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Κυριακή 24 Φεβρουαρίου 2019

Developmental Disorders Child Neurology Open https://journals.sagepub.com/

Vibration-Assisted Home Training Program for Children With Spinal Muscular Atrophy

Christina Stark, MSc12, Ibrahim Duran, MD3, Sebahattin Cirak, MD, Dipl-Chem4, Stefanie Hamacher, MSc5, Heike-Katharina Hoyer-Kuhn, MD1, Oliver Semler, MD16, Eckhard Schoenau, MD123

Child Neurology Open, vol. 5, First Published June 10, 2018.

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Abstract

The aim of this study was to determine the effect of a new method of vibration-assisted neuromuscular rehabilitation in patients with spinal muscular atrophy types II and III. In this retrospective observational study, 38 children (mean age: 4.64 ± 1.95 years) were analyzed. The physiotherapy program, Auf die Beine, combines 6 months of home-based side-alternating whole-body vibration with interval blocks of intensive, goal-directed rehabilitation: 13 days at the start and 6 days after 3 months. Assessments were applied at the beginning (M0), after 6 months of home-based training (M6), and after 6 months of follow-up (M12). Motor abilities were assessed by the Gross Motor Function Measure 66 and Hammersmith Functional Mobility Scale. The Gross Motor Function Measure showed an increase of 1.69 (3.73) points (P = .124) and the Hammersmith Functional Mobility Scale a significant increase of 2.73 ± 1.79 points (P = .007) after 12 months; however, whether this leads to a long-term clinical benefit requires further investigation.

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Clinical Profile of Pediatric Neurological Disorders: Outpatient Department, Khartoum, Sudan

Inaam Noureldyme Mohamed, MD1, Maha Abdelmoneum Elseed, MRCPCH1, Ahlam Abdalrhman Hamed, MD1

Child Neurology Open, vol. 3, First Published April 4, 2016.

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Abstract

Background:

There is no available data from Sudan reflecting the magnitude of the neurological disorders and disabilities in the pediatric age-group. This study aims to evaluate the pattern of neurological disorders among Sudanese children.

Patients and Methods:

This is a retrospective survey of children with epilepsy and other neurodisability disorders seen at pediatric neurology outpatient clinic, during the period from January 2007 to August 2013. The data of 9600 patients were analyzed.

Results:

A total of 6019 patients were included in the study. The majority of the patients had epilepsy that amounted to 52.8%, followed by cerebral palsy (19.1%), congenital anomalies of the central nervous system (6.2%), neuromuscular disorders (3.2%), stroke (2.4%), ataxia and movement disorders (1.9%), assumed genetic syndromes (1.2%), and others.

Conclusion:

Neurological disorders constitute a major cause of chronic morbidity in pediatric age-group.

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Vein of Galen Aneurysmal Malformation in Neonates Presenting With Congestive Heart Failure

Andjenie Madhuban, MD1, Freek van den Heuvel, MD, PhD2, Margriet van Stuijvenberg, MD, PhD2

Child Neurology Open, vol. 3, First Published April 4, 2016.

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Abstract

The authors report the case of a neonate presenting with signs of a congenital cardiac disease. Echocardiography showed a structural normal heart, right-to-left ductal flow, a dilated superior caval vein, and reversed diastolic flow in the proximal descending aorta. Brain magnetic resonance imaging showed a vein of Galen arteriovenous malformation. This highlights the importance of considering an intracranial cause in the differential diagnosis of neonatal congestive heart failure.

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Chromosome 12p Deletion Spanning the GRIN2B Gene Presenting With a Neurodevelopmental Phenotype: A Case Report and Review of Literature

Navin Mishra, MD1, Elizabeth Kouzmitcheva, MD2, Angela Orsino, FRCPC3, Berge A. Minassian, FRCPC24

Child Neurology Open, vol. 3, First Published April 4, 2016.

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Abstract

The GRIN2B (glutamate receptor, ionotropic, N-methyl-d-aspartate 2B) gene, located in the short arm of chromosome 12, encoding the NR2B subunit of the N-methyl-D-aspartate receptor, has recently been recognized to play an important role in corticogenesis and brain plasticity. Deletions in the short arm of chromosome 12 are rare. Hemizygous loss of function of the GRIN2B gene results in developmental delay, whereas gain of function leads to epilepsy, and infantile spasms in particular. In addition, GRIN2B variants have been associated with autism spectrum disorder and schizophrenia. Here the authors report a child with global developmental delay, autistic behavioural features, central hypotonia, dysmorphic features and isolated congenital anomalies of the fingers and toes, and a de novo heterozygous deletion in chromosome locus 12p13.2-p13.1, involving loss of several genes, including GRIN2B. This report and our review of the literature help clarify the distinct phenotypes associated with loss or gain of GRIN2B function.

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MECP2 Duplications in Symptomatic Females: Report on 3 Patients Showing the Broad Phenotypic Spectrum

Victoria San Antonio-Arce, MD1, María Fenollar-Cortés, PhD2, Raluca Oancea Ionescu, PhD2, Teresa DeSantos-Moreno, PhD1, Jesús Gallego-Merlo3, Francisco José Illana Cámara2, María Carmen Cotarelo Pérez, MD2

Child Neurology Open, vol. 3, First Published April 4, 2016.

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Abstract

Xq28 microduplications including the MECP2 gene constitute a 100% penetrant X-linked syndrome in males caused by overexpression of normal MeCP2 protein. A small number of cases of affected females have been reported. This can be due to the location of the duplicated material into an autosome, but it can also be due to the location of the duplicated material into one of the X chromosomes and random or unfavorable skewed X chromosome inactivation, which is much more likely to occur but may be underdiagnosed because of the resulting broad phenotypic spectrum. In order to contribute to the phenotypic delineation of Xq28 microduplications including MECP2 in symptomatic females, the authors present clinical and molecular data on 3 patients illustrating the broad phenotypic spectrum. Our finding underlines the importance of quantitative analysis of MECP2 in females with intellectual disability and raises the question of the indication in females with borderline intellectual performances or learning difficulties.

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Brain Inflammation in an Infant With Hemimegalencephaly, Escalating Seizures, and Epileptic Encephalopathy

Se Hee Kim, MD1, John J. Millichap, MD1, Sookyong Koh, MD, PhD2

Child Neurology Open, vol. 3, First Published April 4, 2016.

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Hemimegalencephaly, a congenital brain malformation typically characterized by enlargement of one hemisphere, is frequently associated with intractable epilepsy. The authors report a case of a 12-month-old girl with hemimegalencephaly who underwent semiurgent hemispherectomy because of rapidly escalating seizures, arrested development, and associated encephalopathy. The brain tissue was examined and evaluated for neuroinflammation. Immunohistochemical analysis of the brain tissue revealed the presence of abundant activated CD68-positive microglia and reactive astrogliosis. Detection of active inflammatory changes in the brain of a patient with hemimegalencephaly complicated by intractable epilepsy suggests a potential role of ongoing brain inflammation in seizure exacerbation and epileptic encephalopathy.

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An Unusual Triad in Pediatric Neurology: A Case Report on Cerebral Palsy, Epilepsy, and Duchenne Muscular Dystrophy

Ruben G. F. Hendriksen, BSc1, Marlien W. Aalbers, MD, PhD12, Jos G. M. Hendriksen, PhD13, Christine E. M. de Die-Smulders, MD, PhD45, Govert Hoogland, PhD67, Johan S. H. Vles, MD, PhD13

Child Neurology Open, vol. 3, First Published April 19, 2016.

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We present a case of an unusual triad in pediatric neurology: a currently 12-year-old boy with cerebral palsy and epilepsy who was later also diagnosed with Duchenne muscular dystrophy. We describe the clinical path that resulted in this exceptional diagnosis. This case report illustrates how different neurological disorders may overshadow each other. In addition, it demonstrates that every child with cerebral palsy and either an atypical clinical course or with inexplicable laboratory values—as well as every infant boy born to a theoretical Duchenne muscular dystrophy carrier—should be subjected to additional investigations.

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De Novo 3q22.3q24 Microdeletion in a Patient With Blepharophimosis–Ptosis–Epicanthus Inversus Syndrome, Dandy-Walker Malformation, and Wisconsin Syndrome

Anand Ramineni, BSc, MBBS, GSCpMed1234, David Coman, MBBS, MPhil, FRACP12345

Child Neurology Open, vol. 3, First Published September 1, 2016.

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Abstract

Interstitial deletions affecting the long arm of chromosome 3 have been associated with a broad phenotype. This has included the features of blepharophimosis–ptosis–epicanthus inversus syndrome, Dandy-Walker malformation, and the rare Wisconsin syndrome. The authors report a young female patient presenting with features consistent with all 3 of these syndromes. This has occurred in the context of a de novo 3q22.3q24 microdeletion including FOXL2, ZIC1, and ZIC4. This patient provides further evidence for the role of ZIC1 and ZIC4 in Dandy-Walker malformation and is the third reported case of Dandy-Walker malformation to have associated corpus callosum thinning. This patient is also only the seventh to be reported with the rare Wisconsin syndrome phenotype.

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Assessing Children With Disabilities Using WHO International Classification of Functioning, Disability and Health Child and Youth Version Activities and Participation D Codes

Niels Ove Illum, MD1, Kim Oren Gradel, PhD23

Child Neurology Open, vol. 2, 4, First Published October 28, 2015.

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Abstract

Aim:

Evaluation of the International Classification of Functioning, Disability and Health child and youth version (ICF-CY) activities and participation d code functions in clinical practice with children across diagnoses, disabilities, ages, and genders.

Methods:

A set of 57 codes were selected and worded to describe children's support needs in everyday life. Parents of children aged 1 to 15 years participated in interviews to discuss and rate their child's disability.

Results:

Of 367 invited parents, 332 (90.5%) participated. The mean age of their children with disability was 9.4 years. The mean code scores were 50.67, the corrected code–total correlations were .76, intercode correlations had the mean of 0.61, and Cronbach's α was .98. As a result of Rasch analysis, graphical data for disability measures paralleled clinical expectations across the total population of 332 children.

Conclusion:

The World Health Organization International Classification of Functioning, Disability and Health child and youth version d code data can provide a coherent measure of severity of disability in children across various diagnoses, ages, and genders.

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Is Chromosome 15q13.3 Duplication Involving CHRNA7 Associated With Oral Clefts?

Yingjun Xie, PhD12

Child Neurology Open, vol. 2, 4, First Published December 14, 2015.

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Abstract

Copy number variants have been associated with intellectual disability, multiple congenital anomalies and craniofacial disorders. It has been reported that microduplication of 15q13.3 is associated with autism, cognitive impairment, seizures, and attention-deficit hyperactivity disorder. Here, the author identified microduplications in the 15q13.3 region in 4 cases from 3 Chinese families using chromosomal microarray analysis–single nucleotide polymorphism array (CMA-SNP). These 4 cases include 2 fetuses from 2 unrelated families and a father and a daughter from a third family. The identified microduplications of 15q13.3 are approximately 400 kb in size, encompassing just 1 gene, cholinergic receptor, neuronal nicotinic, alpha polypeptide 7 (CHRNA7). Three-fourths of the probands exhibit oral clefts, which has not been previously reported in cases with this duplication genotype. Therefore, in this study, the author describes for the first time the common feature of oral clefts in patients carrying a microduplication of 15q13.3 encompassing the CHRNA7 gene, which sheds light on the correlation between CHRNA7 and cleft palate.

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Clinical Phenotype of De Novo GNAO1 Mutation: Case Report and Review of Literature

Inga Talvik, MD, PhD12, Rikke S. Møller, MSc, PhD34, Merilin Vaher, MD2, Ulvi Vaher, MD2, Line HG Larsen, MSc45, Hans A. Dahl, MSc, PhD45, Pilvi Ilves, MD, PhD6, Tiina Talvik, MD, PhD12

Child Neurology Open, vol. 2, 2, First Published May 5, 2015.

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Abstract

Mutations in the guanine nucleotide-binding protein (G protein), α activating activity polypeptide O (GNAO1) gene have recently been described in 6 patients with early infantile epileptic encephalopathies. In the present study, we report the phenotype and the clinical course of a 4-year-old female with an epileptic encephalopathy (Ohtahara syndrome) and profound intellectual disability due to a de novo GNAO1 mutation (c.692A>G; p.Tyr231Cys). Ohtahara syndrome is a devastating early infantile epileptic encephalopathy that can be caused by mutations in different genes, now also including GNAO1. The mutation was found using a targeted next generation sequencing gene panel and demonstrates targeted sequencing as a powerful tool for identifying mutations in genes where only a few de novo mutations have been identified.

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Encephalocraniocutaneous Lipomatosis: A Rare Association With Tethered Spinal Cord Syndrome With Review of Literature

Amal Naous, MD1, Abdel Rahman Shatila, MD1, Zeina Naja, MD1, Ahmad Salaheddine Naja, MD1, Mariam Rajab, MD1

Child Neurology Open, vol. 2, 1, First Published February 13, 2015.

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Abstract

Encephalocraniocutaneous lipomatosis or Haberland syndrome is a rare, congenital neurocutaneous syndrome. It is characterized by unilateral lipomatous hamartomata of the scalp, eyelid, and outer globe of the eye and ipsilateral neurologic malformations. We describe the first case from Lebanon, an infant with classical encephalocraniocutaneous lipomatosis characterized by nevus psiloliparus, unilateral right facial and frontal–temporal subcutaneous lipomas, alopecia, ocular coloboma, aniridia and eyelid nodular tags, ventriculomegaly with intracranial and intraspinal lipomas, and tethered spinal cord. We report this case of rare association between encephalocraniocutaneous lipomatosis and tethered spinal cord syndrome and stress on the importance of spinal cord evaluation in encephalocraniocutaneous lipomatosis.

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FOXG1 Mutation is a Low-Incidence Genetic Cause in Atypical Rett Syndrome

Christine K. Byun1, Jin Sook Lee, MD1, Byung Chan Lim, MD1, Ki Joong Kim, MD, PhD1, Yong Seung Hwang, MD, PhD1, Jong-Hee Chae, MD, PhD1

Child Neurology Open, vol. 2, 1, First Published February 10, 2015.

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Due to the genetic and clinical heterogeneity of Rett syndrome, patients with nonclassic phenotypes are classified as an atypical Rett syndrome, that is, preserved speech variant, early seizure variant, and congenital variant. Respectively, MECP2, CDKL5, and FOXG1 have been found to be the causative genes, but FOXG1 variants are the rarest and least studied. We performed mutational analyses for FOXG1 on 11 unrelated patients without MECP2 and CDKL5 mutations, who were diagnosed with atypical Rett syndrome. One patient, who suffered from severe early-onset mental retardation and multiple-type intractable seizures, carried a novel, de novo FOXG1 mutation (p.Gln70Pro). This case concurs with previous studies that have reported yields of ∼10%. FOXG1-related atypical Rett syndrome is rare in Korean population, but screening of this gene in patients with severe mental retardation, microcephaly, and early-onset multiple seizure types without specific genetic causes can help broaden the phenotypic spectrum of the distinct FOXG1-related syndrome.

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Childhood-Onset Progressive Dystonia With Mitochondrial DNA G14459A Mutation: Efficacy of Long-Term Sodium Succinate Treatment

Ayaka Koide, MD, PhD1, Hiroshi Ozawa, MD, PhD2, Masaya Kubota, MD, PhD3, Yuichi Goto, MD, PhD4

Child Neurology Open, vol. 1, 1, First Published November 10, 2014.

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This article reports the case of an 11-year-old boy with progressive dystonia caused by the homoplasmic G14459A mitochondrial DNA mutation. The patient presented with focal dystonia in the right upper limb at 3 years of age, which progressed over 4 years to exhibit dystonia in both the upper and lower limbs. At 7 years of age, high signal intensity lesions in the bilateral striata and the midbrain were observed on fluid-attenuated inversion recovery images. It was observed on diffusion-weighted images that with time, these high signal intensity lesions migrated from the putamen to the caudate nuclei, which closely correlated with disease progression. Because his symptoms and abnormal magnetic resonance imaging findings progressed despite treatment with coenzyme Q10 and l-carnitine, at 7 years of age he was then started on sodium succinate, hoping to improve his complex I deficiency. After treatment, progression of MRI abnormalities appeared to have been suppressed for 4 years, although no improvement was observed in dystonia.

Is calcium supplementation always needed in patients with hypoparathyroidism?

Summary

Oral calcium salts are recommended for the treatment of chronic hypoparathyroidism (HypoPT), although dosimetry is variable between individual patients and clinicians. However, patient feedback on calcium salts can be negative, particularly due to gastrointestinal side‐effects and hypercalciuria‐related complications.

We begin with a clinical case of a HypoPT patient taking oral calcium salts following thyroid surgery, who requested support in reducing her dose of these with a view to stopping entirely. To evaluate her request, we first describe the usual treatment of HypoPT according to current guidance, and then present data from (a) a case notes review of a cohort of 24 HypoPT patients managed with a "no calcium" treatment regimen by single physician (b) a comprehensive online survey of HypoPT patients' treatment and experiences (n‐330).

The case notes review found that target‐range serum calcium levels were successfully achieved in all 24 patients since transitioning to a "no calcium" regimen, without any break‐through hypocalcaemia‐related symptoms, the development of new renal stones, the occurrence of calcium‐related hospital admissions, or the finding of significant hypercalciuria. The online survey identified 36% of HypoPT patients who continued to take activated vitamin D, but had discontinued calcium supplements. HypoPT patients not currently taking calcium reported a significantly lower prevalence of adverse effects and outcomes, both compared to their previous experiences whilst taking calcium and also compared to the 64% of patients who continued to take oral calcium.

We conclude that, subject to methodological limitations, there are significant issues of tolerability arising from conventional calcium‐based treatment regimens for patients with chronic HypoPT. For selected patients, it may be reasonable to facilitate a managed therapeutic transition to "no calcium" regimen, and we also propose that calcium‐based regimes be prospectively evaluated against calcium‐free (or calcium‐low) alternatives.

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Σάββατο 23 Φεβρουαρίου 2019

Characteristic imaging findings of acantholytic squamous cell carcinoma: a case report

Abstract

Acantholytic squamous cell carcinoma (ASCC) is an uncommon, histopathologically distinct variant of squamous cell carcinoma. ASCC commonly occurs in areas of skin exposed to sunlight and has only rarely been seen on mucosal surfaces such as the oral cavity. Although the World Health Organization has defined ASCC as an original entity, the imaging findings of ASCC have not been adequately described. We herein report a case of ASCC occurring in the oral mucosa with emphasis on the findings of several imaging studies: panoramic radiography, intraoral radiography, contrast-enhanced computed tomography, magnetic resonance imaging, and fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography.

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Photochemical removal of acetaldehyde using 172 nm vacuum ultraviolet excimer lamp in N 2 or air at atmospheric pressure

Abstract

The photochemical removal of acetaldehyde was studied in N₂ or air (O₂ 1–20%) at atmospheric pressure using side-on and head-on types of 172 nm Xe₂ excimer lamps. When CH₃CHO was decomposed in N₂ using the head-on lamp (HL), CH₄, CO, and CO₂ were observed as products in FTIR spectra. The initial removal rate of CH₃CHO in N₂ was ascertained as 0.37 min⁻¹. In air (1–20% O₂), HCHO, HCOOH, CO, and CO₂ were observed as products in FTIR spectra. The removal rate of CH₃CHO in air using the side-on lamp (SL) increased from 3.2 to 18.6 min⁻¹ with decreasing O₂ concentration from 20 to 1%. It also increased from 2.5 to 3.7 min⁻¹ with increasing CH₃CHO concentration from 150 to 1000 ppm at 20% O₂. The best energy efficiency of the CH₃CHO removal using the SL in a flow system was 2.8 g/kWh at 1% O₂. Results show that the contribution of O(₁D) and O₃ is insignificant in the initial decomposition of CH₃CHO. It was inferred that CH₃CHO is initially decomposed by the O(₃P) + CH₃CHO reaction at 5–20% O₂, whereas the contribution of direct vacuum ultraviolet (VUV) photolysis increases concomitantly with decreasing O₂ pressure at < 5% O₂. After initial decomposition of CH₃CHO, it was oxidized further by reactions of O(₃P), OH, and O₃ with various intermediates such as HCHO, HCOOH, and CO, leading to CO₂ as a final product.

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Exploring inter-species sensitivity to a model hydrocarbon, 2-Methylnaphtalene, using a process-based model

Abstract

We compared inter-species sensitivity to a model narcotic compound, 2-Methylnaphthalene, to test if taxonomical relatedness, feeding guilds, and trophic level govern species sensitivities on species distributed in different regions. We fitted a toxicokinetic-toxicodynamic model to survival patterns over time for 26 species using new and raw data from the literature. Species sensitivity distributions provided little insight into understanding patterns in inter-species sensitivity. The range of no-effect concentrations (NEC) obtained for 26 species showed little variation (mean 0.0081 mM; SD 0.009). Results suggest that the NEC alone does not explain the complexity of the species tolerances. The dominant rate constant and the derived time to observe an effect (t₀), a function of concentration, might provide the means for depicting patterns in sensitivity and better ecotoxicological testing. When comparing the t₀ functions, we observed that Arctic species have shorter time frames to start showing effects. Mollusks and second trophic level species took longer to build up a lethal body burden than the rest. Coupling our results with fate and transport models would allow forecasting narcotic compounds toxicity in time and thus improve risk assessment.

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MYT1L mutation in a patient causes intellectual disability and early onset of obesity: a case report and review of the literature

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print

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The effect of therapy on plasma ghrelin and leptin levels, and appetite in children with iron deficiency anemia

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print

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Generation of biodiesel from industrial wastewater using oleaginous yeast: performance and emission characteristics of microbial biodiesel and its blends on a compression injection diesel engine

Abstract

Microbial-derived biodiesel was tested on a lab scale CI diesel engine for carrying out exhaust emission and performance characteristics. The performance, emission, and combustion characteristics of a single cylinder four stroke fixed compression ratio engine when fueled with microbial bio-diesel and its 10–30% blends with diesel (on a volume basis) were investigated and compared with conventional diesel. The bio-diesel was obtained from microbes which were grown by combining distillery spent wash with lignocellulosic hydrolysate at nutrient deprived conditions. The microbes consumed the wastes and converted the high strength waste water into lipids, which were trans-esterified to form bio-diesel. Testing of microbial bio-diesel blends with ordinary diesel at different loading pressures and the emission characteristics were compared. Results indicate that with increasing of the blends, reduction of HC and CO emissions were observed, whilst brake thermal efficiency maxed out at 20% blending. Further increase of blends showed a tendency of increasing of both emissions in the exhaust stream. The Brake Specific Fuel consumption was observed to decline with blending until 20% and then increased. The nitrogen oxide emissions, however, were found to increase with increasing blend ratios and reached a maximum at 20% blend. The escalation of HC, CO, CO₂, and NOx emissions was also observed at higher blending ratios and higher engine loads. The performance studies were able to show that out of the three blends of biodiesel, 20% biodiesel blend was able to deliver the best of reduced hydrocarbon and carbon monoxide emissions, whilst also delivering the highest Brake thermal efficiency and the lowest Brake Specific Fuel consumption.

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Lifestyle and pregnancy complications in polycystic ovary syndrome: The SCOPE Cohort Study

Summary

Objectives

To investigate the risk of pregnancy complications in women with and without polycystic ovary syndrome after consideration of lifestyle factors.

Design

Prospective cohort.

Patients and measurements

Participants (n=5628) were apparently healthy nulliparous women with singleton pregnancies from the Screening for Pregnancy Endpoints study in New Zealand, Australia, United Kingdom and Ireland. Multivariable regression models were performed assessing the association of self‐reported polycystic ovary syndrome status with pregnancy complications with consideration of lifestyle factors at the 15^th week of gestation.

Results

Women with polycystic ovary syndrome (n=354) were older, had a higher socioeconomic index and body mass index and were less likely to consume alcohol and smoke but more likely to do vigorous exercise and take multivitamins. In univariable analysis polycystic ovary syndrome was associated with increased risk of gestational diabetes [OR: 2.2, 95% CI: 1.2,

4.0]. In multivariable models, polycystic ovary syndrome was only significantly associated with decreased risk of large for gestational age [OR: 0.62, 95% CI: 0.40, 0.98] with a population attributable risk of 0.22%. None of the other outcomes were attributable to polycystic ovary syndrome status.

Conclusions

Polycystic ovary syndrome is associated with a lower risk of large for gestational age infants. In this low risk population, the risk of pregnancy complications was not increased in women with polycystic ovary syndrome who were following a healthy lifestyle. Further studies are warranted assessing the contribution of lifestyle factors to the risk of pregnancy complications in higher risk groups of women with and without polycystic ovary syndrome.

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Anti‐Müllerian hormone variability and its implications for the number of oocytes retrieved following individualized dosing with follitropin delta

summary

Objective

The stability of anti‐Müllerian hormone (AMH) across and between menstrual cycles has been the subject of debate. The objective of this analysis was to study the inter‐ and intra‐cycle variability in repeated measurements and assess the impact on an individualized gonadotropin dosing algorithm and predicted oocyte yield.

Design

Retrospective analysis of repeat AMH measures from a randomized controlled trial.

Patients

1326 women aged 18‐40 years.

Measurements

Serum AMH levels at screening and at cycle day 2‐3 in up to three ovarian stimulation cycles. AMH variability and its impact on gonadotropin dose and the predicted number of oocytes.

Results

Repeat serum AMH measurements were strongly correlated within individual women (correlation coefficient 0.92). AMH exhibited limited within‐subject variation (coefficient of variation 23%), a small time‐related decline (mean 6% decrease/year), but no systematic variation across the menstrual cycle. Irrespective of whether the AMH screening value or the AMH at the initiation of ovarian stimulation was used, for women with an AMH level <15 pmol/L, 93% would receive the same gonadotropin dose and attain an identical number of oocytes in 97% of cases. For women with an AMH level ≥15 pmol/L, 80% would receive an individualized dose within ±1.5 μg and 90% would attain ±1 oocyte.

Conclusion

AMH variability had limited impact on individualized gonadotropin dosing, with 95% of women predicted to obtain an oocyte yield that does not vary beyond 1 oocyte count, irrespective of whether a random or early follicular AMH measurement was used to determine the individualized gonadotropin dose.

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Snapshot of environmental condition in different tropical estuarine systems by using S. cucullata (an edible oyster) as bio-indicator

Abstract

Accumulation of toxic metals and indigenous bacteria in oyster, (Saccostrea cucullata) and their impact on antioxidant enzyme activities in the biological system was studied and used to provide snapshot of environmental condition in different tropical estuarine systems. The sedimentary Cd, Pb, and Hg concentration varied from 0.1 to 1.8, 22.0 to 98.0, and 0.03 to 0.11 mg kg⁻¹ (dry wt.) respectively. The bioaccumulated Cd, Pb, and Hg concentration in the oysters ranged from 3.6 to 9.0, 0.03 to 8.0, and 0.06 to 0.1 mg kg⁻¹ (dry wt.) respectively. In the oyster, the Cd concentration was well above the safe limit whereas the Pb and Hg concentrations were below the safe limit recommended by the European Commission (EC No. 1881/2006) for human consumption. The MPN value in the raw oyster for fecal coliforms (33–110 × 10³/100 g) exceeded the United States Food and Drug Administration (USFDA) approved limits. Increase in antioxidant enzymes (catalase, superoxide dismutase, glutathione-s-transferase, and metallothionein) activities with increasing pollutants loading was observed. The activities of antioxidant enzymes in the oyster were found to be very useful tool for evaluating environmental condition in any tropical estuarine systems.

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Combined effects of NaCl and fluoxetine on the freshwater planarian, Schmidtea mediterranea (Platyhelminthes: Dugesiidae)

Abstract

Increasing salinity levels in freshwaters due to natural and anthropogenic sources pose risk to exposed aquatic organisms. However, there is a paucity of information on how salinity may influence the effects of other chemical stressors especially psychiatric pharmaceuticals. Freshwater planarians which have been suggested as bioindicator species in aquatic habitats were used in this study to evaluate toxic effects of sodium chloride (NaCl) used here as a surrogate for increasing salinity, and its influence on the effects of the antidepressant, fluoxetine. Effects of NaCl on Schmidtea mediterranea were evaluated using survival, regeneration, locomotion, feeding, and reproduction as endpoints. Subsequently, combined effects of NaCl and fluoxetine on planarians' locomotion and reproduction were also evaluated. Result showed that exposure to increased NaCl concentrations is toxic to planarians with 48 and 96 h LC₅₀ of 9.15 and 7.55 g NaCl L⁻¹ respectively and exposure to sub-lethal concentrations led to reductions in feeding (LOEC of 0.75 g NaCl L⁻¹ or 1906 μS cm⁻¹ at 20 °C) and reproduction (LOEC 3.0 g NaCl L⁻¹ or 5530 μS cm⁻¹ at 20 °C), delayed head regeneration (LOEC of 1.5 g NaCl L⁻¹ or 3210 μS cm⁻¹ at 20 °C), and also slight decreases in locomotor activity. Moreover, some developmental malformations were observed in regenerating planarians, as well as delayed or inhibition of wound healing and degeneration after fissioning and during head regeneration. A significant interaction between fluoxetine and NaCl was observed for locomotor activity and unlike planarians exposed to fluoxetine alone, fissioned planarians and their pieces from the combined exposure treatments were also unable to regenerate missing portions. Results show that S. mediterranea can be highly sensitive to low NaCl concentrations and that this stressor can alter the effects of fluoxetine. The implication of these effects for planarian populations in the natural habitat is discussed as well as the need for more research on the effects of neuroactive pharmaceuticals under relevant exposure scenarios.

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Safety and efficacy of multisession gamma knife radiosurgery for residual or recurrent pituitary adenomas

Abstract

Purpose

To define the efficacy and complications of multisession Gamma Knife radiosurgery (MGKRS) delivered in three consecutive sessions for the treatment of residual or recurrent pituitary adenomas (PAs).

Methods

This was a retrospective study of data from the Neurosurgery and Gamma Knife Radiosurgery Department at San Raffaele Hospital between May 2008 and September 2017. We recruited 47 consecutive patients undergoing MGKRS in three consecutive fractions for residual or recurrent PA with a distance from the anterior optic pathway inferior to 2–3 mm.

Results

Thirty-eight (80.8%) patients had a nonfunctioning-PA (NFPA) while 9 (19.2%) had a hormone-secreting PA (HSPA). Tumor control was achieved in 100% of patients. Tumor shrinkage was seen in 33 out of 44 (75.0%) patients with a radiological follow-up. Mean tumor volume before MGKRS was 3.93 cm³. The mean tumor volume at last follow-up was 2.11 cm³, with a mean tumor shrinkage of 50.2%, as compared with baseline. One case of suspected radiation-induced optic neuropathy (RION) was documented while new-onset hypopituitarism for any axis occurred in 12 of the 31 (38.7%) patients at risk. The mean follow-up was 44.6 ± 4.0 months (range, 6–111 months).

Conclusions

MGKRS is a valid alternative to external fractionated radiotherapy and other types of stereotactic radiosurgery for the treatment of PAs, achieving a high tumor control rate with a low risk of visual deterioration. Moreover, the majority of patients showed a significant reduction of tumor size in the long term.

https://ift.tt/2GYIBF5

Safety and efficacy of multisession gamma knife radiosurgery for residual or recurrent pituitary adenomas

Abstract

Purpose

To define the efficacy and complications of multisession Gamma Knife radiosurgery (MGKRS) delivered in three consecutive sessions for the treatment of residual or recurrent pituitary adenomas (PAs).

Methods

Results

Conclusions

https://ift.tt/2GYIBF5

Refining Techniques in Eyebrow Transplantation

Publication date: Available online 22 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Chi-Feng Yen, Mei-Ching Lee, Yau-Li Huang

https://ift.tt/2Ep9y2T

Basal Cell Carcinoma: Additional Subtypes and Therapeutic Advances

Publication date: Available online 22 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Philip R. Cohen

https://ift.tt/2V9hY4a

Randomized Phase 3 Evaluation of Trifarotene 50 μG/G Cream Treatment Of Moderate Facial And Truncal ACNE

Publication date: Available online 22 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Jerry Tan, Diane Thiboutot, Georg Popp, Melinda Gooderham, Charles Lynde, James Del Rosso, Jonathan Weiss, Ulrike Blume-Peytavi, Jolanta Weglovska, Sandra Johnson, Lawrence Parish, Dagmara Witkowska, Nestor Sanchez Colon, Alessandra Alió Saenz, Faiz Ahmad, Michael Graeber, Linda Stein Gold

Abstract

Background

Acne vulgaris often affects the face, shoulders, chest, and back but treatment of non-facial acne has not been rigorously studied.

Objectives

Assess the safety/efficacy of trifarotene 50 μg/g cream, a novel topical retinoid, in moderate facial and truncal acne.

Methods

Two phase III double-blind, randomized, vehicle-controlled, 12-week studies of once-daily trifarotene cream vs vehicle in subjects aged ≥9 years. Primary endpoints were success rate on face Investigator Global Assessment (IGA, clear/almost clear and ≥2 grade improvement) and absolute change from baseline in inflammatory/non-inflammatory counts from baseline to week 12. Secondary endpoints were success rate on trunk (clear/almost clear and ≥2 grade improvement) and absolute change in truncal inflammatory/non-inflammatory counts from baseline to week 12. Safety was assessed through adverse events, local tolerability, vital signs, and routine laboratory testing.

Results

In both studies, at Week 12, facial (IGA) and truncal (PGA) success rates and change in inflammatory and non-inflammatory lesion counts (both absolute and %) were all highly significant (p<0.001) in favor of trifarotene compared to the vehicle.

Limitations

Adjunctive topical or systemic treatments were not studied.

Conclusion

These studies demonstrate that trifarotene appears to be safe, efficacious and well-tolerated in treatment of both facial and truncal acne.

https://ift.tt/2GGCTbK

Management of Acute Radiation Dermatitis: A Review of the Literature and Proposal for Treatment Algorithm

Publication date: Available online 22 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Amanda Rosenthal, Rachel Israilevich, Ronald Moy

Abstract

Radiation dermatitis is a common sequela of radiation therapy; up to 95% of patients will develop moderate-to-severe skin reactions. No gold-standard currently exists for the treatment of acute radiation-induced skin toxicity. It is, therefore, imperative to develop a greater understanding of management options available to allow clinicians to make informed decisions when managing radiation oncology patients. This literature review discusses the topical agents studied for the treatment of acute radiation dermatitis, reviews their mechanisms of action, and presents a treatment algorithm for clinicians managing patients suffering from radiation dermatitis.

https://ift.tt/2EqOCJ5

The language profile of progressive supranuclear palsy

Publication date: Available online 22 February 2019

Source: Cortex

Author(s): E. Catricalà, V. Boschi, S. Cuoco, F. Galiano, M. Picillo, E. Gobbi, A. Miozzo, C. Chesi, V. Esposito, G. Santangelo, M.T. Pellecchia, V.M. Borsa, P. Barone, P. Garrard, S. Iannaccone, S.F. Cappa

Abstract

A progressive speech/language disorder, such as the non fluent/agrammatic variant of primary progressive aphasia and progressive apraxia of speech, can be due to neuropathologically verified Progressive Supranuclear Palsy (PSP). The prevalence of linguistic deficits and the linguistic profile in PSP patients who present primarily with a movement disorder is unknown. In the present study, we investigated speech and language performance in a sample of clinically diagnosed PSP patients using a comprehensive language battery, including, besides traditional language tests, a detailed analysis of connected speech (picture description task assessing 26 linguistic features). The aim was to identify the most affected linguistic levels in seventeen PSP with a movement disorder presentation, compared to 21 patients with Parkinson's disease and 27 healthy controls. Machine learning methods were used to detect the most relevant language tests and linguistic features characterizing the language profile of PSP patients. Our results indicate that even non-clinically aphasic PSP patients have subtle language deficits, in particular involving the lexical-semantic and discourse levels. Patients with the Richardson's syndrome showed a lower performance in the word comprehension task with respect to the other PSP phenotypes with predominant frontal presentation, parkinsonism and progressive gait freezing. The present findings support the usefulness of a detailed language assessment in all patients in the PSP spectrum.

https://ift.tt/2SV9uAR

Recent electrochemical methods in electrochemical degradation of halogenated organics: a review

Abstract

Halogenated organics are widely used in modern industry, agriculture, and medicine, and their large-scale emissions have led to soil and water pollution. Electrochemical methods are attractive and promising techniques for wastewater treatment and have been developed for degradation of halogenated organic pollutants under mild conditions. Electrochemical techniques are classified according to main reaction pathways: (i) electrochemical reduction, in which cleavage of C-X (X = F, Cl, Br, I) bonds to release halide ions and produce non-halogenated and non-toxic organics and (ii) electrochemical oxidation, in which halogenated organics are degraded by electrogenerated oxidants. The electrode material is crucial to the degradation efficiency of an electrochemical process. Much research has therefore been devoted to developing appropriate electrode materials for practical applications. This paper reviews recent developments in electrode materials for electrochemical degradation of halogenated organics. And at the end of this paper, the characteristics of new combination methods, such as photocatalysis, nanofiltration, and the use of biochemical method, are discussed.

https://ift.tt/2NnIvYR

Acromegaly can be cured by first-line pasireotide treatment?

https://ift.tt/2GH0VmC

Acromegaly can be cured by first-line pasireotide treatment?

https://ift.tt/2GH0VmC

A rare hereditary and metastatic paraganglioma involved in both spermatic cord and testis

https://ift.tt/2Ta1Yl4

Effect of labelling plane angulation and position on labelling efficiency and cerebral blood flow quantification in pseudo-continuous arterial spin labelling

Publication date: Available online 22 February 2019

Source: Magnetic Resonance Imaging

Author(s): Magdalena Sokolska, Alan Bainbridge, Alvaro R. Villabona, Xavier Golay, David Thomas

Abstract

Pseudo-continuous arterial spin labelling (pCASL) is the MRI method of choice for non-invasive perfusion measurement in research and clinical practice. Knowledge of the labelling efficiency, α, is essential for accurate quantification of cerebral blood flow (CBF). Typically, a theoretical α value is used, based on an idealistic model and an assumption of spins flowing perpendicularly to the labelling plane. The aim of this work was to investigate the effect of violating this assumption, and to characterize the influence of labelling plane angulation with respect to the vessel direction on labelling efficiency and measured CBF.

The effect of labelling plane angulation on labelling efficiency was demonstrated using a numerical simulation of spins at different velocities. Acquisitions from healthy volunteers were used to test the effect of a range of angulation offsets. Additional sub-optimal positions of the labelling plane with respect to the vertebral arteries, at locations where the direction of flow changes significantly from the head-foot direction, were also considered.

No significant change in the measured CBF was seen when the labelling plane was angled up to 60° to the labelled vessel or when it was placed in sub-optimal positions. This study shows that in adult subjects, the efficiency of pCASL is robust to the angulation and positioning of the labelling plane beyond the range of potential operator error.

https://ift.tt/2SW3VC8

Centrofacial Rejuventation (Volume III).

No abstract available

https://ift.tt/2IyUG6c

Review: Reconstructive Surgery of the Hand and Upper Extremity

No abstract available

https://ift.tt/2T4vMzF

Venous Thromboembolism After Abdominal Wall Reconstruction: A Prospective Analysis and Review of the Literature

Introduction: Ventral hernias are a common problem after exploratory laparotomy, and plastic surgeons often become involved for hernia repair in complex situations. Plastic surgeons can achieve fascial closure through primary repair, an external oblique aponeurosis release, or a transversus abdominis release. Currently, there is scant literature evaluating venous thromboembolism (VTE) rates after these procedures. We sought to evaluate our own experience with complex abdominal wall reconstruction and VTE events. Methods: We retrospectively reviewed our prospectively collected database of all patients who have undergone complex abdominal wall reconstruction by a single surgeon at our institution from September 2013 to February 2018. Demographic data, anticoagulant use, Caprini score, operative time, and post-operative VTE events were recorded. A literature search was also performed, identifying all published articles evaluating VTE events after abdominal wall reconstruction Results: We identified 175 patients for analysis. Four patients were found to have post-operative VTE events, for a total VTE rate of 2.3%. The average Caprini score for these patients was 8.5, compared to 5.26 for those without a VTE event, and no deaths were reported from these complications. On literature review, three papers were identified in the literature discussing VTE after abdominal wall reconstruction, all based on the ACS-NSQIP database. Conclusion: Patients undergoing complex abdominal wall reconstruction are at high risk for VTE events. There is scant literature published on this topic, but surgeons should be aware of the risk for VTE after complex abdominal wall reconstruction and work to minimize this risk as much as able. Financial Disclosure Statement: Dr. Janis has served as a prior consultant for LifeCell, Bard, Pacira, and Allergan greater than 12 months ago, but has no current active affiliations. He receives royalties from Thieme Publishing. The remaining authors have no conflicts of interest to disclose. No funding was received for this research. Corresponding author: Jeffrey E. Janis, MD, FACS, Professor of Plastic Surgery, Neurosurgery, Neurology, and Surgery, Department of Plastic Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Suite 2100, Columbus, OH 43212, USA. Phone: (614) 293-8566, Fax: (614) 293-9024, E-mail: Jeffrey.Janis@osumc.edu ©2019American Society of Plastic Surgeons

https://ift.tt/2IyUBzq

Letter to Editor Regarding: “Location of the Internal Mammary Vessels for Microvascular Autologous Breast Reconstruction: The ‘1–2–3 Rule”

No abstract available

https://ift.tt/2T7qzaf

Reply to Letter to Editor Regarding: “Location of the Internal Mammary Vessels for Microvascular Autologous Breast Reconstruction: The ‘1–2–3 Rule”

No abstract available

https://ift.tt/2IyUtzW

Transaxillary nipple-sparing mastectomy, lymphadenectomy and direct-to-implant submuscular breast reconstruction using endoscopic technique: a step toward the “aesthetic mastectomy”.

No abstract available

https://ift.tt/2T6XGLn

Patients satisfaction following cosmetic procedures: the role of App-Pain

No abstract available

https://ift.tt/2IyUiog

Performance on the Plastic Surgery In-Service Exam Can Predict Success on the American Board of Plastic Surgery Written Exam

Background: Originally developed for resident self-assessment, the Plastic Surgery In-Service Exam has been administered for over 45 years. The Accreditation Council for Graduate Medical Education requires at least 70% of graduates pass the American Board of Plastic Surgery Written Exam. This study evaluates the role of In-Service Exam scores in predicting Written Exam success. Methods: In-Service Exam scores from 2009-2015 were collected from the National Board of Medical Examiners. Data included residency training track, training year, and exam year. Written Exam data were gathered from the American Board of Plastic Surgery. Multivariate analysis was done and receiver operating characteristics curves were used to identify optimal In-Service Exam score cutpoints for Written Exam success. Results: Data from 1,364 residents were included. Residents that failed the Written Exam had significantly lower In-Service scores than those that passed (p

https://ift.tt/2TdlTj8

Reshaping the oversized waist through Oblique flankplasty with Lipoabdominoplasty (OFLA)

Introduction: Designed in response circumferential lower body lifts (LBL) failure to deepen waists, oblique flankplasty with lipoabdominoplasty (OFLA) not only aesthetically reshapes the waist, but also the hips, buttocks, and upper lateral thighs with minimal morbidity. Methods: OFLA technique was standardized with 3 of 53 cases presented. Clinical records of operations on the lower torso from March 2000 to January 2018 yielded 30 initial OFLA cases, and hundreds of LBLs. A subset of randomly selected LBL and flank liposuction operations yielded 91 cases. Through SurveyMonkey©, authors and 16 unbiased observers graded flank and global deformity using the Pittsburgh and novel posterior trunk aesthetics scales. Results: OFLA deepened and smoothly transitioned waists. Medial rotation of the lateral buttocks over posterior iliac spine retained lateral fullness and establish hip prominence. Central buttock laxity was corrected without intergluteal cleft lengthening. The immediate result persisted, satisfying high patient expectations. There were three minor complications and three non-excisional revisions with no unscheduled hospital admissions. All cases mean flank deformity of 1.93 was by chi-square analysis significantly more than 0.88 post-operative deformity (p

https://ift.tt/2IyUcNq

“Effect of Mature Adipocyte-Derived Dedifferentiated Fat (DFAT) Cells on Formation of Basement Membrane after Cultured Epithelial Autograft on Artificial Dermis”

Background: Artificial dermis (AD) is an important option for preparing full-thickness wounds for cultured epithelial autograft (CEA). Long-term fragility after CEA remains a problem, probably due to lack of basement membrane (BM) proteins. We hypothesized that treating AD with mesenchymal stem cells would promote BM protein production. We tested this using dedifferentiated fat (DFAT) cells in a porcine experimental model. Methods: This study employed four male LWD swine. Cultured epithelium (CE) and DFAT cells were prepared from skin and subcutaneous fat tissue harvested from the cervical region. Full-thickness open dorsal wounds were created and treated with AD (Pelnac®, GUNZE, Japan) to prepare a graft bed for CEA. Two groups were established. Control group: AD treated with 0.5 mL normal saline solution was applied to the wounds. DFAT group: AD treated with DFAT cells (0.5 X 105 cells) suspended in 0.5 mL of normal saline solution was sprayed to the wounds. On the 10th postoperative day, the prepared CE was grafted onto the generated dermis-like tissue. Fourteen days later, tissue specimens were harvested and histologically evaluated. Results: Light microscopy of H&E sections revealed beginning of rete ridge formation in the DFAT group. Synthesis of both Collagen IV and Laminin-5 was significantly enhanced in the DFAT group. Transmission electron microscopy revealed a nearly mature BM including anchoring fibrils in the DFAT group. Conclusion: Combined use of AD and DFAT cells promotes post-CEA production and deposition of basement membrane proteins at the dermal-epidermal junction and BM development including anchoring fibrils. Financial Disclosure Statement: This work was supported by JSPS KAKENHI Grant Number 15K10954. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. ACKNOWLEDGMENTS: This work was supported by JSPS KAKENHI Grant Number 15K10954. Disclosure: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. Corresponding author: Kazutaka Soejima, MD, Department of Plastic and Reconstructive Surgery, School of Medicine, Nihon University, 30-1 Kamicho, Oyaguchi, Itabashi-ku, Tokyo 173-8610, Japan. soejima.kazutaka@nihon-u.ac.jp ©2019American Society of Plastic Surgeons

https://ift.tt/2TdlKMC

Systemic administration of adipose-derived stromal cells concurrent with fat grafting

Background: Cell-assisted lipotransfer (CAL), a technique involving free fat grafting mixed with adipose-derived stromal cells (ASCs), has gained popularity for enhancing fat graft retention. In terms of stem cell delivery, intravenous injection can be a novel alternative with clinical value. However, the effects of intravenously injected ASCs concurrent with fat grafting have not been described. We investigated the histologic and microenvironmental changes in grafted fat when ASCs were intravenously injected concurrent with grafting. Methods: Using a modified animal model of CAL, adipose tissue from GFP-expressing C57BL/6J (B6) mice was grafted into recipient wild-type B6 mice, followed by intravenous injection of ASCs from DsRed-expressing B6 mice. The distribution of ASCs was evaluated using bioluminescent imaging and graft volume was measured using micro-computed tomography scans. Donor fat and ASCs were traced using immunofluorescent staining. Results: We identified the recruitment of ASCs inside the graft after intravenous injection of ASCs concurrent with grafting despite the arrest of cells in the lungs. Intravenous injection of ASCs resulted in significantly higher adipogenesis gene expression, retention of graft volume, and vascular density of the graft. A tracing study performed until postoperative week 8 revealed that intravenously injected ASCs mainly induced angiogenesis and adipogenesis by paracrine action rather than direct differentiation. Conclusions: Consistent with results of CAL, ASC supplementation by systemic administration led to improved retention of the fat graft. The findings broaden the surgical options for fat grafting and enhance the clinical value of CAL. * The first two authors contributed equally to this study. Ung Sik Jin, M.D., Ph.D. , Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Phone: 82-2-2072-2370, Fax: 82-2-3675-7792, E-mail: usj1011@snu.ac.kr Financial disclosures: The authors have no financial or institutional interest in any of the drugs, materials, or devices described in this article. Acknowledgement: This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (NRF-2017R1A2B1006403 to Hak Chang and NRF-2018R1C1B6004618 to Il-Kug Kim). Statement on IACUC approval: Animal care and experimental procedures were approved by the Institutional Animal Care and Use Committee (No. 17-0163-S1A1) of Seoul National University Hospital. Corresponding authors: Hak Chang, M.D., Ph.D. , Department of Plastic and Reconstructive Surgery,. Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Phone: 82-2-2072-3086, Fax: 82-2-747-5130, E-mail: hchang@snu.ac.kr ©2019American Society of Plastic Surgeons

https://ift.tt/2IxDePJ

Facial Nerve Trauma: Clinical Evaluation and Management Strategies

Summary: The field of facial paralysis requires the reconstructive surgeon to apply a wide spectrum of reconstructive and aesthetic principles utilizing a comprehensive array of surgical tools, including microsurgery, peripheral nerve surgery, and aesthetic facial surgery on the road to optimize patient outcomes. The distinct deficits created by different anatomic levels of facial nerve injury require a fundamental understanding of facial nerve anatomy. Palsy duration, followed by location and mechanism, will determine mimetic muscle salvageability, either via direct repair, grafting, or nerve transfers, while longer palsy durations will necessitate introducing a new neuromuscular unit, whether by muscle transfer or free functional muscle transplant. A thorough history, physical examination, and basic understanding of ancillary studies, emphasizing palsy duration, location, and mechanism of injury are critical in evaluation, prognostication, and treatment strategies in traumatic facial palsy patients. The importance of ancillary and aesthetic procedures should never be understated. Although these do not provide motion, they constitute essential tools in the treatment of facial paralysis, providing both protective and improved aesthetic outcomes, yielding the highest impact in final surgeon and patient satisfaction, bringing our patients to smile not only on the outside, but also on the inside. Financial disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding author: Shai M. Rozen, MD, FACS, University of Texas Southwestern Medical Center, 1801 Inwood Road, 5th Floor, Dallas, TX 75390-9132, Shai.Rozen@utsouthwestern.edu ©2019American Society of Plastic Surgeons

https://ift.tt/2TaVCSl

Modified Selective Neurectomy for the Treatment of Post-Facial Paralysis Synkinesis

Background: In order to address functional and smile dysfunction associated with post-facial paralysis synkinesis, the senior author (BA) has offered "modified selective neurectomy" of the lower division of the facial nerve as a long-term solution. This article examines technical considerations and outcomes of this procedure. Methods: A retrospective review was conducted of patients who underwent modified selective neurectomy of buccal and cervical branches of the facial nerve by a single surgeon over a four-and-a-half-year period. House-Brackmann facial grading scores, electronic clinician-graded facial function scale (eFACE), and OnabotulinumtoxinA BTX-A) dosages were examined before and after the procedure. Results: 63 patients underwent modified selective neurectomy between June 20, 2013 and August 12, 2017. There were no serious complications. The revision rate was 17%. Temporary oral incompetence was reported in 7 patients (11%) postoperatively. A statistically significant improvement was achieved in eFACE analysis of nasolabial fold depth at rest, oral commissure movement with smile, nasolabial fold orientation with smile, nasolabial depth with smile, depressor labii inferioris lower lip movement, midfacial synkinesis, mentalis synkinesis, platysmal synkinesis, static score, dynamic score, synkinesis score, periocular score, lower face and neck score, midface and smile score. There was a significant decrease in BTX-A dosage and House-Brackmann score after the surgery. Conclusions: Modified selective neurectomy of the buccal and cervical divisions of the facial nerve is an effective long-term treatment for smile dysfunction in patients with post-facial paralysis synkinesis. Financial Disclosure Statement: Dr. Massry & Azizzadeh receive royalties from Elsevier & Springer. Dr. Azizzadeh was a co-investigator for Checkpoint head and neck nerve stimulator/locator product validation study (2004). The other authors have no financial or conflicts of interest to disclose. No funding was received for this article. Corresponding Author: Babak Azizzadeh, MD, The Center for Advanced Facial Plastic Surgery, 9401 Wilshire Boulevard, Suite 650, Beverly Hills, California 90212 USA, Drazizzadeh@gmail.com ©2019American Society of Plastic Surgeons

https://ift.tt/2IAeUwu

Hyaluronic Acid-Povidone Iodine Compound Facilitates Diabetic Wound Healing in A Streptozotocin-induced Diabetes Rodent Model

Purpose: This study investigated whether the compound of hyaluronic acid (HA)-povidone iodine (PI) has the potential effectiveness to enhance diabetic wound healing. Materials and Methods: In this study, a dorsal skin defect (area, 6×5 cm) in a streptozotocin-induced diabetes rodent model was used. Seventy male Wistar rats were divided into 7 groups: normal control, diabetic control receiving no treatment, diabetic rat treated with HAL only (lower molecular weight 100 KDa); HAH only (higher molecular weight 1000 KDa); PI only (01%); HAL-PI compound; and HAH-PI compound groups. The wound dressing was changed twice per week. Wound healing progress was assessed once per 3 days post-operatively. Histologic examination was performed with hematoxylin and eosin staining. CD45, Ki-67, prolyl 4-hydroxylase (rPH), and vascular endothelial growth factor (VEGF) were evaluated with immunohistochemical (IHC) staining. Results: The results revealed that the wound area was significantly reduced in the HAH-PI treated diabetic rats as compared to the control group (P

https://ift.tt/2TfqCAA

Response

No abstract available

https://ift.tt/2Ixplku

A rare hereditary and metastatic paraganglioma involved in both spermatic cord and testis

https://ift.tt/2Ta1Yl4

Single centre review of the use of costal cartilage for reconstruction of the nasal dorsum

Abstract

Background

Reconstruction of the nasal skeleton aims to allow optimal air passage as well as a cosmetically pleasing appearance. Autogenous graft materials are the gold standard due to low extrusion and infection rates. A larger source of cartilage is required for complex secondary nasal reconstruction which makes costal cartilage an ideal source of autogenous material.

Methods

We performed a retrospective review of all patients undergoing nasal reconstruction with autogenous costal cartilage between the years 2005 to 2016. All procedures were performed by a single surgeon across two hospital sites. Patient charts were reviewed to determine aetiology, indication for surgery, referral source, post-operative complications, need for revision surgery and the length of follow-up.

Results

There was a total of 28 patients, 68% male with an average age of 37 years. The majority were referred from ENT (50%) followed by plastic or maxillofacial surgeons (21%). The commonest indication for surgery was previous nasal trauma (53%), and 88% of patients with trauma as the aetiology had previous nasal surgery prior to costal cartilage reconstruction. The commonest complication was warping of the costal cartilage graft; this occurred in 18% of patients; a slipped costal cartilage graft occurred in 4%. The revision rate was 32%. There were no cases of pneumothorax, pleural tear and post-operative infection.

Conclusions

Despite the availability of alternative cartilage sources and the risk of cartilage warping, autogenous costal cartilage is still the ideal cartilage source for complex nasal reconstruction. It is readily available, durable and versatile. Several recent studies have reported alterations in surgical technique to reduce warping. This will subsequently reduce rates of revision surgery and ensure this versatile cartilage source continues to be utilised by surgeons in future.

Level of Evidence: Level IV, therapeutic study

https://ift.tt/2SVMiCH

Reamputation in a cohort of critical limb ischemia patients surviving 2 years after minor amputation

https://ift.tt/2E7r9v6

Flexor pulley reconstruction using a transverse carpal ligament: a case report

Abstract

Although various techniques exist for pulley reconstruction, none are useful for all patients. We performed flexor pulley reconstruction using a transverse carpal ligament which has the advantages of a useful gliding surface, sufficient width and thickness, anatomical similarity to the pulley, and adequate durability. Cosmetically, all the surgical scars are on the volar side while functionally, we can avoid invasion to both the flexion and extension sides.

https://ift.tt/2SVMguz

Thromboprophylaxis in breast microvascular reconstruction: a review of the literature

Abstract

Microsurgical breast reconstruction patients are at an increased risk for venous thromboembolism (VTE) due to numerous risk factors. A meta-analysis focusing on anti-thrombotics in breast microsurgery has yet to be completed. We aimed to perform a systematic review of the literature to examine the effects of thromboprophylaxis in breast microsurgical reconstruction with a focus on patient and flap complications. A PubMed, Cochrane, and Medline database search was conducted with the following keywords: "venous thrombosis, thromboprophylaxis, mechanical, pneumatic compression, aspirin, heparin, dextran, ketorolac, toradol, warfarin, and coumadin." Results were combined with the terms "breast microsurgery" and "breast free flap." All articles that resulted were analyzed. The reference list for each included article was analyzed for other applicable articles. Only articles that addressed pre-operative or post-operative anti-coagulation were included. For data analysis, if the article reported that there were no flap complications, it was assumed there were no operative hematomas, vessel thrombosis, or flap loss. Two hundred and fifty-seven studies were screened from the abovementioned search results and 17 fit inclusion criteria. The majority of included studies were retrospective chart reviews and the type of thromboprophylaxis and its effect on complications was rarely the primary end point. Due to lack of reporting on patient and flap characteristics that could impact outcomes, subgroup analysis was impossible. There has yet to be a consensus on the most effective way to prevent VTE in women undergoing microsurgical breast reconstruction without increasing the risk of hematoma and flap compromise. Studies published to date vary in their thromboprophylatic regimens and rarely include a control or comparison group to allow for intra- or inter-group analysis. There is a need for well-done, randomized, controlled trials in order to determine the best approach to thromboprophylaxis in these patients.

https://ift.tt/2E7r5eQ

Anatomical position of umbilicus in Latin-American patients

Abstract

Background

The umbiIicus is a natural scar, and the periumbilical area is characterized by a round or ellipsoid shape with a slight depression of 2.5–3.0 cm in diameter. It represents an essential feature in the overall body contour, and consequently exists as one of the most esthetically recognized landmarks on the abdominal wall. The umbilicus lies along the midline at the level of the intervertebral discs between the third and fourth lumbar vertebrae and is considered the only admissible scar on the human body. Given that the umbilicus aids in defining the median abdominal sulcus, it is considered the greatest esthetic component of the abdomen. Thus, the effect of the umbilicus on the esthetic appearance of the abdomen remains key—its position on the abdominal wall and its shape and depth represent important factors influencing conceptions of beauty and psychological well-being.

Methods

The aim of this study was to establish a quantitative index by evaluating skeletal landmarks surrounding the anterior wall of abdomen to determine the normal anatomical position of the umbilicus in a sample of Latin-American young women. In this descriptive cross-sectional study, 100 nulliparous Latin-American women, aged 21 to 32 years, were enrolled and examined in the supine position. The mathematical relationship of the umbilicus to various nearby anatomical structures (xiphoid process, pubic symphysis, vulvar commissure, and iliac crests) was determined in order to define its ideal localization.

Results

In the majority of patients, we observed a slight lateral deviation of the umbilicus, an average distance measuring 14.55 cm between the xiphoid process and the umbilicus, and an average distance measuring 13.14 cm between the umbilicus and the pubic symphysis, with a ratio of 1.10:1. In patients on whom the umbilicus was located medially, the relationship of the distance between the umbilicus and the anterior superior iliac crest, and the distance between both iliac crests, had a ratio of 0.53:1.

Conclusions

Although numerous studies have examined what constitutes the esthetically ideal umbilicus, no publication, up until now, reports mathematical values.

Level of Evidence: Level III, risk / prognostic study.

https://ift.tt/2T752OU

In vitro bioactivity of laser surface-treated Ti6Al4V alloy

Abstract

The effects of lasing parameters on the precipitation of hydroxyapatite (HA) on the commercial Ti6Al4V alloy in simulated body fluid (SBF) were investigated. Ti6Al4V plates were polished and ultrasonically cleaned in acetone and ethyl alcohol, respectively. The specimen surfaces were treated with Er:YAG laser using super short pulse (SSP, 50 μs) and very short pulse (VSP, 100 μs) modes. Surface roughness was measured before and after laser treatment. The specimens were immersed in simulated body fluid (SBF) for 1, 3, and 7 days and, then the amount of Ca and P precipitation on specimens was determined using SEM/EDS analysis. An average roughness varying between 0.19 and 0.81 μm in surface roughness was detected in all laser-treated specimens depending on the lasing parameters. The highest surface roughness and Ca precipitation were found in VSP group (20 Hz and 5 W). Laser treatment of specimen surfaces has dramatically increased the HA precipitation due to the increasing surface roughness. It is also concluded that the immersion time was effective on the HA precipitation as well.

https://ift.tt/2U6lgoE

Effectiveness of 405-nm blue LED light for degradation of Candida biofilms formed on PMMA denture base resin

Abstract

This study investigated (i) the degradation effect of 405-nm blue light-emitting diode (LED) light irradiation on Candida albicans and C. glabrata biofilms formed on denture base resin and (ii) the effects of 405-nm blue LED light irradiation on the mechanical and surface characteristics of the resin. Polymethyl methacrylate denture base resin discs were prepared, and C. albicans or C. glabrata biofilms formed on the denture base resin discs. Each biofilm was irradiated with 405-nm blue LED light under a constant output power (280 mW/cm²) for different times in a moisture chamber with 100% relative humidity. Postirradiation, each biofilm was analyzed using a colony-forming unit assay, fluorescence microscopy, and scanning electron microscopy (SEM). Parallelepiped specimens of acrylic resin were prepared, and changes in their flexural strength (FS), flexural modulus (FM), and surface roughness (R_a) preirradiation and postirradiation with 405-nm blue LED light were evaluated. Irradiation for 30 min completely inhibited colony formation in both Candida species. Fluorescence microscopy showed that almost all Candida cells were killed because of irradiation. SEM images showed various cell damage patterns, such as wrinkles, shrinkage, and cell surface damage. An increase in FS was noted postirradiation, but no significant changes were observed in FM and R_a preirradiation and postirradiation. In conclusion, irradiation with 405-nm blue LED light induces degradation of C. albicans and C. glabrata biofilms on denture base resin, even in the absence of photosensitizers, without resin surface deterioration.

https://ift.tt/2BNxXhc

Correction to: Optimization of the dermal wrap in inferior pedicle reduction mammoplasty: An Egyptian experience

The authors wish to clarify that Dina M. Badwai refers to Dina M. Badawi. The authors apologise for this error.

https://ift.tt/2T0KcBG

Oxytocin Alleviates Cellular Senescence through Oxytocin Receptor‐Mediated ERK/Nrf2 Signalling

Summary

Background

Oxytocin (OT) is a neuropeptide hormone that has many beneficial biological effects, including protection against age‐related disorders. However, less is known about its role in intrinsic skin ageing, which is accelerated by an increase in senescent cell fraction in skin tissue.

Objectives

Here, we investigated the novel function and the underlying mechanism of OT in preventing cellular senescence in normal human dermal fibroblasts (NHDFs) isolated from the skin of female donors of different ages.

Methods

NHDFs from young and old donors were exposed to conditioned medium (CM) from senescent or control NHDFs in the presence or absence of 10 nM OT for 3 days and continuously subcultured for 12 days. Subsequently, various age‐associated signs of senescence including decreased proliferation rate, elevated p16 and p21 level, and positivity for senescence‐associated β‐galactosidase (SA‐β‐Gal) expression were examined.

Results

We found that OT suppressed senescence‐associated secretory phenotype (SASP)‐induced senescence in NHDFs and its effect depended on the age of donor's NHDFs. The inhibitory effects of OT required the OT receptor‐mediated extracellular signal‐regulated kinase (ERK)/nuclear factor‐erythroid 2‐related factor 2 (Nrf2) signalling. Age‐dependent anti‐senescence effects of OT is closely related to the OT receptor (OTXR) gene hypermethylation.

Conclusions

Our findings bring to light OT role as a new clinical strategy for the prevention of skin ageing.

https://ift.tt/2IyJFSt

Post‐zygotic mosaicism in a woman with Goltz syndrome mimics segmental angioma serpiginosum

Abstract

A 30‐year‐old Caucasian woman with no relevant medical history or family history presented to dermatology with a benign fibrous papule on her nose and was incidentally found to have an unusual rash on her legs. It had developed after birth, was itchy and aggravated by hot weather. She had no previous miscarriages and had a healthy 2‐year‐old daughter. On examination there were red, scaly plaques and areas of dermal atrophy in a blaschkoid distribution on the lower left leg (Fig 1a) and a linear punctate eruption over the right inner thigh (Fig 1b).

https://ift.tt/2T9PEkO

LEKTI domains 6, 7 and 8+9 serve as substrates for transglutaminase 1: implications for targeted therapy of Netherton syndrome

Abstract

Background

Transglutaminase 1 (TG1) plays a key role in the formation of the cornified envelope and thus in the maintenance of the epidermal barrier. Patients with Netherton syndrome (LEKTI deficiency) have an increased activity of TG1 as well as of serin proteases.

Objective

We wondered whether there is a functional biochemical link between TG1 and LEKTI and whether LEKTI domains could possibly serve as substrates for TG1.

Methods

We analysed the protein sequence of LEKTI for possible TG1 recognition sites using bioinformatics. Synthetic peptides and recombinant LEKTI domains D6, D7, D8+9 were examined in‐vitro and in‐situ for possible substrate specificity. The recombinant LEKTI domains were studied for inhibitory activity in a KLK5 activity test.

Results

We identified possible TG1 consensus sequences in LEKTI domains D6, D7, D8+9 pointing to a novel biological link between these two proteins. Indeed, synthesized short peptides from these consensus sequences were incorporated into the TG1 activity zone of the epidermis. In‐vitro the recombinant entire domains of LEKTI showed substrate‐specificity for TG1, which could again be confirmed in‐situ. The inhibitory activity of the recombinant LEKTI domains was confirmed by a KLK5 inhibition test. The strongest inhibition was observed for domain D8+D9.

Conclusion

There are specific domains of LEKTI, which are recognized and processed by transglutaminase 1. LEKTI domains D6, D7 and D8+9 contribute to the formation and protection of the cornified envelope. These results impact the development of protein replacement therapy approaches for Netherton syndrome.

https://ift.tt/2IyJSVL

Erythematotelangiectatic rosacea may be associated with a subclinical stage of demodicosis. A case control study

Summary

Background

Facial densities of Demodex mite have been observed to be greater in patients with demodicosis and papulopustular rosacea than in healthy control patients. In patients with erythematotelangiectatic rosacea (ETR), this density has been observed to be similar to or greater than that of healthy controls. Erythema and telangiectasia, characteristics of ETR, are often observed among patients with pityriasis folliculorum, a discreet demodicosis, suggesting a possible link between these conditions.

Objectives

To compare the facial Demodex densities of patients with clinical ETR and patients with healthy skin, demodicosis, rosacea with papulopustules, and other dermatoses.

Methods

In this retrospective study, we recorded Demodex densities measured using two consecutive standardised skin biopsies (SSSB1 and SSSB2) in 23 patients with ETR, 20 healthy control patients, 590 patients with demodicosis, 254 with rosacea with papulopustules, and 180 with other facial dermatoses.

Results

Patients with ETR had higher Demodex densities than did the healthy controls (mean ±SEM, SSSB1: 15.7±6.3 vs. 1.8±1.1 Demodex(D)/cm² [p=0.042]; SSSB2: 38.0±13.7 vs. 5.1±2.1 D/cm² [p=0.026]) and patients with other dermatoses (SSSB1: 0.4±0.1D/cm² [p=0.004]; SSSB2: 1.3±0.3 D/cm² [p=0.004]), but lower than patients with demodicosis (SSSB1: 82.7±4.2D/cm² [p=0.008]; SSSB2: 172.2±7.7 D/cm² [p=0.001]) or rosacea with papulopustules (SSSB1: 86.6±7.3 D/cm² [p=0.027]; SSSB2: 197.0±12.1 D/cm² [p=0.002]).

Conclusions

ETR may be associated with non‐visible Demodex proliferation, possibly corresponding to a subclinical stage of demodicosis. Dermatologists should be aware of this potential association and look for subclinical demodicosis in patients with ETR, so that topical acaricidal treatment can be offered if Demodex density is high.

https://ift.tt/2TahEoj

Digitally reconstructed top‐down view images provides intuitive understanding of correlation between dermoscopy and histopathology: A good educational tool

Abstract

Dermoscopy is an optical technique, which enables us to observe the fine structures especially in melanocytic skin lesions. In the dermoscopic structures of melanocytic lesions, including nevocellular nevus and melanoma, 1) pigment network, 2) dots and globules, and 3) streaks are main components. The irregularity of these structures helps us differentiate benign nevi from malignant melanoma.

https://ift.tt/2IyJt5H

Open‐label, Investigator‐Initiated, Single Site Exploratory Trial Evaluating Secukinumab, an anti IL17A monoclonal antibody, for Patients with Moderate‐to‐Severe Hidradenitis Suppurativa

Abstract

Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease of the apocrine gland‐rich intertriginous areas.¹ HS lesions have an elevated Th17 immune response, and it is often challenging to treat patients, with existing therapies having limited efficacy.^2,3 We sought to investigate the role of secukinumab, a human monoclonal antibody that inhibits Interleukin‐17A, in HS treatment.

https://ift.tt/2T6ZIuU

Clinical presentation, therapeutic approach and outcome of primary cutaneous marginal zone B‐cell lymphoma presenting as AL amyloidoma of the skin

Abstract

Primary cutaneous marginal zone B‐cell lymphoma (PCMZBCL) usually presents with erythematous papules, plaques and nodules. It is characterized by an indolent proliferation of marginal zone, plasmacytoid and plasma cells with an immunoglobulin light chain restriction. Local radiotherapy, topical or intralesional corticosteroids and surgery are effective therapeutic options in localized disease.

https://ift.tt/2IuNB6U

A visualized investigation on the intellectual structure and evolution of waste printed circuit board research during 2000–2016

Abstract

Waste printed circuit boards (WPCBs) containing various metals and hazardous materials are considered as a secondary resource and an environmental pollution source. A systematic overview of WPCB study was conducted by using CiteSpace. The relevant knowledge of 242 documents was collected from SCI-Expanded database (SCIE) and saved as txt files. A 556-node and 636-link network and 17 clusters were obtained. Based on co-citation network, nonmetallic material treatment and recycling, metal recovery, pyrolysis treatment, and new technology development were successively the most attractive fields in the study period. Timeline pattern showed that mechanical processing attracted great attention in the initial period and profitability assessment was the latest hot spot in WPCB study. The results could provide a reference for future work in WPCB field.

https://ift.tt/2XfOaVk

Risk factors associated with long-term outcomes after active and supporting periodontal treatments: impact of various compliance definitions on tooth loss

Abstract

Objectives

The aim of this retrospective study was to determine factors influencing tooth loss during a long-term follow-up, emphasizing the impact of various compliance definitions.

Materials and methods

Patients with periodontitis who were treated and presenting for maintenance care for at least up to 6 years were included. The effects of compliance and other patient- and treatment-related factors on tooth loss were assessed. Lack of compliance was defined in three ways: (1) fewer than 1.4 visits per year (irregular compliers), (2) no maintenance visit over a 2-year period (erratic compliers), and (3) no maintenance visit over a 2- to 5-year period (partial compliers) and no maintenance visit for a period of more than 5 years (non-compliers).

Results

One hundred and one patients were selected. The mean follow-up was 9.72 ± 1.17 years. Tooth loss per patient-year was significantly higher in erratic compliers (0.35 ± 0.19) and non-compliers (0.40 ± 0.20) compared with compliers (0.18 ± 0.10). No significant differences were found for irregular (0.30 ± 0.17) and partial (0.25 ± 0.15) compliers. Similar results were obtained for the number of patients who lost more than three teeth. Multivariable regression analysis showed that lack of compliance and periodontitis severity (more than 3% of periodontal pockets > 7 mm at baseline) were independent risk factors for tooth loss.

Conclusions

During long-term follow-up, non-compliance and initial periodontitis severity were the principal risk factors that increased tooth loss.

Clinical relevance

Tooth loss associated with lack of compliance was essentially observed in patients with long continuous periods without maintenance visits and was less influenced by patients' attended mean visit frequency.

https://ift.tt/2NlOdu3

Παρασκευή 22 Φεβρουαρίου 2019

Voigt‐Futcher pigmentary demarcation lines

Abstract

Pigmentary demarcation lines (PDLs) are physiological abrupt transitions between hyperpigmented and lighter skin, a common and sometimes troubling feature of normal skin. They are seen in a majority of dark‐complexioned women and a substantial percentage of light‐complexioned ones too. We review this salient finding and approaches to its management.

https://ift.tt/2VgibCI

Additively Manufactured Reactive Material Architectures as a Programmable Heat Source

3D Printing and Additive Manufacturing, Ahead of Print.

https://ift.tt/2BQ8wva

Clinical Outcomes of Patients with Advanced Cancer and Pre‐Existing Autoimmune Diseases Treated with Anti‐Programmed Death‐1 Immunotherapy: A Real‐World Transverse Study

AbstractBackground.Patients with a history of autoimmune diseases (AIDs) have not usually been included in clinical trials with immune checkpoint inhibitors.Materials and Methods.Consecutive patients with advanced cancer, treated with anti‐programmed death‐1 (PD‐1) agents, were evaluated according to the presence of pre‐existing AIDs. The incidence of immune‐related adverse events (irAEs) and clinical outcomes were compared among subgroups.Results.A total of 751 patients were enrolled; median age was 69 years. Primary tumors were as follows: non‐small cell lung cancer, 492 (65.5%); melanoma, 159 (21.2%); kidney cancer, 94 (12.5%); and others, 6 (0.8%). Male/female ratio was 499/252. Eighty‐five patients (11.3%) had pre‐existing AIDs, further differentiated in clinically active (17.6%) and inactive (82.4%). Among patients with pre‐existing AIDs, incidence of irAEs of any grade was significantly higher when compared with patients without AIDs (65.9% vs. 39.9%). At multivariate analysis, both inactive (p = .0005) and active pre‐existing AIDs (p = .0162), female sex (p = .0004), and Eastern Cooperative Oncology Group Performance Status <2 (p = .0030) were significantly related to a higher incidence of irAEs of any grade. No significant differences were observed regarding grade 3/4 irAEs and objective response rate among subgroups. Pre‐existing AIDs were not significantly related with progression‐free survival and overall survival.Conclusion.This study quantifies the increased risk of developing irAEs in patients with pre‐existing AIDs who had to be treated with anti‐PD‐1 immunotherapy. Nevertheless, the incidence of grade 3/4 irAEs is not significantly higher when compared with control population. The finding of a greater incidence of irAEs among female patients ranks among the "hot topics" in gender‐related differences in immuno‐oncology.Implications for Practice.Patients with a history of autoimmune diseases (AIDs) have not usually been included in clinical trials with immune checkpoint inhibitors but are frequent in clinical practice. This study quantifies the increased risk of developing immune‐related adverse events (irAEs) in patients with pre‐existing AIDs who had to be treated with anti‐programmed death‐1 immunotherapy. Nevertheless, their toxicities are mild and the incidence of grade 3/4 irAEs is not significantly higher compared with those of controls. These results will help clinicians in everyday practice, improving their ability to offer a proper counselling to patients, in order to offer an immunotherapy treatment even to patients with pre‐existing autoimmune disease.

https://ift.tt/2VhDC6u

Minimally Invasive Cordotomy for Refractory Cancer Pain: A Randomized Controlled Trial

AbstractBackground.Up to 30% of patients with cancer continue to suffer from pain despite aggressive supportive care. The present study aimed to determine whether cordotomy can improve cancer pain refractory to interdisciplinary palliative care.Materials and Methods.In this randomized controlled trial, we recruited patients with refractory unilateral somatic pain, defined as a pain intensity (PI) ≥4, after more than three palliative care evaluations. Patients were randomized to percutaneous computed tomography‐guided cordotomy or continued interdisciplinary palliative care. The primary outcome was 33% improvement in PI at 1 week after cordotomy or study enrollment as measured by the Edmonton Symptom Assessment Scale.Results.Sixteen patients were enrolled (nine female, median age 58 years). Six of seven patients (85.7%) randomized to cordotomy experienced >33% reduction in PI (median preprocedure PI = 7, range 6–10; 1 week after cordotomy median PI = 1, range 0–6; p = .022). Zero of nine patients randomized to palliative care achieved a 33% reduction in PI. Seven patients (77.8%) randomized to palliative care elected to undergo cordotomy after 1 week. All of these patients experienced >33% reduction in PI (median preprocedure PI = 8, range 4–10; 1 week after cordotomy median PI = 0, range 0–1; p = .022). No patients were withdrawn from the study because of adverse effects of the intervention.Conclusion.These data support the use of cordotomy for pain refractory to optimal palliative care. The findings of this study justify a large‐scale randomized controlled trial of percutaneous cordotomy.Implications for Practice.This prospective clinical trial was designed to determine the improvement in pain intensity in patients randomized to either undergo cordotomy or comprehensive palliative care for medically refractory cancer pain. This study shows that cordotomy is effective in reducing pain for medically refractory cancer pain, and these results can be used to design a large‐scale comparative randomized controlled trial that could provide the evidence needed to include cordotomy as a treatment modality in the guidelines for cancer pain management.

https://ift.tt/2EpFLHn

Cost of Disease Progression in Patients with Metastatic Breast, Lung, and Colorectal Cancer

AbstractIntroduction.To reduce health care costs and improve care, payers and physician groups are piloting value‐based and episodic or bundled‐care payment models in oncology. Disease progression and associated costs may affect these models, particularly if such programs do not account for disease severity and progression risk across patient populations. This study estimated the incremental cost of disease progression in patients diagnosed with metastatic breast cancer (mBC), colorectal cancer (mCRC) and lung cancer (mLC) and compared costs among patients with and without progression.Methods.This was a retrospective study using U.S. administrative claims data from commercial and Medicare Advantage health care enrollees with evidence of mBC, mCRC, and mLC and systemic antineoplastic agent use from July 1, 2006, to August 31, 2014. Outcome measures included disease progression, 12‐month health care costs, and 3‐year cumulative predictive health care costs.Results.Of 5,709 patients with mBC, 3,707 patients with mCRC, and 5,201 patients with mLC, 56.8% of patients with mBC, 58.1% of those with mCRC, and 80.3% of those with mLC patients had evidence of disease progression over 12 months. Among patients with mBC and mCRC, adjusted and unadjusted health care costs were significantly higher among progressors versus nonprogressors. Per‐patient‐per‐month costs, which accounted for variable follow‐up time, were almost twice as high among progressors versus nonprogressors in patients with mBC, mCRC, and mLC. In each of the three cancer types, delays in progression were associated with lower health care costs.Conclusion.Progression of mLC, mBC, and mCRC was associated with higher health care costs over a 12‐month period. Delayed cancer progression was associated with substantial cost reductions in patients with each of the three cancer types.Implications for Practice.Data on the rates and incremental health care costs of disease progression in patients with solid tumor cancers are lacking. This study estimated the incremental costs of disease progression in patients diagnosed with lung cancer, breast cancer, and colorectal cancer and compared health care costs in patients with and without evidence of disease progression in a real‐world population. The data obtained in our study quantify the economic value of delaying or preventing disease progression and may inform payers and physician groups about value‐based payment programs.

https://ift.tt/2VhDK5Y

Comparison of the Clinicopathological Characteristics and Genetic Alterations Between Patients with Gastric Cancer with or Without Helicobacter pylori Infection

AbstractBackground.Helicobacter pylori (HP) can induce epithelial cells and intestinal metaplasia with genetic damage that makes them highly susceptible to the development of gastric cancer (GC).Materials and Methods.Between 2005 and 2010, 356 patients with gastric cancer who received curative surgery were enrolled. Analysis of HP, Epstein‐Barr virus (EBV) infection, PIK3CA amplification, and mutation analysis of 68 mutations in eight genes using a mass spectrometric single‐nucleotide polymorphism genotyping technology was conducted. The clinicopathological characteristics of patients with or without HP infection were compared.Results.Among the 356 patients, 185 (52.0%) had HP infection. For intestinal‐type GC, patients with HP infection were more likely to be younger and had fewer PI3K/AKT pathway genetic mutations than those without HP infection. For diffuse‐type GC, patients with HP infection were characterized by less male predominance, less lymphoid stroma, fewer microsatellite instability‐high tumors, and fewer PI3K/AKT pathway genetic mutations than those without HP infection. Patients with HP infection had less tumor recurrence and a better 5‐year overall survival (87.7% vs. 73.9%, p = .012) and disease‐free survival (64.1% vs. 51.3%, p = .013) than those without HP infection, especially for intestinal‐type GC. For EBV‐negative GC, patients with HP infection had fewer PI3K/AKT pathway mutations and a better 5‐year overall survival and disease‐free survival than those without HP infection. Multivariate analysis demonstrated that HP infection was an independent prognostic factor regarding overall survival and disease‐free survival.Conclusion.Patients with GC with HP infection were associated with fewer PI3K/AKT pathway genetic mutations and better survival than those without HP infection, especially for EBV‐negative and intestinal‐type GC.Implications for Practice.Patients with gastric cancer with Helicobacter pylori (HP) infection had fewer PI3K/AKT pathway genetic mutations, less tumor recurrence, and better survival than those without HP infection, especially for Epstein‐Barr virus (EBV)‐negative and intestinal‐type gastric cancer. HP infection is an independent prognostic factor regarding overall survival and disease‐free survival. Future in vivo and in vitro studies of the correlation among HP infection, PI3K/AKT pathway, and EBV infection in gastric cancer are required.

https://ift.tt/2EpDn3w

A Phase II Study of Genexol‐PM and Cisplatin as Induction Chemotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma

AbstractLessons Learned. Induction chemotherapy with Genexol‐PM and cisplatin demonstrated modest tumor response in locally advanced head and neck squamous cell carcinoma.Considering favorable toxicity profiles and promising survival data, further studies on this regimen are warranted in patients with head and neck squamous cell carcinoma.Background.Genexol‐PM is a polymeric micellar formulation of paclitaxel without Cremophor EL. We investigated the efficacy and safety of Genexol‐PM plus cisplatin as induction chemotherapy (IC) in patients with locally advanced head and neck squamous cell carcinoma (LA‐HNSCC).Methods.Patients received Genexol‐PM (230 mg/m2) and cisplatin (60 mg/m2) every 3 weeks as IC. After three cycles of IC, definitive treatment of either concurrent chemoradiotherapy (CCRT) with weekly cisplatin (30 mg/m2) or surgery was performed. The primary endpoint was overall response rate (ORR) after IC.Results.Of 52 patients enrolled, 47 completed three cycles of IC, and the ORR was 55.8% (95% confidence interval, 42.3–69.3). Although there was one treatment‐related death, toxicity profiles to Genexol‐PM and cisplatin were generally favorable, and the most common grade 3 or 4 toxicities were neutropenia (15.4%), anorexia (7.7%), and general weakness (7.7%). Fifty‐one patients received definitive treatment (CCRT [n = 44] or radical surgery [n = 7]). The rate of complete response following CCRT was 81.8% (36/44). After a median follow‐up of 39 months, estimates of progression‐free survival (PFS) and overall survival (OS) at 3 years were 54.3% and 71.3%, respectively.Conclusion.IC with Genexol‐PM and cisplatin demonstrated modest tumor response with well‐tolerated toxicity profiles for patients with LA‐HNSCC.

https://ift.tt/2Vho4Q5

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Κυριακή 24 Φεβρουαρίου 2019

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