Abnormal amplitude of low frequency fluctuation and functional connectivity in non-neuropsychiatric systemic lupus erythematosus: a resting-state fMRI study

Abstract

Purpose

To explore the amplitude of low frequency fluctuation (ALFF) and functional connectivity (FC) disorders in non-neuropsychiatric systemic lupus erythematosus (non-NPSLE) patients by resting-state functional magnetic resonance imaging (rs-fMRI) and to study whether there are some clinical biomarkers that can be used to monitor the brain dysfunction.

Methods

Based on the rs-fMRI data of 36 non-NPSLE patients and 30 normal controls, we first obtained the regions with abnormal ALFF signals in non-NPSLE patients. Then, by taking these areas as seed regions of interest (ROIs), we calculated the FC between ROIs and the whole brain to assess the network-level alterations. Finally, we correlated the altered values of ALFF and FC in non-NPSLE patients to some clinical data.

Results

Compared with the controls, non-NPSLE patients showed decreased ALFF in bilateral precuneus and increased ALFF in right cuneus and right calcarine fissure surrounding cortex (CAL). At network level, non-NPSLE patients exhibited higher FC between left precuneus and left middle occipital gyrus (MOG)/left superior occipital gyrus (SOG)/right middle frontal gyrus (MFG)/right dorsolateral superior frontal gyrus (SFGdor), and higher FC between right cuneus and bilateral precuneus/left posterior cingulate gyrus (PCG). The abnormal ALFF in right CAL and abnormal FC in right cuneus–left precuneus, right cuneus–right precuneus, and right cuneus–left PCG were correlated with the patients' certain clinical data (p < 0.05).

Conclusion

Rs-fMRI is a promising tool for detecting the brain function disorders in non-NPSLE patients and to help understand the neurophysiological mechanisms. C4 and Systemic Lupus Erythematosus Disease Activity Index may be biomarkers of brain dysfunction in non-NPSLE patients.

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Single inhaler maintenance and reliever therapy in pediatric asthma

Purpose of review Asthma affects more than 25 million people worldwide and continues to grow in prevalence. According to a center for disease control and prevention (CDC) report, the total annual cost of asthma in the United States between 2008 and 2013, including medical care, absenteeism, and mortality, was $81.9 billion. Although the National Institute of Health guidelines recommend fixed inhaled corticosteroid (ICS) dosing, the 2008–2010 Medical Expenditure Panel Survey showed that asthma is still poorly controlled. Single inhaler maintenance and reliever therapy (SMART) offers a possible alternative management plan. This is a review of SMART vs. current treatment guidelines. Recent findings SMART addresses variable inflammation with symptom-driven dosing of ICS. It relies on a combination inhaler that has a long-acting β-agonist, which has an immediate onset of action to provide quick relief, in combination with an ICS. Recent studies show that SMART decreases the frequency and severity of asthma exacerbations when compared to fixed ICS dosing. In addition, intermittent use of ICS gave a reduced effect on growth and permitted a lower total amount of ICS to be delivered. Summary SMART appears to outperform treatment that is based on current guidelines in the United States. As inhalers capable of being used for SMART are already approved, what is needed is Food and Drug Administration approval of the SMART strategy. Correspondence to Jay M. Portnoy, MD, Section of Allergy, Asthma and Immunology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA. Tel: +1 816 960-8885; fax: +1 816 960-8888; e-mail: jportnoy@cmh.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Phenotypes of wheezing and asthma in preschool children

Purpose of review The purpose of this review is to provide an overview of the identified phenotypes of preschool wheezing. Recent findings Early life wheezing patterns have been described in multiple populations, with several commonalities found between cohorts. Early life environmental exposures have been found to be differentially associated with preschool wheezing phenotypes and their future trajectories. These include allergen and microbe exposure, environmental tobacco smoke exposure, and maternal stress and depression. Elevated IgE in early life may also influence future asthma risk. Summary Preschool wheezing phenotypes are heterogeneous and complex, with trajectories that are related to factors including environmental exposures. More research is needed to characterize these relationships, hopefully leading to targeted prevention strategies. Correspondence to Leonard B. Bacharier, MD, Campus Box 8116, 660 S. Euclid Ave., St. Louis, MO 63110, USA. Tel: +1 314 454 2694; e-mail: Bacharier_l@wustl.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Phenotypes of wheezing and asthma in preschool children

Purpose of review The purpose of this review is to provide an overview of the identified phenotypes of preschool wheezing. Recent findings Early life wheezing patterns have been described in multiple populations, with several commonalities found between cohorts. Early life environmental exposures have been found to be differentially associated with preschool wheezing phenotypes and their future trajectories. These include allergen and microbe exposure, environmental tobacco smoke exposure, and maternal stress and depression. Elevated IgE in early life may also influence future asthma risk. Summary Preschool wheezing phenotypes are heterogeneous and complex, with trajectories that are related to factors including environmental exposures. More research is needed to characterize these relationships, hopefully leading to targeted prevention strategies. Correspondence to Leonard B. Bacharier, MD, Campus Box 8116, 660 S. Euclid Ave., St. Louis, MO 63110, USA. Tel: +1 314 454 2694; e-mail: Bacharier_l@wustl.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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The roles of NADPH oxidase in modulating neutrophil effector responses

Abstract

Neutrophils are phagocytic innate immune cells essential for killing bacteria via activation of a wide variety of effector responses and generation of large amounts of reactive oxygen species (ROS). Majority of the ROS in neutrophils is generated by activation of the superoxide‐generating enzyme NADPH oxidase. Independent of their anti‐microbial function, NADPH oxidase‐derived ROS have emerged as key regulators of host immune responses and neutrophilic inflammation. Data from patients with inherited defects in the NADPH oxidase subunit alleles that ablate its enzyme function as well as mouse models demonstrate profound dysregulation of host inflammatory responses, neutrophil hyper‐activation and tissue damage in response to microbial ligands or tissue trauma. A large body of literature now demonstrates how oxidants function as essential signaling molecules that are essential for the regulation of neutrophil responses during priming, degranulation, neutrophil extracellular trap formation, and apoptosis, independent of their role in microbial killing. In this review we summarize how NADPH oxidase‐derived oxidants modulate neutrophil function in a cell intrinsic manner and regulate host inflammatory responses. In addition, we summarize studies that have elucidated possible roles of oxidants in neutrophilic responses within the oral mucosa and periodontal disease.

This article is protected by copyright. All rights reserved.

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The roles of NADPH oxidase in modulating neutrophil effector responses

Abstract

Neutrophils are phagocytic innate immune cells essential for killing bacteria via activation of a wide variety of effector responses and generation of large amounts of reactive oxygen species (ROS). Majority of the ROS in neutrophils is generated by activation of the superoxide‐generating enzyme NADPH oxidase. Independent of their anti‐microbial function, NADPH oxidase‐derived ROS have emerged as key regulators of host immune responses and neutrophilic inflammation. Data from patients with inherited defects in the NADPH oxidase subunit alleles that ablate its enzyme function as well as mouse models demonstrate profound dysregulation of host inflammatory responses, neutrophil hyper‐activation and tissue damage in response to microbial ligands or tissue trauma. A large body of literature now demonstrates how oxidants function as essential signaling molecules that are essential for the regulation of neutrophil responses during priming, degranulation, neutrophil extracellular trap formation, and apoptosis, independent of their role in microbial killing. In this review we summarize how NADPH oxidase‐derived oxidants modulate neutrophil function in a cell intrinsic manner and regulate host inflammatory responses. In addition, we summarize studies that have elucidated possible roles of oxidants in neutrophilic responses within the oral mucosa and periodontal disease.

This article is protected by copyright. All rights reserved.

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Patient Phenotyping in OSA

Abstract

Purpose of Review

OSA treatment paradigms are evolving from a "one treatment for all" philosophy to personalised therapeutic options based on anatomical and physiological phenotypes. Understanding these different phenotypes will become vital for clinicians as OSA testing and treatment become more targeted.

Recent Findings

Phenotyping of the pharynx and upper airway is vital to inform anatomical treatment options such as surgery and mandibular advancement splints. Manipulated CPAP testing allows determination of traits such as arousal threshold, muscular responsiveness and ventilatory control. Targeted therapies of each of these physiological traits have shown promise in selected patients in the research context.

Summary

Current treatment paradigms are based on anatomical therapies (CPAP, MAS, surgery); the limitations of which may be particularly evident in patients with physiological contributors to their OSA. Physiological phenotyping is an area of ongoing research into non-anatomical traits which contribute to airway obstruction.

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Patient Phenotyping in OSA

Abstract

Purpose of Review

OSA treatment paradigms are evolving from a "one treatment for all" philosophy to personalised therapeutic options based on anatomical and physiological phenotypes. Understanding these different phenotypes will become vital for clinicians as OSA testing and treatment become more targeted.

Recent Findings

Phenotyping of the pharynx and upper airway is vital to inform anatomical treatment options such as surgery and mandibular advancement splints. Manipulated CPAP testing allows determination of traits such as arousal threshold, muscular responsiveness and ventilatory control. Targeted therapies of each of these physiological traits have shown promise in selected patients in the research context.

Summary

Current treatment paradigms are based on anatomical therapies (CPAP, MAS, surgery); the limitations of which may be particularly evident in patients with physiological contributors to their OSA. Physiological phenotyping is an area of ongoing research into non-anatomical traits which contribute to airway obstruction.

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Water Waves to Sound Waves: Using Zebrafish to Explore Hair Cell Biology

AbstractAlthough perhaps best known for their use in developmental studies, over the last couple of decades, zebrafish have become increasingly popular model organisms for investigating auditory system function and disease. Like mammals, zebrafish possess inner ear mechanosensory hair cells required for hearing, as well as superficial hair cells of the lateral line sensory system, which mediate detection of directional water flow. Complementing mammalian studies, zebrafish have been used to gain significant insights into many facets of hair cell biology, including mechanotransduction and synaptic physiology as well as mechanisms of both hereditary and acquired hair cell dysfunction. Here, we provide an overview of this literature, highlighting some of the particular advantages of using zeb...

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Water Waves to Sound Waves: Using Zebrafish to Explore Hair Cell Biology

AbstractAlthough perhaps best known for their use in developmental studies, over the last couple of decades, zebrafish have become increasingly popular model organisms for investigating auditory system function and disease. Like mammals, zebrafish possess inner ear mechanosensory hair cells required for hearing, as well as superficial hair cells of the lateral line sensory system, which mediate detection of directional water flow. Complementing mammalian studies, zebrafish have been used to gain significant insights into many facets of hair cell biology, including mechanotransduction and synaptic physiology as well as mechanisms of both hereditary and acquired hair cell dysfunction. Here, we provide an overview of this literature, highlighting some of the particular advantages of using zeb...

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Patient Phenotyping in OSA

Abstract

Purpose of Review

OSA treatment paradigms are evolving from a "one treatment for all" philosophy to personalised therapeutic options based on anatomical and physiological phenotypes. Understanding these different phenotypes will become vital for clinicians as OSA testing and treatment become more targeted.

Recent Findings

Phenotyping of the pharynx and upper airway is vital to inform anatomical treatment options such as surgery and mandibular advancement splints. Manipulated CPAP testing allows determination of traits such as arousal threshold, muscular responsiveness and ventilatory control. Targeted therapies of each of these physiological traits have shown promise in selected patients in the research context.

Summary

Current treatment paradigms are based on anatomical therapies (CPAP, MAS, surgery); the limitations of which may be particularly evident in patients with physiological contributors to their OSA. Physiological phenotyping is an area of ongoing research into non-anatomical traits which contribute to airway obstruction.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SOXZqL

Patient Phenotyping in OSA

Abstract

Purpose of Review

OSA treatment paradigms are evolving from a "one treatment for all" philosophy to personalised therapeutic options based on anatomical and physiological phenotypes. Understanding these different phenotypes will become vital for clinicians as OSA testing and treatment become more targeted.

Recent Findings

Phenotyping of the pharynx and upper airway is vital to inform anatomical treatment options such as surgery and mandibular advancement splints. Manipulated CPAP testing allows determination of traits such as arousal threshold, muscular responsiveness and ventilatory control. Targeted therapies of each of these physiological traits have shown promise in selected patients in the research context.

Summary

Current treatment paradigms are based on anatomical therapies (CPAP, MAS, surgery); the limitations of which may be particularly evident in patients with physiological contributors to their OSA. Physiological phenotyping is an area of ongoing research into non-anatomical traits which contribute to airway obstruction.

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Re: Postoperative Pain and Opioid Analgesic Requirements After Orthognathic Surgery

We read with interest the article by Mobini et al.1 We appreciate their effort to emphasize the concept of postoperative pain and opioid analgesic requirements after orthognathic surgery. What we want to add is the fact that, rather than using opioids alone for the management of pain after orthognathic surgery, nonsteroidal anti-inflammatory drugs (NSAIDs) should be combined with opioids as part of a balanced analgesia regimen. NSAIDs allow the spare use of opioids and subsequently might decrease the opioid-mediated side effects as mentioned by the authors.

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Re: Postoperative Pain and Opioid Analgesic Requirements After Orthognathic Surgery

We read with interest the article by Mobini et al.1 We appreciate their effort to emphasize the concept of postoperative pain and opioid analgesic requirements after orthognathic surgery. What we want to add is the fact that, rather than using opioids alone for the management of pain after orthognathic surgery, nonsteroidal anti-inflammatory drugs (NSAIDs) should be combined with opioids as part of a balanced analgesia regimen. NSAIDs allow the spare use of opioids and subsequently might decrease the opioid-mediated side effects as mentioned by the authors.

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Jorge A. Marrero, MD, MS - Surveying the View From the Driver ’s Seat in Hepatocellular Carcinoma: Bringing Into Focus Hepatology’s Key Role in Guiding HCC Care Down the Path to Improved Outcomes

Surveying the View From the Driver's Seat in Hepatocellular Carcinoma: Bringing Into Focus Hepatology's Key Role in Guiding HCC Care Down the Path to Improved Outcomes (Source: PeerView CME/CE Audio Podcast - Immunology)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Kurt Schalper, MD, PhD and Edward B. Garon, MD, MS - Advances and Challenges in Refining the Use of Cancer Immunotherapies Through Biomarker Testing: Practical Guidance for Pathologists on the Front Lines of the Immuno-Oncology Revolution

Advances and Challenges in Refining the Use of Cancer Immunotherapies Through Biomarker Testing: Practical Guidance for Pathologists on the Front Lines of the Immuno-Oncology Revolution (Source: PeerView CME/CE Audio Podcast - Immunology)

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Meta-Analysis: Vitamin D Pills Lower COPD Exacerbation Risk

(MedPage Today) -- But only in patients with baseline deficiency (Source: MedPage Today Allergy)

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Jorge A. Marrero, MD, MS - Surveying the View From the Driver ’s Seat in Hepatocellular Carcinoma: Bringing Into Focus Hepatology’s Key Role in Guiding HCC Care Down the Path to Improved Outcomes

Surveying the View From the Driver's Seat in Hepatocellular Carcinoma: Bringing Into Focus Hepatology's Key Role in Guiding HCC Care Down the Path to Improved Outcomes (Source: PeerView CME/CE Audio Podcast - Immunology)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Kurt Schalper, MD, PhD and Edward B. Garon, MD, MS - Advances and Challenges in Refining the Use of Cancer Immunotherapies Through Biomarker Testing: Practical Guidance for Pathologists on the Front Lines of the Immuno-Oncology Revolution

Advances and Challenges in Refining the Use of Cancer Immunotherapies Through Biomarker Testing: Practical Guidance for Pathologists on the Front Lines of the Immuno-Oncology Revolution (Source: PeerView CME/CE Audio Podcast - Immunology)

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Meta-Analysis: Vitamin D Pills Lower COPD Exacerbation Risk

(MedPage Today) -- But only in patients with baseline deficiency (Source: MedPage Today Allergy)

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Mucin in benign thyroid nodules: treatment related change or not?

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Mucin in benign thyroid nodules: treatment related change or not?

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VIXX5r

Re: Postoperative Pain and Opioid Analgesic Requirements After Orthognathic Surgery

We read with interest the article by Mobini et al.1 We appreciate their effort to emphasize the concept of postoperative pain and opioid analgesic requirements after orthognathic surgery. What we want to add is the fact that, rather than using opioids alone for the management of pain after orthognathic surgery, nonsteroidal anti-inflammatory drugs (NSAIDs) should be combined with opioids as part of a balanced analgesia regimen. NSAIDs allow the spare use of opioids and subsequently might decrease the opioid-mediated side effects as mentioned by the authors.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QCHhZK

In vitro Cytotoxicity of a Library of BODIPY-anthracene and -pyrene Dyads for Application in Photodynamic Therapy

Photochem. Photobiol. Sci., 2019, Accepted Manuscript
DOI: 10.1039/C8PP00402A, Paper

Susan Callaghan, Mikhail A. Filatov, Huguette Savoie, Ross W Boyle, Mathias O Senge
The facile synthesis and in vitro activity of a library of heavy atom-free BODIPY-anthracene, -pyrene dyads (BAD-13–BPyrD-19) and a control (BODIPY 20) are reported. We demonstrate that singlet oxygen produced...
The content of this RSS Feed (c) The Royal Society of Chemistry

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Re: Postoperative Pain and Opioid Analgesic Requirements After Orthognathic Surgery

We read with interest the article by Mobini et al.1 We appreciate their effort to emphasize the concept of postoperative pain and opioid analgesic requirements after orthognathic surgery. What we want to add is the fact that, rather than using opioids alone for the management of pain after orthognathic surgery, nonsteroidal anti-inflammatory drugs (NSAIDs) should be combined with opioids as part of a balanced analgesia regimen. NSAIDs allow the spare use of opioids and subsequently might decrease the opioid-mediated side effects as mentioned by the authors.

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In vitro Cytotoxicity of a Library of BODIPY-anthracene and -pyrene Dyads for Application in Photodynamic Therapy

Photochem. Photobiol. Sci., 2019, Accepted Manuscript
DOI: 10.1039/C8PP00402A, Paper

Susan Callaghan, Mikhail A. Filatov, Huguette Savoie, Ross W Boyle, Mathias O Senge
The facile synthesis and in vitro activity of a library of heavy atom-free BODIPY-anthracene, -pyrene dyads (BAD-13–BPyrD-19) and a control (BODIPY 20) are reported. We demonstrate that singlet oxygen produced...
The content of this RSS Feed (c) The Royal Society of Chemistry

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Blood endotyping distinguishes the profile of vitiligo from that of other inflammatory and autoimmune skin diseases

Peripheral blood skin-homing/cutaneous lymphocyte antigen (CLA)+ T cells emerge as biomarkers of cutaneous immune activation in patients with inflammatory skin diseases (atopic dermatitis [AD] and alopecia areata [AA]). However, blood phenotyping across these subsets is not yet available in patients with vitiligo. (Source: Journal of Allergy and Clinical Immunology)

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Blood endotyping distinguishes the profile of vitiligo from that of other inflammatory and autoimmune skin diseases

Peripheral blood skin-homing/cutaneous lymphocyte antigen (CLA)+ T cells emerge as biomarkers of cutaneous immune activation in patients with inflammatory skin diseases (atopic dermatitis [AD] and alopecia areata [AA]). However, blood phenotyping across these subsets is not yet available in patients with vitiligo. (Source: Journal of Allergy and Clinical Immunology)

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Meta-Analysis: Vitamin D Pills Lower COPD Exacerbation Risk

(MedPage Today) -- But only in patients with baseline deficiency (Source: MedPage Today Allergy)

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Prices Still Explain High U.S. Health Care Spending

Health care prices explain difference in spending between United States and other countries (Source: The Doctors Lounge - Psychiatry)

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Meta-Analysis: Vitamin D Pills Lower COPD Exacerbation Risk

(MedPage Today) -- But only in patients with baseline deficiency (Source: MedPage Today Allergy)

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Prices Still Explain High U.S. Health Care Spending

Health care prices explain difference in spending between United States and other countries (Source: The Doctors Lounge - Psychiatry)

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Risk assessment and recommendations for forester exposure to hymenoptera - Dillane D, Richards SL, Balanay JAG, Langley R.

This study assessed the impacts of ... (Source: SafetyLit)

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Aufmerksamkeitslenkung in der Verhaltenstherapie

Die Steuerung der Aufmerksamkeit stellt eine Schlüsselkomponente der Informationsverarbeitung dar. Dysfunktionale Aufmerksamkeitsprozesse (im Sinne von Aufmerksamkeitsverzerrungen) sind gemäß kognitiv-behavioraler Modelle an der Entstehung und Aufrechterhaltung nahezu aller psychischen Störungen beteiligt. Der Aufmerksamkeitsumlenkung kommt als verhaltenstherapeutische Methode deshalb eine zentrale Rolle zu. Die Evidenzlage zur Wirksamkeit verschiedener Techniken der Aufmerksamkeitslenkung ist jedoch bislang heterogen und vor allem im therapeutischen Kontext wenig erforscht. Im vorliegenden Beitrag werden die praktische Durchführung und Besonderheiten einer bewährten mehrteiligen Aufmerksamkeitslenkung anhand von konkreten Textbeispielen und möglichen Schwierigkeiten illustriert. Kernelemente sind die Psychoedukation zur Funktionalität der Aufmerksamkeit, die Durchführung von Verhaltensexperimenten sowie der Transfer und die Förderung der Selbststeuerung im Alltag von Betroffenen.
Verhaltenstherapie

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Entwicklung einer ressourcenorientierten kognitiv-verhaltenstherapeutischen Gruppenbehandlung für chronisch depressive Patienten: Eine Pilotstudie

Hintergrund: Chronisch depressive Patienten profitieren im Durchschnitt weniger von psychotherapeutischen Verfahren als Patienten mit einer akuten oder rezidivierenden depressiven Störung. Eine Augmentierung der Einzeltherapie durch eine ressourcenorientierte Gruppentherapie könnte zu einer Verbesserung der Wirksamkeit führen. Stichprobe: 16 chronisch depressive Patienten nahmen zusätzlich zu einer Einzeltherapie an einer Gruppentherapie mit 12 Sitzungen teil. Methode: Die Schwere der depressiven Symptomatik (Becks Depressions-Inventar(BDI)-II) wurde zu 4 Messzeitpunkten (zu Beginn der Therapie, vor der Gruppentherapie, nach der Gruppentherapie und nach der Gesamttherapie) erfasst. Neben der varianzanalytischen Auswertung wurde der Reliable Change Index berechnet. Vor und nach der Gruppe wurden darüber hinaus die Ressourcenrealisierung Wohlbefinden (RES-WB) und das Inkongruenzniveau (INK-K) erfasst. Individuelle Zielerreichungen und die Bewertung der Gruppentherapie durch die Patienten werden berichtet. Ergebnisse: Die Depressivität nahm über den gesamten Therapiezeitraum signifikant ab (_p#x03B7; = 0,853, p p#x03B7; = 0,25, p = 0,051; Gruppentherapie + Einzeltherapie: _p#x03B7; = 0,35, p p#x03B7; = 0,79, p Einschränkungen: Berichtet werden erste Ergebnisse einer Pilotstudie im naturalistischen Setting ohne randomisierte Zuweisung, es gab keine Kontrollgruppe. Schlussfolgerungen: Der Einsatz aktiver, ressourcenorientierter Methoden in einer kognitiv-behavioralen Gruppentherapie der Depression zeigte vielversprechende Ergebnisse. In einem kontrollierten Design mit einer größeren Stichprobe sollen differenzielle Effekte untersucht werden.
Verhaltenstherapie

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Prices Still Explain High U.S. Health Care Spending

Health care prices explain difference in spending between United States and other countries (Source: The Doctors Lounge - Psychiatry)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SQwjlg

Risk assessment and recommendations for forester exposure to hymenoptera - Dillane D, Richards SL, Balanay JAG, Langley R.

This study assessed the impacts of ... (Source: SafetyLit)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AG5bOK

Mucin in benign thyroid nodules: treatment related change or not?

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SO8kD9

Aufmerksamkeitslenkung in der Verhaltenstherapie

Die Steuerung der Aufmerksamkeit stellt eine Schlüsselkomponente der Informationsverarbeitung dar. Dysfunktionale Aufmerksamkeitsprozesse (im Sinne von Aufmerksamkeitsverzerrungen) sind gemäß kognitiv-behavioraler Modelle an der Entstehung und Aufrechterhaltung nahezu aller psychischen Störungen beteiligt. Der Aufmerksamkeitsumlenkung kommt als verhaltenstherapeutische Methode deshalb eine zentrale Rolle zu. Die Evidenzlage zur Wirksamkeit verschiedener Techniken der Aufmerksamkeitslenkung ist jedoch bislang heterogen und vor allem im therapeutischen Kontext wenig erforscht. Im vorliegenden Beitrag werden die praktische Durchführung und Besonderheiten einer bewährten mehrteiligen Aufmerksamkeitslenkung anhand von konkreten Textbeispielen und möglichen Schwierigkeiten illustriert. Kernelemente sind die Psychoedukation zur Funktionalität der Aufmerksamkeit, die Durchführung von Verhaltensexperimenten sowie der Transfer und die Förderung der Selbststeuerung im Alltag von Betroffenen.
Verhaltenstherapie

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Entwicklung einer ressourcenorientierten kognitiv-verhaltenstherapeutischen Gruppenbehandlung für chronisch depressive Patienten: Eine Pilotstudie

Hintergrund: Chronisch depressive Patienten profitieren im Durchschnitt weniger von psychotherapeutischen Verfahren als Patienten mit einer akuten oder rezidivierenden depressiven Störung. Eine Augmentierung der Einzeltherapie durch eine ressourcenorientierte Gruppentherapie könnte zu einer Verbesserung der Wirksamkeit führen. Stichprobe: 16 chronisch depressive Patienten nahmen zusätzlich zu einer Einzeltherapie an einer Gruppentherapie mit 12 Sitzungen teil. Methode: Die Schwere der depressiven Symptomatik (Becks Depressions-Inventar(BDI)-II) wurde zu 4 Messzeitpunkten (zu Beginn der Therapie, vor der Gruppentherapie, nach der Gruppentherapie und nach der Gesamttherapie) erfasst. Neben der varianzanalytischen Auswertung wurde der Reliable Change Index berechnet. Vor und nach der Gruppe wurden darüber hinaus die Ressourcenrealisierung Wohlbefinden (RES-WB) und das Inkongruenzniveau (INK-K) erfasst. Individuelle Zielerreichungen und die Bewertung der Gruppentherapie durch die Patienten werden berichtet. Ergebnisse: Die Depressivität nahm über den gesamten Therapiezeitraum signifikant ab (_p#x03B7; = 0,853, p p#x03B7; = 0,25, p = 0,051; Gruppentherapie + Einzeltherapie: _p#x03B7; = 0,35, p p#x03B7; = 0,79, p Einschränkungen: Berichtet werden erste Ergebnisse einer Pilotstudie im naturalistischen Setting ohne randomisierte Zuweisung, es gab keine Kontrollgruppe. Schlussfolgerungen: Der Einsatz aktiver, ressourcenorientierter Methoden in einer kognitiv-behavioralen Gruppentherapie der Depression zeigte vielversprechende Ergebnisse. In einem kontrollierten Design mit einer größeren Stichprobe sollen differenzielle Effekte untersucht werden.
Verhaltenstherapie

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Meta-Analysis: Vitamin D Pills Lower COPD Exacerbation Risk

(MedPage Today) -- But only in patients with baseline deficiency (Source: MedPage Today Allergy)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Prices Still Explain High U.S. Health Care Spending

Health care prices explain difference in spending between United States and other countries (Source: The Doctors Lounge - Psychiatry)

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Risk assessment and recommendations for forester exposure to hymenoptera - Dillane D, Richards SL, Balanay JAG, Langley R.

This study assessed the impacts of ... (Source: SafetyLit)

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Mucin in benign thyroid nodules: treatment related change or not?

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Water Waves to Sound Waves: Using Zebrafish to Explore Hair Cell Biology

Abstract

Although perhaps best known for their use in developmental studies, over the last couple of decades, zebrafish have become increasingly popular model organisms for investigating auditory system function and disease. Like mammals, zebrafish possess inner ear mechanosensory hair cells required for hearing, as well as superficial hair cells of the lateral line sensory system, which mediate detection of directional water flow. Complementing mammalian studies, zebrafish have been used to gain significant insights into many facets of hair cell biology, including mechanotransduction and synaptic physiology as well as mechanisms of both hereditary and acquired hair cell dysfunction. Here, we provide an overview of this literature, highlighting some of the particular advantages of using zebrafish to investigate hearing and hearing loss.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AGIGcm

Water Waves to Sound Waves: Using Zebrafish to Explore Hair Cell Biology

Abstract

Although perhaps best known for their use in developmental studies, over the last couple of decades, zebrafish have become increasingly popular model organisms for investigating auditory system function and disease. Like mammals, zebrafish possess inner ear mechanosensory hair cells required for hearing, as well as superficial hair cells of the lateral line sensory system, which mediate detection of directional water flow. Complementing mammalian studies, zebrafish have been used to gain significant insights into many facets of hair cell biology, including mechanotransduction and synaptic physiology as well as mechanisms of both hereditary and acquired hair cell dysfunction. Here, we provide an overview of this literature, highlighting some of the particular advantages of using zebrafish to investigate hearing and hearing loss.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AGIGcm

GINGIVAL MANIFESTATIONS OF TUBERCULOSIS IN PEDIATRIC PATIENTS: SERIES OF FOUR CASES

The aim of the study was to evaluate gingival manifestation of tuberculosis (TB) in the oral cavity in pediatric patients.

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Diagnostic performance of 68 Ga-PSMA PET/CT in the detection of prostate cancer prior to initial biopsy: comparison with cancer-predicting nomograms

Abstract

Purpose

To assess the diagnostic performance of ⁶⁸Ga-PSMA PET/CT for detecting suspected prostate cancer (PCa) and to compare it with that of two cancer-predicting nomograms.

Methods

We performed a retrospective analysis of 146 consecutive patients with suspected PCa based on symptoms or elevated total prostate-specific antigen (tPSA) levels who underwent ⁶⁸Ga-PSMA PET/CT and histopathologic examinations from April 2017 to April 2018 in a large tertiary care hospital in China. The ⁶⁸Ga-PSMA PET/CT results (PCa or benignancy) were evaluated by two experienced nuclear medicine specialists. The risk of positive PCa was evaluated using ERSPC and PCPT nomograms. The diagnostic performances of ⁶⁸Ga-PSMA PET/CT and that of the two nomograms were compared via receiver operating characteristic (ROC) curve analysis, decision curve analysis, and logistic regression.

Results

A total of 58 patients with tPSA of 0.4–50 ng/ml were included in the final analysis; PCa diagnosis was confirmed in 37 patients and excluded in 21 patients. ROC analysis showed that the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ⁶⁸Ga-PSMA PET/CT were 91.67, 81.82, 89.19, and 85.71%, respectively, in per-patient analyses. ⁶⁸Ga-PSMA PET/CT exhibited a higher AUC (0.867) than those of ERSPC-RC3 (0.855) and PCPT-RC (0.770). The net benefit of ⁶⁸Ga-PSMA PET/CT was greatest for patients within threshold probabilities of 15–90%. Among the 58 patients, 11 (19%) biopsies suggested by ERSPC-RC3 were unnecessary and could have been avoided if judged by the ⁶⁸Ga-PSMA PET/CT results. Multivariate analysis revealed that the maximum standardised uptake value (SUV_max) and prostate volume were significant predictive factors for positive PCa results.

Conclusion

In suspected PCa patients with tPSA of 0.4–50 ng/ml, ⁶⁸Ga-PSMA PET/CT outperformed the nomograms in predicting cancer and reducing unnecessary biopsies. In addition, the risk of PCa was positively correlated with a higher SUV_max and lower prostate volume, which could help clinicians in making preliminary estimates of individual cancer risk, monitoring ⁶⁸Ga-PSMA PET/CT false-positive results and making biopsy decisions in daily medical practice.

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GINGIVAL MANIFESTATIONS OF TUBERCULOSIS IN PEDIATRIC PATIENTS: SERIES OF FOUR CASES

The aim of the study was to evaluate gingival manifestation of tuberculosis (TB) in the oral cavity in pediatric patients.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RnbrWc

Diagnostic performance of 68 Ga-PSMA PET/CT in the detection of prostate cancer prior to initial biopsy: comparison with cancer-predicting nomograms

Abstract

Purpose

To assess the diagnostic performance of ⁶⁸Ga-PSMA PET/CT for detecting suspected prostate cancer (PCa) and to compare it with that of two cancer-predicting nomograms.

Methods

We performed a retrospective analysis of 146 consecutive patients with suspected PCa based on symptoms or elevated total prostate-specific antigen (tPSA) levels who underwent ⁶⁸Ga-PSMA PET/CT and histopathologic examinations from April 2017 to April 2018 in a large tertiary care hospital in China. The ⁶⁸Ga-PSMA PET/CT results (PCa or benignancy) were evaluated by two experienced nuclear medicine specialists. The risk of positive PCa was evaluated using ERSPC and PCPT nomograms. The diagnostic performances of ⁶⁸Ga-PSMA PET/CT and that of the two nomograms were compared via receiver operating characteristic (ROC) curve analysis, decision curve analysis, and logistic regression.

Results

A total of 58 patients with tPSA of 0.4–50 ng/ml were included in the final analysis; PCa diagnosis was confirmed in 37 patients and excluded in 21 patients. ROC analysis showed that the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ⁶⁸Ga-PSMA PET/CT were 91.67, 81.82, 89.19, and 85.71%, respectively, in per-patient analyses. ⁶⁸Ga-PSMA PET/CT exhibited a higher AUC (0.867) than those of ERSPC-RC3 (0.855) and PCPT-RC (0.770). The net benefit of ⁶⁸Ga-PSMA PET/CT was greatest for patients within threshold probabilities of 15–90%. Among the 58 patients, 11 (19%) biopsies suggested by ERSPC-RC3 were unnecessary and could have been avoided if judged by the ⁶⁸Ga-PSMA PET/CT results. Multivariate analysis revealed that the maximum standardised uptake value (SUV_max) and prostate volume were significant predictive factors for positive PCa results.

Conclusion

In suspected PCa patients with tPSA of 0.4–50 ng/ml, ⁶⁸Ga-PSMA PET/CT outperformed the nomograms in predicting cancer and reducing unnecessary biopsies. In addition, the risk of PCa was positively correlated with a higher SUV_max and lower prostate volume, which could help clinicians in making preliminary estimates of individual cancer risk, monitoring ⁶⁸Ga-PSMA PET/CT false-positive results and making biopsy decisions in daily medical practice.

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Free Tissue Transfer with the Free Rectus Abdominis Flap in High-Risk Patients above 65 Years – A Retrospective Cohort Study

Though technically feasible, free tissue transfer carries the risk of perioperative morbidity and mortality in elderly patients. In order to minimize operative treatment time and complication rates, we choose the rectus abdominis muscle (RAM) flap.

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Allogenic Endothelial Progenitor Cell Transplantation Increases Flap Survival through an Upregulation of eNOs and VEGF on Venous Flap Survival in Rabbits

Endothelial progenitor cells (EPCs) are one type of bone marrow hematopoietic stromal cells which play a vital role in neovascularization and tissue repair. In this study, we investigated whether EPCs promote flap survival in a rabbit venous model.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FlMBQ6

Free Tissue Transfer with the Free Rectus Abdominis Flap in High-Risk Patients above 65 Years – A Retrospective Cohort Study

Though technically feasible, free tissue transfer carries the risk of perioperative morbidity and mortality in elderly patients. In order to minimize operative treatment time and complication rates, we choose the rectus abdominis muscle (RAM) flap.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FrjmdG

Allogenic Endothelial Progenitor Cell Transplantation Increases Flap Survival through an Upregulation of eNOs and VEGF on Venous Flap Survival in Rabbits

Endothelial progenitor cells (EPCs) are one type of bone marrow hematopoietic stromal cells which play a vital role in neovascularization and tissue repair. In this study, we investigated whether EPCs promote flap survival in a rabbit venous model.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FlMBQ6

Water Waves to Sound Waves: Using Zebrafish to Explore Hair Cell Biology

Abstract

Although perhaps best known for their use in developmental studies, over the last couple of decades, zebrafish have become increasingly popular model organisms for investigating auditory system function and disease. Like mammals, zebrafish possess inner ear mechanosensory hair cells required for hearing, as well as superficial hair cells of the lateral line sensory system, which mediate detection of directional water flow. Complementing mammalian studies, zebrafish have been used to gain significant insights into many facets of hair cell biology, including mechanotransduction and synaptic physiology as well as mechanisms of both hereditary and acquired hair cell dysfunction. Here, we provide an overview of this literature, highlighting some of the particular advantages of using zebrafish to investigate hearing and hearing loss.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AGIGcm

Water Waves to Sound Waves: Using Zebrafish to Explore Hair Cell Biology

Abstract

Although perhaps best known for their use in developmental studies, over the last couple of decades, zebrafish have become increasingly popular model organisms for investigating auditory system function and disease. Like mammals, zebrafish possess inner ear mechanosensory hair cells required for hearing, as well as superficial hair cells of the lateral line sensory system, which mediate detection of directional water flow. Complementing mammalian studies, zebrafish have been used to gain significant insights into many facets of hair cell biology, including mechanotransduction and synaptic physiology as well as mechanisms of both hereditary and acquired hair cell dysfunction. Here, we provide an overview of this literature, highlighting some of the particular advantages of using zebrafish to investigate hearing and hearing loss.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AGIGcm

Improving the Diagnostic Capability of the Modified Barium Swallow Study Through Standardization of an Esophageal Sweep Protocol

AbstractThe modified   barium swallow (MBS) study is a videofluoroscopic evaluation of oropharyngeal swallow function. Esophageal imaging is not routinely performed during an MBS, and few guidelines for implementation or interpretation exist. Aims of the current investigation were to (1) delineate the percentage of n ormal, oropharyngeal, esophageal, and mixed swallowing dysfunction, (2) develop operational definitions for rating our standardization cursory view of esophageal bolus flow, and (3) determine inter-rater reliability between speech pathology (SLP) and physician raters for categorizing esophageal abno rmalities. A two-phase retrospective review of 358 patient charts and MBS studies was conducted. Esophageal bolus flow was operationally defined as (1) normal, (2) anatomic abn...

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Improving the Diagnostic Capability of the Modified Barium Swallow Study Through Standardization of an Esophageal Sweep Protocol

AbstractThe modified   barium swallow (MBS) study is a videofluoroscopic evaluation of oropharyngeal swallow function. Esophageal imaging is not routinely performed during an MBS, and few guidelines for implementation or interpretation exist. Aims of the current investigation were to (1) delineate the percentage of n ormal, oropharyngeal, esophageal, and mixed swallowing dysfunction, (2) develop operational definitions for rating our standardization cursory view of esophageal bolus flow, and (3) determine inter-rater reliability between speech pathology (SLP) and physician raters for categorizing esophageal abno rmalities. A two-phase retrospective review of 358 patient charts and MBS studies was conducted. Esophageal bolus flow was operationally defined as (1) normal, (2) anatomic abn...

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Do helminth infections underpin urban‐rural differences in risk factors for allergy‐related outcomes?

Abstract

Background

It is proposed that helminth exposure protects against allergy‐related disease, by mechanisms that include disconnecting risk factors (such as atopy) from effector responses.

Objective

We aimed to assess how helminth exposure influences rural‐urban differences in risk factors for allergy‐related outcomes in tropical low‐ and middle‐income countries.

Methods

In cross‐sectional surveys in Ugandan rural Schistosoma mansoni (Sm)‐endemic islands, and in nearby mainland urban communities with lower helminth exposure, we assessed risk factors for atopy (allergen‐specific skin prick test [SPT] reactivity and IgE [asIgE] sensitisation) and clinical allergy‐related outcomes (wheeze, urticaria, rhinitis, visible flexural dermatitis), and effect‐modification by Sm exposure.

Results

Dermatitis and SPT reactivity were more prevalent among urban participants, urticaria and asIgE sensitisation among rural participants. Pairwise associations between clinical outcomes, and between atopy and clinical outcomes, were stronger in the urban survey. In the rural survey, SPT positivity was inversely associated with bathing in lakewater, Schistosoma‐specific IgG4 and Sm infection. In the urban survey, SPT positivity was positively associated with age, non‐Ugandan maternal tribe, being born in a city/town, BCG scar and light Sm infection. Setting (rural versus urban) was an effect modifier for risk factors including Sm and Schistosoma‐specific IgG4. In both surveys, the dominant risk factors for asIgE sensitisation were Schistosoma‐specific antibody levels and helminth infections. Handwashing and recent malaria treatment reduced odds of asIgE sensitisation among rural but not urban participants. Risk factors for clinical outcomes also differed by setting. Despite suggestive trends, we did not find sufficient evidence to conclude that helminth (Sm) exposure explained rural‐urban differences in risk factors.

Conclusions and clinical relevance

Risk factors for allergy‐related outcomes differ between rural and urban communities in Uganda but helminth exposure is unlikely to be the sole mechanism of the observed effect modification between the two settings. Other environmental exposures may contribute significantly.

This article is protected by copyright. All rights reserved.

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Do helminth infections underpin urban‐rural differences in risk factors for allergy‐related outcomes?

Abstract

Background

It is proposed that helminth exposure protects against allergy‐related disease, by mechanisms that include disconnecting risk factors (such as atopy) from effector responses.

Objective

We aimed to assess how helminth exposure influences rural‐urban differences in risk factors for allergy‐related outcomes in tropical low‐ and middle‐income countries.

Methods

In cross‐sectional surveys in Ugandan rural Schistosoma mansoni (Sm)‐endemic islands, and in nearby mainland urban communities with lower helminth exposure, we assessed risk factors for atopy (allergen‐specific skin prick test [SPT] reactivity and IgE [asIgE] sensitisation) and clinical allergy‐related outcomes (wheeze, urticaria, rhinitis, visible flexural dermatitis), and effect‐modification by Sm exposure.

Results

Dermatitis and SPT reactivity were more prevalent among urban participants, urticaria and asIgE sensitisation among rural participants. Pairwise associations between clinical outcomes, and between atopy and clinical outcomes, were stronger in the urban survey. In the rural survey, SPT positivity was inversely associated with bathing in lakewater, Schistosoma‐specific IgG4 and Sm infection. In the urban survey, SPT positivity was positively associated with age, non‐Ugandan maternal tribe, being born in a city/town, BCG scar and light Sm infection. Setting (rural versus urban) was an effect modifier for risk factors including Sm and Schistosoma‐specific IgG4. In both surveys, the dominant risk factors for asIgE sensitisation were Schistosoma‐specific antibody levels and helminth infections. Handwashing and recent malaria treatment reduced odds of asIgE sensitisation among rural but not urban participants. Risk factors for clinical outcomes also differed by setting. Despite suggestive trends, we did not find sufficient evidence to conclude that helminth (Sm) exposure explained rural‐urban differences in risk factors.

Conclusions and clinical relevance

Risk factors for allergy‐related outcomes differ between rural and urban communities in Uganda but helminth exposure is unlikely to be the sole mechanism of the observed effect modification between the two settings. Other environmental exposures may contribute significantly.

This article is protected by copyright. All rights reserved.

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Effects of Stromal Vascular Fraction on Breast Cancer Growth and Fat Engraftment in NOD/SCID Mice

Abstract

Background

To overcome unpredictable fat graft resorption, cell-assisted lipotransfer using stromal vascular fraction (SVF) has been introduced. However, its effect on cancer growth stimulation and its oncological safety are debatable. We investigated the effect of SVF on adjacent breast cancer and transplanted fat in a mouse model.

Methods

A breast cancer xenograft model was constructed by injecting 2 × 10⁶ MDA-MB-231-luc breast cancer cells into the right lower back of 40 NOD/SCID mice. Two weeks later, cancer size was sorted according to signal density using an in vivo optical imaging system, and 36 mice were included. Human fat was extracted from the abdomen, and SVFs were isolated using a component isolator. The mice were divided into four groups: A, controls; B, injected with 30 μl SVF; C, injected with 0.5 ml fat and 30 μl saline; group D, injected with 0.5 ml fat and 30 μl SVF. Magnetic resonance imaging and three-dimensional micro-computed tomography volumetric analysis were performed at 4 and 8 weeks.

Results

Tumor volume was 43.6, 42.3, 48.7, and 42.4 mm³ at the initial time point and 6780, 5940, 6080, and 5570 mm³ at 8 weeks in groups A, B, C, and D, respectively. Fat graft survival volume after 8 weeks was 49.32% and 62.03% in groups C and D, respectively. At 2-month follow-up after fat grafting in the xenograft model, SVF injection showed an increased fat survival rate and did not increase the adjacent tumor growth significantly.

Conclusion

Fat grafting with SVF yields satisfactory outcome in patients who undergo breast reconstruction surgery.

No Level Assigned

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Effects of Stromal Vascular Fraction on Breast Cancer Growth and Fat Engraftment in NOD/SCID Mice

Abstract

Background

To overcome unpredictable fat graft resorption, cell-assisted lipotransfer using stromal vascular fraction (SVF) has been introduced. However, its effect on cancer growth stimulation and its oncological safety are debatable. We investigated the effect of SVF on adjacent breast cancer and transplanted fat in a mouse model.

Methods

A breast cancer xenograft model was constructed by injecting 2 × 10⁶ MDA-MB-231-luc breast cancer cells into the right lower back of 40 NOD/SCID mice. Two weeks later, cancer size was sorted according to signal density using an in vivo optical imaging system, and 36 mice were included. Human fat was extracted from the abdomen, and SVFs were isolated using a component isolator. The mice were divided into four groups: A, controls; B, injected with 30 μl SVF; C, injected with 0.5 ml fat and 30 μl saline; group D, injected with 0.5 ml fat and 30 μl SVF. Magnetic resonance imaging and three-dimensional micro-computed tomography volumetric analysis were performed at 4 and 8 weeks.

Results

Tumor volume was 43.6, 42.3, 48.7, and 42.4 mm³ at the initial time point and 6780, 5940, 6080, and 5570 mm³ at 8 weeks in groups A, B, C, and D, respectively. Fat graft survival volume after 8 weeks was 49.32% and 62.03% in groups C and D, respectively. At 2-month follow-up after fat grafting in the xenograft model, SVF injection showed an increased fat survival rate and did not increase the adjacent tumor growth significantly.

Conclusion

Fat grafting with SVF yields satisfactory outcome in patients who undergo breast reconstruction surgery.

No Level Assigned

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Early onset oral tongue squamous cell carcinoma: Associated factors and patient outcomes

Abstract

Background

Incidence of oral tongue squamous cell carcinoma (OTC) is rising among those under age 50 years. The etiology is unknown.

Methods

A total of 395 cases of OTC diagnosed and/or treated at Vanderbilt University Medical Center between 2000 and 2017 were identified. Of those, 113 (28.6%) were early onset (age < 50 years). Logistic regression was used to identify factors associated with early onset OTC. Cox proportional hazards models evaluated survival and recurrence.

Results

Compared to typical onset patients, patients with early onset OTC were more likely to receive multimodality treatment (surgery and radiation; adjusted odds ratio [aOR], 2.7; 95% confidence interval [CI], 1.2‐6.3) and report a history of snuff use (aOR, 5.4; 95% CI, 1.8‐15.8) and were less likely to report a history of cigarette use (aOR, 0.5; 95% CI, 0.2‐0.9). Early onset patients had better overall survival (adjusted hazard ratio, 0.6).

Conclusions

This is the largest study to evaluate factors associated with early onset OTC and the first to report an association with snuff.

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Ultraviolet light‐related DNA damage mutation signature distinguishes cutaneous from mucosal or other origin for head and neck squamous cell carcinoma of unknown primary site

Abstract

Background

Head and neck squamous cell carcinoma of unknown primary site (HNSCCUP) is a diagnostic challenge. Identification of an ultraviolet (UV) light‐related DNA damage signature using next‐generation sequencing (NGS) can classify the primary site of origin as cutaneous.

Methods

A 62‐year‐old male was seen with 2 months of left neck swelling. He was a lifetime nonsmoker but had a history of cutaneous squamous cell carcinoma (SCC) of the left helix. He was also found to have left hilar adenopathy. He had a p16‐negative HNSCCUP on fine needle aspiration (FNA) biopsy of the left neck.

Results

NGS of the FNA specimen revealed a high number of somatic mutations that were mostly C to T transitions, indicating a UV mutation signature and confirming the diagnosis of cutaneous SCC.

Conclusions

Identification of a UV DNA damage signature with NGS distinguishes HNSCCUP of cutaneous vs mucosal or other squamous cell carcinoma origin.

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Intratumoral generation of 2‐fluoroadenine to treat solid malignancies of the head and neck

Abstract

This report describes treatment of locoregional head and neck squamous cell carcinoma (HNSCC) by an innovative, experimental strategy involving generation of a robust anti‐cancer agent (2‐fluoroadenine [F‐Ade]) following transduction by Escherichia coli purine nucleoside phosphorylase (PNP) in a small number of tumor cells. F‐Ade works by a unique mechanism of action (ablation of RNA and protein synthesis) and confers tumor regressions of otherwise refractory HNSCC in human subjects. Clinical studies have now advanced to a pivotal (registration‐directed) trial involving locoregional HNSCC, with plans to begin subject enrollment late in 2018. The present review is the first to summarize use of PNP in the context of HNSCC, and provides background regarding this emerging anti‐cancer approach.

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Preoperative neutrophil lymphocyte ratio but not platelet lymphocyte ratio predicts survival and early relapse in patients with oral, pharyngeal, and lip cancer

Abstract

Background

To evaluate the prognostic value of preoperative neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in oral, pharyngeal, and lip cancer for survival and relapse.

Methods

Clinic‐pathologic and hematological records were retrospectively retrieved. Patients completed follow‐up period were included for survival and relapse analysis.

Results

The preoperative NLR value was a prognostic factor for both overall survival and relapse‐free survival. The high NLR group demonstrated higher total relapse rate, higher local relapse rate, and higher relapse rate within 12 months. However, the preoperative PLR did not associate with survival or relapse.

Conclusions

The preoperative NLR, not PLR, is an independent prognostic indicator of survival. It also exhibits predictive value for relapse, particularly early relapse within 12 months. The preoperative NLR value might be recommended as a useful tool for predicting the outcomes and stratifying patients for different management strategies.

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Paraganglioma of the head and neck region, treated with radiation therapy, a Rare Cancer Network study

Abstract

Background

Paraganglioma of the head and neck (HNPGL) are rare often benign tumors. Surgery and radiation therapy (RT) are the main treatment choices. We present an analysis of outcome and toxicity after RT from 13 institutions of the Rare Cancer Network.

Methods

Data were collected using a questionnaire concerning patients' characteristics, treatment, and outcome. A total of 81 patients with 82 HNPGL were analyzed.

Results

The median follow‐up was 48 months (1‐456). Sixty‐two lesions were treated with conventional RT and 20 lesions with stereotactic RT. Local control (LC) was achieved in 69 out of 77 lesions. Late toxicity occurred in 17 patients. Patients treated with stereotactic RT experienced neither disease progression nor late toxicity. Four patients with a follow‐up longer than 20 years experienced disease progression.

Conclusion

RT for HNPGL offered good local control with acceptable toxicity. Stereotactic RT might offer better results. Long‐term follow‐up is required.

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Impact of extent of parotidectomy on early and long‐term complications: A prospective multicenter cohort trial

Abstract

Background

In this prospective nonrandomized multicenter trial, we analyze the incidence of early and late complications after parotidectomy in correlation to the extent of dissection.

Methods

A total of 148 patients underwent a parotidectomy for a benign lesion in the superficial lobe. The number of intraoperatively dissected main facial nerve branches was photo‐documented and defined the extent of tissue dissection. Early postoperative complications including sialocele were evaluated until 4 weeks after surgery. Late complications as facial nerve palsy, Frey´s syndrome (FS) and the outcome of the scar and substance loss were furthermore assessed after 6 and 12 months.

Results

Early complications occurred in 22 patients (14%) and did not depend on the extent of facial nerve dissection (all P > .05). However, patients with higher number of intraoperatively dissected facial nerve branches showed significantly higher palsy scores on the first postoperative day (P = .026). FS occurred with incidence of 69% and correlated significantly to the extent of dissection (P = .003). Appearance of the scar and substance loss improved significantly during the follow‐up (P < .001 and P < ,005, respectively) without significant correlation to the extent of dissection (P > .05 for both variables after 12 months).

Conclusions

Less extensive tissue dissection resulted in better postoperative facial nerve function on the first postoperative day and in lower incidence of FS after 12 months. However, incidence of early complications did not depend on the extent of surgery.

The study was registered in the German Clinical Trials Register prior to conducting the research. DRKS‐ID: DRKS00008967, URL:http://apps.who.int/trialsearch/.

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ACAAI: School District'Risks Children's Lives' by Not Stocking Epinephrine

(MedPage Today) -- Weatherford, Texas, board votes to use OTC Benadryl instead (Source: MedPage Today Allergy)

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Preoperative neutrophil lymphocyte ratio but not platelet lymphocyte ratio predicts survival and early relapse in patients with oral, pharyngeal, and lip cancer

Abstract

Background

To evaluate the prognostic value of preoperative neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in oral, pharyngeal, and lip cancer for survival and relapse.

Methods

Clinic‐pathologic and hematological records were retrospectively retrieved. Patients completed follow‐up period were included for survival and relapse analysis.

Results

The preoperative NLR value was a prognostic factor for both overall survival and relapse‐free survival. The high NLR group demonstrated higher total relapse rate, higher local relapse rate, and higher relapse rate within 12 months. However, the preoperative PLR did not associate with survival or relapse.

Conclusions

The preoperative NLR, not PLR, is an independent prognostic indicator of survival. It also exhibits predictive value for relapse, particularly early relapse within 12 months. The preoperative NLR value might be recommended as a useful tool for predicting the outcomes and stratifying patients for different management strategies.

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Early onset oral tongue squamous cell carcinoma: Associated factors and patient outcomes

Abstract

Background

Incidence of oral tongue squamous cell carcinoma (OTC) is rising among those under age 50 years. The etiology is unknown.

Methods

A total of 395 cases of OTC diagnosed and/or treated at Vanderbilt University Medical Center between 2000 and 2017 were identified. Of those, 113 (28.6%) were early onset (age < 50 years). Logistic regression was used to identify factors associated with early onset OTC. Cox proportional hazards models evaluated survival and recurrence.

Results

Compared to typical onset patients, patients with early onset OTC were more likely to receive multimodality treatment (surgery and radiation; adjusted odds ratio [aOR], 2.7; 95% confidence interval [CI], 1.2‐6.3) and report a history of snuff use (aOR, 5.4; 95% CI, 1.8‐15.8) and were less likely to report a history of cigarette use (aOR, 0.5; 95% CI, 0.2‐0.9). Early onset patients had better overall survival (adjusted hazard ratio, 0.6).

Conclusions

This is the largest study to evaluate factors associated with early onset OTC and the first to report an association with snuff.

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Ultraviolet light‐related DNA damage mutation signature distinguishes cutaneous from mucosal or other origin for head and neck squamous cell carcinoma of unknown primary site

Abstract

Background

Head and neck squamous cell carcinoma of unknown primary site (HNSCCUP) is a diagnostic challenge. Identification of an ultraviolet (UV) light‐related DNA damage signature using next‐generation sequencing (NGS) can classify the primary site of origin as cutaneous.

Methods

A 62‐year‐old male was seen with 2 months of left neck swelling. He was a lifetime nonsmoker but had a history of cutaneous squamous cell carcinoma (SCC) of the left helix. He was also found to have left hilar adenopathy. He had a p16‐negative HNSCCUP on fine needle aspiration (FNA) biopsy of the left neck.

Results

NGS of the FNA specimen revealed a high number of somatic mutations that were mostly C to T transitions, indicating a UV mutation signature and confirming the diagnosis of cutaneous SCC.

Conclusions

Identification of a UV DNA damage signature with NGS distinguishes HNSCCUP of cutaneous vs mucosal or other squamous cell carcinoma origin.

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Intratumoral generation of 2‐fluoroadenine to treat solid malignancies of the head and neck

Abstract

This report describes treatment of locoregional head and neck squamous cell carcinoma (HNSCC) by an innovative, experimental strategy involving generation of a robust anti‐cancer agent (2‐fluoroadenine [F‐Ade]) following transduction by Escherichia coli purine nucleoside phosphorylase (PNP) in a small number of tumor cells. F‐Ade works by a unique mechanism of action (ablation of RNA and protein synthesis) and confers tumor regressions of otherwise refractory HNSCC in human subjects. Clinical studies have now advanced to a pivotal (registration‐directed) trial involving locoregional HNSCC, with plans to begin subject enrollment late in 2018. The present review is the first to summarize use of PNP in the context of HNSCC, and provides background regarding this emerging anti‐cancer approach.

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Treatment modalities and outcomes of Fanconi anemia patients with head and neck squamous cell carcinoma: A series of 9 cases and review of the literature

Abstract

Background

Fanconi anemia (FA) is associated with an increased risk of developing head and neck squamous cell cancer (HNSCC) and presents a treatment dilemma due to concerns of increased toxicities from chemotherapy and radiation therapy (RT).

Methods

We reviewed the literature on HNSCC in FA patients and report on our experience treating 9 FA patients with HNSCC.

Results

Surgery was generally well‐tolerated and surgery alone resulted in durable local control for 2 patients. Four patients received adjuvant RT that was tolerable in most cases, although 1 patient required a treatment break and early cessation of RT. Three of the irradiated patients received concurrent cetuximab.

Conclusions

In patients with adverse features, adjuvant radiation with concurrent cetuximab may be feasible with careful monitoring, although local disease control is infrequent. Early detection via screening permitting a surgery‐alone approach represents the best opportunity for cure in FA patients with HSNCC.

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Importance of tumor budding grade as independent prognostic factor for early tongue squamous cell carcinoma

Abstract

Background

Factors involved in neck lymph node metastasis (NLM) and prognosis of early tongue squamous cell carcinoma (SCC) remain unknown.

Methods

We analyzed disease‐specific survival (DSS) and NLM including tumor budding grade (TBG) among 64 patients with cT1/2N0 tongue SCC.

Results

Univariate analysis of DSS of primary lesions uncovered significant differences in new cT, pT, new pT, pDiameter, venous infiltration, and TBG. Multivariate analysis selected only TBG3 as a predictor of NLM (odds ratio, 9.55; 95% confidence interval [CI], 1.80‐50.8; P = .008), and a prognostic factor for DSS (hazard ratio, 4.41; 95% CI, 1.34‐14.5; P = .02).

Conclusion

The sole predictor of NLM and the prognosis of early tongue SCC was TBG, indicating that it might help to select overwhelming risk patients.

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ACAAI: School District'Risks Children's Lives' by Not Stocking Epinephrine

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Daily Aspirin May Curb COPD Exacerbations Daily Aspirin May Curb COPD Exacerbations

Daily aspirin use appears to reduce the risk of exacerbations and have other beneficial effects in patients with chronic obstructive pulmonary disease (COPD), according to an observational study.Reuters Health Information (Source: Medscape Allergy Headlines)

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Is CT or MRI the optimal imaging investigation for the diagnosis of large vestibular aqueduct syndrome and large endolymphatic sac anomaly?

Abstract

Background and purpose

We explored whether there was a difference between measurements obtained with CT and MRI for the diagnosis of large vestibular aqueduct syndrome or large endolymphatic sac anomaly, and whether this influenced diagnosis on the basis of previously published threshold values (Valvassori and Cincinnati). We also investigated whether isolated dilated extra-osseous endolymphatic sac occurred on MRI. Secondary objectives were to compare inter-observer reproducibility for the measurements, and to investigate any mismatch between the diagnoses using the different criteria.

Materials/methods

Subjects diagnosed with large vestibular aqueduct syndrome or large endolymphatic sac anomalies were retrospectively analysed. For subjects with both CT and MRI available (n = 58), two independent observers measured the midpoint and operculum widths. For subjects with MRI (± CT) available (n = 84), extra-osseous sac widths were also measured.

Results

There was no significant difference between the width measurements obtained with CT versus MRI. CT alone diagnosed large vestibular aqueduct syndrome or large endolymphatic sac anomalies in 2/58 (Valvassori) and 4/58 (Cincinnati), whilst MRI alone diagnosed them in 2/58 (Valvassori). There was 93% CT/MRI diagnostic agreement using both criteria. Only 1/84 demonstrated isolated extra-osseous endolymphatic sac dilatation. The MRI-based LVAS/LESA diagnosis was less dependent on which criteria were used. Midpoint measurements are more reproducible between observers and between CT/MR imaging modalities.

Conclusion

Supplementing MRI with CT results in additional diagnoses using either criterion, however, there is no net increased diagnostic sensitivity for CT versus MRI when applying the Valvassori criteria. Isolated enlargement of the extra-osseous endolymphatic sac is rare.

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ACAAI: School District'Risks Children's Lives' by Not Stocking Epinephrine

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Daily Aspirin May Curb COPD Exacerbations Daily Aspirin May Curb COPD Exacerbations

Daily aspirin use appears to reduce the risk of exacerbations and have other beneficial effects in patients with chronic obstructive pulmonary disease (COPD), according to an observational study.Reuters Health Information (Source: Medscape Allergy Headlines)

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Effects of Stromal Vascular Fraction on Breast Cancer Growth and Fat Engraftment in NOD/SCID Mice

Abstract

Background

To overcome unpredictable fat graft resorption, cell-assisted lipotransfer using stromal vascular fraction (SVF) has been introduced. However, its effect on cancer growth stimulation and its oncological safety are debatable. We investigated the effect of SVF on adjacent breast cancer and transplanted fat in a mouse model.

Methods

A breast cancer xenograft model was constructed by injecting 2 × 10⁶ MDA-MB-231-luc breast cancer cells into the right lower back of 40 NOD/SCID mice. Two weeks later, cancer size was sorted according to signal density using an in vivo optical imaging system, and 36 mice were included. Human fat was extracted from the abdomen, and SVFs were isolated using a component isolator. The mice were divided into four groups: A, controls; B, injected with 30 μl SVF; C, injected with 0.5 ml fat and 30 μl saline; group D, injected with 0.5 ml fat and 30 μl SVF. Magnetic resonance imaging and three-dimensional micro-computed tomography volumetric analysis were performed at 4 and 8 weeks.

Results

Tumor volume was 43.6, 42.3, 48.7, and 42.4 mm³ at the initial time point and 6780, 5940, 6080, and 5570 mm³ at 8 weeks in groups A, B, C, and D, respectively. Fat graft survival volume after 8 weeks was 49.32% and 62.03% in groups C and D, respectively. At 2-month follow-up after fat grafting in the xenograft model, SVF injection showed an increased fat survival rate and did not increase the adjacent tumor growth significantly.

Conclusion

Fat grafting with SVF yields satisfactory outcome in patients who undergo breast reconstruction surgery.

No Level Assigned

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Is CT or MRI the optimal imaging investigation for the diagnosis of large vestibular aqueduct syndrome and large endolymphatic sac anomaly?

Abstract

Background and purpose

We explored whether there was a difference between measurements obtained with CT and MRI for the diagnosis of large vestibular aqueduct syndrome or large endolymphatic sac anomaly, and whether this influenced diagnosis on the basis of previously published threshold values (Valvassori and Cincinnati). We also investigated whether isolated dilated extra-osseous endolymphatic sac occurred on MRI. Secondary objectives were to compare inter-observer reproducibility for the measurements, and to investigate any mismatch between the diagnoses using the different criteria.

Materials/methods

Subjects diagnosed with large vestibular aqueduct syndrome or large endolymphatic sac anomalies were retrospectively analysed. For subjects with both CT and MRI available (n = 58), two independent observers measured the midpoint and operculum widths. For subjects with MRI (± CT) available (n = 84), extra-osseous sac widths were also measured.

Results

There was no significant difference between the width measurements obtained with CT versus MRI. CT alone diagnosed large vestibular aqueduct syndrome or large endolymphatic sac anomalies in 2/58 (Valvassori) and 4/58 (Cincinnati), whilst MRI alone diagnosed them in 2/58 (Valvassori). There was 93% CT/MRI diagnostic agreement using both criteria. Only 1/84 demonstrated isolated extra-osseous endolymphatic sac dilatation. The MRI-based LVAS/LESA diagnosis was less dependent on which criteria were used. Midpoint measurements are more reproducible between observers and between CT/MR imaging modalities.

Conclusion

Supplementing MRI with CT results in additional diagnoses using either criterion, however, there is no net increased diagnostic sensitivity for CT versus MRI when applying the Valvassori criteria. Isolated enlargement of the extra-osseous endolymphatic sac is rare.

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ACAAI: School District'Risks Children's Lives' by Not Stocking Epinephrine

(MedPage Today) -- Weatherford, Texas, board votes to use OTC Benadryl instead (Source: MedPage Today Allergy)

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Daily Aspirin May Curb COPD Exacerbations Daily Aspirin May Curb COPD Exacerbations

Daily aspirin use appears to reduce the risk of exacerbations and have other beneficial effects in patients with chronic obstructive pulmonary disease (COPD), according to an observational study.Reuters Health Information (Source: Medscape Allergy Headlines)

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Effects of Stromal Vascular Fraction on Breast Cancer Growth and Fat Engraftment in NOD/SCID Mice

Abstract

Background

To overcome unpredictable fat graft resorption, cell-assisted lipotransfer using stromal vascular fraction (SVF) has been introduced. However, its effect on cancer growth stimulation and its oncological safety are debatable. We investigated the effect of SVF on adjacent breast cancer and transplanted fat in a mouse model.

Methods

A breast cancer xenograft model was constructed by injecting 2 × 10⁶ MDA-MB-231-luc breast cancer cells into the right lower back of 40 NOD/SCID mice. Two weeks later, cancer size was sorted according to signal density using an in vivo optical imaging system, and 36 mice were included. Human fat was extracted from the abdomen, and SVFs were isolated using a component isolator. The mice were divided into four groups: A, controls; B, injected with 30 μl SVF; C, injected with 0.5 ml fat and 30 μl saline; group D, injected with 0.5 ml fat and 30 μl SVF. Magnetic resonance imaging and three-dimensional micro-computed tomography volumetric analysis were performed at 4 and 8 weeks.

Results

Tumor volume was 43.6, 42.3, 48.7, and 42.4 mm³ at the initial time point and 6780, 5940, 6080, and 5570 mm³ at 8 weeks in groups A, B, C, and D, respectively. Fat graft survival volume after 8 weeks was 49.32% and 62.03% in groups C and D, respectively. At 2-month follow-up after fat grafting in the xenograft model, SVF injection showed an increased fat survival rate and did not increase the adjacent tumor growth significantly.

Conclusion

Fat grafting with SVF yields satisfactory outcome in patients who undergo breast reconstruction surgery.

No Level Assigned

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Analysis of the factors associated with diagnostic skin test positivity in immediate‐type hypersensitivity reactions due to proton pump inhibitors

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Analysis of the factors associated with diagnostic skin test positivity in immediate‐type hypersensitivity reactions due to proton pump inhibitors

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Restoration of olfaction: is there light at the end of the tunnel?

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The Significant Correlation Between the Density of the Cochlea Otic Capsule and Spine in Hearing Loss Patients

This study aimed to analyzes the correlation between the density of the cochlea otic capsule and the ear bone towards the femur and spine density in patients with reduction in bone density. This was a cross-sectional observational type analytic retrospective study analyzing 30 samples of patients with a reduction in bone density that have HRCT Mastoid examination results during 2017 at RSSA Malang 's osteoporosis polyclinic. From 30 samples, most were female with an age range of 51–60 years old. The average femur, spine, ear bone and cochlea otic capsule of the osteoporosis group was lower than the osteopenia group. The spine density was significantly correlated with the otic capsule den sity. There was a positive significant correlation between the spine density towards the otic caps...

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Safety of transarterial radioembolization with Yttrium-90 glass microspheres without cystic artery occlusion

Abstract

Purpose

To assess radiation-induced cholecystitis in cases of cystic artery origin nearby the treatment zone for transarterial radioembolization (TARE) treatment.

Materials and methods

Patients with primary or secondary malignant liver tumors treated with TARE, in whom cystic artery was located in the surrounding area of the treatment zone on 99m-technetium-MAA angiograms, were included in this study. Whole liver dose, tumor dose and healthy injected liver dose, lung dose and if applicable the gallbladder dose were all calculated by using the Medical Internal Radiation Dose (MIRD) formula from SPECT–CT images. Qualitative and quantitative assessment of the gallbladder was performed on SPECT–CT. The observed adverse events were classified according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE v5.0).

Results

A total of 34 TARE procedures from 29 patients (18 men and 11 women), with a mean age of 65 ± 13.3 years meeting the inclusion criteria, were involved in the current study. The mean tumor dose, healthy injected liver dose, healthy whole liver dose and gallbladder dose were 204.9 ± 66.8 Gy, 70.5 ± 15.7 Gy, 31.1 ± 12.7 Gy and 96.4 ± 53.4 Gy, respectively. The mean follow-up period was 14 ± 5.2 months. Qualitative assessment revealed gallbladder radioactivity on SPECT–CT in 11 (32.3%) patients with six mild and five moderate–severe radioactivities. There were no detected grade 2 or 3 adverse events.

Conclusion

TARE is safely performed without cystic artery embolization when its origin is close to the treatment area.

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The Significant Correlation Between the Density of the Cochlea Otic Capsule and Spine in Hearing Loss Patients

This study aimed to analyzes the correlation between the density of the cochlea otic capsule and the ear bone towards the femur and spine density in patients with reduction in bone density. This was a cross-sectional observational type analytic retrospective study analyzing 30 samples of patients with a reduction in bone density that have HRCT Mastoid examination results during 2017 at RSSA Malang 's osteoporosis polyclinic. From 30 samples, most were female with an age range of 51–60 years old. The average femur, spine, ear bone and cochlea otic capsule of the osteoporosis group was lower than the osteopenia group. The spine density was significantly correlated with the otic capsule den sity. There was a positive significant correlation between the spine density towards the otic caps...

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Safety of transarterial radioembolization with Yttrium-90 glass microspheres without cystic artery occlusion

Abstract

Purpose

To assess radiation-induced cholecystitis in cases of cystic artery origin nearby the treatment zone for transarterial radioembolization (TARE) treatment.

Materials and methods

Patients with primary or secondary malignant liver tumors treated with TARE, in whom cystic artery was located in the surrounding area of the treatment zone on 99m-technetium-MAA angiograms, were included in this study. Whole liver dose, tumor dose and healthy injected liver dose, lung dose and if applicable the gallbladder dose were all calculated by using the Medical Internal Radiation Dose (MIRD) formula from SPECT–CT images. Qualitative and quantitative assessment of the gallbladder was performed on SPECT–CT. The observed adverse events were classified according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE v5.0).

Results

A total of 34 TARE procedures from 29 patients (18 men and 11 women), with a mean age of 65 ± 13.3 years meeting the inclusion criteria, were involved in the current study. The mean tumor dose, healthy injected liver dose, healthy whole liver dose and gallbladder dose were 204.9 ± 66.8 Gy, 70.5 ± 15.7 Gy, 31.1 ± 12.7 Gy and 96.4 ± 53.4 Gy, respectively. The mean follow-up period was 14 ± 5.2 months. Qualitative assessment revealed gallbladder radioactivity on SPECT–CT in 11 (32.3%) patients with six mild and five moderate–severe radioactivities. There were no detected grade 2 or 3 adverse events.

Conclusion

TARE is safely performed without cystic artery embolization when its origin is close to the treatment area.

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Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT [HEAD & NECK]

BACKGROUND AND PURPOSE:

Minimally invasive parathyroid surgery relies critically on image guidance, but data comparing the efficacy of various imaging modalities are scarce. Our aim was to perform a blinded comparison of the localizing capability of technetium Tc99m sestamibi SPECT, multiphase multidetector 4D CT, and the combination of these 2 modalities (technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT).

MATERIALS AND METHODS:

We reviewed the records of 31 (6 men, 25 women; median age, 56 years) consecutive patients diagnosed with biochemically confirmed primary hyperparathyroidism between November 2009 and March 2010 who underwent preoperative technetium Tc99m sestamibi SPECT and multiphase multidetector 4D CT performed on the same scanner with pathologic confirmation by resection of a single parathyroid adenoma. Accuracy was determined separately for localization to the correct side and quadrant using surgical localization as the standard of reference.

RESULTS:

Surgical resection identified 14 left and 17 right parathyroid adenomas and 2 left inferior, 12 left superior, 11 right inferior, and 6 right superior parathyroid adenomas. For left/right localization, technetium Tc99m sestamibi SPECT achieved an accuracy of 93.5% (29 of 31), multiphase multidetector 4D CT achieved 96.8% accuracy (30 of 31), and technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT achieved 96.8% accuracy (30 of 31). For quadrant localization, technetium Tc99m sestamibi SPECT accuracy was 67.7% (21 of 31), multiphase multidetector 4D CT accuracy was 87.1% (27 of 31), and technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT accuracy was 93.5% (29 of 31). Reader diagnostic confidence was consistently ranked lowest for technetium Tc99m sestamibi SPECT and highest for technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT.

CONCLUSIONS:

For left/right localization of parathyroid adenomas, all modalities performed equivalently. For quadrant localization, technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT is superior to technetium Tc99m sestamibi SPECT.

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Brain {beta}-Amyloid and Atrophy in Individuals at Increased Risk of Cognitive Decline [ADULT BRAIN]

BACKGROUND AND PURPOSE:

The relationship between brain β-amyloid and regional atrophy is still incompletely understood in elderly individuals at risk of dementia. Here, we studied the associations between brain β-amyloid load and regional GM and WM volumes in older adults who were clinically evaluated as being at increased risk of cognitive decline based on cardiovascular risk factors.

MATERIALS AND METHODS:

Forty subjects (63–81 years of age) were recruited as part of a larger study, the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability. Neuroimaging consisted of PET using ¹¹C Pittsburgh compound-B and T1-weighted 3D MR imaging for the measurement of brain β-amyloid and GM and WM volumes, respectively. All subjects underwent clinical, genetic, and neuropsychological evaluations for the assessment of cognitive function and the identification of cardiovascular risk factors.

RESULTS:

Sixteen subjects were visually evaluated as showing cortical β-amyloid (positive for β-amyloid). In the voxel-by-voxel analyses, no significant differences were found in GM and WM volumes between the samples positive and negative for β-amyloid. However, in the sample positive for β-amyloid, increases in ¹¹C Pittsburgh compound-B uptake were associated with reductions in GM volume in the left prefrontal (P = .02) and right temporal lobes (P = .04).

CONCLUSIONS:

Our results show a significant association between increases in brain β-amyloid and reductions in regional GM volume in individuals at increased risk of cognitive decline. This evidence is consistent with a model in which increases in β-amyloid incite neurodegeneration in memory systems before cognitive impairment manifests.

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Disproportionate International Contributions to Subspecialties of Neuroradiology in the American Journal of Neuroradiology [LETTERS]

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Defining the Normal Dorsal Contour of the Corpus Callosum with Time [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Morphological changes of the corpus callosum have been associated with a large number of congenital neurocognitive and psychiatric disorders. Focal defects or notches of the dorsal surface of the corpus callosum have not been well characterized. Our purpose was the following; 1) to characterize the dorsal contour of the corpus callosum during the life span, 2) to characterize the relationship of contour deviations to neighboring vessels, and 3) to determine whether contour deviations are congenital or acquired.

MATERIALS AND METHODS:

We retrospectively reviewed normal sagittal T1-weighted brain MR images. A "notch" was defined as a concavity in the dorsal surface at least 1 mm in depth. The corpus callosum was considered to be "undulating" if there were >2 notches, including an anterior and posterior notch. The presence of a pericallosal artery and its relationship to a notch were assessed.

RESULTS:

We reviewed 1639 MR imaging studies, spanning 0–89 years of age. A total of 1102 notches were identified in 823 studies; 344 (31%) were anterior, 660 (60%) were posterior, and 98 (9%), undulating. There was a positive correlation between the prevalence (P < .001) and depth (P = .028) of an anterior notch and age and a negative correlation between the prevalence of a posterior notch and age (P < .001). There was no difference between patient sex and corpus callosum notching (P = .884). Of the 823 studies with notches, 490 (60%) were associated with a pericallosal artery (P < .001).

CONCLUSIONS:

The prevalence and depth of notches in the anterior corpus callosum increase significantly with age; this finding suggests that most notches are acquired. There is a significant positive association between the presence of a corpus callosum notch and adjacent pericallosal arteries, suggesting that this may play a role in notch formation.

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Erratum [ERRATA]

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Determinants of Deep Gray Matter Atrophy in Multiple Sclerosis: A Multimodal MRI Study [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Deep gray matter involvement is a consistent feature in multiple sclerosis. The aim of this study was to evaluate the relationship between different deep gray matter alterations and the development of subcortical atrophy, as well as to investigate the possible different substrates of volume loss between phenotypes.

MATERIALS AND METHODS:

Seventy-seven patients with MS (52 with relapsing-remitting and 25 with progressive MS) and 41 healthy controls were enrolled in this cross-sectional study. MR imaging investigation included volumetric, DTI, PWI and Quantitative Susceptibility Mapping analyses. Deep gray matter structures were automatically segmented to obtain volumes and mean values for each MR imaging metric in the thalamus, caudate, putamen, and globus pallidus. Between-group differences were probed by ANCOVA analyses, while the contribution of different MR imaging metrics to deep gray matter atrophy was investigated via hierarchic multiple linear regression models.

RESULTS:

Patients with MS showed a multifaceted involvement of the thalamus and basal ganglia, with significant atrophy of all deep gray matter structures (P < .001). In the relapsing-remitting MS group, WM lesion burden proved to be the main contributor to volume loss for all deep gray matter structures (P ≤ .006), with a minor role of local microstructural damage, which, in turn, was the main determinant of deep gray matter atrophy in patients with progressive MS (P ≤ .01), coupled with thalamic susceptibility changes (P = .05).

CONCLUSIONS:

Our study confirms the diffuse involvement of deep gray matter in MS, demonstrating a different behavior between MS phenotypes, with subcortical GM atrophy mainly determined by global WM lesion burden in patients with relapsing-remitting MS, while local microstructural damage and susceptibility changes mainly accounted for the development of deep gray matter volume loss in patients with progressive MS.

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"Ears of the Lynx" MRI Sign Is Associated with SPG11 and SPG15 Hereditary Spastic Paraplegia [PEDIATRICS]

BACKGROUND AND PURPOSE:

The "ears of the lynx" MR imaging sign has been described in case reports of hereditary spastic paraplegia with a thin corpus callosum, mostly associated with mutations in the spatacsin vesicle trafficking associated gene, causing Spastic Paraplegia type 11 (SPG11). This sign corresponds to long T1 and T2 values in the forceps minor of the corpus callosum, which appears hyperintense on FLAIR and hypointense on T1-weighted images. Our purpose was to determine the sensitivity and specificity of the ears of the lynx MR imaging sign for genetic cases compared with common potential mimics.

MATERIALS AND METHODS:

Four independent raters, blinded to the diagnosis, determined whether the ears of the lynx sign was present in each of a set of 204 single anonymized FLAIR and T1-weighted MR images from 34 patients with causal mutations associated with SPG11 or Spastic Paraplegia type 15 (SPG15). 34 healthy controls, and 34 patients with multiple sclerosis.

RESULTS:

The interrater reliability for FLAIR images was substantial (Cohen , 0.66–0.77). For these images, the sensitivity of the ears of the lynx sign across raters ranged from 78.8 to 97.0 and the specificity ranged from 90.9 to 100. The accuracy of the sign, measured by area under the receiver operating characteristic curve, ranged from very good (87.1) to excellent (93.9).

CONCLUSIONS:

The ears of the lynx sign on FLAIR MR imaging is highly specific for the most common genetic subtypes of hereditary spastic paraplegia with a thin corpus callosum. When this sign is present, there is a high likelihood of a genetic mutation, particularly associated with SPG11 or SPG15, even in the absence of a family history.

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Reliability of MR Imaging-Based Posterior Fossa and Brain Stem Measurements in Open Spinal Dysraphism in the Era of Fetal Surgery [SPINE]

BACKGROUND AND PURPOSE:

Fetal MR imaging is part of the comprehensive prenatal assessment of fetuses with open spinal dysraphism. We aimed to assess the reliability of brain stem and posterior fossa measurements; use the reliable measurements to characterize fetuses with open spinal dysraphism versus what can be observed in healthy age-matched controls; and document changes in those within 1 week after prenatal repair.

MATERIALS AND METHODS:

Retrospective evaluation of 349 MR imaging examinations took place, including 274 in controls and 52 in fetuses with open spinal dysraphism, of whom 23 underwent prenatal repair and had additional early postoperative MR images. We evaluated measurements of the brain stem and the posterior fossa and the ventricular width in all populations for their reliability and differences between the groups.

RESULTS:

The transverse cerebellar diameter, cerebellar herniation level, clivus-supraocciput angle, transverse diameter of the posterior fossa, posterior fossa area, and ventricular width showed an acceptable intra- and interobserver reliability (intraclass correlation coefficient > 0.5). In fetuses with open spinal dysraphism, these measurements were significantly different from those of healthy fetuses (all with P < .0001). Furthermore, they also changed significantly (P value range = .01 to < .0001) within 1 week after the fetal operation with an evolution toward normal, most evident for the clivus-supraocciput angle (65.9 ± 12.5°; 76.6 ± 10.9; P < .0001) and cerebellar herniation level (–9.9 ± 4.2 mm; –0.7 ± 5.2; P < .0001).

CONCLUSIONS:

In fetuses with open spinal dysraphism, brain stem measurements varied substantially between observers. However, measurements characterizing the posterior fossa could be reliably assessed and were significantly different from normal. Following a fetal operation, these deviations from normal values changed significantly within 1 week.

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T1-Hyperintense Plaques on Intracranial-versus-Extracranial Vessel Wall MRI [LETTERS]

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Celebrating 35 Years of the AJNR: January 1984 edition [35 YEARS AGO IN AJNR]

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Brain {beta}-Amyloid and Atrophy in Individuals at Increased Risk of Cognitive Decline [ADULT BRAIN]

BACKGROUND AND PURPOSE:

The relationship between brain β-amyloid and regional atrophy is still incompletely understood in elderly individuals at risk of dementia. Here, we studied the associations between brain β-amyloid load and regional GM and WM volumes in older adults who were clinically evaluated as being at increased risk of cognitive decline based on cardiovascular risk factors.

MATERIALS AND METHODS:

Forty subjects (63–81 years of age) were recruited as part of a larger study, the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability. Neuroimaging consisted of PET using ¹¹C Pittsburgh compound-B and T1-weighted 3D MR imaging for the measurement of brain β-amyloid and GM and WM volumes, respectively. All subjects underwent clinical, genetic, and neuropsychological evaluations for the assessment of cognitive function and the identification of cardiovascular risk factors.

RESULTS:

Sixteen subjects were visually evaluated as showing cortical β-amyloid (positive for β-amyloid). In the voxel-by-voxel analyses, no significant differences were found in GM and WM volumes between the samples positive and negative for β-amyloid. However, in the sample positive for β-amyloid, increases in ¹¹C Pittsburgh compound-B uptake were associated with reductions in GM volume in the left prefrontal (P = .02) and right temporal lobes (P = .04).

CONCLUSIONS:

Our results show a significant association between increases in brain β-amyloid and reductions in regional GM volume in individuals at increased risk of cognitive decline. This evidence is consistent with a model in which increases in β-amyloid incite neurodegeneration in memory systems before cognitive impairment manifests.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QCnB8d