Purpose: To describe a novel technique to correct cicatricial lower lid entropion and retraction using a transverse lower lid tarsotomy with an interposed tarsoconjunctival flap posterior lamellar spacer. Methods: Technique description and retrospective interventional case series. Results: Four patients underwent the procedure—two with complications following treatment of sinonasal carcinoma and two with complications following orbital fracture repair. All patients had failed prior posterior lamellar spacer grafts, including donor sclera, dermis-fat graft, and hard palate mucosa. Average time to flap takedown was 20 (11–28) days, with an average follow-up interval of 8.4 (6.2–11.5) months. All patients had resolution of lower lid entropion and significant improvement of lower lid retraction with an average of 2.8 mm (2.0–4.3) of elevation. There were no serious complications, and all patients reported significant improvement in ocular surface symptoms. Conclusions: Transverse tarsotomy combined with a tarsoconjunctival flap is effective for the correction of cicatricial lower lid retraction and entropion in eyelids that have failed surgery with traditional posterior lamellar spacer grafts. Accepted for publication September 18, 2018. The authors have no financial or conflicts of interest to disclose. Presented at the American Society of Ophthalmic Plastic and Reconstructive Surgery Spring Scientific Symposium on June 3, 2018 in Austin, TX. This study was approved by The Ohio State University Institutional Review Board. Address correspondence and reprint requests to Raymond I. Cho, M.D., F.A.C.S., Department of Ophthalmology and Visual Science, The Ohio State University Wexner Medical Center, Columbus, OH. E-mail: raymond.cho@osumc.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Παρασκευή 26 Οκτωβρίου 2018
Impact of Food and Drug Administration Approval of Vismodegib on Prevalence of Orbital Exenteration as a Necessary Surgical Treatment for Locally Advanced Periocular Basal Cell Carcinoma
Purpose: To test the hypothesis that the US Food and Drug Administration approval of vismodegib in early 2012 has reduced the prevalence of orbital exenteration for locally advanced periocular basal cell carcinoma (BCC). Methods: Following institutional review board approval, the authors reviewed clinical and pathological data of patients with locally advanced periocular BCC (T4 per the eyelid carcinoma classification in the 8th edition of the AJCC Cancer Staging Manual) treated by the senior author during 2006–2018. Patients were grouped into those who were treated before February 2012 ("before vismodegib approval") and those who presented later ("after vismodegib approval"). Results: Forty-two patients with locally advanced periocular BCC were treated during the study period, of whom 31 were men. The median age at presentation was 66 years (range, 43–90). Twenty-two patients had T4a and 20 had T4b tumors. Thirteen patients were treated before and 29 were treated after vismodegib approval. The 2 groups did not differ in age distribution (p = 0.164), sex distribution (p = 0.270), prevalence of recurrent tumor at presentation (p = 0.317), or duration of treatment with vismodegib (p = 0.605). Orbital exenteration was significantly more prevalent in patients treated before vismodegib approval than after (46% vs. 10%, p = 0.016), and vismodegib treatment was significantly more prevalent in patients treated after vismodegib approval than before (when vismodegib was given in clinical trials; 69% vs. 23%, p = 0.008). There was a trend toward more patients retaining their eyes at last follow-up in patients treated after vismodegib approval (83% vs. 54%, p = 0.066). Conclusions: The prevalence of orbital exenteration as a necessary surgical procedure in patients with a locally advanced periocular BCC has fallen since the Food and Drug Administration approval of vismodegib. Although vismodegib is not specifically approved for organ-sparing, it has changed the authors' practice and enabled eye preservation in patients with locally advanced periocular BCC, who would otherwise require an orbital exenteration. Accepted for publication August 31, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Bita Esmaeli, M.D., Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, Unit 1488, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030. E-mail: besmaeli@mdanderson.org © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Unilateral Eyelid Swelling as a Sign of Antimelanoma Differentiation–Associated Gene 5 (Anti-MDA5)-Antibody–Positive Dermatomyositis
The authors describe a 40-year-old woman who presented with unilateral eyelid swelling, and later on developed heliotrope rash, extensive oral and cutaneous ulcers, and muscle weakness. She was diagnosed with dermatomyositis associated with antimelanoma differentiation–associated gene 5 antibody. Even after combination of immunosupressants including a corticosteroid, tacrolimus, and rituximab, her eyelid swelling and oral ulcers progressively worsened. Administration of loading and then monthly intravenous immunoglobulin resulted in clinical remission, suggesting that intravenous immunoglobulin could be a useful remedy in cases refractory to conventional immunosuppressive agents, especially those with antimelanoma differentiation–associated gene 5 antibody-dermatomyositis. Accepted for publication September 13, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Stacey C. Lam, M.B.B.S., M.R.C.S.Ed., Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, 147K Argyle Street, Kowloon, Hong Kong Special Administrative Region, China. E-mail: staceylam@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Multicentric Mucinous Adenocarcinoma in the Periorbital Region
Primary mucinous adenocarcinoma of the skin is an uncommon malignancy in clinical practice, but multicentric presentation of the malignancy is considered even more rare. In this case report, the authors present a 70-year-old woman with multicentric primary mucinous adenocarcinoma of the skin manifesting with 2 separate lesions located on the right eyelid and cheek. Lesion removal and immunohistochemical staining ruled out mucinous adenocarcinoma of the skin secondary to lung or thyroid carcinoma, however, was inconclusive for breast carcinoma. A negative breast examination and mammography determined the lesions were primary mucinous adenocarcinoma of the skin. Lesion removal resulted in a large defect, which was repaired using a tarsoconjunctival flap and right cheek rotational/advancement flap. Six months postoperatively, the patient's vision returned to baseline with excellent eyelid position and no evidence of local recurrence. Oral consent for the report and photographs was obtained from the patient and filed. Accepted for publication August 28, 2018. None of the contributing authors involved have any financial or personal interest in this article. The authors have no conflicts of interest to disclose. Address correspondence and reprint requests to Marie B. Somogyi, M.D., TOC Eye and Face, 3705 Medical Parkway Suite 120, Austin, TX 78705. E-mail msomogyi@tocaustin.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Spinal Ewing Sarcoma Metastatic to Bilateral Orbits
A 39-year-old woman with primary spinal Ewing sarcoma and known lung metastases presented with painless bilateral decreased visual acuity over a 1-month period. Examination revealed bilateral disc edema. MRI of the brain/orbits showed metastatic lesions to the dura and bilateral orbits. Venous sinus thrombosis extending to the jugular vein was also noted. To the authors' knowledge, this is the first case of bilateral orbital metastasis and papilledema secondary to Ewing sarcoma and related hypercoagulability. Accepted for publication August 29, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Renelle Pointdujour-Lim, M.D., Smilow Cancer Hospital at Yale New Haven Hospital, 35 Park Street, New Haven, CT, 06511. E-mail: Renelle.lim@yale.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Impact of Food and Drug Administration Approval of Vismodegib on Prevalence of Orbital Exenteration as a Necessary Surgical Treatment for Locally Advanced Periocular Basal Cell Carcinoma
Purpose: To test the hypothesis that the US Food and Drug Administration approval of vismodegib in early 2012 has reduced the prevalence of orbital exenteration for locally advanced periocular basal cell carcinoma (BCC). Methods: Following institutional review board approval, the authors reviewed clinical and pathological data of patients with locally advanced periocular BCC (T4 per the eyelid carcinoma classification in the 8th edition of the AJCC Cancer Staging Manual) treated by the senior author during 2006–2018. Patients were grouped into those who were treated before February 2012 ("before vismodegib approval") and those who presented later ("after vismodegib approval"). Results: Forty-two patients with locally advanced periocular BCC were treated during the study period, of whom 31 were men. The median age at presentation was 66 years (range, 43–90). Twenty-two patients had T4a and 20 had T4b tumors. Thirteen patients were treated before and 29 were treated after vismodegib approval. The 2 groups did not differ in age distribution (p = 0.164), sex distribution (p = 0.270), prevalence of recurrent tumor at presentation (p = 0.317), or duration of treatment with vismodegib (p = 0.605). Orbital exenteration was significantly more prevalent in patients treated before vismodegib approval than after (46% vs. 10%, p = 0.016), and vismodegib treatment was significantly more prevalent in patients treated after vismodegib approval than before (when vismodegib was given in clinical trials; 69% vs. 23%, p = 0.008). There was a trend toward more patients retaining their eyes at last follow-up in patients treated after vismodegib approval (83% vs. 54%, p = 0.066). Conclusions: The prevalence of orbital exenteration as a necessary surgical procedure in patients with a locally advanced periocular BCC has fallen since the Food and Drug Administration approval of vismodegib. Although vismodegib is not specifically approved for organ-sparing, it has changed the authors' practice and enabled eye preservation in patients with locally advanced periocular BCC, who would otherwise require an orbital exenteration. Accepted for publication August 31, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Bita Esmaeli, M.D., Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, Unit 1488, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030. E-mail: besmaeli@mdanderson.org © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Unilateral Eyelid Swelling as a Sign of Antimelanoma Differentiation–Associated Gene 5 (Anti-MDA5)-Antibody–Positive Dermatomyositis
The authors describe a 40-year-old woman who presented with unilateral eyelid swelling, and later on developed heliotrope rash, extensive oral and cutaneous ulcers, and muscle weakness. She was diagnosed with dermatomyositis associated with antimelanoma differentiation–associated gene 5 antibody. Even after combination of immunosupressants including a corticosteroid, tacrolimus, and rituximab, her eyelid swelling and oral ulcers progressively worsened. Administration of loading and then monthly intravenous immunoglobulin resulted in clinical remission, suggesting that intravenous immunoglobulin could be a useful remedy in cases refractory to conventional immunosuppressive agents, especially those with antimelanoma differentiation–associated gene 5 antibody-dermatomyositis. Accepted for publication September 13, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Stacey C. Lam, M.B.B.S., M.R.C.S.Ed., Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, 147K Argyle Street, Kowloon, Hong Kong Special Administrative Region, China. E-mail: staceylam@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Multicentric Mucinous Adenocarcinoma in the Periorbital Region
Primary mucinous adenocarcinoma of the skin is an uncommon malignancy in clinical practice, but multicentric presentation of the malignancy is considered even more rare. In this case report, the authors present a 70-year-old woman with multicentric primary mucinous adenocarcinoma of the skin manifesting with 2 separate lesions located on the right eyelid and cheek. Lesion removal and immunohistochemical staining ruled out mucinous adenocarcinoma of the skin secondary to lung or thyroid carcinoma, however, was inconclusive for breast carcinoma. A negative breast examination and mammography determined the lesions were primary mucinous adenocarcinoma of the skin. Lesion removal resulted in a large defect, which was repaired using a tarsoconjunctival flap and right cheek rotational/advancement flap. Six months postoperatively, the patient's vision returned to baseline with excellent eyelid position and no evidence of local recurrence. Oral consent for the report and photographs was obtained from the patient and filed. Accepted for publication August 28, 2018. None of the contributing authors involved have any financial or personal interest in this article. The authors have no conflicts of interest to disclose. Address correspondence and reprint requests to Marie B. Somogyi, M.D., TOC Eye and Face, 3705 Medical Parkway Suite 120, Austin, TX 78705. E-mail msomogyi@tocaustin.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Update on Genitourinary MR Imaging
Publication date: Available online 25 October 2018
Source: Magnetic Resonance Imaging Clinics of North America
Author(s): Ersan Altun
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Update on Genitourinary MR Imaging
Publication date: Available online 25 October 2018
Source: Magnetic Resonance Imaging Clinics of North America
Author(s): Ersan Altun
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CRISPR Craft: DNA Editing the Reconstructive Ladder
Summary: The clustered regularly interspaced short palindromic repeats (CRISPR) system of genome editing represents a major technological advance spanning all areas of genetics and downstream applications. CRISPR's potential impact on treating human disease encompasses all clinical specialties, including areas important to the plastic surgeon such as oncology, wound healing, immunology, and craniofacial malformations. Plastic surgeons should gain familiarity with this gene editing technology, and become active contributors and leaders in applying CRISPR to their respective areas of expertise. This review describes the history and basic mechanism of CRISPR genome editing, highlights current and future applications, and discusses limitations. The authors will consider CRISPR's potentia...
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CRISPR Craft: DNA Editing the Reconstructive Ladder
Summary: The clustered regularly interspaced short palindromic repeats (CRISPR) system of genome editing represents a major technological advance spanning all areas of genetics and downstream applications. CRISPR's potential impact on treating human disease encompasses all clinical specialties, including areas important to the plastic surgeon such as oncology, wound healing, immunology, and craniofacial malformations. Plastic surgeons should gain familiarity with this gene editing technology, and become active contributors and leaders in applying CRISPR to their respective areas of expertise. This review describes the history and basic mechanism of CRISPR genome editing, highlights current and future applications, and discusses limitations. The authors will consider CRISPR's potentia...
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Modulation of Antibody Responses to the V1V2 and V3 Regions of HIV-1 Envelope by Immune Complex Vaccines
Catarina E. Hioe, Rajnish Kumar, Chitra Upadhyay, Muzafar Jan, Alisa Fox, Vincenza Itri, Kristina K. Peachman, Mangala Rao, Lily Liu, Nathan C. Lo, Michael Tuen, Xunqing Jiang, Xiang-Peng Kong, Susan Zolla-Pazner (Source: Frontiers in Immunology)
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Modulation of Antibody Responses to the V1V2 and V3 Regions of HIV-1 Envelope by Immune Complex Vaccines
Catarina E. Hioe, Rajnish Kumar, Chitra Upadhyay, Muzafar Jan, Alisa Fox, Vincenza Itri, Kristina K. Peachman, Mangala Rao, Lily Liu, Nathan C. Lo, Michael Tuen, Xunqing Jiang, Xiang-Peng Kong, Susan Zolla-Pazner (Source: Frontiers in Immunology)
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The Pro-tumorigenic IL-33 Involved in Antitumor Immunity: A Yin and Yang Cytokine
Jean-Jacques Fourni é, Mary Poupot (Source: Frontiers in Immunology)
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The Pro-tumorigenic IL-33 Involved in Antitumor Immunity: A Yin and Yang Cytokine
Jean-Jacques Fourni é, Mary Poupot (Source: Frontiers in Immunology)
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Expanding the Therapeutic Window for CAR T Cell Therapy in Solid Tumors: The Knowns and Unknowns of CAR T Cell Biology
Keisuke Watanabe, Shunichiro Kuramitsu, Avery D. Posey, Carl H. June (Source: Frontiers in Immunology)
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Issue Information
American Journal of Reproductive Immunology,Volume 80, Issue 5, November 2018. (Source: American Journal of Reproductive Immunology)
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Audiological and clinical outcomes of a transcutaneous bone conduction hearing implant: 6 ‐month results from a multicenter study
Clinical Otolaryngology,Volume 0, Issue ja, -Not available-. (Source: Clinical Otolaryngology)
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Expanding the Therapeutic Window for CAR T Cell Therapy in Solid Tumors: The Knowns and Unknowns of CAR T Cell Biology
Keisuke Watanabe, Shunichiro Kuramitsu, Avery D. Posey, Carl H. June (Source: Frontiers in Immunology)
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CD169+ Macrophages Capture and Dendritic Cells Instruct: The Interplay of the Gatekeeper and the General of the Immune System
Joanna Grabowska, Miguel A. Lopez-Venegas, Alsya J. Affandi, Joke M. M. den Haan (Source: Frontiers in Immunology)
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CD169+ Macrophages Capture and Dendritic Cells Instruct: The Interplay of the Gatekeeper and the General of the Immune System
Joanna Grabowska, Miguel A. Lopez-Venegas, Alsya J. Affandi, Joke M. M. den Haan (Source: Frontiers in Immunology)
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Innate Lymphoid Cells in the Maternal and Fetal Compartments
Derek Miller, Kenichiro Motomura, Valeria Garcia-Flores, Roberto Romero, Nardhy Gomez-Lopez (Source: Frontiers in Immunology)
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Innate Lymphoid Cells in the Maternal and Fetal Compartments
Derek Miller, Kenichiro Motomura, Valeria Garcia-Flores, Roberto Romero, Nardhy Gomez-Lopez (Source: Frontiers in Immunology)
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Immunoproteasome Inhibition Impairs T and B Cell Activation by Restraining ERK Signaling and Proteostasis
Christian Schmidt, Thilo Berger, Marcus Groettrup, Michael Basler (Source: Frontiers in Immunology)
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Induction of Tolerogenic Dendritic Cells by Endogenous Biomolecules: An Update
Urban Švajger, Primož Rožman (Source: Frontiers in Immunology)
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Immunoproteasome Inhibition Impairs T and B Cell Activation by Restraining ERK Signaling and Proteostasis
Christian Schmidt, Thilo Berger, Marcus Groettrup, Michael Basler (Source: Frontiers in Immunology)
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Induction of Tolerogenic Dendritic Cells by Endogenous Biomolecules: An Update
Urban Švajger, Primož Rožman (Source: Frontiers in Immunology)
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Editorial Board
Publication date: November 2018Source: Autoimmunity Reviews, Volume 17, Issue 11Author(s): (Source: Autoimmunity Reviews)
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Editorial Board
Publication date: November 2018Source: Autoimmunity Reviews, Volume 17, Issue 11Author(s): (Source: Autoimmunity Reviews)
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The role of dietary sodium in autoimmune diseases: The salty truth
Publication date: November 2018Source: Autoimmunity Reviews, Volume 17, Issue 11Author(s): Kassem Sharif, Howard Amital, Yehuda ShoenfeldAbstractAutoimmune diseases are a group of heterogeneous condition that occur secondary to the intrinsic loss of tolerance to self- antigens. In genetically susceptible individuals, the complex interplay of environmental factors and epigenetic deregulations have been proposed to drive disease etiopathogenesis. Various environmental variables have been identified including viral infections, exposure to pollutants, stress and dietary factors. Sodium, a major constituent of salt is essential for mammalian physiology. However, high salt intake may play a role in the development of autoimmune diseases. Several lines of evidence point toward the role of high so...
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The role of dietary sodium in autoimmune diseases: The salty truth
Publication date: November 2018Source: Autoimmunity Reviews, Volume 17, Issue 11Author(s): Kassem Sharif, Howard Amital, Yehuda ShoenfeldAbstractAutoimmune diseases are a group of heterogeneous condition that occur secondary to the intrinsic loss of tolerance to self- antigens. In genetically susceptible individuals, the complex interplay of environmental factors and epigenetic deregulations have been proposed to drive disease etiopathogenesis. Various environmental variables have been identified including viral infections, exposure to pollutants, stress and dietary factors. Sodium, a major constituent of salt is essential for mammalian physiology. However, high salt intake may play a role in the development of autoimmune diseases. Several lines of evidence point toward the role of high so...
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Evaluating the IgMi mouse as a novel tool to study B ‐cell biology
European Journal of Immunology, EarlyView. (Source: European Journal of Immunology)
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Evaluating the IgMi mouse as a novel tool to study B ‐cell biology
European Journal of Immunology, EarlyView. (Source: European Journal of Immunology)
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Protein Inhibitor of Activated STAT (PIAS) Negatively Regulates the JAK/STAT Pathway by Inhibiting STAT Phosphorylation and Translocation
Guo-Juan Niu, Ji-Dong Xu, Wen-Jie Yuan, Jie-Jie Sun, Ming-Chong Yang, Zhong-Hua He, Xiao-Fan Zhao, Jin-Xing Wang (Source: Frontiers in Immunology)
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Protein Inhibitor of Activated STAT (PIAS) Negatively Regulates the JAK/STAT Pathway by Inhibiting STAT Phosphorylation and Translocation
Guo-Juan Niu, Ji-Dong Xu, Wen-Jie Yuan, Jie-Jie Sun, Ming-Chong Yang, Zhong-Hua He, Xiao-Fan Zhao, Jin-Xing Wang (Source: Frontiers in Immunology)
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Exercise-Induced Anaphylaxis: Literature Review and Recent Updates
AbstractPurpose of ReviewThis paper will review the pathophysiology, diagnosis, and treatment of exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis with an emphasis on novel studies published in the past several years.Recent FindingsExercise-induced anaphylaxis (EIAn) is a clinical syndrome characterized by anaphylaxis during or shortly after physical exertion. The syndrome is broadly grouped into two categories: exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis (FDEIAn). Recent literature indicates that FDEIAn is a primary IgE-mediated food allergy which is augmented by several cofactors. Cofactors such as exercise, NSAIDs, and alcohol increase intestinal permeability and allow increased antigen uptake, thereby causing symptoms. The p...
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Exercise-Induced Anaphylaxis: Literature Review and Recent Updates
AbstractPurpose of ReviewThis paper will review the pathophysiology, diagnosis, and treatment of exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis with an emphasis on novel studies published in the past several years.Recent FindingsExercise-induced anaphylaxis (EIAn) is a clinical syndrome characterized by anaphylaxis during or shortly after physical exertion. The syndrome is broadly grouped into two categories: exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis (FDEIAn). Recent literature indicates that FDEIAn is a primary IgE-mediated food allergy which is augmented by several cofactors. Cofactors such as exercise, NSAIDs, and alcohol increase intestinal permeability and allow increased antigen uptake, thereby causing symptoms. The p...
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Cover
American Journal of Reproductive Immunology,Volume 80, Issue 5, November 2018. (Source: American Journal of Reproductive Immunology)
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Cover
American Journal of Reproductive Immunology,Volume 80, Issue 5, November 2018. (Source: American Journal of Reproductive Immunology)
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Issue Information
American Journal of Reproductive Immunology,Volume 80, Issue 5, November 2018. (Source: American Journal of Reproductive Immunology)
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Audiological and clinical outcomes of a transcutaneous bone conduction hearing implant: 6 ‐month results from a multicenter study
Clinical Otolaryngology,Volume 0, Issue ja, -Not available-. (Source: Clinical Otolaryngology)
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Lateral pharyngotomy
Publication date: Available online 25 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): O. Laccourreye, A. Villeneuve, F. Rubin, F.C. Holsinger
Abstract
Based on a review of the medical literature, the authors document the key technical points, variants, technical errors to avoid and main functional results of lateral pharyngotomy for resection of cancers originating from the lateral oro and/or hypopharynx.
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Assessment of swallowing function after circumferential pharyngolaryngectomy. A multicenter study by the GETTEC group
Publication date: Available online 25 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): S. Morinière, P. Gorphe, F. Espitalier, D. Blanchard, N. Fakhry, N. Saroul, C. Bach, X. Dufour, C. Fuchsmann, S. Vergez, S. Albert
Abstract
Objective
Circumferential pharyngolaryngectomy is performed for advanced pharyngeal tumor or in a context of postradiation recurrence. Several free or pedicle flaps have been described for pharyngeal defect reconstruction, with choice at the surgeon's discretion. The aim of this study was to evaluate long-term swallowing function according to the type of flap used for reconstruction.
Material and method
A multicenter retrospective study was conducted from January to September 2016 within the French GETTEC head and neck tumor study group. All patients in remission after circumferential pharyngolaryngectomy were included and filled out the Deglutition Handicap Index (DHI) questionnaire and underwent swallowing function fiberoptic endoscopy assessment. 46 patients (39 men, 7 women) were included. Reconstruction used a tubularized forearm free flap (FFF group) in 19 cases, pectoralis major myocutaneous flap (PMMF group) in 15 cases and free jejunum flap (FJF group) in 12 cases.
Results
Mean DHI was 24: 20 in the FFF group, 23 in the FJF group and 25 in the PMMF group, without significant differences. 27 patients had normal swallowing, 9 mixed diet, 8 liquid diet and 3 were fed by gastrostomy. On endoscopy, free flaps (FJF and FFF) were associated with significantly greater rates of normal swallowing of saliva and yogurt than in the PMMF group (P = 0.04).
Conclusion
Type of flap reconstruction after circumferential pharyngolaryngectomy had no significant impact on postoperative swallowing function assessed on the self-administered DHI questionnaire.
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Impact of cochlear implantation on peripheral vestibular function in adults
Publication date: Available online 25 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): V. Colin, P. Bertholon, S. Roy, A. Karkas
Abstract
Objective
Cochlear implantation may have a detrimental effect on vestibular function and residual hearing. Our goal was to investigate the impact of cochlear implantation on peripheral vestibular function and the symptomatology that ensues.
Material and methods
A prospective observational study included all adults undergoing cochlear implantation by the same operator between July 2014 and December 2015, with pre- and postoperative (4 months) neurovestibular balance examination comprising a questionnaire and clinical tests [head impulse test (HIT), head-shaking test (HST), skull vibration test (SVT)] and instrumental tests [caloric test of the lateral semicircular canal and cervical vestibular-evoked myogenic potentials (cVEMP)].
Results
Twenty-two patients were included, with a mean age of 62 years and sex-ratio of 1.2. Before implantation, 50% of subjects (n = 11) reported at least one episode of vertigo associated with balance disorder during their life. After implantation, there were 11 cases of vertigo but only one patient described persistent discomfort related to vertigo 4 months after surgery. Patients with impaired vestibular function after 4 months, taking all symptoms together, were all aged more than 75 years. HIT was abnormal in 18% of cases before implantation and in 59% after (P = NS). HST showed nystagmus in one patient both before and after surgery. Only 18% of patients showed nystagmus induced by SVT before surgery, increasing to one-third after surgery (P = NS). Caloric test of the lateral canal showed hypofunction in 50% of cases before surgery, including 10% of cases with areflexia. This rate increased after surgery to 58%, with 18% areflexia (P = NS). cVEMPs were not detected in 68% of cases before implantation and this rate increased to 86% after surgery (P = NS). There were no significant associations (P > 0.05) between test results and symptoms.
Conclusions
In the medium term, although older subjects more frequently presented vestibular disorder, cochlear implantation induced little vertigo or balance disorder, sometimes even improving vestibular function. However, vestibular disorders were frequent preoperatively and increased postoperatively. We tested vestibular function on different stimulation frequencies and yet found no correlation between postoperative test results and postoperative vertigo.
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Lateral pharyngotomy
Publication date: Available online 25 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): O. Laccourreye, A. Villeneuve, F. Rubin, F.C. Holsinger
Abstract
Based on a review of the medical literature, the authors document the key technical points, variants, technical errors to avoid and main functional results of lateral pharyngotomy for resection of cancers originating from the lateral oro and/or hypopharynx.
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Assessment of swallowing function after circumferential pharyngolaryngectomy. A multicenter study by the GETTEC group
Publication date: Available online 25 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): S. Morinière, P. Gorphe, F. Espitalier, D. Blanchard, N. Fakhry, N. Saroul, C. Bach, X. Dufour, C. Fuchsmann, S. Vergez, S. Albert
Abstract
Objective
Circumferential pharyngolaryngectomy is performed for advanced pharyngeal tumor or in a context of postradiation recurrence. Several free or pedicle flaps have been described for pharyngeal defect reconstruction, with choice at the surgeon's discretion. The aim of this study was to evaluate long-term swallowing function according to the type of flap used for reconstruction.
Material and method
A multicenter retrospective study was conducted from January to September 2016 within the French GETTEC head and neck tumor study group. All patients in remission after circumferential pharyngolaryngectomy were included and filled out the Deglutition Handicap Index (DHI) questionnaire and underwent swallowing function fiberoptic endoscopy assessment. 46 patients (39 men, 7 women) were included. Reconstruction used a tubularized forearm free flap (FFF group) in 19 cases, pectoralis major myocutaneous flap (PMMF group) in 15 cases and free jejunum flap (FJF group) in 12 cases.
Results
Mean DHI was 24: 20 in the FFF group, 23 in the FJF group and 25 in the PMMF group, without significant differences. 27 patients had normal swallowing, 9 mixed diet, 8 liquid diet and 3 were fed by gastrostomy. On endoscopy, free flaps (FJF and FFF) were associated with significantly greater rates of normal swallowing of saliva and yogurt than in the PMMF group (P = 0.04).
Conclusion
Type of flap reconstruction after circumferential pharyngolaryngectomy had no significant impact on postoperative swallowing function assessed on the self-administered DHI questionnaire.
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Impact of cochlear implantation on peripheral vestibular function in adults
Publication date: Available online 25 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): V. Colin, P. Bertholon, S. Roy, A. Karkas
Abstract
Objective
Cochlear implantation may have a detrimental effect on vestibular function and residual hearing. Our goal was to investigate the impact of cochlear implantation on peripheral vestibular function and the symptomatology that ensues.
Material and methods
A prospective observational study included all adults undergoing cochlear implantation by the same operator between July 2014 and December 2015, with pre- and postoperative (4 months) neurovestibular balance examination comprising a questionnaire and clinical tests [head impulse test (HIT), head-shaking test (HST), skull vibration test (SVT)] and instrumental tests [caloric test of the lateral semicircular canal and cervical vestibular-evoked myogenic potentials (cVEMP)].
Results
Twenty-two patients were included, with a mean age of 62 years and sex-ratio of 1.2. Before implantation, 50% of subjects (n = 11) reported at least one episode of vertigo associated with balance disorder during their life. After implantation, there were 11 cases of vertigo but only one patient described persistent discomfort related to vertigo 4 months after surgery. Patients with impaired vestibular function after 4 months, taking all symptoms together, were all aged more than 75 years. HIT was abnormal in 18% of cases before implantation and in 59% after (P = NS). HST showed nystagmus in one patient both before and after surgery. Only 18% of patients showed nystagmus induced by SVT before surgery, increasing to one-third after surgery (P = NS). Caloric test of the lateral canal showed hypofunction in 50% of cases before surgery, including 10% of cases with areflexia. This rate increased after surgery to 58%, with 18% areflexia (P = NS). cVEMPs were not detected in 68% of cases before implantation and this rate increased to 86% after surgery (P = NS). There were no significant associations (P > 0.05) between test results and symptoms.
Conclusions
In the medium term, although older subjects more frequently presented vestibular disorder, cochlear implantation induced little vertigo or balance disorder, sometimes even improving vestibular function. However, vestibular disorders were frequent preoperatively and increased postoperatively. We tested vestibular function on different stimulation frequencies and yet found no correlation between postoperative test results and postoperative vertigo.
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A Multimodality Review of Adrenal Tumors
Publication date: Available online 25 October 2018
Source: Current Problems in Diagnostic Radiology
Author(s): Peeyush Bhargava, Guillermo Sangster, Kabiul Haque, John Garrett, Maren Donato, Horacio D'Agostino
Abstract
Adrenal tumors are very commonly encountered in the practice of radiology. They may arise from the adrenal gland itself, either the cortex or the medulla, or they could be secondary lesions. They may be benign or malignant. The functioning adrenal tumors lead to hypersecretion of adrenal hormones leading to clinical syndromes. Computed Tomography is the most common imaging modality used for the initial evaluation of adrenal tumors. Magnetic Resonance Imaging (MRI) and functional scintigraphic techniques are frequently used for atypical presentations or further evaluation. We present a multimodality review of common and uncommon adrenal tumors. We highlight their characteristic and specific imaging features which help us in making a diagnosis and suggesting an appropriate follow up for further management. The spectrum of adrenal tumors is wide with varying appearances on different imaging modalities. Imaging techniques used for adrenal tumor imaging have their own strengths and weaknesses as it relates to the final diagnosis. It is important to be familiar with imaging characteristics of adrenal tumors for appropriate diagnosis and management. Differentiation of benign (leave alone) tumors from malignant (surgical) ones along with appropriate disposition of incidentalomas are some of the challenges facing the radiologist.
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Tinnitus information online - does it ring true?
| Related Articles |
Tinnitus information online - does it ring true?
J Laryngol Otol. 2018 Oct 24;:1-6
Authors: McKearney RM, MacKinnon RC, Smith M, Baker R
Abstract
OBJECTIVE: To assess, using standardised tools, the quality and readability of online tinnitus information that patients are likely to access.
METHODS: A standardised review was conducted of websites relating to tinnitus and its management. Each website was scored using the DISCERN instrument and the Flesch Reading Ease scale.
RESULTS: Twenty-seven unique websites were evaluated. The mean DISCERN score of the websites was 34.5 out of 80 (standard deviation = 11.2). This would be considered 'fair' in quality. Variability in DISCERN score between websites was high (range, 15-57: 'poor' to 'very good'). Website readability was poor, with a mean Flesch Reading Ease score of 52.6 (standard deviation = 7.7); this would be considered 'difficult' to read.
CONCLUSION: In general, the quality of tinnitus websites is fair and the readability is poor, with substantial variability in quality between websites. The Action on Hearing Loss and the British Tinnitus Association websites were identified as providing the highest quality information.
PMID: 30353795 [PubMed - as supplied by publisher]
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A Multimodality Review of Adrenal Tumors
Publication date: Available online 25 October 2018
Source: Current Problems in Diagnostic Radiology
Author(s): Peeyush Bhargava, Guillermo Sangster, Kabiul Haque, John Garrett, Maren Donato, Horacio D'Agostino
Abstract
Adrenal tumors are very commonly encountered in the practice of radiology. They may arise from the adrenal gland itself, either the cortex or the medulla, or they could be secondary lesions. They may be benign or malignant. The functioning adrenal tumors lead to hypersecretion of adrenal hormones leading to clinical syndromes. Computed Tomography is the most common imaging modality used for the initial evaluation of adrenal tumors. Magnetic Resonance Imaging (MRI) and functional scintigraphic techniques are frequently used for atypical presentations or further evaluation. We present a multimodality review of common and uncommon adrenal tumors. We highlight their characteristic and specific imaging features which help us in making a diagnosis and suggesting an appropriate follow up for further management. The spectrum of adrenal tumors is wide with varying appearances on different imaging modalities. Imaging techniques used for adrenal tumor imaging have their own strengths and weaknesses as it relates to the final diagnosis. It is important to be familiar with imaging characteristics of adrenal tumors for appropriate diagnosis and management. Differentiation of benign (leave alone) tumors from malignant (surgical) ones along with appropriate disposition of incidentalomas are some of the challenges facing the radiologist.
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Tinnitus information online - does it ring true?
| Related Articles |
Tinnitus information online - does it ring true?
J Laryngol Otol. 2018 Oct 24;:1-6
Authors: McKearney RM, MacKinnon RC, Smith M, Baker R
Abstract
OBJECTIVE: To assess, using standardised tools, the quality and readability of online tinnitus information that patients are likely to access.
METHODS: A standardised review was conducted of websites relating to tinnitus and its management. Each website was scored using the DISCERN instrument and the Flesch Reading Ease scale.
RESULTS: Twenty-seven unique websites were evaluated. The mean DISCERN score of the websites was 34.5 out of 80 (standard deviation = 11.2). This would be considered 'fair' in quality. Variability in DISCERN score between websites was high (range, 15-57: 'poor' to 'very good'). Website readability was poor, with a mean Flesch Reading Ease score of 52.6 (standard deviation = 7.7); this would be considered 'difficult' to read.
CONCLUSION: In general, the quality of tinnitus websites is fair and the readability is poor, with substantial variability in quality between websites. The Action on Hearing Loss and the British Tinnitus Association websites were identified as providing the highest quality information.
PMID: 30353795 [PubMed - as supplied by publisher]
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Image Quality Performance of Virtual Single-Source CT Using Dual-Source Computed Tomography
Publication date: Available online 25 October 2018
Source: Academic Radiology
Author(s): Babak Alikhani, Martin Werner, Leila Jamali, Frank Wacker, Thomas Werncke
Rationale and Objectives
The aim of this study is to analyze the image quality provided by a dual-source (DS) data set and a single-source (SS) data set at the same radiation exposure, in order to evaluate a dose splitting method for dual-source scanning protocols.
Materials and Methods
A 192-slice dual-source third generation CT (Somatom Force; Siemens Healthcare, Forchheim, Germany) was used to image a Catphan phantom (Catphan503; The Phantom Laboratory, Salem, New York) utilizing different X-ray tube voltages from 70 to 120 kVp with an organ-based tube-current modulation technique (X-CARE; Siemens Healthcare, Forchheim, Germany). In order to keep the radiation dose (given by volume computed tomography dose index) in a clinically relevant range, different X-ray tube time-current products ranging from 80 to 300 mAs were selected. The data sets by each X-ray tube voltage were collected using a single-source as well as a dual-source mode. The measurements in the dual-source mode were performed with five different tube currents of the X-ray tube A and B. Thereby, the tube current ratios were 50%|50% (DS 0.5), 60%|40% (DS 0.6), 70%|30% (DS 0.7), 80%|20% (DS 0.8), and 90%|10% (DS 0.9). The images were reconstructed by the use of a filter-back projection (Br40) and an advanced mode led iterative reconstruction algorithms (advanced modeled iterative reconstruction algorithms [ADMIRE]; Siemens Healthcare, Forchheim, Germany) with a strength range of 1–5. The image quality was evaluated in terms of noise, contrast-to-noise ratio (CNR), low-contrast detectability expressed as the structural similarity index (SSIM) and spatial resolution quantified by the full width at half maximum of the line-spread function.
Results
Image noise decreased by the use of the dual-source mode, which led to improvement of their CNR compared to the single-source mode. SSIM showed an almost constant behavior by both modes. The spatial resolution indicated a lower trend by the dual-source mode in comparison to the single-source mode. However, the loss of the spatial resolution performance was lower than 5% for the dual-source modes.
Conclusion
The presented phantom study demonstrated that SSIM and spatial resolution performance obtained by dual-source CT protocols showed a negligible variation to those by the single-source CT. However, the noise and CNR displayed an improvement for the dual-source CT. Therefore, the use of the dual-source CT enables to split the radiation dose between X-ray tubes and to compare the data sets with different radiation dose levels without loss in the image quality.
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Prophylactic versus reactive gastrostomy tube placement in advanced head and neck cancer treated with definitive chemoradiotherapy: A systematic review
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Shearwood McClelland, Janna Z. Andrews, Huma Chaudhry, Sewit Teckie, Anuj Goenka
Abstract
Although chemoradiotherapy (CRT) has improved disease outcomes in advanced head and neck cancer (aHNC), toxicity remains a major concern. Treatment interruptions and decreased quality of life (QOL) can occur due to malnutrition, secondary to mucositis, dysphagia and odynophagia. Gastrostomy tubes are used in many patients to improve nutrition during CRT. The optimal timing of PEG placement in patients with aHNC undergoing CRT remains controversial. Using the PubMed database, we performed a systematic review of published CRT series in aHNC to guide decision-making regarding optimal timing of percutaneous endoscopic gastrostomy (PEG) placement. We aimed to compare outcomes when patients are treated with prophylactic PEG (pPEG) versus reactive PEG (rPEG). Twenty-two studies examining the role of PEG placement in CRT for aHNC were reviewed. pPEG reduces the number of malnourished patients (defined as >10% of body weight), but average weight loss at various time points following treatment appears similar to patients with rPEG. pPEG is also associated with improved QOL at 6 months, and greater long term PEG dependence. Clinical and dosimetric parameters that correlate with malnutrition in patients without pPEG include advanced age, percent weight loss preceding treatment, and radiation dose to the pharyngeal constrictor muscles. Based on this evidence, our institutional strategy is to encourage pPEG in those patients deemed at greatest risk of becoming malnourished during the course of treatment, and to approach the remainder of patients with rPEG.
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Image Quality Performance of Virtual Single-Source CT Using Dual-Source Computed Tomography
Publication date: Available online 25 October 2018
Source: Academic Radiology
Author(s): Babak Alikhani, Martin Werner, Leila Jamali, Frank Wacker, Thomas Werncke
Rationale and Objectives
The aim of this study is to analyze the image quality provided by a dual-source (DS) data set and a single-source (SS) data set at the same radiation exposure, in order to evaluate a dose splitting method for dual-source scanning protocols.
Materials and Methods
A 192-slice dual-source third generation CT (Somatom Force; Siemens Healthcare, Forchheim, Germany) was used to image a Catphan phantom (Catphan503; The Phantom Laboratory, Salem, New York) utilizing different X-ray tube voltages from 70 to 120 kVp with an organ-based tube-current modulation technique (X-CARE; Siemens Healthcare, Forchheim, Germany). In order to keep the radiation dose (given by volume computed tomography dose index) in a clinically relevant range, different X-ray tube time-current products ranging from 80 to 300 mAs were selected. The data sets by each X-ray tube voltage were collected using a single-source as well as a dual-source mode. The measurements in the dual-source mode were performed with five different tube currents of the X-ray tube A and B. Thereby, the tube current ratios were 50%|50% (DS 0.5), 60%|40% (DS 0.6), 70%|30% (DS 0.7), 80%|20% (DS 0.8), and 90%|10% (DS 0.9). The images were reconstructed by the use of a filter-back projection (Br40) and an advanced mode led iterative reconstruction algorithms (advanced modeled iterative reconstruction algorithms [ADMIRE]; Siemens Healthcare, Forchheim, Germany) with a strength range of 1–5. The image quality was evaluated in terms of noise, contrast-to-noise ratio (CNR), low-contrast detectability expressed as the structural similarity index (SSIM) and spatial resolution quantified by the full width at half maximum of the line-spread function.
Results
Image noise decreased by the use of the dual-source mode, which led to improvement of their CNR compared to the single-source mode. SSIM showed an almost constant behavior by both modes. The spatial resolution indicated a lower trend by the dual-source mode in comparison to the single-source mode. However, the loss of the spatial resolution performance was lower than 5% for the dual-source modes.
Conclusion
The presented phantom study demonstrated that SSIM and spatial resolution performance obtained by dual-source CT protocols showed a negligible variation to those by the single-source CT. However, the noise and CNR displayed an improvement for the dual-source CT. Therefore, the use of the dual-source CT enables to split the radiation dose between X-ray tubes and to compare the data sets with different radiation dose levels without loss in the image quality.
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Evolution of robotic systems for transoral head and neck surgery
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Howard Poon, Changsheng Li, Wenchao Gao, Hongliang Ren, Chwee Ming Lim
Abstract
Oropharyngeal tumor is traditionally resected from an open approach, often necessitating the need of a midline mandibulotomy in order to remove tumor safely with oncologic margins. The limitations imposed by a transoral route include poor visualization of the inferior extent of the oropharynx, rigid instrumentation, and inability to resect tumor that extends caudally into the supraglottis. While visualization with angled endoscopes, coupled with flexible laser development and microscopic magnification may overcome some of these limitations, this technique suffers from linear trajectory of the instruments which hampers expedient surgical resection in a 3-dimensional fashion. With development of the Da Vinci Surgical System, the safety and oncologic feasibility of removing oropharyngeal tumors are made possible because it provides a 3-dimensional magnification of the surgical field and wristed maneuverability of the surgical instruments which enable surgeons to operate around tight anatomical confines. Nevertheless, this first-generation robot is continually being modified with more flexibility and maneuverability through the development of robots like the FLEX Robotic System and more recently the Da Vinci Single Port System (SP). In this review, we will discuss the historic developments of robots for transoral applications, present the current approved robotic systems, and highlight the upcoming robots for transoral robotic surgery (TORS). Finally, we will also propose an ideal TORS surgical robot by highlighting the engineering technologies to accomplish these challenges.
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Prophylactic versus reactive gastrostomy tube placement in advanced head and neck cancer treated with definitive chemoradiotherapy: A systematic review
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Shearwood McClelland, Janna Z. Andrews, Huma Chaudhry, Sewit Teckie, Anuj Goenka
Abstract
Although chemoradiotherapy (CRT) has improved disease outcomes in advanced head and neck cancer (aHNC), toxicity remains a major concern. Treatment interruptions and decreased quality of life (QOL) can occur due to malnutrition, secondary to mucositis, dysphagia and odynophagia. Gastrostomy tubes are used in many patients to improve nutrition during CRT. The optimal timing of PEG placement in patients with aHNC undergoing CRT remains controversial. Using the PubMed database, we performed a systematic review of published CRT series in aHNC to guide decision-making regarding optimal timing of percutaneous endoscopic gastrostomy (PEG) placement. We aimed to compare outcomes when patients are treated with prophylactic PEG (pPEG) versus reactive PEG (rPEG). Twenty-two studies examining the role of PEG placement in CRT for aHNC were reviewed. pPEG reduces the number of malnourished patients (defined as >10% of body weight), but average weight loss at various time points following treatment appears similar to patients with rPEG. pPEG is also associated with improved QOL at 6 months, and greater long term PEG dependence. Clinical and dosimetric parameters that correlate with malnutrition in patients without pPEG include advanced age, percent weight loss preceding treatment, and radiation dose to the pharyngeal constrictor muscles. Based on this evidence, our institutional strategy is to encourage pPEG in those patients deemed at greatest risk of becoming malnourished during the course of treatment, and to approach the remainder of patients with rPEG.
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The existence of early stage oral mucosal melanoma: A 10-year retrospective analysis of 170 patients in a single institute
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Yunteng Wu, Lizheng Wang, Xuhui Ma, Wei Guo, Guoxin Ren
Abstract
Background
Oral mucosal melanoma (OMM) is an aggressive tumor with an extremely low incidence, and the current TNM Staging System has classified all OMMs as high stage. However, controversy remains regarding the existence of early stage OMMs.
Patients and methods
The clinical and pathological features, treatments and outcomes of 170 OMM patients treated in a single institution from January 2007 to July 2017 were retrospectively analyzed. Multivariate analysis was performed to identify significant prognostic factors for overall survival (OS).
Results
Multivariate analysis identified positive cervical lymph nodes (p < 0.0001), nodular OMMs (p < 0.0001), ulceration (p = 0.002), and level III or level IV invasion (p < 0.0001) as independent poor prognostic factors for OS. Nodular OMM patients with a tumor size ≤1 cm had a better outcome than those with a tumor size >1 cm (p < 0.0001). Twenty-two patients with superficial invasion had a favorable survival without the need of adjuvant therapy (postoperative chemotherapy or radiotherapy), and the current TNM Staging System was not suitable for those patients. Patients with deep invasion were more likely to suffer from recurrence and distant metastasis.
Conclusions
Tumor size ≤1 cm and OMM in situ, although extremely rare, do exist. It is advisable for AJCC to consider tumor size ≤1 cm and OMM in situ as the early stage of OMM when updating the new Oral Melanoma Staging System.
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Evolution of robotic systems for transoral head and neck surgery
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Howard Poon, Changsheng Li, Wenchao Gao, Hongliang Ren, Chwee Ming Lim
Abstract
Oropharyngeal tumor is traditionally resected from an open approach, often necessitating the need of a midline mandibulotomy in order to remove tumor safely with oncologic margins. The limitations imposed by a transoral route include poor visualization of the inferior extent of the oropharynx, rigid instrumentation, and inability to resect tumor that extends caudally into the supraglottis. While visualization with angled endoscopes, coupled with flexible laser development and microscopic magnification may overcome some of these limitations, this technique suffers from linear trajectory of the instruments which hampers expedient surgical resection in a 3-dimensional fashion. With development of the Da Vinci Surgical System, the safety and oncologic feasibility of removing oropharyngeal tumors are made possible because it provides a 3-dimensional magnification of the surgical field and wristed maneuverability of the surgical instruments which enable surgeons to operate around tight anatomical confines. Nevertheless, this first-generation robot is continually being modified with more flexibility and maneuverability through the development of robots like the FLEX Robotic System and more recently the Da Vinci Single Port System (SP). In this review, we will discuss the historic developments of robots for transoral applications, present the current approved robotic systems, and highlight the upcoming robots for transoral robotic surgery (TORS). Finally, we will also propose an ideal TORS surgical robot by highlighting the engineering technologies to accomplish these challenges.
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Successful oral desensitization in children with cow's milk anaphylaxis: Clinical and laboratory evaluation up to nine-years follow-up
Publication date: Available online 25 October 2018
Source: Allergologia et Immunopathologia
Author(s): M. Alves-Correia, Â. Gaspar, L.-M. Borrego, J. Azevedo, C. Martins, M. Morais-Almeida
Abstract
Introduction
Cow's milk protein allergy (CMPA) is the most common food allergy in children worldwide. Some children have severe and persistent CMPA, with near-fatal reactions after exposure to trace amounts of cow's milk-proteins (CMP). Strict avoidance diet is difficult, negatively affects quality of life and represents a conservative approach. Therefore, different therapeutic strategies are necessary.
Objective
We aimed to assess long-term efficacy and safety of oral immunotherapy (OIT) in children with severe and long-lasting IgE-mediated CMPA.
Materials and methods
The authors present four case reports of patients with CMPA who underwent CMP-OIT, that have been under long-term follow-up up to nine years. We provide information about the clinical and laboratory evaluation. Skin prick tests (SPT), specific IgE and IgG4 were performed before, during, and after OIT. Immune profile after OIT was assessed by flow cytometry (lymphocyte subsets, regulatory T and B cells).
Results
The success rate was 100%, and all patients currently have a free diet with minimal diary ingestion of 200 mL CMP or equivalent. Specific IgE levels and SPT to CMP have progressively decreased, and specific IgG4 levels have increased. CD4+CD25+CD127−/dim regulatory T cells were increased after OIT.
Conclusions
OIT ensured a clinical tolerance state after up to nine years, confirmed by both clinical and immune profile, allowing a diet without restrictions, with high satisfaction from patients and caregivers. We emphasize that OIT should be performed only by allergy experts in the hospital setting, and that only motivated families should be enrolled, since it is essential to ensure CMP daily intake at home.
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Basics of Iterative Reconstruction Methods in Computed Tomography: A Vendor-independent Overview
Publication date: Available online 26 October 2018
Source: European Journal of Radiology
Author(s): Wolfram Stiller
Abstract
Over the past two decades, technical innovations in computed tomography (CT) have constantly extended its spectrum of clinical applications and made new radiodiagnostic applications accessible. At the same time, concerns have arisen with respect to the radiation exposure to the patients caused by CT examinations. In order to address this issue, different strategies for radiation dose reduction in CT have been introduced, spanning technical approaches as well as specific examination techniques applied in clinical practice, such as reduced-dose CT. Developed technical approaches for reducing radiation dose in CT by improvements of CT scanner hardware and acquisition mechanisms, however, have not been sufficient to address the degradation of image quality caused by increasing noise and susceptibility to artifacts inherent to reduced-dose CT acquisitions. Recent advances in computing power have enabled the development of software-based methods for iterative image reconstruction (IR) in CT enabling simultaneous reduction of image noise and improvement of overall image quality. Thereby, IR allows for dose reduction by reconstruction of low-noise image data from intrinsically noisy reduced-dose CT acquisitions, thereby preserving diagnostic image quality equivalent to current clinical standards.
This review provides an overview of the underlying basic principles of iterative image reconstruction methods currently available for and applied in CT imaging, independent of vendor-specific details regarding algorithms and implementations. It discusses potential strengths and weaknesses of these CT image reconstruction techniques in view of their application in clinical routine, especially in view of the potential of IR for noise and artifact reduction as well as for radiation dose reduction. Furthermore, the effect of statistical (hybrid) and model-based IR methods on image quality are exemplarily illustrated in comparison to filtered back projection (FBP) traditionally used for image reconstruction in CT.
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The existence of early stage oral mucosal melanoma: A 10-year retrospective analysis of 170 patients in a single institute
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Yunteng Wu, Lizheng Wang, Xuhui Ma, Wei Guo, Guoxin Ren
Abstract
Background
Oral mucosal melanoma (OMM) is an aggressive tumor with an extremely low incidence, and the current TNM Staging System has classified all OMMs as high stage. However, controversy remains regarding the existence of early stage OMMs.
Patients and methods
The clinical and pathological features, treatments and outcomes of 170 OMM patients treated in a single institution from January 2007 to July 2017 were retrospectively analyzed. Multivariate analysis was performed to identify significant prognostic factors for overall survival (OS).
Results
Multivariate analysis identified positive cervical lymph nodes (p < 0.0001), nodular OMMs (p < 0.0001), ulceration (p = 0.002), and level III or level IV invasion (p < 0.0001) as independent poor prognostic factors for OS. Nodular OMM patients with a tumor size ≤1 cm had a better outcome than those with a tumor size >1 cm (p < 0.0001). Twenty-two patients with superficial invasion had a favorable survival without the need of adjuvant therapy (postoperative chemotherapy or radiotherapy), and the current TNM Staging System was not suitable for those patients. Patients with deep invasion were more likely to suffer from recurrence and distant metastasis.
Conclusions
Tumor size ≤1 cm and OMM in situ, although extremely rare, do exist. It is advisable for AJCC to consider tumor size ≤1 cm and OMM in situ as the early stage of OMM when updating the new Oral Melanoma Staging System.
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Lymphatic Interventions for Isolated, Iatrogenic Chylous Ascites: A Multi-Institution Experience
Publication date: Available online 25 October 2018
Source: European Journal of Radiology
Author(s): Bill S. Majdalany, Mamdouh Khayat, Trevor Downing, Timothy P. Killoran, Ghassan El-Haddad, Minhaj S. Khaja, Wael A. Saad
Abstract
Objectives
Lymphangiography and thoracic duct embolization are established treatments for post-surgical chylothorax. There is only limited experience in their application to treat post-surgical chylous ascites. A multi-center analysis of the technical and clinical success of lymphangiography and lymphatic interventions in the treatment of isolated, iatrogenic chylous ascites is reported.
Methods
21 patients (14 males; 7 females) aged 3 - 84 years (mean 56.9 years; median 63 years) were treated for isolated, iatrogenic chylous ascites between August 2012 and January 2018. Initial referrals occurred between 5 – 330 days (mean 72.7 days; median 40 days) after failing conservative therapy. Daily leak volumes ranged from 100 – 3000 mL. Lymphangiographic findings, techniques, clinical outcomes, and complications were recorded.
Results
21 patients underwent 29 procedures. Seven patients underwent multiple procedures after chylous ascites persisted. Bilateral nodal lymphangiography (NL) was technically successful in all (100%) patients. Lymphangiography identified a leak in 14/21 (67%) patients and in 16/29 procedures (55%). Ten procedures (34%) consisted of NL alone and one (3.4%) consisted of NL combined with lymphatic disruption (LD). Six procedures (21%) consisted of nodal glue embolization (NGE) while nine procedures (31%) were catheter-based lymphatic embolization. Three separate patients underwent three procedures (10%) consisting of balloon-occluded retrograde abdominal lymphatic embolization. Clinical success, defined as no additional drainage of chylous ascites at 15 days, was ultimately achieved in 18/21 patients (86%). There were no major or minor complications.
Conclusion
Lymphatic interventions can successfully treat post-surgical chylous ascites. Given the low risk of procedural complication, early intervention is encouraged.
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Successful oral desensitization in children with cow's milk anaphylaxis: Clinical and laboratory evaluation up to nine-years follow-up
Publication date: Available online 25 October 2018
Source: Allergologia et Immunopathologia
Author(s): M. Alves-Correia, Â. Gaspar, L.-M. Borrego, J. Azevedo, C. Martins, M. Morais-Almeida
Abstract
Introduction
Cow's milk protein allergy (CMPA) is the most common food allergy in children worldwide. Some children have severe and persistent CMPA, with near-fatal reactions after exposure to trace amounts of cow's milk-proteins (CMP). Strict avoidance diet is difficult, negatively affects quality of life and represents a conservative approach. Therefore, different therapeutic strategies are necessary.
Objective
We aimed to assess long-term efficacy and safety of oral immunotherapy (OIT) in children with severe and long-lasting IgE-mediated CMPA.
Materials and methods
The authors present four case reports of patients with CMPA who underwent CMP-OIT, that have been under long-term follow-up up to nine years. We provide information about the clinical and laboratory evaluation. Skin prick tests (SPT), specific IgE and IgG4 were performed before, during, and after OIT. Immune profile after OIT was assessed by flow cytometry (lymphocyte subsets, regulatory T and B cells).
Results
The success rate was 100%, and all patients currently have a free diet with minimal diary ingestion of 200 mL CMP or equivalent. Specific IgE levels and SPT to CMP have progressively decreased, and specific IgG4 levels have increased. CD4+CD25+CD127−/dim regulatory T cells were increased after OIT.
Conclusions
OIT ensured a clinical tolerance state after up to nine years, confirmed by both clinical and immune profile, allowing a diet without restrictions, with high satisfaction from patients and caregivers. We emphasize that OIT should be performed only by allergy experts in the hospital setting, and that only motivated families should be enrolled, since it is essential to ensure CMP daily intake at home.
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Basics of Iterative Reconstruction Methods in Computed Tomography: A Vendor-independent Overview
Publication date: Available online 26 October 2018
Source: European Journal of Radiology
Author(s): Wolfram Stiller
Abstract
Over the past two decades, technical innovations in computed tomography (CT) have constantly extended its spectrum of clinical applications and made new radiodiagnostic applications accessible. At the same time, concerns have arisen with respect to the radiation exposure to the patients caused by CT examinations. In order to address this issue, different strategies for radiation dose reduction in CT have been introduced, spanning technical approaches as well as specific examination techniques applied in clinical practice, such as reduced-dose CT. Developed technical approaches for reducing radiation dose in CT by improvements of CT scanner hardware and acquisition mechanisms, however, have not been sufficient to address the degradation of image quality caused by increasing noise and susceptibility to artifacts inherent to reduced-dose CT acquisitions. Recent advances in computing power have enabled the development of software-based methods for iterative image reconstruction (IR) in CT enabling simultaneous reduction of image noise and improvement of overall image quality. Thereby, IR allows for dose reduction by reconstruction of low-noise image data from intrinsically noisy reduced-dose CT acquisitions, thereby preserving diagnostic image quality equivalent to current clinical standards.
This review provides an overview of the underlying basic principles of iterative image reconstruction methods currently available for and applied in CT imaging, independent of vendor-specific details regarding algorithms and implementations. It discusses potential strengths and weaknesses of these CT image reconstruction techniques in view of their application in clinical routine, especially in view of the potential of IR for noise and artifact reduction as well as for radiation dose reduction. Furthermore, the effect of statistical (hybrid) and model-based IR methods on image quality are exemplarily illustrated in comparison to filtered back projection (FBP) traditionally used for image reconstruction in CT.
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Lymphatic Interventions for Isolated, Iatrogenic Chylous Ascites: A Multi-Institution Experience
Publication date: Available online 25 October 2018
Source: European Journal of Radiology
Author(s): Bill S. Majdalany, Mamdouh Khayat, Trevor Downing, Timothy P. Killoran, Ghassan El-Haddad, Minhaj S. Khaja, Wael A. Saad
Abstract
Objectives
Lymphangiography and thoracic duct embolization are established treatments for post-surgical chylothorax. There is only limited experience in their application to treat post-surgical chylous ascites. A multi-center analysis of the technical and clinical success of lymphangiography and lymphatic interventions in the treatment of isolated, iatrogenic chylous ascites is reported.
Methods
21 patients (14 males; 7 females) aged 3 - 84 years (mean 56.9 years; median 63 years) were treated for isolated, iatrogenic chylous ascites between August 2012 and January 2018. Initial referrals occurred between 5 – 330 days (mean 72.7 days; median 40 days) after failing conservative therapy. Daily leak volumes ranged from 100 – 3000 mL. Lymphangiographic findings, techniques, clinical outcomes, and complications were recorded.
Results
21 patients underwent 29 procedures. Seven patients underwent multiple procedures after chylous ascites persisted. Bilateral nodal lymphangiography (NL) was technically successful in all (100%) patients. Lymphangiography identified a leak in 14/21 (67%) patients and in 16/29 procedures (55%). Ten procedures (34%) consisted of NL alone and one (3.4%) consisted of NL combined with lymphatic disruption (LD). Six procedures (21%) consisted of nodal glue embolization (NGE) while nine procedures (31%) were catheter-based lymphatic embolization. Three separate patients underwent three procedures (10%) consisting of balloon-occluded retrograde abdominal lymphatic embolization. Clinical success, defined as no additional drainage of chylous ascites at 15 days, was ultimately achieved in 18/21 patients (86%). There were no major or minor complications.
Conclusion
Lymphatic interventions can successfully treat post-surgical chylous ascites. Given the low risk of procedural complication, early intervention is encouraged.
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Combined Treatment with Zinc Aspartate and Intravenous Immunoglobulins (IVIGs) Ameliorates Experimental Autoimmune Encephalomyelitis (EAE).
Authors: Straubel D, Thielitz A, Reinhold A, Grüngreiff K, Reinhold D Abstract Intravenous immunoglobulins (IVIGs) are widely used in replacement therapy of primary and secondary immunodeficiency disorders and in approved autoimmune indications. In addition, IVIG application is used off-label for treatment of other autoimmune diseases, e.g., multiple sclerosis (MS), an inflammatory autoimmune disorder with a clear T cell-mediated immune pathogenesis. The trace element zinc is shown to play a regulatory role in the maintenance of immune functions. Changes of zinc homeostasis affect both the innate and the adaptive immune system. On one hand, therapeutic zinc supplementation can normalize impaired immune functions due to zinc deficiency. On the other hand, therapeutic zinc supplemen...
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Update on Vertigo in Autoimmune Disorders, from Diagnosis to Treatment.
Authors: Girasoli L, Cazzador D, Padoan R, Nardello E, Felicetti M, Zanoletti E, Schiavon F, Bovo R Abstract The prevalence of autoimmune diseases has been increasing over the last 20 years. The clinical presentation of this large and heterogeneous group of disorders depends on whether the involvement is organ-specific or non-organ-specific. Dizziness, vertigo, and disequilibrium are common symptoms reported by patients with vestibulocochlear involvement. The association of vertigo and autoimmune diseases has been largely documented, suggesting that autoimmune disorders could be overrepresented in patients with vertigo in comparison to the general population. The aim of this review is to present the recent literature findings in the field of autoimmune-mediated diseases with cochle...
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Potential Antinociceptive Effects of Chinese Propolis and Identification on Its Active Compounds.
Authors: Sun L, Liao L, Wang B Abstract Propolis is an important bee product which has been applied to the treatment of several diseases. The aim of this study was to understand the material basis of Chinese propolis on pain relief; different Chinese propolis fractions (40W, 40E, 70E, and 95E raw propolis extracted followed by 40%, 70%, or 95% ethanol) were prepared, and their antinociceptive effects were evaluated. By analyzing using UPLC-Q-TOF-MS, we showed that 40W was rich in phenolic acids, like caffeic acid, while 40E, 70E, and 95E have relatively high levels in flavonoids, like galangin, pinocembrin, and chrysin. Notably, chrysin amounts in 70E and 95E are much higher than those in 40E fraction. Antinociceptive effects by these propolis fractions were evaluated in mice using...
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Induction of Autonomous Memory Alveolar Macrophages Requires T Cell Help and Is Critical to Trained Immunity
Publication date: Available online 25 October 2018Source: CellAuthor(s): Yushi Yao, Mangalakumari Jeyanathan, Siamak Haddadi, Nicole G. Barra, Maryam Vaseghi-Shanjani, Daniela Damjanovic, Rocky Lai, Sam Afkhami, Yonghong Chen, Anna Dvorkin-Gheva, Clinton S. Robbins, Jonathan D. Schertzer, Zhou XingSummaryInnate immune memory is an emerging area of research. However, innate immune memory at major mucosal sites remains poorly understood. Here, we show that respiratory viral infection induces long-lasting memory alveolar macrophages (AMs). Memory AMs are programed to express high MHC II, a defense-ready gene signature, and increased glycolytic metabolism, and produce, upon re-stimulation, neutrophil chemokines. Using a multitude of approaches, we reveal that the priming, but not maintenance, ...
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Considerations on the ‘corseting’ or ‘strangling’ technique to treat large venous malformations
Publication date: Available online 25 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): Margherita Dessy, Federica Giovanditto, Marco Cucurullo, Ambra Dionisio, Carlotta Liberale, Giacomo Colletti
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Apical U-shape splitting technique for undercut areas of the anterior alveolar ridge: a prospective non-randomized controlled study
Publication date: Available online 25 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): Q. Wu, B. Yang, S. Gao, P. Gong, L. Xiang, Y. Man, Y. Qu
Abstract
The aim of this study was to investigate a novel apical U-shape splitting technique for horizontal bone augmentation in undercut areas and to compare its efficacy with that of guided bone regeneration (GBR). This was a prospective non-randomized controlled clinical trial. A total of 36 patients, who presented with a labial undercut that was not able to house a normally inclined implant, underwent the new technique or GBR. Radiographic and clinical data were obtained preoperatively, immediately after surgery, and 12 months after surgery. Pairwise comparisons of changes in ridge width gain, marginal bone loss, and pink aesthetic score were performed; correlations with pristine ridge morphology were investigated. The results showed similar marginal bone loss in the two groups. The overall ridge width gains in the new technique group (2.56 ± 1.92 mm) and GBR group (0.73 ± 1.21 mm) differed significantly (P < 0.05). The pink aesthetic score was higher for the new technique group (11.75 ± 1.22) than for the GBR group (9.25 ± 1.86) (P < 0.01). The morphology of the concavity had different impacts on regeneration in the two groups. The apical U-shape splitting technique, as a safe and effective alternative to GBR, provided a significant increase in bone volume gain where labial fenestration was inevitable during implant placement.
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‘Corseting’ and ‘strangling’—two techniques sharing similar concepts to treat large venous malformations in the head and neck region
Publication date: Available online 25 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): S.C. Nair, J.P. Chawla, S.S. Shroff, B. Kumar, A. Shah
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Update on Vertigo in Autoimmune Disorders, from Diagnosis to Treatment.
Authors: Girasoli L, Cazzador D, Padoan R, Nardello E, Felicetti M, Zanoletti E, Schiavon F, Bovo R Abstract The prevalence of autoimmune diseases has been increasing over the last 20 years. The clinical presentation of this large and heterogeneous group of disorders depends on whether the involvement is organ-specific or non-organ-specific. Dizziness, vertigo, and disequilibrium are common symptoms reported by patients with vestibulocochlear involvement. The association of vertigo and autoimmune diseases has been largely documented, suggesting that autoimmune disorders could be overrepresented in patients with vertigo in comparison to the general population. The aim of this review is to present the recent literature findings in the field of autoimmune-mediated diseases with cochle...
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2SjbYoG
Potential Antinociceptive Effects of Chinese Propolis and Identification on Its Active Compounds.
Authors: Sun L, Liao L, Wang B Abstract Propolis is an important bee product which has been applied to the treatment of several diseases. The aim of this study was to understand the material basis of Chinese propolis on pain relief; different Chinese propolis fractions (40W, 40E, 70E, and 95E raw propolis extracted followed by 40%, 70%, or 95% ethanol) were prepared, and their antinociceptive effects were evaluated. By analyzing using UPLC-Q-TOF-MS, we showed that 40W was rich in phenolic acids, like caffeic acid, while 40E, 70E, and 95E have relatively high levels in flavonoids, like galangin, pinocembrin, and chrysin. Notably, chrysin amounts in 70E and 95E are much higher than those in 40E fraction. Antinociceptive effects by these propolis fractions were evaluated in mice using...
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Induction of Autonomous Memory Alveolar Macrophages Requires T Cell Help and Is Critical to Trained Immunity
Publication date: Available online 25 October 2018Source: CellAuthor(s): Yushi Yao, Mangalakumari Jeyanathan, Siamak Haddadi, Nicole G. Barra, Maryam Vaseghi-Shanjani, Daniela Damjanovic, Rocky Lai, Sam Afkhami, Yonghong Chen, Anna Dvorkin-Gheva, Clinton S. Robbins, Jonathan D. Schertzer, Zhou XingSummaryInnate immune memory is an emerging area of research. However, innate immune memory at major mucosal sites remains poorly understood. Here, we show that respiratory viral infection induces long-lasting memory alveolar macrophages (AMs). Memory AMs are programed to express high MHC II, a defense-ready gene signature, and increased glycolytic metabolism, and produce, upon re-stimulation, neutrophil chemokines. Using a multitude of approaches, we reveal that the priming, but not maintenance, ...
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Considerations on the ‘corseting’ or ‘strangling’ technique to treat large venous malformations
Publication date: Available online 25 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): Margherita Dessy, Federica Giovanditto, Marco Cucurullo, Ambra Dionisio, Carlotta Liberale, Giacomo Colletti
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PSamke
‘Corseting’ and ‘strangling’—two techniques sharing similar concepts to treat large venous malformations in the head and neck region
Publication date: Available online 25 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): S.C. Nair, J.P. Chawla, S.S. Shroff, B. Kumar, A. Shah
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The transfer of fallout plutonium from paddy soil to rice: A field study in Japan
Publication date: January 2019
Source: Journal of Environmental Radioactivity, Volume 196
Author(s): Youyi Ni, Zhongtang Wang, Jian Zheng, Keiko Tagami, Qiuju Guo, Shigeo Uchida, Hirofumi Tsukada
Abstract
Reported transfer factor (TF) values of Pu from paddy soil to rice are rather scarce, despite the radiotoxicity of Pu and the irreplaceable role of rice in Asian peoples' diets. Here, we conducted a field study to investigate the transfer of global fallout Pu from paddy soil to rice grain (hulled rice) in Japan. The 240Pu/239Pu atomic ratios in two rice grain samples out of 16 samples were determined and the ratios corresponded well with the global fallout value. The soil-to-rice TFPu in 12 Japanese prefectures ranged from 4.5 × 10−6 to 1.2 × 10−4 with a geometric mean of 3.3 × 10−5. The TFs of rice obtained in this study were compatible to the TFs for the broad heading "cereals" compiled in the IAEA Technical Report Series No. 472. Weak correlations were found between the TF and the investigated soil characteristics such as soil pH and loss on ignition. Regarding the TFs for cerium (Ce) and thorium (Th) which are commonly considered as Pu analogues, we observed no significant correlations between the log(TFPu) and log(TFCe) or log(TFPu) and log(TFTh). On the other hand, interestingly, a significantly positive correlation (r = 0.795, p < 0.001) was observed between log(TFPu) and log(TFU). In view of the observed similarity of TF values for U and Pu from soil to rice, we thought that using the easy-to-measure TFU to estimate TFPu from soil to rice might be suggested although the mechanism was unclear.
Graphical abstract
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Meteoric 10Be in aerosol filters in the city of Seville
Publication date: January 2019
Source: Journal of Environmental Radioactivity, Volume 196
Author(s): S. Padilla, J.M. López-Gutiérrez, G. Manjón, R. García-Tenorio, J.A. Galván, M. García-León
Abstract
Cosmogenic radionuclides in the one-million-year half-life range, like 10Be, find application fields in several Sciences. They are powerful tools in Geology and Geochronology, as they are very important tracers on the Earth, being utilized as chronometer. Meteoric 10Be (T1/2 = 1.39 × 106 y) associated to aerosols can be used as a tracer of atmospheric processes and specifically as indicators of the cosmogenic interactions in lower Stratosphere, upper Troposphere, the air exchange between both and deposition processes on the Earth surface. The applications of 10Be are even more relevant when combined with other radionuclides such as 26Al. In order to provide new data about concentration 10Be in this type of samples, the first atmospheric air filters in Spain have been analysed. Values around 104 at/m3 (atoms per cubic meter of air) for 10Be have been obtained. Due to the location and the features of the sampling site (urban area, at sea level and mid latitude), a new radiochemical procedure was designed and developed in our laboratory for the Accelerator Mass Spectrometry (AMS) measurement of 10Be in this kind of samples. The samples were measured in SARA, the 1 MV AMS system at Centro Nacional de Aceleradores (CNA).
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Differentiating acute food protein-induced enterocolitis syndrome from its mimics: a comparison of clinical features and routine laboratory biomarkers
Publication date: Available online 25 October 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Eric Lee, Elizabeth H. Barnes, Sam Mehr, Dianne E. Campbell
Abstract
Background
Food protein-induced enterocolitis syndrome (FPIES) is frequently misdiagnosed and subject to diagnostic delay. Profuse vomiting, the cardinal feature of acute FPIES, may occur in more common paediatric disorders such as gastroenteritis and sepsis.
Objectives
We sought to determine differentiating features at acute presentation between FPIES, gastroenteritis and sepsis in young children presenting to an emergency department (ED) with profuse vomiting.
Methods
We conducted a retrospective case-control study of children aged 6 months to 4 years with a diagnosis of acute FPIES who had presented to ED and compared the clinical features, vital signs and routine laboratory studies of this cohort to similarly aged children presenting to ED with vomiting diagnosed with bacterial/viral gastroenteritis or bacterial sepsis.
Results
181 acute FPIES ED presentations were compared to 55 gastroenteritis and 36 bacterial sepsis ED presentations. Children with FPIES were more likely to present with lethargy, floppiness and pallor. Compared to FPIES, children with sepsis were likely to present with fever, tachycardia, tachypnea and diarrhoea, whilst those with gastroenteritis were likely to present with fever, diarrhoea and blood in stools. Normal CRP, leucocytosis, lymphocytosis, thrombocytosis, low MPV and an elevated albumin/globulin ratio were more commonly seen in FPIES than sepsis or gastroenteritis. No other clinical or laboratory markers examined reliably distinguished between the three disease groups.
Conclusions
In the young vomiting child, lethargy, floppiness, pallor without fever and normal CRP should alert clinicians to a possible diagnosis of FPIES. In contrast a highly elevated CRP is not a feature of FPIES, and in such cases an alternative diagnosis must be considered.
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Application of synchrotron radiation and other techniques in analysis of radioactive microparticles emitted from the Fukushima Daiichi Nuclear Power Plant accident-A review
Publication date: January 2019
Source: Journal of Environmental Radioactivity, Volume 196
Author(s): Fei Chen, Jun Hu, Yoshio Takahashi, Masatoshi Yamada, M. Safiur Rahman, Guosheng Yang
Abstract
During the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, large amounts of radioactive materials were released into the environment. Among them, a large proportion of the radionuclides, such as Cs, entered into the environment as radioactive microparticles (RMs). In recent years, the characterization of RMs based on synchrotron radiation (SR) techniques has been reported, since their physical and chemical properties played an important role in evaluating the chemical reactions and physical changes that occurred when the nuclear material meltdowns took place. In this review, we summarize separation and measurement technologies used in studies of RMs, and we emphasize the application of SR-based techniques in the characterization of RMs. We report research progress, including information for elemental composition, isotopic distribution, radioactivity, and formation processes. Also, we compare the RMs from the FDNPP and the Chernobyl Nuclear Power Plant accidents. The SR-based technologies offer great improvement in the resolution and precision compared to conventional technologies, such as X-ray fluorescence and X-ray diffraction.
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The transfer of fallout plutonium from paddy soil to rice: A field study in Japan
Publication date: January 2019
Source: Journal of Environmental Radioactivity, Volume 196
Author(s): Youyi Ni, Zhongtang Wang, Jian Zheng, Keiko Tagami, Qiuju Guo, Shigeo Uchida, Hirofumi Tsukada
Abstract
Reported transfer factor (TF) values of Pu from paddy soil to rice are rather scarce, despite the radiotoxicity of Pu and the irreplaceable role of rice in Asian peoples' diets. Here, we conducted a field study to investigate the transfer of global fallout Pu from paddy soil to rice grain (hulled rice) in Japan. The 240Pu/239Pu atomic ratios in two rice grain samples out of 16 samples were determined and the ratios corresponded well with the global fallout value. The soil-to-rice TFPu in 12 Japanese prefectures ranged from 4.5 × 10−6 to 1.2 × 10−4 with a geometric mean of 3.3 × 10−5. The TFs of rice obtained in this study were compatible to the TFs for the broad heading "cereals" compiled in the IAEA Technical Report Series No. 472. Weak correlations were found between the TF and the investigated soil characteristics such as soil pH and loss on ignition. Regarding the TFs for cerium (Ce) and thorium (Th) which are commonly considered as Pu analogues, we observed no significant correlations between the log(TFPu) and log(TFCe) or log(TFPu) and log(TFTh). On the other hand, interestingly, a significantly positive correlation (r = 0.795, p < 0.001) was observed between log(TFPu) and log(TFU). In view of the observed similarity of TF values for U and Pu from soil to rice, we thought that using the easy-to-measure TFU to estimate TFPu from soil to rice might be suggested although the mechanism was unclear.
Graphical abstract
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Meteoric 10Be in aerosol filters in the city of Seville
Publication date: January 2019
Source: Journal of Environmental Radioactivity, Volume 196
Author(s): S. Padilla, J.M. López-Gutiérrez, G. Manjón, R. García-Tenorio, J.A. Galván, M. García-León
Abstract
Cosmogenic radionuclides in the one-million-year half-life range, like 10Be, find application fields in several Sciences. They are powerful tools in Geology and Geochronology, as they are very important tracers on the Earth, being utilized as chronometer. Meteoric 10Be (T1/2 = 1.39 × 106 y) associated to aerosols can be used as a tracer of atmospheric processes and specifically as indicators of the cosmogenic interactions in lower Stratosphere, upper Troposphere, the air exchange between both and deposition processes on the Earth surface. The applications of 10Be are even more relevant when combined with other radionuclides such as 26Al. In order to provide new data about concentration 10Be in this type of samples, the first atmospheric air filters in Spain have been analysed. Values around 104 at/m3 (atoms per cubic meter of air) for 10Be have been obtained. Due to the location and the features of the sampling site (urban area, at sea level and mid latitude), a new radiochemical procedure was designed and developed in our laboratory for the Accelerator Mass Spectrometry (AMS) measurement of 10Be in this kind of samples. The samples were measured in SARA, the 1 MV AMS system at Centro Nacional de Aceleradores (CNA).
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