http://ift.tt/2imnNHX
Πέμπτη 22 Δεκεμβρίου 2016
The impaired and/or disabled anesthesiologist.
http://ift.tt/2imnNHX
Effect of submucosal dexamethasone injection on postoperative pain, oedema, and trismus following mandibular third molar surgery: a prospective, randomized, double-blind clinical trial
Publication date: Available online 21 December 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): I.M. Mojsa, R. Pokrowiecki, K. Lipczynski, D. Czerwonka, K. Szczeklik, M. Zaleska
The aim of this study was to investigate the effect of the submucosal injection of 1ml dexamethasone (4mg/ml) on pain, swelling, and trismus following the extraction of retained lower third molars. Ninety patients (mean age 23.5 years) were split randomly into three equal study groups (30 patients in each): the 'before' group received dexamethasone 15min before surgery and placebo 15min after surgery; the 'after' group received placebo 15min before surgery and dexamethasone 15min after surgery; the 'placebo' group received placebo 15min before surgery and placebo 15min after surgery. Postoperative pain was recorded by the patients using a visual analogue scale, numerical rating scale, and the McGill Pain Questionnaire at 1, 2, 4, 6, 8, 12, and 24h after surgery. The patients also recorded the total number of analgesic doses consumed during the 24h after the procedure. Swelling (determined using linear measurements of the face) and trismus (determined through measurement of maximum mouth opening) were assessed at 48h, 72h, and 7 days following surgery. Better control of pain, swelling, and trismus was demonstrated for dexamethasone in comparison to placebo. Postoperative dexamethasone provided better pain control than preoperative dexamethasone. There was no difference in total rescue analgesic intake between the preoperative and postoperative dexamethasone groups.
http://ift.tt/2hOp8KF
Effectiveness of the European Chromium VI Directive for cement implementation on occupational allergic contact dermatitis occurrence: Assessment in France and UK
Hexavalent chromium is the main sensitizer in wet cement and a common cause of occupational allergic contact dermatitis (OACD), especially among workers in the construction industry.1,2 The European Chromium VI directive3 transposed into national regulations in France and UK respectively on May and January 2005, prohibits selling or using of hydrated cement with more than 0.0002% of chromium. This was achieved through the addition of ferrous sulphate to the dry product, allowing to reduce chromium VI to chromium III which is less sensitizing.
This article is protected by copyright. All rights reserved.
http://ift.tt/2imjlcj
Mast cells are permissive for rhinovirus replication: potential implications for asthma exacerbations
Abstract
Background
Human rhinoviruses (HRVs) are a major trigger of asthma exacerbations, with the bronchial epithelium being the major site of HRV infection and replication. Mast cells (MCs) play a key role in asthma where their numbers are increased in the bronchial epithelium with increasing disease severity.
Objective
In view of the emerging role of MCs in innate immunity and increased localisation to the asthmatic bronchial epithelium, we investigated whether HRV infection of MCs generated innate immune responses which were protective against infection.
Methods
The LAD2 MC line or primary human cord blood-derived MCs (CBMCs) were infected with HRV or UV-irradiated HRV at increasing multiplicities of infection (MOI) without or with IFN-β or IFN-λ. After 24 h, innate immune responses were assessed by RT-qPCR and IFN protein release by ELISA. Viral replication was determined by RT-qPCR and virion release by TCID50 assay.
Results
HRV infection of LAD2 MCs induced expression of IFN-β, IFN-λ and IFN-stimulated genes. However, LAD2 MCs were permissive for HRV replication and release of infectious HRV particles. Similar findings were observed with CBMCs. Neutralisation of the type I IFN receptor had minimal effects on viral shedding suggesting that endogenous type I IFN signalling offered limited protection against HRV. However, augmentation of these responses by exogenous IFN-β, but not IFN-λ, protected MCs against HRV infection.
Conclusion and clinical relevance
MCs are permissive for the replication and release of HRV which is prevented by exogenous IFN-β treatment. Taken together these findings suggest a novel mechanism whereby MCs may contribute to HRV-induced asthma exacerbations.
This article is protected by copyright. All rights reserved.
http://ift.tt/2i165x2
Implementation of next generation sequencing into pediatric hematology-oncology practice: moving beyond actionable alterations
Background: Molecular characterization has the potential to advance the management of pediatric cancer and high-risk hematologic disease. The clinical integration of genome sequencing into standard clinical practice has been limited and the potential utility of genome sequencing to identify clinically impactful information beyond targetable alterations has been underestimated. Methods: The Precision in Pediatric Sequencing (PIPseq) Program at Columbia University Medical Center instituted prospective clinical next generation sequencing (NGS) for pediatric cancer and hematologic disorders at risk for treatment failure. We performed cancer whole exome sequencing (WES) of patient-matched tumor-normal samples and RNA sequencing (RNA-seq) of tumor to identify sequence variants, fusion transcripts, relative gene expression, and copy number variation (CNV). A directed cancer gene panel assay was used when sample adequacy was a concern. Constitutional WES of patients and parents was performed when a constitutionally encoded disease was suspected. Results were initially reviewed by a molecular pathologist and subsequently by a multi-disciplinary molecular tumor board. Clinical reports were issued to the ordering physician and posted to the patient's electronic medical record. Results: NGS was performed on tumor and/or normal tissue from 101 high-risk pediatric patients. Potentially actionable alterations were identified in 38% of patients, of which only 16% subsequently received matched therapy. In an additional 38% of patients, the genomic data provided clinically relevant information of diagnostic, prognostic, or pharmacogenomic significance. RNA-seq was clinically impactful in 37/65 patients (57%) providing diagnostic and/or prognostic information for 17 patients (26%) and identified therapeutic targets in 15 patients (23%). Known or likely pathogenic germline alterations were discovered in 18/90 patients (20%) with 14% having germline alternations in cancer predisposition genes. American College of Medical Genetics (ACMG) secondary findings were identified in six patients. Conclusions: Our results demonstrate the feasibility of incorporating clinical NGS into pediatric hematology-oncology practice. Beyond the identification of actionable alterations, the ability to avoid ineffective/inappropriate therapies, make a definitive diagnosis, and identify pharmacogenomic modifiers is clinically impactful. Taking a more inclusive view of potential clinical utility, 66% of cases tested through our program had clinically impactful findings and samples interrogated with both WES and RNA-seq resulted in data that impacted clinical decisions in 75% of cases.
http://ift.tt/2hO67YV
Comparative safety and effectiveness of serotonin receptor antagonists in patients undergoing chemotherapy: a systematic review and network meta-analysis
Background: Although serotonin (5-HT 3 ) receptor antagonists are effective in reducing nausea and vomiting, they may be associated with increased cardiac risk. Our objective was to examine the comparative safety and effectiveness of 5-HT 3 receptor antagonists (e.g., dolasetron, granisetron, ondansetron, palonosetron, tropisetron) alone or combined with steroids for patients undergoing chemotherapy. Methods: We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception until December 2015 for studies comparing 5-HT 3 receptor antagonists with each other or placebo in chemotherapy patients. The search results were screened, data were abstracted, and risk of bias was appraised by pairs of reviewers, independently. Random-effects meta-analyses and network meta-analyses (NMAs) were conducted. Results: After screening 9226 citations and 970 full-text articles, we included 299 studies (n = 58,412 patients). None of the included studies reported harms for active treatment versus placebo. For NMAs on the risk of arrhythmia (primary outcome; three randomized controlled trials [RCTs], 627 adults) and mortality (secondary outcome; eight RCTs, 4823 adults), no statistically significant differences were observed between agents. A NMA on the risk of QTc prolongation showed a significantly greater risk for dolasetron + dexamethasone versus ondansetron + dexamethasone (four RCTs, 3358 children and adults, odds ratio 2.94, 95% confidence interval 2.13–4.17).For NMAs on the number of patients without nausea (44 RCTs, 11,664 adults, 12 treatments), number of patients without vomiting (63 RCTs, 15,460 adults, 12 treatments), and number of patients without chemotherapy-induced nausea or vomiting (27 RCTs, 10,924 adults, nine treatments), all agents were significantly superior to placebo. For a NMA on severe vomiting (10 RCTs, 917 adults), all treatments decreased the risk, but only ondansetron and ramosetron were significantly superior to placebo. According to a rank-heat plot with the surface under the cumulative ranking curve results, palonosetron + steroid was ranked the safest and most effective agent overall. Conclusions: Most 5-HT 3 receptor antagonists were relatively safe when compared with each other, yet none of the studies compared active treatment with placebo for harms. However, dolasetron + dexamethasone may prolong the QTc compared to ondansetron + dexamethasone. All agents were effective for reducing risk of nausea, vomiting, and chemotherapy-induced nausea or vomiting.Trial registrationThis study was registered at PROSPERO: (CRD42013003564).
http://ift.tt/2ii46VM
Implementation of next generation sequencing into pediatric hematology-oncology practice: moving beyond actionable alterations
Background: Molecular characterization has the potential to advance the management of pediatric cancer and high-risk hematologic disease. The clinical integration of genome sequencing into standard clinical practice has been limited and the potential utility of genome sequencing to identify clinically impactful information beyond targetable alterations has been underestimated. Methods: The Precision in Pediatric Sequencing (PIPseq) Program at Columbia University Medical Center instituted prospective clinical next generation sequencing (NGS) for pediatric cancer and hematologic disorders at risk for treatment failure. We performed cancer whole exome sequencing (WES) of patient-matched tumor-normal samples and RNA sequencing (RNA-seq) of tumor to identify sequence variants, fusion transcripts, relative gene expression, and copy number variation (CNV). A directed cancer gene panel assay was used when sample adequacy was a concern. Constitutional WES of patients and parents was performed when a constitutionally encoded disease was suspected. Results were initially reviewed by a molecular pathologist and subsequently by a multi-disciplinary molecular tumor board. Clinical reports were issued to the ordering physician and posted to the patient's electronic medical record. Results: NGS was performed on tumor and/or normal tissue from 101 high-risk pediatric patients. Potentially actionable alterations were identified in 38% of patients, of which only 16% subsequently received matched therapy. In an additional 38% of patients, the genomic data provided clinically relevant information of diagnostic, prognostic, or pharmacogenomic significance. RNA-seq was clinically impactful in 37/65 patients (57%) providing diagnostic and/or prognostic information for 17 patients (26%) and identified therapeutic targets in 15 patients (23%). Known or likely pathogenic germline alterations were discovered in 18/90 patients (20%) with 14% having germline alternations in cancer predisposition genes. American College of Medical Genetics (ACMG) secondary findings were identified in six patients. Conclusions: Our results demonstrate the feasibility of incorporating clinical NGS into pediatric hematology-oncology practice. Beyond the identification of actionable alterations, the ability to avoid ineffective/inappropriate therapies, make a definitive diagnosis, and identify pharmacogenomic modifiers is clinically impactful. Taking a more inclusive view of potential clinical utility, 66% of cases tested through our program had clinically impactful findings and samples interrogated with both WES and RNA-seq resulted in data that impacted clinical decisions in 75% of cases.
http://ift.tt/2hO67YV
Comparative safety and effectiveness of serotonin receptor antagonists in patients undergoing chemotherapy: a systematic review and network meta-analysis
Background: Although serotonin (5-HT 3 ) receptor antagonists are effective in reducing nausea and vomiting, they may be associated with increased cardiac risk. Our objective was to examine the comparative safety and effectiveness of 5-HT 3 receptor antagonists (e.g., dolasetron, granisetron, ondansetron, palonosetron, tropisetron) alone or combined with steroids for patients undergoing chemotherapy. Methods: We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception until December 2015 for studies comparing 5-HT 3 receptor antagonists with each other or placebo in chemotherapy patients. The search results were screened, data were abstracted, and risk of bias was appraised by pairs of reviewers, independently. Random-effects meta-analyses and network meta-analyses (NMAs) were conducted. Results: After screening 9226 citations and 970 full-text articles, we included 299 studies (n = 58,412 patients). None of the included studies reported harms for active treatment versus placebo. For NMAs on the risk of arrhythmia (primary outcome; three randomized controlled trials [RCTs], 627 adults) and mortality (secondary outcome; eight RCTs, 4823 adults), no statistically significant differences were observed between agents. A NMA on the risk of QTc prolongation showed a significantly greater risk for dolasetron + dexamethasone versus ondansetron + dexamethasone (four RCTs, 3358 children and adults, odds ratio 2.94, 95% confidence interval 2.13–4.17).For NMAs on the number of patients without nausea (44 RCTs, 11,664 adults, 12 treatments), number of patients without vomiting (63 RCTs, 15,460 adults, 12 treatments), and number of patients without chemotherapy-induced nausea or vomiting (27 RCTs, 10,924 adults, nine treatments), all agents were significantly superior to placebo. For a NMA on severe vomiting (10 RCTs, 917 adults), all treatments decreased the risk, but only ondansetron and ramosetron were significantly superior to placebo. According to a rank-heat plot with the surface under the cumulative ranking curve results, palonosetron + steroid was ranked the safest and most effective agent overall. Conclusions: Most 5-HT 3 receptor antagonists were relatively safe when compared with each other, yet none of the studies compared active treatment with placebo for harms. However, dolasetron + dexamethasone may prolong the QTc compared to ondansetron + dexamethasone. All agents were effective for reducing risk of nausea, vomiting, and chemotherapy-induced nausea or vomiting.Trial registrationThis study was registered at PROSPERO: (CRD42013003564).
http://ift.tt/2ii46VM
Arterial ligation versus embolization in epistaxis management: Counterintuitive national trends
Objectives/Hypothesis
Arterial ligation and embolization are treatment modalities indicated in severe and refractory epistaxis. The purpose of this study was to examine temporal trends and compare outcomes in treatment of hospitalized epistaxis patients with ligation or embolization.
Methods
This retrospective cohort analysis utilized the 2008 to 2013 National Inpatient Sample to identify patients admitted with a primary diagnosis of epistaxis, and an associated procedure code for ligation or embolization.
Results
A total of 1,813 cases met the inclusion criteria, with 57.1% undergoing ligation. During the study period, treatment with ligation has trended downward, whereas treatment with embolization has remained constant. Overall, ligated patients were older (64.1 vs. 62.4 years; P = 0.027) and had higher rates of congestive heart failure (15.1% vs. 9.8%; P = 0.001). No significant differences in rates of chronic pulmonary disease, coagulopathy, liver disease, or hereditary hemorrhagic telangiectasia were observed between cohorts. No differences were observed in rates of blood transfusion, stroke, blindness, or in-hospital mortality; however, ligated patients had lower rates of intubation/tracheostomy (2.8% vs. 5.3%; P = 0.009). Ligated patients also experienced shorter hospital stays (3.6 vs. 4.0 days; P = 0.014) and incurred lower hospital charges ($33,029 vs. $69,304; P < 0.001).
Conclusion
Compared to embolization, ligation is associated with significantly decreased hospital charges and shorter hospital stay, without an increase in complication rates. Counterintuitively, ligation appears to be trending downward nationally in its use relative to embolization.
Level of Evidence
2C. Laryngoscope, 2016
http://ift.tt/2hYUrAk
Voice disorders and associated risk markers among young adults in the United States
Objectives/Hypothesis
To examine the prevalence of voice disorders in young adults and identify sociodemographic factors, health conditions, and behaviors associated with voice disorder prevalence.
Study Design
Cross-sectional analysis of data from the National Longitudinal Study of Adolescent to Adult Health.
Methods
During home interviews, 14,794 young adults, aged 24 to 34 years, reported their health conditions and behaviors. Presence and duration of voice disorders were reported over the past 12 months. We computed overall and stratified prevalence estimates by age, gender, race/ethnicity, medical conditions, smoking, and alcohol use. Multiple logistic regression was used to identify independent risk factors for a voice disorder while accounting for the complex sample design.
Results
Six percent of participants reported a voice disorder lasting at least 3 days. Females had 56% greater odds of voice disorders than males. Number of days drinking alcohol was associated with voice disorders, but number of smoking days was not. Conditions that increased the likelihood of voice disorders included hypertension (OR = 1.42 [95% confidence interval {CI}: 1.07-1.89]), tinnitus (OR = 1.53 [95% CI: 1.06-2.20]), and anxiety/panic disorder (OR = 1.26 [95% CI: 1.00-1.60]). Results were independent of gender, alcohol consumption, upper respiratory symptoms, and lower respiratory conditions including asthma, bronchitis/emphysema, and gastrointestinal symptoms (diarrhea/nausea/vomiting).
Conclusions
Voice disorders in young adulthood were associated with hypertension, tinnitus, and anxiety. Greater awareness of these relationships may facilitate voice evaluation among people who seek healthcare for these chronic conditions.
Level of Evidence
2b Laryngoscope, 2016
http://ift.tt/2hfi6hd
Lower airway disease and pituitary surgery: Is there an association with postoperative cerebrospinal fluid leak?
Objectives/Hypothesis
To explore the relationship between lower airway disease and postoperative cerebrospinal fluid (CSF) rhinorrhea among patients undergoing pituitary surgery
Study Design
Retrospective review.
Methods
A retrospective review of the Healthcare Cost and Utilization Project's 2013 National Inpatient Sample was conducted to characterize the hospital stay and surgical outcomes of patients undergoing pituitary surgery. Patients with lower airway disease (including chronic obstructive pulmonary disease and asthma) were compared to a disease-free population identifying demographics and complications over-represented in the lower airway group.
Results
The majority of hypophysectomies (92.1%) were performed via a transsphenoidal approach. Among transsphenoidal patients, individuals with asthma (92.8% of the lower airway disease cohort) harbored a greater postoperative CSF leak rate (4.7% vs. 2.7%, P = .022), and were more likely to develop postoperative diabetes insipidus (6.2% vs. 4.1%, P = .024) and neurological complications (13.0% vs. 9.6%, P = .010) when compared to a lower airway disease-free cohort. Patients with CSF rhinorrhea had longer lengths of stay (7.8 days vs. 4.5 days, P < .001) and higher discharge costs ($148,309 vs. $76,246, P < .001). A binary logistic regression model identified having asthma (P = .042), being female (P = .011), and having gastroesophageal reflux disease (P = .006) as independent predictors of postoperative CSF rhinorrhea.
Conclusions
Several patient comorbidities including asthma are associated with a greater risk of postoperative CSF rhinorrhea. Perioperative lower airway assessment and disease control may potentially decrease one's risk of this complication, although further inquiry is urgently needed to identify optimal preventive strategies.
Level of Evidence
2c. Laryngoscope, 2016
http://ift.tt/2hYIlHF
Implementation of next generation sequencing into pediatric hematology-oncology practice: moving beyond actionable alterations
Background: Molecular characterization has the potential to advance the management of pediatric cancer and high-risk hematologic disease. The clinical integration of genome sequencing into standard clinical practice has been limited and the potential utility of genome sequencing to identify clinically impactful information beyond targetable alterations has been underestimated. Methods: The Precision in Pediatric Sequencing (PIPseq) Program at Columbia University Medical Center instituted prospective clinical next generation sequencing (NGS) for pediatric cancer and hematologic disorders at risk for treatment failure. We performed cancer whole exome sequencing (WES) of patient-matched tumor-normal samples and RNA sequencing (RNA-seq) of tumor to identify sequence variants, fusion transcripts, relative gene expression, and copy number variation (CNV). A directed cancer gene panel assay was used when sample adequacy was a concern. Constitutional WES of patients and parents was performed when a constitutionally encoded disease was suspected. Results were initially reviewed by a molecular pathologist and subsequently by a multi-disciplinary molecular tumor board. Clinical reports were issued to the ordering physician and posted to the patient's electronic medical record. Results: NGS was performed on tumor and/or normal tissue from 101 high-risk pediatric patients. Potentially actionable alterations were identified in 38% of patients, of which only 16% subsequently received matched therapy. In an additional 38% of patients, the genomic data provided clinically relevant information of diagnostic, prognostic, or pharmacogenomic significance. RNA-seq was clinically impactful in 37/65 patients (57%) providing diagnostic and/or prognostic information for 17 patients (26%) and identified therapeutic targets in 15 patients (23%). Known or likely pathogenic germline alterations were discovered in 18/90 patients (20%) with 14% having germline alternations in cancer predisposition genes. American College of Medical Genetics (ACMG) secondary findings were identified in six patients. Conclusions: Our results demonstrate the feasibility of incorporating clinical NGS into pediatric hematology-oncology practice. Beyond the identification of actionable alterations, the ability to avoid ineffective/inappropriate therapies, make a definitive diagnosis, and identify pharmacogenomic modifiers is clinically impactful. Taking a more inclusive view of potential clinical utility, 66% of cases tested through our program had clinically impactful findings and samples interrogated with both WES and RNA-seq resulted in data that impacted clinical decisions in 75% of cases.
http://ift.tt/2hO67YV
Comparative safety and effectiveness of serotonin receptor antagonists in patients undergoing chemotherapy: a systematic review and network meta-analysis
Background: Although serotonin (5-HT 3 ) receptor antagonists are effective in reducing nausea and vomiting, they may be associated with increased cardiac risk. Our objective was to examine the comparative safety and effectiveness of 5-HT 3 receptor antagonists (e.g., dolasetron, granisetron, ondansetron, palonosetron, tropisetron) alone or combined with steroids for patients undergoing chemotherapy. Methods: We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception until December 2015 for studies comparing 5-HT 3 receptor antagonists with each other or placebo in chemotherapy patients. The search results were screened, data were abstracted, and risk of bias was appraised by pairs of reviewers, independently. Random-effects meta-analyses and network meta-analyses (NMAs) were conducted. Results: After screening 9226 citations and 970 full-text articles, we included 299 studies (n = 58,412 patients). None of the included studies reported harms for active treatment versus placebo. For NMAs on the risk of arrhythmia (primary outcome; three randomized controlled trials [RCTs], 627 adults) and mortality (secondary outcome; eight RCTs, 4823 adults), no statistically significant differences were observed between agents. A NMA on the risk of QTc prolongation showed a significantly greater risk for dolasetron + dexamethasone versus ondansetron + dexamethasone (four RCTs, 3358 children and adults, odds ratio 2.94, 95% confidence interval 2.13–4.17).For NMAs on the number of patients without nausea (44 RCTs, 11,664 adults, 12 treatments), number of patients without vomiting (63 RCTs, 15,460 adults, 12 treatments), and number of patients without chemotherapy-induced nausea or vomiting (27 RCTs, 10,924 adults, nine treatments), all agents were significantly superior to placebo. For a NMA on severe vomiting (10 RCTs, 917 adults), all treatments decreased the risk, but only ondansetron and ramosetron were significantly superior to placebo. According to a rank-heat plot with the surface under the cumulative ranking curve results, palonosetron + steroid was ranked the safest and most effective agent overall. Conclusions: Most 5-HT 3 receptor antagonists were relatively safe when compared with each other, yet none of the studies compared active treatment with placebo for harms. However, dolasetron + dexamethasone may prolong the QTc compared to ondansetron + dexamethasone. All agents were effective for reducing risk of nausea, vomiting, and chemotherapy-induced nausea or vomiting.Trial registrationThis study was registered at PROSPERO: (CRD42013003564).
http://ift.tt/2ii46VM
Implementation of next generation sequencing into pediatric hematology-oncology practice: moving beyond actionable alterations
Background: Molecular characterization has the potential to advance the management of pediatric cancer and high-risk hematologic disease. The clinical integration of genome sequencing into standard clinical practice has been limited and the potential utility of genome sequencing to identify clinically impactful information beyond targetable alterations has been underestimated. Methods: The Precision in Pediatric Sequencing (PIPseq) Program at Columbia University Medical Center instituted prospective clinical next generation sequencing (NGS) for pediatric cancer and hematologic disorders at risk for treatment failure. We performed cancer whole exome sequencing (WES) of patient-matched tumor-normal samples and RNA sequencing (RNA-seq) of tumor to identify sequence variants, fusion transcripts, relative gene expression, and copy number variation (CNV). A directed cancer gene panel assay was used when sample adequacy was a concern. Constitutional WES of patients and parents was performed when a constitutionally encoded disease was suspected. Results were initially reviewed by a molecular pathologist and subsequently by a multi-disciplinary molecular tumor board. Clinical reports were issued to the ordering physician and posted to the patient's electronic medical record. Results: NGS was performed on tumor and/or normal tissue from 101 high-risk pediatric patients. Potentially actionable alterations were identified in 38% of patients, of which only 16% subsequently received matched therapy. In an additional 38% of patients, the genomic data provided clinically relevant information of diagnostic, prognostic, or pharmacogenomic significance. RNA-seq was clinically impactful in 37/65 patients (57%) providing diagnostic and/or prognostic information for 17 patients (26%) and identified therapeutic targets in 15 patients (23%). Known or likely pathogenic germline alterations were discovered in 18/90 patients (20%) with 14% having germline alternations in cancer predisposition genes. American College of Medical Genetics (ACMG) secondary findings were identified in six patients. Conclusions: Our results demonstrate the feasibility of incorporating clinical NGS into pediatric hematology-oncology practice. Beyond the identification of actionable alterations, the ability to avoid ineffective/inappropriate therapies, make a definitive diagnosis, and identify pharmacogenomic modifiers is clinically impactful. Taking a more inclusive view of potential clinical utility, 66% of cases tested through our program had clinically impactful findings and samples interrogated with both WES and RNA-seq resulted in data that impacted clinical decisions in 75% of cases.
http://ift.tt/2hO67YV
Comparative safety and effectiveness of serotonin receptor antagonists in patients undergoing chemotherapy: a systematic review and network meta-analysis
Background: Although serotonin (5-HT 3 ) receptor antagonists are effective in reducing nausea and vomiting, they may be associated with increased cardiac risk. Our objective was to examine the comparative safety and effectiveness of 5-HT 3 receptor antagonists (e.g., dolasetron, granisetron, ondansetron, palonosetron, tropisetron) alone or combined with steroids for patients undergoing chemotherapy. Methods: We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception until December 2015 for studies comparing 5-HT 3 receptor antagonists with each other or placebo in chemotherapy patients. The search results were screened, data were abstracted, and risk of bias was appraised by pairs of reviewers, independently. Random-effects meta-analyses and network meta-analyses (NMAs) were conducted. Results: After screening 9226 citations and 970 full-text articles, we included 299 studies (n = 58,412 patients). None of the included studies reported harms for active treatment versus placebo. For NMAs on the risk of arrhythmia (primary outcome; three randomized controlled trials [RCTs], 627 adults) and mortality (secondary outcome; eight RCTs, 4823 adults), no statistically significant differences were observed between agents. A NMA on the risk of QTc prolongation showed a significantly greater risk for dolasetron + dexamethasone versus ondansetron + dexamethasone (four RCTs, 3358 children and adults, odds ratio 2.94, 95% confidence interval 2.13–4.17).For NMAs on the number of patients without nausea (44 RCTs, 11,664 adults, 12 treatments), number of patients without vomiting (63 RCTs, 15,460 adults, 12 treatments), and number of patients without chemotherapy-induced nausea or vomiting (27 RCTs, 10,924 adults, nine treatments), all agents were significantly superior to placebo. For a NMA on severe vomiting (10 RCTs, 917 adults), all treatments decreased the risk, but only ondansetron and ramosetron were significantly superior to placebo. According to a rank-heat plot with the surface under the cumulative ranking curve results, palonosetron + steroid was ranked the safest and most effective agent overall. Conclusions: Most 5-HT 3 receptor antagonists were relatively safe when compared with each other, yet none of the studies compared active treatment with placebo for harms. However, dolasetron + dexamethasone may prolong the QTc compared to ondansetron + dexamethasone. All agents were effective for reducing risk of nausea, vomiting, and chemotherapy-induced nausea or vomiting.Trial registrationThis study was registered at PROSPERO: (CRD42013003564).
http://ift.tt/2ii46VM
Implementation of next generation sequencing into pediatric hematology-oncology practice: moving beyond actionable alterations
Background: Molecular characterization has the potential to advance the management of pediatric cancer and high-risk hematologic disease. The clinical integration of genome sequencing into standard clinical practice has been limited and the potential utility of genome sequencing to identify clinically impactful information beyond targetable alterations has been underestimated. Methods: The Precision in Pediatric Sequencing (PIPseq) Program at Columbia University Medical Center instituted prospective clinical next generation sequencing (NGS) for pediatric cancer and hematologic disorders at risk for treatment failure. We performed cancer whole exome sequencing (WES) of patient-matched tumor-normal samples and RNA sequencing (RNA-seq) of tumor to identify sequence variants, fusion transcripts, relative gene expression, and copy number variation (CNV). A directed cancer gene panel assay was used when sample adequacy was a concern. Constitutional WES of patients and parents was performed when a constitutionally encoded disease was suspected. Results were initially reviewed by a molecular pathologist and subsequently by a multi-disciplinary molecular tumor board. Clinical reports were issued to the ordering physician and posted to the patient's electronic medical record. Results: NGS was performed on tumor and/or normal tissue from 101 high-risk pediatric patients. Potentially actionable alterations were identified in 38% of patients, of which only 16% subsequently received matched therapy. In an additional 38% of patients, the genomic data provided clinically relevant information of diagnostic, prognostic, or pharmacogenomic significance. RNA-seq was clinically impactful in 37/65 patients (57%) providing diagnostic and/or prognostic information for 17 patients (26%) and identified therapeutic targets in 15 patients (23%). Known or likely pathogenic germline alterations were discovered in 18/90 patients (20%) with 14% having germline alternations in cancer predisposition genes. American College of Medical Genetics (ACMG) secondary findings were identified in six patients. Conclusions: Our results demonstrate the feasibility of incorporating clinical NGS into pediatric hematology-oncology practice. Beyond the identification of actionable alterations, the ability to avoid ineffective/inappropriate therapies, make a definitive diagnosis, and identify pharmacogenomic modifiers is clinically impactful. Taking a more inclusive view of potential clinical utility, 66% of cases tested through our program had clinically impactful findings and samples interrogated with both WES and RNA-seq resulted in data that impacted clinical decisions in 75% of cases.
http://ift.tt/2hO67YV
Comparative safety and effectiveness of serotonin receptor antagonists in patients undergoing chemotherapy: a systematic review and network meta-analysis
Background: Although serotonin (5-HT 3 ) receptor antagonists are effective in reducing nausea and vomiting, they may be associated with increased cardiac risk. Our objective was to examine the comparative safety and effectiveness of 5-HT 3 receptor antagonists (e.g., dolasetron, granisetron, ondansetron, palonosetron, tropisetron) alone or combined with steroids for patients undergoing chemotherapy. Methods: We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception until December 2015 for studies comparing 5-HT 3 receptor antagonists with each other or placebo in chemotherapy patients. The search results were screened, data were abstracted, and risk of bias was appraised by pairs of reviewers, independently. Random-effects meta-analyses and network meta-analyses (NMAs) were conducted. Results: After screening 9226 citations and 970 full-text articles, we included 299 studies (n = 58,412 patients). None of the included studies reported harms for active treatment versus placebo. For NMAs on the risk of arrhythmia (primary outcome; three randomized controlled trials [RCTs], 627 adults) and mortality (secondary outcome; eight RCTs, 4823 adults), no statistically significant differences were observed between agents. A NMA on the risk of QTc prolongation showed a significantly greater risk for dolasetron + dexamethasone versus ondansetron + dexamethasone (four RCTs, 3358 children and adults, odds ratio 2.94, 95% confidence interval 2.13–4.17).For NMAs on the number of patients without nausea (44 RCTs, 11,664 adults, 12 treatments), number of patients without vomiting (63 RCTs, 15,460 adults, 12 treatments), and number of patients without chemotherapy-induced nausea or vomiting (27 RCTs, 10,924 adults, nine treatments), all agents were significantly superior to placebo. For a NMA on severe vomiting (10 RCTs, 917 adults), all treatments decreased the risk, but only ondansetron and ramosetron were significantly superior to placebo. According to a rank-heat plot with the surface under the cumulative ranking curve results, palonosetron + steroid was ranked the safest and most effective agent overall. Conclusions: Most 5-HT 3 receptor antagonists were relatively safe when compared with each other, yet none of the studies compared active treatment with placebo for harms. However, dolasetron + dexamethasone may prolong the QTc compared to ondansetron + dexamethasone. All agents were effective for reducing risk of nausea, vomiting, and chemotherapy-induced nausea or vomiting.Trial registrationThis study was registered at PROSPERO: (CRD42013003564).
http://ift.tt/2ii46VM
Cyclosporine-A induces endoplasmic reticulum stress in human gingival fibroblasts – An in vitro study
Publication date: Available online 22 December 2016
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Suresh Ranga Rao, Supraja Ajitkumar, Rajasekaran Subbarayan, Dinesh Murugan Girija
Drug induced gingival overgrowth is one of the side effects affecting the gingiva due to administration of certain systemic drugs. Cyclosporine A is one such drug which is commonly used in organ transplant conditions. The resultant overgrowth is fibrotic and extensive in nature which could impair patient esthetics and masticatory function. Endoplasmic reticulum stress is a recently identified phenomenon implicated in other fibrotic pathologies such as lung and renal fibrosis. In fact, endoplasmic reticulum stress has been known to play an important role in cyclosporine A induced renal fibrosis. Thus in this study, we sought to identify it's role in drug induced gingival overgrowth.
http://ift.tt/2im3A59
Effect of a brief episode of experimental muscle pain on jaw movement and jaw-muscle activity during chewing
The aims of this study were to determine whether: (i) the jaw motor system develops a new pattern of jaw movement and/or jaw-muscle activity after resolution of an acute episode of jaw-muscle pain; and (ii) if jaw-muscle activity and jaw-movement features change progressively with repetition of a chewing sequence. Jaw movement and jaw muscle (masseter, anterior temporalis, and digastric) activity were recorded during free and rate-standardized chewing in eight asymptomatic participants (pain infusion group), before and at three time blocks up to 45 min after a single 0.2-ml bolus infusion of 5% hypertonic saline into the right masseter muscle. The same procedure, without infusion, was performed in another eight participants (control group). There were no significant main effects of group on jaw movement and muscle activity, suggesting that there were no persistent post-pain effects on chewing. Across groups, repetitions of free and unstandardized chewing movements were associated with progressive increases in velocity and amplitude of jaw movement and masseter and temporalis electromyographic (EMG) activity. These findings suggest that factors unrelated to pain, such as practice effects, may be playing a role in the changes in jaw movement and jaw-muscle activity observed after resolution of an acute episode of jaw-muscle pain.
http://ift.tt/2iii89N
Clinical Significance of Dynamics of Programmed Death Ligand-1 Expression on Circulating CD14+ Monocytes and CD19+ B Cells with the Progression of Hepatitis B Virus Infection
Viral Immunology , Vol. 0, No. 0.
http://ift.tt/2ilQfts
Negligible Thyroid Hormone Content Present in Nonprescription U.S. Weight Loss Products
http://ift.tt/2ii7K25
Iodine Supplementation in Women During Preconception, Pregnancy, and Lactation: Current Clinical Practice by U.S. Obstetricians and Midwives
Thyroid , Vol. 0, No. 0.
http://ift.tt/2i7J1dw
Implementation of next generation sequencing into pediatric hematology-oncology practice: moving beyond actionable alterations
Background: Molecular characterization has the potential to advance the management of pediatric cancer and high-risk hematologic disease. The clinical integration of genome sequencing into standard clinical practice has been limited and the potential utility of genome sequencing to identify clinically impactful information beyond targetable alterations has been underestimated. Methods: The Precision in Pediatric Sequencing (PIPseq) Program at Columbia University Medical Center instituted prospective clinical next generation sequencing (NGS) for pediatric cancer and hematologic disorders at risk for treatment failure. We performed cancer whole exome sequencing (WES) of patient-matched tumor-normal samples and RNA sequencing (RNA-seq) of tumor to identify sequence variants, fusion transcripts, relative gene expression, and copy number variation (CNV). A directed cancer gene panel assay was used when sample adequacy was a concern. Constitutional WES of patients and parents was performed when a constitutionally encoded disease was suspected. Results were initially reviewed by a molecular pathologist and subsequently by a multi-disciplinary molecular tumor board. Clinical reports were issued to the ordering physician and posted to the patient's electronic medical record. Results: NGS was performed on tumor and/or normal tissue from 101 high-risk pediatric patients. Potentially actionable alterations were identified in 38% of patients, of which only 16% subsequently received matched therapy. In an additional 38% of patients, the genomic data provided clinically relevant information of diagnostic, prognostic, or pharmacogenomic significance. RNA-seq was clinically impactful in 37/65 patients (57%) providing diagnostic and/or prognostic information for 17 patients (26%) and identified therapeutic targets in 15 patients (23%). Known or likely pathogenic germline alterations were discovered in 18/90 patients (20%) with 14% having germline alternations in cancer predisposition genes. American College of Medical Genetics (ACMG) secondary findings were identified in six patients. Conclusions: Our results demonstrate the feasibility of incorporating clinical NGS into pediatric hematology-oncology practice. Beyond the identification of actionable alterations, the ability to avoid ineffective/inappropriate therapies, make a definitive diagnosis, and identify pharmacogenomic modifiers is clinically impactful. Taking a more inclusive view of potential clinical utility, 66% of cases tested through our program had clinically impactful findings and samples interrogated with both WES and RNA-seq resulted in data that impacted clinical decisions in 75% of cases.
http://ift.tt/2hO67YV
Comparative safety and effectiveness of serotonin receptor antagonists in patients undergoing chemotherapy: a systematic review and network meta-analysis
Background: Although serotonin (5-HT 3 ) receptor antagonists are effective in reducing nausea and vomiting, they may be associated with increased cardiac risk. Our objective was to examine the comparative safety and effectiveness of 5-HT 3 receptor antagonists (e.g., dolasetron, granisetron, ondansetron, palonosetron, tropisetron) alone or combined with steroids for patients undergoing chemotherapy. Methods: We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception until December 2015 for studies comparing 5-HT 3 receptor antagonists with each other or placebo in chemotherapy patients. The search results were screened, data were abstracted, and risk of bias was appraised by pairs of reviewers, independently. Random-effects meta-analyses and network meta-analyses (NMAs) were conducted. Results: After screening 9226 citations and 970 full-text articles, we included 299 studies (n = 58,412 patients). None of the included studies reported harms for active treatment versus placebo. For NMAs on the risk of arrhythmia (primary outcome; three randomized controlled trials [RCTs], 627 adults) and mortality (secondary outcome; eight RCTs, 4823 adults), no statistically significant differences were observed between agents. A NMA on the risk of QTc prolongation showed a significantly greater risk for dolasetron + dexamethasone versus ondansetron + dexamethasone (four RCTs, 3358 children and adults, odds ratio 2.94, 95% confidence interval 2.13–4.17).For NMAs on the number of patients without nausea (44 RCTs, 11,664 adults, 12 treatments), number of patients without vomiting (63 RCTs, 15,460 adults, 12 treatments), and number of patients without chemotherapy-induced nausea or vomiting (27 RCTs, 10,924 adults, nine treatments), all agents were significantly superior to placebo. For a NMA on severe vomiting (10 RCTs, 917 adults), all treatments decreased the risk, but only ondansetron and ramosetron were significantly superior to placebo. According to a rank-heat plot with the surface under the cumulative ranking curve results, palonosetron + steroid was ranked the safest and most effective agent overall. Conclusions: Most 5-HT 3 receptor antagonists were relatively safe when compared with each other, yet none of the studies compared active treatment with placebo for harms. However, dolasetron + dexamethasone may prolong the QTc compared to ondansetron + dexamethasone. All agents were effective for reducing risk of nausea, vomiting, and chemotherapy-induced nausea or vomiting.Trial registrationThis study was registered at PROSPERO: (CRD42013003564).
http://ift.tt/2ii46VM
Comparison of level and degree of upper airway obstruction by Müller's maneuver and drug-induced sleep endoscopy in obstructive sleep apnea patients
Publication date: Available online 21 December 2016
Source:Auris Nasus Larynx
Author(s): Ah Ra Jung, Tae Kyung Koh, Su Jin Kim, Kun Hee Lee, Joong Saeng Cho, Sung Wan Kim
ObjectiveThis study aimed to compare and analyze the level and degree of observed upper airway obstruction in patients with obstructive sleep apnea (OSA) using Müller's maneuver (MM) and drug-induced sleep endoscopy (DISE). We sought to find a method for evaluating the upper airway that could be used to determine surgical sites.MethodsThis study included 80 OSA patients who visited Kyung Hee Medical Center and underwent polysomnography (PSG) from March 2013 to March 2014. Obstructive levels observed by MM were classified into retropalatal level, or the lateral wall and retroglossal level. These levels were compared with those determined by DISE through the VOTE classification.ResultsBased on the results of MM and DISE, lateral wall and retropalatal level obstructions showed relatively high conformity, while retroglossal level obstruction exhibited considerable differences. When evaluated at each level, patients with obstruction on MM also showed partial or complete obstruction on DISE at same level, and patients with no obstruction on DISE also showed no obstruction on MM at same level.ConclusionBoth examination methods revealed the same obstruction levels in all cases except epiglottic level, but there were some differences in obstructive degree. MM is capable of detecting obstruction levels in the upper airway and can be used to determine surgical sites in cases when DISE cannot be used due to a patient's condition or a clinic's circumstances.
http://ift.tt/2i7AxmG
Salmon roe (ikura)–induced anaphylaxis in a child
Anaphylaxis is a potentially fatal IgE-mediated allergic reaction of rapid onset. Food ingestion comprises nearly 50% of patients with anaphylaxis presenting to emergency departments in the western world.1 In the United States, 15 million Americans are believed to have food allergies, which correlates to 1 in every 13 children younger than 18 years.1 The most common food allergens are milk, egg, wheat, soy, peanuts, shellfish, tree nuts, and fish. Roes from fish or other aquatic species are not commonly reported as a cause of food allergy in the United States, although it is a much more common allergen in Japan, where fish roe is consumed widely.
http://ift.tt/2hNGiIz
Sex differences in activation of lung-related type 2 innate lymphoid cells in experimental asthma
Sex differences in asthma phenotypes and prevalence have been well described. In experimental animal models of asthma, female mice have increased airway hyperresponsiveness, eosinophil influx, and increased type 2 cytokine production (ie, interleukin [IL] 4, IL-5, and IL-13) in the lungs after allergen challenge when compared with males. Although CD4+ TH2 cells are known to produce type 2 cytokines, the type 2 innate lymphoid cells (ILC2s) are better described for producing much larger quantities of IL-5 and IL-13 compared with TH2 cells.
http://ift.tt/2ilrxK3
Multiport Combined Endoscopic Approach to Nonembolized Juvenile Nasopharyngeal Angiofibroma with Parapharyngeal Extension: An Emerging Concept
Background. Surgical approaches to the parapharyngeal space (PPS) are challenging by virtue of deep location and neurovascular content. Juvenile Nasopharyngeal Angiofibroma (JNA) is a formidable hypervascular tumor that involves multiple compartments with increase in size. In tumors with extension to parapharyngeal space, the endonasal approach was observed to be inadequate. Combined Endoscopic Endonasal Approaches and Endoscopic Transoral Surgery (EEA-ETOS) approach has provided a customized alternative of multicorridor approach to access JNA for its safe and efficient resection. Methods. The study demonstrates a case series of patients of JNA with prestyloid parapharyngeal space extension operated by endoscopic endonasal and endoscopic transoral approach for tumor excision. Results. The multiport EEA-ETOS approach was used to provide wide exposure to access JNA in parapharyngeal space. No major complications were observed. No conversion to external approach was required. Postoperative morbidity was low and postoperative scans showed no residual tumor. A one-year follow-up was maintained and there was no evidence of disease recurrence. Conclusion. Although preliminary, our experience demonstrates safety and efficacy of multiport approach in providing access to multiple compartments, facilitating total excision of JNA in selected cases.
http://ift.tt/2hhZO0y
Do vasoactive agents negatively influence the success of Maxillo-Facial microvascular free-flap surgery: A retrospective audit
Introduction: Microvascular free-flap surgery has become the gold standard in Head and Neck oncology reconstruction. Current literature states free-flap success rates of 95%. Evidence suggests that adverse effect on blood flow to the flap remains the primary cause of failure, which may be linked to the type of vasoconstrictor used during anaesthesia. The premise of this audit is to assess the success rate of microsurgical free-flaps in the Oral and Maxillo-facial Surgery department at Royal Derby Hospital (RDH) and review whether the administration of vasoactive agents has an effect on this.
http://ift.tt/2hwViaw
Intraoperative neck positioning for maxillofacial procedures on patients with cervical spine injuries, is it safe to remove the collar?
Introduction: Concomitant cervical spine and maxillofacial injury is reported in 2.2-11% of trauma patients. High-risk c-spine injuries not requiring immediate fixation are immobilised in a semi-rigid collar support, interfering with assessment and timely treatment of maxillofacial injuries. This can lead to extensive (delayed) maxillofacial surgery once healing has occurred. We present (for the first time) magnetic resonance images (MRI) demonstrating the alignment of the cervical spine during common maxillofacial procedures in order to assist spinal surgeons in deciding whether it is safe to undertake surgery without collar support.
http://ift.tt/2hwJV2x
Medial sural artery perforator and radial forearm free flaps: pros and cons of two essential intra-oral mucosal reconstruction choices for OMFS surgeons
Aims: A comparison of two versatile fasciocutaneous free flaps, namely the medial sural artery perforator (MSAP) and radial forearm free flaps (RFFF) utilised for oral cavity reconstruction of soft tissue defects.
http://ift.tt/2hNxySs
Cast-cap splint in the management of medication-related osteonecrosis of the jaw
We describe the management of a pathological fracture in a patient with medication-related osteonecrosis using a cast-cap splint. In selected cases this is a simple solution to what can be a difficult condition to treat.
http://ift.tt/2hi0Kly
Should elderly patients presenting with facial injuries have a targeted follow-up in place? A service evaluation
Background: The proportion of elderly patients over 65 years of age is increasing in developed countries. Maxillofacial injuries in over-65s are commonly caused by falls, possibly signifying an increase in frailty. The comprehensive geriatric assessment (CGA) addresses this increase, while reducing subsequent frailty-type admissions. No studies have considered whether to introduce the CGA following presentation with a facial injury.
http://ift.tt/2hwU3Il
An Audit on the Outcome of Craniofacial Implants over the past 20 years
Introduction/ Aim: Osseo-integrated craniofacial implants have become an established method for replacement of facial prosthesis by incorporating titanium implants for better retention and aesthetics. The objective of this study was to assess success rate of intra-oral and extra-oral craniofacial implant placements in congenital, trauma and cancer patients who may have had radiotherapy.
http://ift.tt/2hi4MdV
The East Grinstead Consent Collaborative: National Audit of Consent for Orthognathic Surgery
Background: The East Grinstead Consent Collaborative (EGCC) is a trainee led retrospective audit of consent in all the subspecialties of oral and maxillofacial surgery. The project was successfully initiated with head and neck and the collaborative is now collecting data for orthognathic surgery.
http://ift.tt/2hi1OG0
Our experience of using the second crease Blepharoplasty incision at the mid-Yorkshire NHS trust to access and repair orbital floor fractures. A discussion of the adequacy of exposure, perioperative and long term complications of this approach
At Midyorkshire NHS trust we encounter a high volume of traumatic injuries to the Zygomatic-orbital complex. Historically, these fractures were accessed and repaired via a second crease Blepharoplasty incision to the lower eyelid. This is a well-established approach for several reasons but has the obvious drawback of a visible scar that is potentially unanaesthetic left behind. We are currently debating a change of practice to the trans-conjunctival pre-septal approach to avoid this scarring but endeavoured to see if this change is warranted.
http://ift.tt/2hhXp5U
Trans oral robotic surgery of Head and Neck tumours – results from a UK OMFS department
Introduction: Robot-assisted surgery is well established in several surgical specialties including urology, gynaecology and cardiac surgery. Trans oral robotic surgery (TORS) has been reported in Head and Neck Surgery however its use is still in it's infancy in the UK and <10 hospitals only are currently providing this service one of which is University Hospital, Coventry
http://ift.tt/2iluGtc
Case presentation on ReCell (TM) resurfacing of near total scalp defect post melanoma excision
Introduction: We present a case of extensive scalp defect reconstructed with Re-cell (TM) technique. An 87 year old gentleman presented with a large lentigo malignant melanoma, which when excised caused a defect comprising 75% of his scalp. The patient's multiple co-morbidities prevented split skin grafting. We present a series of photographs detailing the complete healing process over a four month period.
http://ift.tt/2hNu9mL
The Unstable Fractured Zygomatic Arch - Simple solutions for a difficult situation
Introduction: Isolated zygomatic arch fractures are relatively common and can usually be treated by simple closed reduction techniques, most often via a temporal approach.In the instance of a highly displaced fracture with unfavourable muscle pull or severe comminution, supplementary support may be required to prevent subsequent depression of the arch prior to fracture healing.
http://ift.tt/2ilzfU6
Enhanced recovery in head and neck oncology - Is it truly a benefit?
Introduction: Enhanced recovery after surgery (ERAS) programmes have been shown to accelerate recovery, reduce morbidity and shorten length of stay (LOS) across a range of surgical specialties, although little has been published for head and neck patients.
http://ift.tt/2iluDO2
A new classification for the mandible defect based on a systematic review of segmental resection and composite microvascular reconstruction
Introduction: There is no universally accepted classification system for the mandibular defect. The aim of this paper is to systematically review the literature and design a new classification based on those reports.
http://ift.tt/2hNuiGL
Midface trauma in the over 65's: A Level 1 Trauma Centre Experience
Midfacial maxillofacial injury as a consequence of trauma has a significant public health impact. The increase in our ageing population has seen a mirrored increase in the number of patients over the age of 65 to present with midfacial maxillofacial injuries. This is reflected in historical data that has seen a general increase in maxillofacial injuries in the general population. Elderly patients require thorough assessment and appropriate investigations. Our aim was to demonstrate the incidence of midface maxillofacial trauma in the older population attending the emergency department in a level one major trauma centre and describe the potential causes for this increase and its financial implications.
http://ift.tt/2ilq1XZ
Surgical disciplines contributing to Head and Neck Cancer Provision in England: Where are we now?
Aims: We aimed to analyse the current provision of head and neck cancer surgery in England with respect to operative caseloads of oral and maxillofacial, ear nose and throat and plastic surgeons.
http://ift.tt/2hNzWbN
Averting the failing flap a review of the historical and technical advances
Introduction: Free flap reconstruction is the gold standard surgical option for reconstruction of head and neck surgical defects. The free vascularised tissue graft was performed by Seidenberg in 1959 to repair oesophageal defects. The first mandibular reconstruction was done in 1989 using fibula by Hidalgo.
http://ift.tt/2ilz7UC
Tomorrow's World: 3D Printing in Oral and Maxillofacial Surgery
3D printing, a process of the production of a three-dimensional object from a digital file, has been hailed as the start of the third industrial revolution. A complex process also known as additive manufacturing has come to encompass various techniques such as stereolithography, fuse deposition modelling and selective laser sintering to name a few. From aerospace technology to clothing to firearms this exciting technology is being developed in most fields but how can this be applied to Oral and Maxillofacial surgery (OMFS)?
http://ift.tt/2hNFBPg
A 5 year retrospective notes review comparing patterns of trauma in adult cyclists and motorcyclists with facial injuries brought into a major London Trauma Centre between 2010-15
This study compared the patterns of trauma in helmeted and un helmeted cyclists and motorcyclists, particularly the location of facial fractures, head injuries, and the distribution of serious injuries across the body. Data was collected from Trauma Audit and Research Network, and 140 patients were found between 2010-15 who had been brought into King's College Hospital, London Emergency Department, of which 115 were deemed appropriate. Proportionately, cyclists without helmets suffered on average 1.48 fractures to the face, against 1.96 in cyclists with helmets.
http://ift.tt/2ilmwRs
The elective management of maxillofacial trauma: improving surgical outcomes using computer-aided design and rapid prototyping for patient-specific solutions
Introduction: Treatment of complex maxillofacial trauma requires careful planning to optimise results. Traditional techniques rely on contouring osteosynthesis plates peri-operatively; this can be challenging due to difficulties in visualising the anatomy whilst maintaining adequate fracture reduction. The resulting prosthesis can be sub-optimally contoured leading to increased failure rates. Computer-aided design (CAD) combined with rapid prototyping (RP), has subsequently been applied to elective oral and maxillofacial surgery.
http://ift.tt/2hNzTNv
Cross-reactive LTP sensitization in food-dependent exercise-induced urticaria/anaphylaxis: a pilot study of a component-resolved and in vitro depletion approach
Background: Challenge tests for food-dependent exercise-induced anaphylaxis (FDEIA) carry some risk and have a high rate of false negatives. Our aim was to explore the usefulness of an in vitro immunodepletion assay and an allergen microarray test in the identification of IgE-mediated cross-reactive food allergens in patients with suspected FDEIA or food-dependent exercise-induced urticaria and panallergen sensitization. Methods: Three patients with a history of food dependent exercise induced urticaria/anaphylaxis and food panallergen sensitization in whom a food-exercise challenge was not feasible were selected: a 25-year-old man with cholinergic urticaria who experienced generalized urticaria and angioedema during a soccer match after drinking a peach-based soft drink; a 19-year-old woman with allergic rhinitis and controlled asthma who experienced anaphylactic shock while playing soccer, having eaten walnuts in the previous 90 min; and a 57-year-old man with baker's asthma who experienced four episodes of anaphylaxis during exercise after ingesting wheat-containing food. All individuals underwent a diagnostic work-up with skin prick tests, specific IgE (sIgE) and ImmunoCAP ISAC test. For the in vitro immunodepletion procedure, patients' serum was pre-incubated with the suspected native allergen (peach, walnut, or wheat) in solid phase (ImmunoCAP). The eluted serum, containing unbound IgE, was collected and samples were re-tested using Immunocap ISAC 112 and compared with baseline results. Results: All individuals were sensitized to lipid transfer proteins. The first patient was sensitized to Pru p 3, Cor a 8, Jug r 3, and Ara h 9; after pre-incubation with peach there was 100% depletion of sIgE to all components. The second patient was sensitized to Pru p 3, Cor a 8, Jug r 3, and Ara h 9; immunodepletion with walnut depleted sIgE to Ara h 9 by 67%, Pru p 3 and Pla a 3 (60%), Art v 3 (75%), Jug r 3 (88%), and Cor a 8 (100%). The third patient was sensitized to Pru p 3, Jug r 3, Ara h 9, and Tri a 14; immunodepletion with wheat depleted Tri a 14 only (100%). Conclusions: In vitro immunodepletion might be a useful diagnostic tool in food dependent exercise induced urticaria/anaphylaxis with panallergen sensitization, particularly for identifying the culprit allergen and guiding dietary elimination recommendations.
http://ift.tt/2hMx3Ih
Surgical treatment of salivary malignant tumors
Although they are of key interest for surgeons, major salivary gland malignant tumors (MaSGMT) are uncommon, with an annual incidence of 6–11 in the parotid and 2–3 cases in the submandibular per 106 population [1–5].
http://ift.tt/2hNwK03
Cross-reactive LTP sensitization in food-dependent exercise-induced urticaria/anaphylaxis: a pilot study of a component-resolved and in vitro depletion approach
Background: Challenge tests for food-dependent exercise-induced anaphylaxis (FDEIA) carry some risk and have a high rate of false negatives. Our aim was to explore the usefulness of an in vitro immunodepletion assay and an allergen microarray test in the identification of IgE-mediated cross-reactive food allergens in patients with suspected FDEIA or food-dependent exercise-induced urticaria and panallergen sensitization. Methods: Three patients with a history of food dependent exercise induced urticaria/anaphylaxis and food panallergen sensitization in whom a food-exercise challenge was not feasible were selected: a 25-year-old man with cholinergic urticaria who experienced generalized urticaria and angioedema during a soccer match after drinking a peach-based soft drink; a 19-year-old woman with allergic rhinitis and controlled asthma who experienced anaphylactic shock while playing soccer, having eaten walnuts in the previous 90 min; and a 57-year-old man with baker's asthma who experienced four episodes of anaphylaxis during exercise after ingesting wheat-containing food. All individuals underwent a diagnostic work-up with skin prick tests, specific IgE (sIgE) and ImmunoCAP ISAC test. For the in vitro immunodepletion procedure, patients' serum was pre-incubated with the suspected native allergen (peach, walnut, or wheat) in solid phase (ImmunoCAP). The eluted serum, containing unbound IgE, was collected and samples were re-tested using Immunocap ISAC 112 and compared with baseline results. Results: All individuals were sensitized to lipid transfer proteins. The first patient was sensitized to Pru p 3, Cor a 8, Jug r 3, and Ara h 9; after pre-incubation with peach there was 100% depletion of sIgE to all components. The second patient was sensitized to Pru p 3, Cor a 8, Jug r 3, and Ara h 9; immunodepletion with walnut depleted sIgE to Ara h 9 by 67%, Pru p 3 and Pla a 3 (60%), Art v 3 (75%), Jug r 3 (88%), and Cor a 8 (100%). The third patient was sensitized to Pru p 3, Jug r 3, Ara h 9, and Tri a 14; immunodepletion with wheat depleted Tri a 14 only (100%). Conclusions: In vitro immunodepletion might be a useful diagnostic tool in food dependent exercise induced urticaria/anaphylaxis with panallergen sensitization, particularly for identifying the culprit allergen and guiding dietary elimination recommendations.
http://ift.tt/2hMx3Ih
Cast-cap splint in the management of medication-related osteonecrosis of the jaw
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): G. Markose, R.M. Graham
We describe the management of a pathological fracture in a patient with medication-related osteonecrosis using a cast-cap splint. In selected cases this is a simple solution to what can be a difficult condition to treat.
http://ift.tt/2i6Wke5
Cross-reactive LTP sensitization in food-dependent exercise-induced urticaria/anaphylaxis: a pilot study of a component-resolved and in vitro depletion approach
Background: Challenge tests for food-dependent exercise-induced anaphylaxis (FDEIA) carry some risk and have a high rate of false negatives. Our aim was to explore the usefulness of an in vitro immunodepletion assay and an allergen microarray test in the identification of IgE-mediated cross-reactive food allergens in patients with suspected FDEIA or food-dependent exercise-induced urticaria and panallergen sensitization. Methods: Three patients with a history of food dependent exercise induced urticaria/anaphylaxis and food panallergen sensitization in whom a food-exercise challenge was not feasible were selected: a 25-year-old man with cholinergic urticaria who experienced generalized urticaria and angioedema during a soccer match after drinking a peach-based soft drink; a 19-year-old woman with allergic rhinitis and controlled asthma who experienced anaphylactic shock while playing soccer, having eaten walnuts in the previous 90 min; and a 57-year-old man with baker's asthma who experienced four episodes of anaphylaxis during exercise after ingesting wheat-containing food. All individuals underwent a diagnostic work-up with skin prick tests, specific IgE (sIgE) and ImmunoCAP ISAC test. For the in vitro immunodepletion procedure, patients' serum was pre-incubated with the suspected native allergen (peach, walnut, or wheat) in solid phase (ImmunoCAP). The eluted serum, containing unbound IgE, was collected and samples were re-tested using Immunocap ISAC 112 and compared with baseline results. Results: All individuals were sensitized to lipid transfer proteins. The first patient was sensitized to Pru p 3, Cor a 8, Jug r 3, and Ara h 9; after pre-incubation with peach there was 100% depletion of sIgE to all components. The second patient was sensitized to Pru p 3, Cor a 8, Jug r 3, and Ara h 9; immunodepletion with walnut depleted sIgE to Ara h 9 by 67%, Pru p 3 and Pla a 3 (60%), Art v 3 (75%), Jug r 3 (88%), and Cor a 8 (100%). The third patient was sensitized to Pru p 3, Jug r 3, Ara h 9, and Tri a 14; immunodepletion with wheat depleted Tri a 14 only (100%). Conclusions: In vitro immunodepletion might be a useful diagnostic tool in food dependent exercise induced urticaria/anaphylaxis with panallergen sensitization, particularly for identifying the culprit allergen and guiding dietary elimination recommendations.
http://ift.tt/2hMx3Ih
Cross-reactive LTP sensitization in food-dependent exercise-induced urticaria/anaphylaxis: a pilot study of a component-resolved and in vitro depletion approach
Background: Challenge tests for food-dependent exercise-induced anaphylaxis (FDEIA) carry some risk and have a high rate of false negatives. Our aim was to explore the usefulness of an in vitro immunodepletion assay and an allergen microarray test in the identification of IgE-mediated cross-reactive food allergens in patients with suspected FDEIA or food-dependent exercise-induced urticaria and panallergen sensitization. Methods: Three patients with a history of food dependent exercise induced urticaria/anaphylaxis and food panallergen sensitization in whom a food-exercise challenge was not feasible were selected: a 25-year-old man with cholinergic urticaria who experienced generalized urticaria and angioedema during a soccer match after drinking a peach-based soft drink; a 19-year-old woman with allergic rhinitis and controlled asthma who experienced anaphylactic shock while playing soccer, having eaten walnuts in the previous 90 min; and a 57-year-old man with baker's asthma who experienced four episodes of anaphylaxis during exercise after ingesting wheat-containing food. All individuals underwent a diagnostic work-up with skin prick tests, specific IgE (sIgE) and ImmunoCAP ISAC test. For the in vitro immunodepletion procedure, patients' serum was pre-incubated with the suspected native allergen (peach, walnut, or wheat) in solid phase (ImmunoCAP). The eluted serum, containing unbound IgE, was collected and samples were re-tested using Immunocap ISAC 112 and compared with baseline results. Results: All individuals were sensitized to lipid transfer proteins. The first patient was sensitized to Pru p 3, Cor a 8, Jug r 3, and Ara h 9; after pre-incubation with peach there was 100% depletion of sIgE to all components. The second patient was sensitized to Pru p 3, Cor a 8, Jug r 3, and Ara h 9; immunodepletion with walnut depleted sIgE to Ara h 9 by 67%, Pru p 3 and Pla a 3 (60%), Art v 3 (75%), Jug r 3 (88%), and Cor a 8 (100%). The third patient was sensitized to Pru p 3, Jug r 3, Ara h 9, and Tri a 14; immunodepletion with wheat depleted Tri a 14 only (100%). Conclusions: In vitro immunodepletion might be a useful diagnostic tool in food dependent exercise induced urticaria/anaphylaxis with panallergen sensitization, particularly for identifying the culprit allergen and guiding dietary elimination recommendations.
http://ift.tt/2hMx3Ih
Molecular cloning, polymorphism, and functional activity of the bovine and water buffalo Mx2 gene promoter region
Background: Bovine Mx2 gene sequences were already reported, but further information about the gene properties is not yet available. The objective of the current study was to elucidate the structural properties of the bovine Mx2 gene mainly the promoter region and its possible functional role. If available, such information would help in assessing the functional properties of the gene, which was reported to confer antiviral action against recombinant VSV. Results: Examinations on the bovine genomic BAC clone—confirmed to contain the Mx2 gene—revealed 883-bp sequences. A computer scan unequivocally identified a 788-bp promoter region containing a typical TATA box, three ISREs and other promoter-specific motifs. Comparative analysis of nine bovine genomic DNA samples showed 19 nucleotide substitutions suggesting the existence of five different genotypes in the promoter region. The water buffalo Mx2 promoter region was determined by using primers based on the bovine Mx2 promoter region disclosing 893-bp, with 56 substitutions, two insertions, 9 and 1 nt at two different sites. A functional analysis of the putative ISRE indicated that ISRE played a synergetic role in the activation of bovine Mx2 gene transcription. Conclusion: Bovine and water buffalo Mx2 promoter region was identified disclosing, the conserved ISRE, located in the proximal end of the promoter region like other members of the antiviral family, suggesting functional activity under interferon stimulation.
http://ift.tt/2igk7vl
Correlations of microRNA-124a and microRNA-30d with clinicopathological features of breast cancer patients with type 2 diabetes mellitus
This study intends to investigate the correlations of miR-124a and miR-30d with clinicopathological features of breast cancer (BC) patients with type 2 diabetes mellitus (T2DM). A total of 72 BC patients with T2DM (diabetic group) and 144 BC patients without T2DM (non-diabetic group) were enrolled in this study. Blood glucose was detected by glucose oxidase methods. Glycosylated hemoglobin (HbA1c) was measured by high performance liquid chromatography. Fasting insulin (FIns) was measured by chemiluminescent microparticle immunoassay. Automatic biochemical analyzer was used to detect triglyceride, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Estradiol (E 2 ) was detected by radioimmunoassay. Homeostasis model assessment was applied to assess the insulin resistance (HOMA-IR) and β-cell insulin secretion (HOMA-IS). The expressions of miR124a and miR-30d were measured by quantitative real-time polymerase chain reaction (qRT-PCR). There were significant differences in age, the ratio of menopause, body mass index (BMI), HDL-C, TC, 2-h plasma glucose (2hPG), FIns, HbA1c, HOMA-IS and HOMA-IR between the diabetic and non-diabetic groups. The diabetic group had higher incidence of lymph node metastasis than non-diabetic group. The miR-124a expression was down-regulated while the miR-30d expression was up-regulated in BC patients with T2DM. The correlation analysis showed that miR-124a expression was positively correlated with HDL-C, while it was negatively correlated with age, HbA1c, LDL-C and E 2 . However, the miR-30d expression was negatively correlated with HDL-C but positively correlated with age, HbA1c, LDL-C and E 2 . In conclusion, miR-124a and miR-30d may be correlated with clinicopathological features of BC patients with T2DM. The miR-124a and miR-30d could serve as novel biomarkers for early diagnosis of BC in patients with T2DM.
http://ift.tt/2igo9nJ
Diagnosis and treatment of spontaneous intracranial hypotension due to cerebrospinal fluid leakage
IntroductionSpontaneous intracranial hypotension is one of the causes of a postural headache in young people. In this study, the diagnosis and treatment results of a case of intracranial hypotension headache due to spinal cerebrospinal fluid leakage were reported. Up to now, there is not absolutely effective treatment for intracranial hypotension headache.Case descriptionA 32-year-old woman complained, a headache after prolonged sitting that presented with nausea; vomiting; increased pain during walking; and decreased or absent pain after lying down. The dramatic improvement of this cephalalgia with epidural blood patch treatment confirmed the diagnosis.Discussion and EvaluationTo the best of our knowledge, this is the first reported of radiographic contrast before and after epidural blood patch. Improved clinical diagnosis and treatment of spontaneous intracranial hypotension. The patient didn't feel any discomfort, no complications such as infection etc. were observed. A small dose of intrathecal gadolthis is the first reported case ofinium during CEMRM allows for improved detection of CSF leakage. Conclusions: Leakage of spinal CSF is a major cause of spontaneous intracranial hypotension. In order to improve clinical diagnosis and provide effective treatment, the precise etiology of spontaneous intracranial hypotension should be investigated in each patient.
http://ift.tt/2i6jRfc
Oscillation criteria for second order Emden-Fowler functional differential equations of neutral type
In this article, some new oscillation criterion for the second order Emden-Fowler functional differential equation of neutral type( r ( t ) | z ′ ( t ) | α − 1 z ′ ( t ) ) ′ + q ( t ) | x ( σ ( t ) ) | β − 1 x ( σ ( t ) ) = 0 ,where z ( t ) = x ( t ) + p ( t ) x ( τ ( t ) ) , α > 0 and β > 0 are established. Our results improve some well-known results which were published recently in the literature. Some illustrating examples are also provided to show the importance of our results.MSC: 34C10, 34K11.
http://ift.tt/2h6iGL6
Application of inequalities technique to dynamics analysis of a stochastic eco-epidemiology model
This paper formulates an infected predator-prey model with Beddington-DeAngelis functional response from a classical deterministic framework to a stochastic differential equation (SDE). First, we provide a global analysis including the global positive solution, stochastically ultimate boundedness, the persistence in mean, and extinction of the SDE system by using the technique of a series of inequalities. Second, by using Itô's formula and Lyapunov methods, we investigate the asymptotic behaviors around the equilibrium points of its deterministic system. The solution of the stochastic model has a unique stationary distribution, it also has the characteristics of ergodicity. Finally, we present a series of numerical simulations of these cases with respect to different noise disturbance coefficients to illustrate the performance of the theoretical results. The results show that if the intensity of the disturbance is sufficiently large, the persistence of the SDE model can be destroyed.
http://ift.tt/2hXaG0V
DEF - a programming language agnostic framework and execution environment for the parallel execution of library routines
There is high demand for library routines that can be included into arbitrary programs and executed in parallel in the Cloud. So our approach is to provide a framework that supports the parallelized execution of library routines, written in different programming languages, from any platform. Our Distributed Execution Framework (DEF) allows to (1) deploy arbitrary routines into a central library and (2) integrate these library routines at runtime into user programs in a way that allows the routines to be executed in parallel in the Cloud. The programming and runtime environment of the library routine is completely transparent to the user and the chosen programming and runtime environment. DEF provides client and library APIs with primitives like search_lib(), create_task(), submit_job() which are integrated into the user's program to access the DEF runtime. DEF allows the user to configure clusters in a public/private Cloud and automatically distributes the tasks for executing the library routines on the workers of the cluster.
http://ift.tt/2hLTOfy
A new proof-of-work mechanism for bitcoin
Background: Bitcoin system, when more than 51% computing power is controlled by a single node, the block chain can be distorted maliciously. This is called 51% attack which is a well-known potential risk that could destroy the Bitcoin system.MethodThe paper proves that under the current proof-of-work mechanism, computing power eventually will be centralized at a single node if miners are rational enough.ResultThe paper propose a new proof-of-work mechanism that improves decentralization and reduces the risk of 51% attack without increasing the risk of Sybil attack.ConcusionsThis new mechanism introduces a series of principles such as Career open to all talents, without distinction of birth, Distribution according to labor and All Men are created equal.
http://ift.tt/2i6ePj0
Dirichlet type problems for Dunkl-Poisson equations
In this paper, using the intertwine relations of differential operators, we study one representation of real analytic functions by Dunkl-harmonic functions, which is a generalization of the well-known Almansi formula. As an application of the representation, we construct a solution of the Dunkl-Poisson equations in Clifford analysis. Then we investigate solutions of homogeneous and inhomogeneous Dirichlet type problems for Dunkl-Poisson's equation, and inhomogeneous Dirichlet problems for Dunkl-Laplace's equation.MSC: 30G35, 35J05, 58C50.
http://ift.tt/2hXcAPm
Above- and below-ground biomass distribution and morphological characteristics respond to nitrogen addition in Pinus tabuliformis
Background: With the continuing deposition of atmospheric nitrogen (N), N has become a major factor affecting ecosystem carbon (C) balance and N cycles. However, it is still unclear how increasing N deposition alters above- and below-ground biomass allocation, especially among different order roots. Pinus tabuliformis Carrière is an important native species in the Loess Plateau of China, as well as the preferred species for artificial afforestation in this area. Methods: One-year-old P. tabuliformis seedlings were treated with six different N concentrations (0, 0.02, 0.04, 0.08, 0.16, and 0.32 g N kg −1 soil year −1 ) for 3 years. Individual P. tabuliformis seedlings were separated into leaves, shoots, and roots in May 2011. Variations in leaf morphology, root characteristics, and their biomasses were investigated. Results: (1) The highest N fertilizer level (0.32 g N kg −1 soil year −1 ) significantly decreased leaf area, root length, and specific root area. (2) Lower levels of N significantly reduced root length, root diameter, and specific root area in the first- and second-order roots. (3) Leaf biomass increased significantly in the higher N treatments (0.02–0.08 g N kg −1 soil year −1 ). However, total seedling biomass under the highest treatment decreased significantly due to excessive N. Biomass of the roots and leaves in the 0.04 g N kg −1 soil year −1 treatment increased compared with that in the control. Conclusions: (1) The lower-order roots (and leaves) were more sensitive than the higher-order roots (and stems) to N application. (2) The specific root area to specific leaf area ratio might be more suitable than area or biomass indices in explaining the utilisation of N by plants. (3) The functional balance hypothesis did not adequately explain the distribution of photosynthetic products among P. tabuliformis organs, but the source-sink relationship hypothesis did. This indicates that roots were the main sink and received a greater distribution of photosynthetic products.
http://ift.tt/2hcIQke
Molecular cloning, polymorphism, and functional activity of the bovine and water buffalo Mx2 gene promoter region
Background: Bovine Mx2 gene sequences were already reported, but further information about the gene properties is not yet available. The objective of the current study was to elucidate the structural properties of the bovine Mx2 gene mainly the promoter region and its possible functional role. If available, such information would help in assessing the functional properties of the gene, which was reported to confer antiviral action against recombinant VSV. Results: Examinations on the bovine genomic BAC clone—confirmed to contain the Mx2 gene—revealed 883-bp sequences. A computer scan unequivocally identified a 788-bp promoter region containing a typical TATA box, three ISREs and other promoter-specific motifs. Comparative analysis of nine bovine genomic DNA samples showed 19 nucleotide substitutions suggesting the existence of five different genotypes in the promoter region. The water buffalo Mx2 promoter region was determined by using primers based on the bovine Mx2 promoter region disclosing 893-bp, with 56 substitutions, two insertions, 9 and 1 nt at two different sites. A functional analysis of the putative ISRE indicated that ISRE played a synergetic role in the activation of bovine Mx2 gene transcription. Conclusion: Bovine and water buffalo Mx2 promoter region was identified disclosing, the conserved ISRE, located in the proximal end of the promoter region like other members of the antiviral family, suggesting functional activity under interferon stimulation.
http://ift.tt/2igk7vl
Correlations of microRNA-124a and microRNA-30d with clinicopathological features of breast cancer patients with type 2 diabetes mellitus
This study intends to investigate the correlations of miR-124a and miR-30d with clinicopathological features of breast cancer (BC) patients with type 2 diabetes mellitus (T2DM). A total of 72 BC patients with T2DM (diabetic group) and 144 BC patients without T2DM (non-diabetic group) were enrolled in this study. Blood glucose was detected by glucose oxidase methods. Glycosylated hemoglobin (HbA1c) was measured by high performance liquid chromatography. Fasting insulin (FIns) was measured by chemiluminescent microparticle immunoassay. Automatic biochemical analyzer was used to detect triglyceride, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Estradiol (E 2 ) was detected by radioimmunoassay. Homeostasis model assessment was applied to assess the insulin resistance (HOMA-IR) and β-cell insulin secretion (HOMA-IS). The expressions of miR124a and miR-30d were measured by quantitative real-time polymerase chain reaction (qRT-PCR). There were significant differences in age, the ratio of menopause, body mass index (BMI), HDL-C, TC, 2-h plasma glucose (2hPG), FIns, HbA1c, HOMA-IS and HOMA-IR between the diabetic and non-diabetic groups. The diabetic group had higher incidence of lymph node metastasis than non-diabetic group. The miR-124a expression was down-regulated while the miR-30d expression was up-regulated in BC patients with T2DM. The correlation analysis showed that miR-124a expression was positively correlated with HDL-C, while it was negatively correlated with age, HbA1c, LDL-C and E 2 . However, the miR-30d expression was negatively correlated with HDL-C but positively correlated with age, HbA1c, LDL-C and E 2 . In conclusion, miR-124a and miR-30d may be correlated with clinicopathological features of BC patients with T2DM. The miR-124a and miR-30d could serve as novel biomarkers for early diagnosis of BC in patients with T2DM.
http://ift.tt/2igo9nJ
Diagnosis and treatment of spontaneous intracranial hypotension due to cerebrospinal fluid leakage
IntroductionSpontaneous intracranial hypotension is one of the causes of a postural headache in young people. In this study, the diagnosis and treatment results of a case of intracranial hypotension headache due to spinal cerebrospinal fluid leakage were reported. Up to now, there is not absolutely effective treatment for intracranial hypotension headache.Case descriptionA 32-year-old woman complained, a headache after prolonged sitting that presented with nausea; vomiting; increased pain during walking; and decreased or absent pain after lying down. The dramatic improvement of this cephalalgia with epidural blood patch treatment confirmed the diagnosis.Discussion and EvaluationTo the best of our knowledge, this is the first reported of radiographic contrast before and after epidural blood patch. Improved clinical diagnosis and treatment of spontaneous intracranial hypotension. The patient didn't feel any discomfort, no complications such as infection etc. were observed. A small dose of intrathecal gadolthis is the first reported case ofinium during CEMRM allows for improved detection of CSF leakage. Conclusions: Leakage of spinal CSF is a major cause of spontaneous intracranial hypotension. In order to improve clinical diagnosis and provide effective treatment, the precise etiology of spontaneous intracranial hypotension should be investigated in each patient.
http://ift.tt/2i6jRfc
Oscillation criteria for second order Emden-Fowler functional differential equations of neutral type
In this article, some new oscillation criterion for the second order Emden-Fowler functional differential equation of neutral type( r ( t ) | z ′ ( t ) | α − 1 z ′ ( t ) ) ′ + q ( t ) | x ( σ ( t ) ) | β − 1 x ( σ ( t ) ) = 0 ,where z ( t ) = x ( t ) + p ( t ) x ( τ ( t ) ) , α > 0 and β > 0 are established. Our results improve some well-known results which were published recently in the literature. Some illustrating examples are also provided to show the importance of our results.MSC: 34C10, 34K11.
http://ift.tt/2h6iGL6
Application of inequalities technique to dynamics analysis of a stochastic eco-epidemiology model
This paper formulates an infected predator-prey model with Beddington-DeAngelis functional response from a classical deterministic framework to a stochastic differential equation (SDE). First, we provide a global analysis including the global positive solution, stochastically ultimate boundedness, the persistence in mean, and extinction of the SDE system by using the technique of a series of inequalities. Second, by using Itô's formula and Lyapunov methods, we investigate the asymptotic behaviors around the equilibrium points of its deterministic system. The solution of the stochastic model has a unique stationary distribution, it also has the characteristics of ergodicity. Finally, we present a series of numerical simulations of these cases with respect to different noise disturbance coefficients to illustrate the performance of the theoretical results. The results show that if the intensity of the disturbance is sufficiently large, the persistence of the SDE model can be destroyed.
http://ift.tt/2hXaG0V
DEF - a programming language agnostic framework and execution environment for the parallel execution of library routines
There is high demand for library routines that can be included into arbitrary programs and executed in parallel in the Cloud. So our approach is to provide a framework that supports the parallelized execution of library routines, written in different programming languages, from any platform. Our Distributed Execution Framework (DEF) allows to (1) deploy arbitrary routines into a central library and (2) integrate these library routines at runtime into user programs in a way that allows the routines to be executed in parallel in the Cloud. The programming and runtime environment of the library routine is completely transparent to the user and the chosen programming and runtime environment. DEF provides client and library APIs with primitives like search_lib(), create_task(), submit_job() which are integrated into the user's program to access the DEF runtime. DEF allows the user to configure clusters in a public/private Cloud and automatically distributes the tasks for executing the library routines on the workers of the cluster.
http://ift.tt/2hLTOfy
A new proof-of-work mechanism for bitcoin
Background: Bitcoin system, when more than 51% computing power is controlled by a single node, the block chain can be distorted maliciously. This is called 51% attack which is a well-known potential risk that could destroy the Bitcoin system.MethodThe paper proves that under the current proof-of-work mechanism, computing power eventually will be centralized at a single node if miners are rational enough.ResultThe paper propose a new proof-of-work mechanism that improves decentralization and reduces the risk of 51% attack without increasing the risk of Sybil attack.ConcusionsThis new mechanism introduces a series of principles such as Career open to all talents, without distinction of birth, Distribution according to labor and All Men are created equal.
http://ift.tt/2i6ePj0
Dirichlet type problems for Dunkl-Poisson equations
In this paper, using the intertwine relations of differential operators, we study one representation of real analytic functions by Dunkl-harmonic functions, which is a generalization of the well-known Almansi formula. As an application of the representation, we construct a solution of the Dunkl-Poisson equations in Clifford analysis. Then we investigate solutions of homogeneous and inhomogeneous Dirichlet type problems for Dunkl-Poisson's equation, and inhomogeneous Dirichlet problems for Dunkl-Laplace's equation.MSC: 30G35, 35J05, 58C50.
http://ift.tt/2hXcAPm
Above- and below-ground biomass distribution and morphological characteristics respond to nitrogen addition in Pinus tabuliformis
Background: With the continuing deposition of atmospheric nitrogen (N), N has become a major factor affecting ecosystem carbon (C) balance and N cycles. However, it is still unclear how increasing N deposition alters above- and below-ground biomass allocation, especially among different order roots. Pinus tabuliformis Carrière is an important native species in the Loess Plateau of China, as well as the preferred species for artificial afforestation in this area. Methods: One-year-old P. tabuliformis seedlings were treated with six different N concentrations (0, 0.02, 0.04, 0.08, 0.16, and 0.32 g N kg −1 soil year −1 ) for 3 years. Individual P. tabuliformis seedlings were separated into leaves, shoots, and roots in May 2011. Variations in leaf morphology, root characteristics, and their biomasses were investigated. Results: (1) The highest N fertilizer level (0.32 g N kg −1 soil year −1 ) significantly decreased leaf area, root length, and specific root area. (2) Lower levels of N significantly reduced root length, root diameter, and specific root area in the first- and second-order roots. (3) Leaf biomass increased significantly in the higher N treatments (0.02–0.08 g N kg −1 soil year −1 ). However, total seedling biomass under the highest treatment decreased significantly due to excessive N. Biomass of the roots and leaves in the 0.04 g N kg −1 soil year −1 treatment increased compared with that in the control. Conclusions: (1) The lower-order roots (and leaves) were more sensitive than the higher-order roots (and stems) to N application. (2) The specific root area to specific leaf area ratio might be more suitable than area or biomass indices in explaining the utilisation of N by plants. (3) The functional balance hypothesis did not adequately explain the distribution of photosynthetic products among P. tabuliformis organs, but the source-sink relationship hypothesis did. This indicates that roots were the main sink and received a greater distribution of photosynthetic products.
http://ift.tt/2hcIQke
Predictive markers for delayed lymph node metastases and survival in early-stage oral squamous cell carcinoma
ABSTRACT
Background
The purpose of this study was to identify clinicopathological and immunohistochemical factors predicting delayed lymph node metastases and survival in early oral squamous cell carcinoma (OSCC).
Methods
The study included 85 consecutive patients with clinically T1 to T2N0 OSCC who were primarily surgically treated between 2000 and 2004.
Results
There were 68 men and 17 women (median age, 61 years; range, 34–82 years). Of all the patients, 25 (29.4%) developed delayed lymph node metastases within 3 to 42 months after treatment of the primary tumor. Multivariate logistic regression analysis identified poorly differentiated tumors, low laminin, and high fibronectin expression as prognosticators of delayed lymph node metastases. Cox's proportional hazards regression analysis demonstrated that moderately differentiated tumors and delayed lymph node metastases had predictive value regarding survival.
Conclusion
Large prospective investigations with reproducibility and the clinical translatability of immunohistochemical methods are needed in order to provide new and effective therapeutic strategies in the future. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
http://ift.tt/2igVOxh
Case of parotid mucoepidermoid carcinoma: Expanding the spectrum of von Hippel-Lindau–related neoplasms
ABSTRACT
Background
von Hippel–Lindau (VHL)-related tumors occurring outside the spectrum of VHL-defining tumors are rare, and mucoepidermoid carcinoma (MEC) in the setting of VHL disease has not been described.
Methods and Results
We describe a patient with confirmed VHL mutation who presented with a parotid mass and a history of 2 central nervous system (CNS) hemangioblastomas and 1 pheochromocytoma. Fine-needle aspiration (FNA) of the mass suggested a benign Warthin tumor. The mass was resected and final pathology revealed a low-grade MEC. Fluorescence in situ hybridization for the MECT1/MAML2 fusion gene frequently associated with MEC was performed and was negative. Molecular testing of tumor cells displayed a likely "second hit" VHL gene mutation.
Conclusion
There is a possible broader role of VHL mutations in tumorigenesis beyond the development of classically described VHL-defining neoplasms. Our case also demonstrates the importance of always considering the possibility of a parotid malignancy in patients with VHL despite a benign FNA. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
http://ift.tt/2h6XHri
Significant and durable clinical benefit from trastuzumab in 2 patients with HER2-amplified salivary gland cancer and a review of the literature
Abstract
Background
Salivary ductal carcinoma and carcinoma ex pleomorphic adenoma (CEPA) are aggressive salivary gland cancers with poor prognosis. The standard of care is resection with or without radiotherapy, and there are no established systemic therapy options.
Methods
We describe 1 patient with metastatic CEPA and 1 patient with metastatic recurrent salivary duct carcinoma whose tumors were evaluated by comprehensive genomic profiling. Testing identified human epidermal growth factor receptor 2 (HER2) amplification in both patients, and an additional activating HER2 mutation in the CEPA case.
Results
Both patients were treated with the HER2-targeting monoclonal antibody trastuzumab (herceptin) plus chemotherapy and experienced rapid responses. Subsequently, both patients were given single-agent maintenance trastuzumab and continue to experience durable disease control.
Conclusion
Given the poor prognosis for salivary gland cancers and the limited treatment options upon recurrence or metastasis, patients should be tested for all classes of HER2 alterations. In cases with HER2 overexpression or activation, targeted therapies, such as trastuzumab are promising. © 2016 Wiley Periodicals, Head Neck, 2016
http://ift.tt/2igSnXy
Lymphatic drainage patterns of oral maxillary tumors: Approachable locations of sentinel lymph nodes mainly at the cervical neck level
Abstract
Background
There is debate if the lymphatic drainage pattern of oral maxillary cancer is to the retropharyngeal lymph nodes or to the cervical lymph nodes. Insight in drainage patterns is important for the indication for neck treatment. The purpose of this study was to identify the lymphatic drainage pattern of oral maxillary cancer via preoperative lymphoscintigraphy.
Methods
Eleven consecutive patients with oral maxillary cancer treated in our center between December 1, 2012, and April 22, 2016 were studied. Sentinel lymph nodes identified by preoperative lymphoscintigraphy after injection of 99mTc-nanocolloid and by intraoperative detection using a γ-probe, were surgically removed and histopathologically examined.
Results
In 10 patients, sentinel lymph nodes were detected and harvested at cervical levels I, II, or III in the neck. In 2 patients, a parapharyngeal sentinel lymph node was detected. One of the harvested sentinel lymph nodes (1/19) was tumor positive.
Conclusion
This study suggests the likelihood of 73% of exclusively cervical level I to III sentinel lymph nodes in oral maxillary cancer. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
http://ift.tt/2h6YuZp
Definitive carbon-ion radiotherapy for locally advanced parotid gland carcinomas
Abstract
Background
The purpose of this study was to present our evaluation of the safety and efficacy of carbon-ion radiotherapy (C-ion RT) for locally advanced parotid gland carcinomas.
Methods
Clinicopathological features and outcomes were evaluated in 46 patients receiving C-ion RT for parotid gland carcinomas.
Results
Sixteen patients had adenoid cystic carcinoma; 8 had adenocarcinoma, 8 had mucoepidermoid carcinoma, and 14 had other carcinomas. T2, T3, T4a, and T4b diseases were diagnosed in 3, 18, 8, and 17 patients, respectively. C-ion RT was provided to 25 patients as the primary treatment, to 20 patients for local recurrences after surgery, and to 1 patient for residual tumor after surgery. During follow-up (median duration, 62 months), 5-year local control and overall survival (OS) rates were 74.5% and 70.1%, respectively. Of the 30 patients without facial nerve palsy before C-ion RT, 25 showed no radiation-induced facial nerve palsy.
Conclusion
C-ion RT is effective and has acceptable toxicity levels for locally advanced parotid gland carcinomas. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
http://ift.tt/2igME4b
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