series of 39 women who had BCS alone. The cancers were significantly larger in the lipofilling group (median 21mm vs. 16mm p=0.011) and the patients were non-significantly younger (median age 49 years vs. 54 p =0.06).ResultsAt a median follow-up of 36 months, results from the Breast Q™ questionnaire showed significantly better cosmetic outcomes with lipofilling (most p <0.001) and less local breast symptoms (p =0.0045). There have been no local recurrences in either group and only 1 of the 35 patients was recalled following post-operative surveillance annual mammography.ConclusionBCS and immediate lipofilling provides superior cosmetic outcomes to standard BCS.



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Long-term results of treatment of advanced dermatofibrosarcoma protuberans (DFSP) with imatinib mesylate - the impact of fibrosarcomatous transformation

Publication date: Available online 22 March 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Piotr Rutkowski, Anna Klimczak, Iwona Ługowska, Beata Jagielska, Michal Wągrodzki, Maria Dębiec-Rychter, Barbara Pieńkowska-Grela, Tomasz Świtaj
BackgroundDermatofibrosarcoma protuberans (DFSP) is rare, infiltrating dermal neoplasm, characterized by indolent growth and low probability of metastases. The first effective systemic therapy in DFSP introduced into clinical practice was imatinib, demonstrating high activity in advanced cases. The aim of the study was to perform an analysis of patients with advanced DFSP treated with imatinib, with or without surgery, in routine clinical practice with long-term follow-up.Patients and MethodsWe analyzed the data of 31 Caucasian patients (14 male, 17 female; median age 56 years) with locally advanced/initially inoperable and/or metastatic DFSP who started therapy with imatinib at initial dose 800 mg daily between 12/2004 and 07/2014. All diagnoses were confirmed cytogenetically for the presence of specific COL1A1-PDGFB fusion. Median follow-up time was 5.3 years.ResultsMetastases were present in 15 cases (8– lungs, 5 – soft tissue, 2 – lymph nodes). Fibrosarcomatous transformation (FS-DFSP) was confirmed in 16 patients (52%). 5-year progression-free survival (PFS) rate was 58% (median 6.8 years), 5-year overall survival (OS) rate was 64% (median time for OS was not reached). The shorter PFS and OS correlated with FS-DFSP and presence of metastatic disease. 5-year PFS rate was 93% for classic DFSP and 33% for FS-DFSP. The best overall responses were: 21 partial responses (68%, including 8 FS-DFSP, but the responses were shorter than for classic DFSP), 6 stable disease (19%) and 4 progressive diseases (13%). Thirteen patients (47%) underwent resection of residual disease and nine of them remained free of disease, although imatinib was discontinued. Median survival after progression on imatinib was 19 months, and longer survival were observed only in cases were rescue surgery/radiotherapy was possible.ConclusionsOur results indicate the long-term activity of imatinib in therapy of inoperable and/or metastatic cases of DFSP, including FS-DFSP. Some DFSP patients initially evaluated as unresectable/metastatic or necessitating mutilating surgery turned resectable after imatinib therapy and this rational approach leading to complete remission maybe potentially curative.



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Low-risk papillary microcarcinoma of the thyroid: A review of active surveillance trials

Publication date: Available online 16 March 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Y. Ito, A. Miyauchi, H. Oda
Papillary microcarcinoma (PMC) of the thyroid is defined as papillary thyroid carcinoma (PTC) measuring ≤1 cm. Many autopsy studies on subjects who died of non-thyroidal diseases reported latent small thyroid carcinoma in up to 5.2% of the subjects. A mass screening study for thyroid cancer in Japanese adult women detected small thyroid cancer in 3.5% of the examinees. This incidence was close to the incidence of latent thyroid cancer and more than 1000 times the prevalence of clinical thyroid cancer in Japanese women reported at that time. The question of whether it was correct to treat such PMCs surgically then arose. In 1993, according to Dr. Miyauchi's proposal, Kuma Hospital initiated an active surveillance trial for low-risk PMC as defined in the text. In 1995, Cancer Institute Hospital in Tokyo, Japan, started a similar observation trial. The accumulated data from the trials at these two institutions strongly suggest that active surveillance (i.e., observation without immediate surgery) can be the first-line management for low-risk PMC. Although our data showed that young age and pregnancy might be risk factors of disease progression, we think that these patients can also be candidates for active surveillance, because all of the patients who showed progression signs were treated successfully with a rescue surgery, and none of them died of PTC. In this review, we summarize the data regarding the active surveillance of low-risk PMC as support for physicians and institutions that are considering adopting this strategy.



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Announcements

Publication date: April 2017
Source:European Journal of Surgical Oncology (EJSO), Volume 43, Issue 4





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Lymph node ratio as a prognostic factor in gastric cancer patients following D1 resection. Comparison with the current TNM Staging System

Publication date: Available online 27 March 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): K. Bouliaris, G. Rachiotis, A. Diamantis, G. Christodoulidis, E. Polychronopoulou, K. Tepetes
IntroductionNodal ratio (NR) has been demonstrated to be an independent prognostic factor in patients with gastric cancer. We evaluated the prognostic role of NR comparing it with the current TNM (2010) classification in gastric cancer patients treated with curative (R0) D1 resection.Materials and MethodsWe retrospectively reviewed 110 patients who underwent R0 resection for gastric cancer at University Hospital of Larissa between 2002 and 2011. All patients had a D1 lymphadenectomy plus the nodes along the left gastric artery. Factors affecting survival as well as correlations between the N status, NR status and resected nodes were investigated.ResultsOn univariate analysis the T, N and NR status but not the numbers of retrieved nodes were significant prognostic factors. Inside N1 and N2 patients with different NR groups were present and survival of some of these subpopulations was statistically different at long rank test. There was a correlation between the nodes retrieved and N status but not with the NR category. On multivariate analysis both N (HR=1.52;95%C.I=1.14-2.01) and NR (HR=7.26;95% C.I.=2.59-20.3) found to be independent prognostic factors.ConclusionPrognostic significance of N status and NR status was comparable. Unlike N status, NR is independent by the number of resected nodes, and therefore it is particularly useful in case of conventional lymphadenectomy.



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Microwave Thermosphere™ Ablation in the multimodal management of colorectal cancer liver metastasis

Publication date: Available online 24 March 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Tullio Piardi, Mikaël Chetboun, Daniele Sommacale, Reza Kianmanesh




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„To clip or not to clip. That is no question!”

Publication date: Available online 23 March 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Marianne Camille Aznar, Icro Meattini, Philip Poortmans, Petra Steyerova, Lynda Wyld




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Tumor regression grade and survival after neoadjuvant treatment in gastro-esophageal cancer: A meta-analysis of 17 published studies

Publication date: Available online 18 March 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): G. Tomasello, F. Petrelli, M. Ghidini, E. Pezzica, R. Passalacqua, F. Steccanella, L. Turati, G. Sgroi, S. Barni
IntroductionMajor pathologic regression after neoadjuvant therapy is a strong and favorable prognostic factor in several types of cancer (breast, rectal and bladder). This information is less clear and has yet to be systematically evaluated in upper gastrointestinal tumors. We performed a meta-analysis to evaluate the prognostic impact of tumor regression after preoperative therapy on disease-free survival (DFS) and overall survival (OS) in gastro-esophageal cancer patients.Methodswe searched for relevant articles in PubMed, SCOPUS, Web of Science, CINAHL, LILACS, Ovid, Cochrane Library, Google Scholar and Embase up to June 2, 2016. Data of tumor regression (complete or near-complete pathologic response) that independently correlated with OS and DFS in multivariate analysis were extracted, and the proper hazard ratios (HRs) with corresponding 95% confidence intervals (95% CIs) were pooled according to the random effect model.Resultsa total of 17 studies—which included 3145 patients—were considered in the final analysis. Major pathologic response was significantly related with better OS (HR 0.46, 95% CI 0.32–0.66, P < 0.001) and DFS (HR = 0.40, 95% CI 0.26–0.62, P < 0.001). Pathologic complete response (pCR) or major tumor regression were associated with the same degree of benefit in outcome compared to no or minimal pathologic regression, regardless of histology.Conclusionmajor pathologic response is associated with a significant improvement in OS compared to no response or minor pathologic changes after neoadjuvant therapy in gastro-esophageal cancers. This should be considered a robust prognostic factor to guide postoperative treatment and follow-up.



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Predictors of growth kinetics and outcomes in small renal masses (SRM ≤4cm in size): Tayside Active Surveillance Cohort (TASC) Study

Publication date: Available online 16 March 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Paterson Catherine, Chin Yew-Fung, Sweeney Clare, Szewczyk-Bieda Magda, Lang Stephen, Nabi Ghulam
ObjectiveTo determine outcomes of small renal masses (≤4cm) on active surveillance and explore factors which can influence their growth.Patients and Methods226 patients between January 2007 and December 2014 were analyzed using cross-linked methodology of healthcare data and independent review. Cancer specific and non-specific survival were the primary outcomes. Growth kinetics, factors influencing growth and need for interventions were secondary outcomes.Results101 (64.4%) solid and 4 (5.9%) cystic SRMs showed growth. 43 (19.02%) of SRMs required treatment interventions. Seven patients (7/158; 4.4%) died due to renal cancer at a median follow-up of 21.7 (SD 10.6, min 6-42) months, all in solid category. Independent review of serial radiological imaging of these 7 cases showed two patients had subtle metastatic disease at the initial presentation, and 5 of the 7 did not adhere to recommended imaging regime. 33 (33/158; 20.8%) died due to other causes including non-renal cancers (14/158; 8.8%). Multivariate analyses showed that lower eGFR at baseline, co-morbidities and tumour location were independently associated with growth in size.ConclusionsA higher cancer-specific mortality was seen in the present study compared to the reported literature. Independent critical review of imaging of cases with poor outcome underscored the importance of adherence to a robust protocol including follow up. Comorbid conditions had a significant impact on growth and overall survival of patients with SRMs.



http://ift.tt/2naS6nZ

In-hospital mortality, 30-day readmission, and length of hospital stay after surgery for primary colorectal cancer: A national population-based study

Publication date: Available online 16 March 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): S. Pucciarelli, M. Zorzi, N. Gennaro, G. Gagliardi, A. Restivo, M. Saugo, A. Barina, M. Rugge, M. Zuin, I. Maretto, D. Nitti
IntroductionThe simultaneous assessment of multiple indicators for quality of care is essential for comparisons of performance between hospitals and health care systems.The aim of this study was to assess the rates of in-hospital mortality and 30-day readmission and length of hospital stay (LOS) in patients who underwent surgical procedures for colorectal cancer between 2005 and 2014 in Italy.MethodsAll patients in the National Italian Hospital Discharge Dataset who underwent a surgical procedure for colorectal cancer during the study period were included. The adjusted odd ratios for risk factors for in-hospital mortality, 30-day readmission, and LOS were calculated using multilevel multivariable logistic regression.ResultsAmong the 353 941 patients, rates of in-hospital mortality and 30-day readmission were 2.5% and 6%, respectively, and the median LOS was 13 days. High comorbidity, emergent/urgent admission, male gender, creation of a stoma, and an open approach increased the risks of all the outcomes at multivariable analysis. Age, hospital volume, hospital geographic location, and discharge to home/non-home produced different effects depending on the outcome considered. The most frequent causes of readmission were infection (19%) and bowel obstruction (14.6%).ConclusionsWe assessed national averages for mortality, LOS and readmission and related trends over a 10-year time. Laparoscopic surgery was the only one that could be modified by improving surgical education. Higher hospital volume was associated with a LOS reduction, but our findings only partially support a policy of centralization for colorectal cancer procedures. Surgical site infection was identified as the most preventable cause of readmission.



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Deficiencies in Global Health Training for Cardiovascular Fellows

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JACC Instructions for Authors

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Autosomal Recessive Cardiomyopathy Presenting as Acute Myocarditis

AbstractBackground

Myocarditis is inflammation of the heart muscle that can follow various viral infections. Why children only rarely develop life-threatening acute viral myocarditis (AVM), given that the causal viral infections are common, is unknown. Genetic lesions might underlie such susceptibilities. Mouse genetic studies demonstrated that interferon (IFN)-α/β immunity defects increased susceptibility to virus-induced myocarditis. Moreover, variations in human TLR3, a potent inducer of IFNs, were proposed to underlie AVM.

Objectives

This study sought to evaluate the hypothesis that human genetic factors may underlie AVM in previously healthy children.

Methods

We tested the role of TLR3-IFN immunity using human induced pluripotent stem cell-derived cardiomyocytes. We then performed whole-exome sequencing of 42 unrelated children with acute myocarditis (AM), some with proven viral causes.

Results

We found that TLR3- and STAT1-deficient cardiomyocytes were not more susceptible to Coxsackie virus B3 (CVB3) infection than control cells. Moreover, CVB3 did not induce IFN-α/β and IFN-α/β-stimulated genes in control cardiomyocytes. Finally, exogenous IFN-α did not substantially protect cardiomyocytes against CVB3. We did not observe a significant enrichment of rare variations in TLR3- or IFN-α/β-related genes. Surprisingly, we found that homozygous but not heterozygous rare variants in genes associated with inherited cardiomyopathies were significantly enriched in AM-AVM patients compared with healthy individuals (p = 2.22E-03) or patients with other diseases (p = 1.08E-04). Seven of 42 patients (16.7%) carried rare biallelic (homozygous or compound heterozygous) nonsynonymous or splice-site variations in 6 cardiomyopathy-associated genes (BAG3, DSP, PKP2, RYR2, SCN5A, or TNNI3).

Conclusions

Previously silent recessive defects of the myocardium may predispose to acute heart failure presenting as AM, notably after common viral infections in children.

http://ift.tt/2oa2WeG

Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI: We Should EXPLORE More!

http://ift.tt/2nFq9ry

Myocarditis: An Intersection Between Genetic and Acquired Causes of Human Cardiomyopathy

http://ift.tt/2nFlSnW

State Requirements for Automated External Defibrillators in American Schools: Framing the Debate About Legislative Action

Abstract

Installation of automated external defibrillators (AEDs) in schools has been associated with increased survival after sudden cardiac arrest. An authoritative academic research database was interrogated to identify all current state statutes pertaining to AEDs in schools. As of February 2016, 17 of 50 U.S. states (34%) require AED installation in at least some of their schools; the remaining states have no legislation. However, requirements are far from comprehensive in these 17 states. Only 5 states offer unequivocal funding to schools for purchasing AEDs. A minority of U.S. states have legislation requiring AED placement in schools, and even fewer provide funding. State legislatures that have not yet enacted legislation requiring AEDs in schools may look to neighboring states for examples of child and adult lifesaving law. Placement of an AED in schools should be implemented with an emergency response plan that trains staff in the recognition and response to cardiac arrest.

http://ift.tt/2nFoVMN

Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate

AbstractBackground

Patients with nonischemic dilated cardiomyopathy (DCM) may be at lower risk for ventricular arrhythmias compared with those with ischemic cardiomyopathy (ICM). In addition, DCM has been identified as a predictor of positive response to cardiac resynchronization therapy (CRT).

Objectives

The aim of this study was to investigate the impact of an additional implantable cardioverter-defibrillator over CRT, according to underlying heart disease, in a large study group of primary prevention patients with heart failure.

Methods

This was an observational, multicenter, European cohort study of 5,307 consecutive patients with DCM or ICM, no history of sustained ventricular arrhythmias, who underwent CRT implantation with (n = 4,037) or without (n = 1,270) a defibrillator. Propensity-score and cause-of-death analyses were used to compare outcomes.

Results

After a mean follow-up period of 41.4 ± 29.0 months, patients with ICM had better survival when receiving CRT with a defibrillator compared with those who received CRT without a defibrillator (hazard ratio for mortality adjusted on propensity score and all mortality predictors: 0.76; 95% confidence interval [CI]: 0.62 to 0.92; p = 0.005), whereas in patients with DCM, no such difference was observed (hazard ratio: 0.92; 95% CI: 0.73 to 1.16; p = 0.49). Compared with recipients of defibrillators, the excess mortality in patients who did not receive defibrillators was related to sudden cardiac death in 8.0% among those with ICM but in only 0.4% of those with DCM.

Conclusions

Among patients with heart failure with indications for CRT, those with DCM may not benefit from additional primary prevention implantable cardioverter-defibrillator therapy, as opposed to those with ICM.

http://ift.tt/2oaaNck

Midwall Fibrosis and 5-Year Outcome in Moderate and Severe Aortic Stenosis

http://ift.tt/2nFx5VA

Should Nonischemic CRT Candidates Receive CRT-P or CRT-D?

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Reply: HDL-C and Mortality

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Exercise Training in Patients With Chronic Heart Failure and Atrial Fibrillation

AbstractBackground

The safety and efficacy of aerobic exercise in heart failure (HF) patients with atrial fibrillation (AF) has not been well evaluated.

Objectives

This study examined whether outcomes with exercise training in HF vary according to AF status.

Methods

HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) randomized 2,331 ambulatory HF patients with ejection fraction ≤35% to exercise training or usual care. We examined clinical characteristics and outcomes (mortality/hospitalization) by baseline AF status (past history of AF or AF on baseline electrocardiogram vs. no AF) using adjusted Cox models and explored an interaction with exercise training. We assessed post-randomization AF events diagnosed via hospitalizations for AF and reports of serious arrhythmia caused by AF.

Results

Of 2,292 patients with baseline rhythm data, 382 (17%) had AF, 1,602 (70%) had sinus rhythm, and 308 (13%) had "other" rhythm. Patients with AF were older and had lower peak Vo₂. Over a median follow-up of 2.6 years, AF was associated with a 24% per year higher rate of mortality/hospitalization (hazard ratio [HR]: 1.53; 95% confidence interval [CI]: 1.34 to 1.74; p < 0.001) in unadjusted analysis; this did not remain significant after adjustment (HR: 1.15; 95% CI: 0.98 to 1.35; p = 0.09). There was no significant difference in AF event rates by randomized treatment assignment in the overall population or by baseline AF status (all p > 0.10). There was no interaction between AF and exercise training on measures of functional status or clinical outcomes (all p > 0.10).

Conclusions

AF in patients with chronic HF was associated with older age, reduced exercise capacity at baseline, and a higher overall rate of clinical events, but not a differential response to exercise training for clinical outcomes or changes in exercise capacity. (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF-ACTION]; NCT00047437)

http://ift.tt/2oaj149

Pulmonary Hypertension in Heart Failure: Pathophysiology, Pathobiology, and Emerging Clinical Perspectives

Abstract

Pulmonary hypertension is a common hemodynamic complication of heart failure. Interest in left-sided pulmonary hypertension has increased remarkably in recent years because its development and consequences for the right heart are now seen as mainstay abnormalities that begin in the early stages of the disease and bear unfavorable prognostic insights. However, some knowledge gaps limit our ability to influence this complex condition. Accordingly, attention is now focused on: 1) establishing a definitive consensus for a hemodynamic definition, perhaps incorporating exercise and fluid challenge; 2) implementing the limited data available on the pathobiology of lung capillaries and small arteries; 3) developing standard methods for assessing right ventricular function and, hopefully, its coupling to pulmonary circulation; and 4) searching for effective therapies that may benefit lung vessels and the remodeled right ventricle. The authors review the pathophysiology, pathobiology, and emerging clinical perspectives on pulmonary hypertension across the broad spectrum of heart failure stages.

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Atrial Fibrillation: A Threat to the Failing Heart?

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Leadership in Cardiology: Development of Cardiologists as Leaders to Improve Our Health Care System

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Electrocardiographic Criteria for the Diagnosis of Left Ventricular Hypertrophy

AbstractBackground

Current electrocardiographic (ECG) criteria for the diagnosis of left ventricular hypertrophy (LVH) have low sensitivity.

Objectives

The goal of this study was to test a new method to improve the diagnostic performance of the electrocardiogram.

Methods

The study was divided into 2 groups, a test and a validation cohort. In the test cohort, 94 patients were analyzed, including 47 with the diagnosis of hypertensive crisis and 47 with normal blood pressure at admission. Echocardiography was used to estimate the left ventricular mass index. Area under the curve (AUC) analysis was used for comparison of single and combined leads. The McNemar test was used to assess agreement among the ECG criteria against the left ventricular mass index. The proposed ECG criteria involved measuring the amplitude of the deepest S wave (S_D) in any single lead and adding it to the S wave amplitude of lead V₄ (SV₄). Currently accepted LVH ECG criteria such as Cornell voltage and Sokolow-Lyon were used for comparison. The validation cohort consisted of 122 consecutive patients referred for an echocardiogram regardless of the admitting diagnosis.

Results

The S_D was the most accurate single lead measurement for the diagnosis of LVH (AUC: 0.80; p < 0.001). When both cohorts were analyzed, the S_D + SV₄ criteria outperformed Cornell voltage with a significantly higher sensitivity (62% [95% confidence interval [CI]: 50% to 72%] vs. 35% [95% CI: 24% to 46%]). The specificities of all the criteria were ≥90%, with no significant difference among them.

Conclusions

The proposed criteria for the ECG diagnosis of LVH improved the sensitivity and overall accuracy of the test.

http://ift.tt/2oab6DK

Electrophysiologically Guided Thoracoscopic Surgery for Advanced Atrial Fibrillation: 5-Year Follow-up

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The Enduring Role of the Electrocardiogram as a Diagnostic Tool in Cardiology

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Comment on the EXPLORE Trial

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The Benefit of Donor-Recipient Matching for Patients Undergoing Heart Transplantation

AbstractBackground

Heart transplant volumes are not matching growing demand, and donor heart use may be decreasing.

Objectives

This study sought to investigate the benefit of heart transplantation compared with waiting while accounting for the estimated risk of a given donor-recipient match.

Methods

This study identified 28,548 heart transplant candidates in the Organ Procurement and Transplant Network between July 2006 and December 2015. Donor-recipient match quality was estimated from the donor risk index. A time-dependent covariate Cox model was used to determine the effect of donor-recipient match quality on the likelihood of a composite outcome while waiting for a transplant or after transplantation. The composite outcome was death or delisting as too ill.

Results

Donor and recipient risk estimates were inversely related to the candidate urgency. Net benefit from heart transplantation was evident across all estimates of donor-recipient status 1A and 1B candidates: status 1A (lowest-risk quartile hazard ratio [HR]: 0.37; 95% confidence interval [CI]: 0.31 to 0.43; highest-risk quartile HR: 0.52; 95% CI: 0.44 to 0.61) and status 1B candidates (lowest-risk quartile HR: 0.41; 95% CI: 0.36 to 0.47; highest-risk quartile HR: 0.66; 95% CI: 0.58 to 0.74). Status 2 candidates showed a benefit from heart transplantation; however, survival benefit was delayed. For the highest-risk donor-recipient matches, a net benefit of transplantation occurred immediately for status 1A candidates, after 12 months for status 1B candidates, and after 3 years for status 2 candidates.

Conclusions

This study demonstrated a survival benefit of heart transplantation across all ranges of estimated donor-recipient match risk for status 1A and status 1B candidates. Donor heart acceptance should be the favored strategy for these candidates. The benefit of transplantation for status 2 candidates was less apparent and dependent on estimated donor-recipient match risk, suggesting that a measure of donor-recipient match quality may be useful when considering the immediate benefit of heart transplantation for status 2 candidates in stable condition.

http://ift.tt/2oagwyU

Reply: Comments on PCI for Concurrent CTOs in Patients With STEMI: We Should EXPLORE More!

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Evaluation of lateral pterygoid muscles in painful temporomandibular joints by signal intensity on fluid-attenuated inversion recovery images

Abstract

Objectives

Pathological changes of the lateral pterygoid muscle (LPM) have been investigated using various modalities, including magnetic resonance (MR) imaging and electromyography. Fluid-attenuated inversion recovery (FLAIR) is an MR sequence that we hypothesized can be used to evaluate abnormalities of the LPM. The purpose of this study was to analyze the FLAIR signal intensity of the LPM in painful temporomandibular joints (TMJs) and investigate the pathological changes of the muscle.

Methods

The study was based on 149 TMJs of 77 patients who were referred for MR imaging of the TMJ. Patients rated their degree of pain during chewing and mouth opening using a visual analog scale (VAS). Regions of interest were placed over the superior and inferior heads of the LPM and gray matter on FLAIR sagittal images. Using the signal intensity of gray matter as a reference, the signal intensity ratio (SIR) of the LPM was calculated. Spearman's rank-correlation coefficient was used to analyze the correlation between the SIR and the VAS score (p < 0.05).

Results

A significant correlation was present between the SIR on FLAIR images and the VAS score.

Conclusions

These results suggest that the FLAIR signal intensity of the superior and inferior heads of the LPM significantly increases as TMJ pain becomes more severe. Thus, FLAIR could be useful in assessing the relationship between the MR signals of the LPM and clinical symptoms.

http://ift.tt/2nav8Ny

Non-contrast computed tomography and magnetic resonance imaging features of mucoepidermoid carcinoma in the salivary glands

Abstract

Background

Use of contrast-enhanced cross-sectional imaging is considered standard practice for investigating mucoepidermoid carcinoma (MEC) in the salivary glands. The purpose of this study was to present the common features of MEC on computed tomography (CT) and magnetic resonance imaging (MRI) without contrast enhancements, and to investigate the possibility of discriminating between MEC and pleomorphic adenoma based on the features observed on both modalities.

Methods

Twenty cases of biopsy-confirmed MEC originating in the salivary glands were reviewed and characterized by two oral and maxillofacial radiologists with regard to the following aspects: detectability, margin, border, encapsulation, content, contrast between lesion and masticator muscle, and bone changes.

Results

Ninety percent of bone changes caused by MEC were detected by CT and sixty-nine percent of tumor existences were detected by MRI. The lesion border could provide a clue to distinguish MEC from pleomorphic adenoma.

Conclusions

Observation of MEC features was possible by both CT and MRI. Among the features, the lesion border could be a clue to distinguish MEC from pleomorphic adenoma.

http://ift.tt/2ntcinL

Basic and important points regarding the diagnosis of oral cancers using fluorine-18-labeled fluoro-2-deoxy- d -glucose positron emission tomography–computed tomography: a review

Abstract

Numerous studies, including our own, have revealed that positron emission tomography–computed tomography (PET/CT) using fluorine-18-labeled fluoro-2-deoxy-d-glucose (¹⁸F-FDG) is effective for the diagnosis of oral cancers. Large amounts of new information about primary tumors and metastatic lymph nodes have been acquired, and the use of ¹⁸F-FDG PET/CT has been shown to improve diagnostic precision in determining both the pathological characteristics of primary oral cancers and the presence of metastatic lymph nodes. However, substantial variations in ¹⁸F-FDG uptake in the oral and maxillofacial regions have been identified, and the differential diagnosis of some oral cancers and metastatic lymph nodes remains difficult for radiologists. Therefore, based on the previous research, the aim of the present study was to review the basic and important points regarding the diagnosis of primary oral cancers and metastatic lymph nodes using ¹⁸F-FDG PET/CT.

http://ift.tt/2nYEpMp

Basic principles of magnetic resonance imaging for beginner oral and maxillofacial radiologists

Abstract

The basic principles and diagnostic methods of magnetic resonance imaging (MRI) for beginning surgeons are described in this review. MRI is an important technique that is essential for diagnoses in the maxillofacial area. It is a scanning method that obtains tomographic images of the human body using a magnetic field. In contrast to computed tomography, it does not utilize X-rays and, therefore, represents a noninvasive test that lacks radiation exposure. It is particularly effective for soft-tissue diagnoses. MRI involves imaging protons in vivo. Protons emit a signal when a radio frequency pulse is applied in a magnetic field; the MRI device then forms an image from these signals. The basic images produced are T1- and T2-weighted images; comparison of these images is the first step of MRI-based diagnosis. Short-T1 inversion recovery images, which eliminate the signal from fat, are also useful for diagnosis. Gadolinium is used as a contrast agent for MRI. Taking sequential images at fixed intervals while injecting the contrast agent and then graphing the contrast effect along the time axis produces a time–signal intensity curve, which is useful for identifying features such as malignant neoplasms based on the graph pattern.

http://ift.tt/2no52aP

Incidental findings on cone-beam computed tomographic images: paranasal sinus findings and nasal septum variations

Abstract

Objective

CBCT applications have received widespread acceptance in dentistry. CBCT scans provide three-dimensional information on anatomic structures and characteristics of pathologies, rather than the two-dimensional information obtained with the conventional techniques. The purpose of this study was to evaluate incidental findings in out-of-interest areas on CBCT images and to reveal their frequency and characteristics.

Methods

A total of 691 CBCT scans from 691 patients were assessed. Demographic data, CBCT indications, and incidental findings outside the primary area of interest, such as anatomical variations and pathologies, were noted. The incidental findings were categorized and analyzed using descriptive statistics.

Results

In total, 1109 incidental findings in paranasal sinuses were noted on 548 of the 691 CBCT scans. The highest rate of incidental findings was maxillary sinus findings, followed by concha bullosa and septum deviation. The most frequently observed pathology was mucosal thickening, followed by polypoid mucosal thickening in the maxillary sinus.

Conclusions

While most incidental findings require no treatment, some conditions will necessitate modification of the treatment plan. Therefore, dental practitioners should be aware of incidental findings and anatomical variations. Correct identification of these findings will reduce unnecessary further diagnostic assessments and allow selection of more appropriate treatment plans.

http://ift.tt/2nYD88a

Gorham’s disease of the mandible: radiological features

Abstract

The most conspicuous element of Gorham's disease is its radiographic features, wherein massive disappearance of the mandible is observed. We report a case of an adolescent boy with massive osteolysis of the mandible in whom the diagnosis of Gorham's disease was made. A 14-year-old boy was referred to the Department of Oral and Maxillofacial Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, for the management of a massive mandibular deformity. He was diagnosed with a hemangioma-like lesion at 1 year of age. The disease had progressed for an unknown number of years. Plain X-rays and computed tomography images were examined for reconstructive surgery planning. Gorham's disease is self-limiting, but has catastrophic results. The role of imaging is huge, particularly for reconstructive surgery planning.

http://ift.tt/2nnRnR3

Disentangling a Bad Reputation: Changing Perceptions of Amyloids

Publication date: Available online 27 March 2017
Source:Trends in Cell Biology
Author(s): Miling Wang, Timothy E. Audas, Stephen Lee
Historically, amyloids were perceived as toxic/irreversible protein aggregates associated with neurodegenerative disorders including Alzheimer's and Parkinson's diseases. Recent papers are challenging this perception by uncovering widespread cellular roles for physiological amyloidogenesis. These findings suggest that the amyloid-fold should be considered, alongside the native-fold and unfolded configurations, as a physiological and reversible protein organization.



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Processing graspable object images and their nouns is impaired in Parkinson’s disease patients

Publication date: Available online 27 March 2017
Source:Cortex
Author(s): Giovanni Buccino, Riccardo Dalla Volta, Gennarina Arabia, Maurizio Morelli, Carmelina Chiriaco, Angela Lupo, Franco Silipo, Aldo Quattrone
According to embodiment, the recruitment of the motor system is necessary to process language material expressing a motor content. Coherently, an impairment of the motor system should affect the capacity to process language items with a motor content. The aim of the present study was to assess the capacity to process graspable objects and their nouns in Parkinson's disease (PD) patients and healthy controls. Participants saw photos and nouns depicting graspable and non-graspable objects. Scrambled images and pseudo-words served as control stimuli. At 150 ms after stimulus presentation, they had to respond when the stimulus referred to a real object, and refrain from responding when it was meaningless (go-no go paradigm). In the control group, participants gave slower motor responses for stimuli (both photos and nouns) related to graspable objects as compared to non-graspable ones. This in keeping with data obtained in a previous study with young healthy participants. In the PD group, motor responses were similar for both graspable and non-graspable items. Moreover, error number was significantly greater than in controls. These findings support the notion that when the motor circuits are lesioned, like in PD, patients do not show the typical modulation of motor responses and have troubles in processing graspable objects and their nouns.



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A homozygous mutation of GNRHR in a familial case diagnosed with polycystic ovary syndrome

Context

PCOS is a heterogeneous condition characterized by hyperandrogenism and chronic anovulation and affects about 10% of women. Its etiology is poorly known, but a dysregulation of gonadotropin secretion is one of its hallmarks.

Objective

As the etiology of PCOS is unclear, we have performed a genome-wide analysis of a consanguineous family with three sisters diagnosed with PCOS.

Methods

Whole-exome sequencing and Sanger sequencing confirmation.

Results

Whole-exome sequencing allowed the detection of the missense variant rs104893836 located in the first coding exon of the GNRHR gene and leading to the p.Gln106Arg (p.Q106R) substitution. Sanger sequencing of all available individuals of the family confirmed that the variant was homozygous in the three affected sisters and heterozygous in both parents.

Conclusions

This is the first description of a GNRHR gene mutation in patients diagnosed with PCOS. Although we do not exclude a possible interaction of the identified variant with the genetic background and/or the environment, our result suggests that genetic alterations in the hypothalamo–pituitary axis may play role in the pathogenesis of PCOS.

http://ift.tt/2nF5W53

Associations between serum levels of calcium, parathyroid hormone and future risk of venous thromboembolism: the Tromso study

Objective

The relationship between serum levels of calcium, parathyroid hormone (PTH) and risk of venous thromboembolism (VTE) has not been addressed in population-based cohorts. We investigated the associations between serum levels of calcium and PTH, with future risk of VTE in a general adult population.

Design

Population-based cohort.

Methods

A total of 27 712 subjects (25–87 years) who participated in Tromsø 4 (1994–1995) and Tromsø 5 (2001–2002) surveys were included in the study, and total calcium and PTH were measured in 27 685 and 8547 subjects respectively. Incident VTE was recorded through December 31, 2012. Cox-regression models with calcium and PTH as time-varying exposures were used to calculate hazard ratios (HR) of VTE by quartiles of calcium and PTH. Quartiles of calcium and PTH were also combined to assess the effect of discordants of both PTH and calcium (e.g. highest and lowest quartiles of both calcium and PTH) on VTE risk using the middle two quartiles as reference.

Results

There were 712 VTEs during 15.0 years of median follow-up. Serum levels of calcium and PTH were not associated with risk of VTE. However, subjects with discordant high serum levels of both calcium and PTH (calcium ≥2.45 mmol/L and PTH ≥4.0 pmol/L) had increased risk of VTE compared to those in subjects with normal calcium and PTH (multivariable HR: 1.78, 95% CI: 1.12–2.84).

Conclusions

Serum levels of calcium and PTH separately were not associated with future risk of VTE, but subjects with high levels of both calcium and PTH had increased risk of VTE compared to those in subjects with normal levels.

http://ift.tt/2o9Zr8g

Risk factors for post-thyroidectomy haemorrhage: a meta-analysis

Background

Post-thyroidectomy haemorrhage is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. In this study, we analysed the potential risk factors for the occurrence of post-thyroidectomy haemorrhage.

Methods

The PubMed and SCIE databases were comprehensively searched for studies published before June 30, 2016. Studies on patients who underwent an open thyroidectomy with or without neck dissection were included, and RevMan 5.3 software was used to analyse the data.

Results

Twenty-five studies and 424 563 patients were included in this meta-analysis, and post-thyroidectomy haemorrhage occurred in 6277 patients (incidence rate = 1.48%). The following variables were associated with an increased risk of post-thyroidectomy haemorrhage: older age (MD = 4.30, 95% CI = 3.09–5.52, P < 0.00001), male sex (OR = 1.73, 95% CI = 1.54–1.94, P < 0.00001), Graves' disease (OR = 1.76, 95% CI = 1.44–2.15, P < 0.00001), antithrombotic agents use (OR = 1.96, 95% CI 1.55–2.49, P < 0.00001), bilateral operation (OR = 1.71, 95% CI = 1.50–1.96, P < 0.00001), neck dissection (OR = 1.53, 95% CI = 1.11–2.11, P = 0.01) and previous thyroid surgery (OR = 1.62, 95% CI = 1.12–2.34, P = 0.01). Malignant tumours (OR = 1.07, 95% CI = 0.89–1.28, P = 0.46) and drainage device use (OR = 1.27, 95% CI = 0.74–2.18, P = 0.4) were not associated with post-thyroidectomy haemorrhage.

Conclusion

Our systematic review identified a number of risk factors for post-thyroidectomy haemorrhage, including older age, male sex, Graves' disease, antithrombotic agents use, bilateral operation, neck dissection and previous thyroid surgery. Early control of modifiable risk factors could improve patient outcomes and satisfaction.

http://ift.tt/2nFgpxs

Increase in thyroglobulin antibody and thyroid peroxidase antibody levels, but not preterm birth-rate, in pregnant Danish women upon iodine fortification

Objective

The presence of thyroid antibodies in pregnancy has been associated with preterm birth. In the non-pregnant population, the implementation of the Danish iodine fortification program has increased the prevalence of thyroid antibodies. This study investigated the prevalence of thyroid peroxidase antibodies (TPOAbs) and thyroglobulin antibodies (TgAbs) in pregnant Danish women before, during and after implementation of the iodine fortification program and association with preterm birth.

Design

Comparative cohort study of 1368 pregnancies from three cohorts gathered before (1996–1998), during (2000–2003) and after (2008–2009) the iodine fortification program.

Methods

In cohort 1 (n = 297), TPOAbs were measured (DYNOtest (BRAHMS)). In cohorts 2 (n = 148) and 3 (n = 923), both TPOAbs and TgAbs were measured (Kryptor immunofluorescent assay (BRAHMS)). The prevalence and effect of antibody positivity were explored using three cut-offs: TPOAbs and/or TgAbs >100 kU/L, TPOAbs and/or TgAbs >60 kU/L and TPOAbs >30 and/or TgAbs >20 kU/L. National preterm birth data were extracted from the National Birth Registry.

Results

In the three cohorts, TPOAb levels >60 kU/L were found in 5.4, 8.1 and 12.0% ( ²(2, n = 1367) = 11.7, P = 0.003) respectively, and TPOAbs and/or TgAbs >60 kU/L in 8.1 and 16.2% in cohorts 2 and 3 respectively ( ²(2, n = 1070) = 6.5, P = 0.01). TgAb levels (>20 kU/L) had increased plenty-fold from cohort 2 to 3 ( ²(1, n = 1071) = 136.5, P < 0.001). Preterm birth occurred in 4.1% of all pregnancies with no effect from antibody positivity (TPOAbs and/or TgAbs >60 kU/L, ²(1, n = 1039) = 0.0, P = 0.98, aOR = 1.1, 95% CI (0.4–2.7)). The national preterm birth-rate showed no increase over the same period.

Conclusions

Thyroid antibody positivity in Danish pregnant women has more than doubled upon the implementation of the iodine fortification program without an increase in preterm birth-rate.

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