Pharyngeal swallowing pressures in the base-of-tongue and hypopharynx regions identified with three-dimensional manometry

Objectives

This study aims to use three-dimensional (3D) high-resolution manometry to identify circumferential pressure patterns generated within the asymmetrical base-of-tongue and hypopharynx regions of the pharynx during deglutition.

Study Design

Case series.

Methods

Radial pressures in the regions of interest were evaluated during swallowing events in 12 healthy subjects using 3D high-resolution manometry.

Results

Repeated measures analysis of variance revealed asymmetrical pharyngeal clearance pressures in the base-of-tongue and hypopharynx regions during swallowing. A significant main effect of direction on pressure was found at the time point of average maximum pressure (P < 0.001) and for pressure integral (P < 0.001), with pressure primarily generated from the posterior direction. An interaction was noted between direction and location when comparing maximum directional pressures, regardless of time (P =0.045), highlighting the differences in anterior pressure production between regions. In contrast to the high posterior pressures produced in the base-of-tongue region, an anteroposterior dominant pressure pattern was observed in the hypopharynx. Pressure waveform complexity in the hypopharynx also is likely attributed to activity in the anterior and posterior directions. Symmetrical pressure generation was observed during intrabolus flow within the hypopharynx.

Conclusion

This study shows that pressure is asymmetrically generated in the base-of-tongue and hypopharynx regions during swallowing of a 10-mL bolus, reflecting the complex anatomy within the pharynx. Understanding of these complex pressure patterns aids in the interpretation of high-resolution manometry and can help guide further study in the clinical assessment and treatment of pharyngeal pathology.

Level of Evidence

4. Laryngoscope, 2016

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Racial disparities in preventable risk factors for head and neck cancer

Objectives/Hypothesis

To demonstrate racial differences in preventable risk behaviors/practices that contribute to head and neck cancer (HNCA).

Study Design

Cross-sectional analysis of large national risk factor survey.

Methods

The Behavioral Risk Factor Surveillance System for 2013 was analyzed. Demographic data were extracted, including age, sex, and race. Social habits considered risk factors for HNCA were also extracted, including alcohol consumption, smoking, and human papillomavirus (HPV) vaccination status. Statistical comparisons were conducted according to race for each risk factor, and additional comparisons were conducted within the American Indian population subgroup for risk factors according to sex.

Results

A total of 238.6 million Americans were surveyed. American Indians reported higher rates of binge drinking (19.0%) than whites (17.3%), blacks (12.4%), and Asian Americans (13.1%; P < .001). This rate was significantly higher for American Indian males (23.5%) versus females (13.7%; P < .001). Mean total drinks per month was higher for whites and American Indians (13.5 and 13.5; P < .001). American Indians reported the highest rates of current smoking (28.1%), followed by blacks (20.1%), whites (18.3%), and Asians (10.2%; P < .001). American Indians also reported the highest rates of every day smoking (18.2%), versus whites (13.3%), blacks (13.1%), and Asians (6.1%; P < .001). Rates of HPV vaccination were lowest for American Indians (11.7%), compared to whites (14.6%), blacks (13.6%), and Asians (12%; P = 0.618).

Conclusions

There are striking racial disparities in the prevalence of preventable risk factors for HNCA. These data highlight the need for targeted education and prevention programs in particular racial groups.

Level of Evidence

4. Laryngoscope, 2017

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Clinical implications of microscopic extrathyroidal extension in patients with papillary thyroid carcinoma

Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy, accounting for ∼90% of all thyroid carcinomas [1]. It is a differentiated carcinoma with a relatively good prognosis and a low mortality rate. However, PTC frequently spreads to the cervical lymph nodes (LN), which is associated with a higher locoregional recurrence. Various clinicopathological factors, including age, gender, tumor size, extrathyroidal extension (ETE), and distant metastasis, are associated with the prognosis of PTC [2–4].

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Corrigendum to ‘“Hidden scar” submandibular gland excision using an endoscope-assisted hairline approach’ [Oral Oncol. 65 (2017) 83–88]

The authors regret that Seung Hoon Woo's name appeared incorrectly in the original article. It appears correctly above.

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Dendritic cell rehab: new strategies to unleash therapeutic immunity in ovarian cancer

Abstract

Immune-based therapies that induce remarkable and durable responses against melanoma and lung cancer have unfortunately demonstrated limited success in ovarian cancer patients. This is likely due to the exceptional immunoregulatory nature of ovarian tumors, which employ numerous strategies to effectively suppress anti-tumor immunity. Here, we summarize a decade of research indicating that ovarian cancers possess an exquisite capacity to subvert the activity of host dendritic cells (DCs) as a key mechanism to impede the development and maintenance of protective T cell-based immune responses. Identifying, understanding, and disabling the precise mechanisms promoting DC dysfunction in ovarian cancer are, therefore, fundamental requirements for devising the next generation of successful immunotherapies against this devastating malignancy.

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Myeloid cells as a target for oligonucleotide therapeutics: turning obstacles into opportunities

Abstract

Immunotherapies emerged as an alternative for cancer treatment, yet their clinical efficacies are still limited, especially in case of solid tumors. Myeloid immune cells, such as macrophages and myeloid-derived suppressor cells (MDSCs), are often hijacked by tumors and become pivotal inhibitors of antitumor immunity. Immunosuppressive functions of tumor-associated myeloid cells result from the activity of Signal Transducer and Activator of Transcription 3 (STAT3), a transcription factor with well-defined tumorigenic and tolerogenic roles in human cancers. To overcome challenges in the development of pharmacological STAT3 inhibitors, we recently developed oligonucleotide-based strategies for cell-selective, in vivo STAT3 targeting. Conjugation of a STAT3siRNA or decoy STAT3 inhibitors to synthetic Toll-like Receptor 9 (TLR9) agonists, CpG oligonucleotides, allowed for selective delivery into TLR9-positive cells. Cellular target for CpG-STAT3 inhibitors include non-malignant, tumor-associated myeloid cells, such as polymorphonuclear MDSCs, as well as cancer cells in acute myeloid leukemia, B cell lymphoma and in certain solid tumors. The chemically modified CpG-STAT3 inhibitors resist serum nucleases and thus can be administered intravenously. Their potency relies on the intracellular gain-of-function effect: release of the central immune checkpoint regulator (STAT3) to unleash proinflammatory signaling (CpG/TLR9) in the same antigen-presenting cell. At the cellular level, CpG-STAT3 inhibitors exert two-pronged effect by rescuing T cells from the immune checkpoint control while decreasing survival of cancer cells. In this article, we review the preclinical data on CpG-STAT3 inhibitors and discuss perspectives of using TLR9-targeted delivery of oligonucleotide therapeutics for the generation of novel, more effective and safer cancer immunotherapies.

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Novel potential scaffold for periodontal tissue engineering

Abstract

Objective

The objective of the study is characterization of novel calcium and zinc-loaded electrospun matrices to be used for periodontal regeneration.

Materials and methods

A polymethylmetacrylate-based membrane was calcium or zinc loaded. Matrices were characterized morphologically by atomic force and scanning electron microscopy and mechanically probed by a nanoindenter. Biomimetic calcium phosphate precipitation on polymeric tissues was assessed. Cell viability tests were performed using oral mucosa fibroblasts. Data were analyzed by Kruskal-Wallis and Mann-Whitney tests or by ANOVA and Student-Newman-Keuls multiple comparisons.

Results

Zinc and calcium loading on matrices did not modify their morphology but increased nanomechanical properties and decreased nanoroughness. Precipitation of calcium and phosphate on the matrix surfaces was observed in zinc-loaded specimens. Matrices were found to be non-toxic to cells in all the assays. Calcium- and zinc-loaded scaffolds presented a very low cytotoxic effect.

Conclusions

Zinc-loaded membranes permit cell viability and promoted mineral precipitation in physiological conditions. Based on the tested nanomechanical properties and scaffold architecture, the proposed membranes may be suitable for cell proliferation.

Clinical relevance

The ability of zinc-loaded matrices to promote precipitation of calcium phosphate deposits, together with their observed non-toxicity and its surface chemistry allowing covalent binding of proteins, may offer new strategies for periodontal regeneration.

http://ift.tt/2liJICP

A lateral cephalometry study of patients with neurofibromatosis type 1

Neurofibromatosis type 1 (NF1) is an autosomal dominant transmitted tumour suppressor syndrome and also a bone disease. Osseous dysplasia affecting the craniofacial region is characteristic of NF1. The aim of this study was to analyse the lateral cephalograms of NF1 patients in comparison to individuals who were not affected by this condition in order to describe the skeletal phenotype of NF1 in more detail.

http://ift.tt/2kUJ79d

Fracture patterns after bilateral sagittal split osteotomy of the mandibular ramus according to the Obwegeser/Dal Pont and Hunsuck/Epker modifications

The aim of this study was to compare the fracture patterns after sagittal split osteotomy according to Obwegeser/Dal Pont (ODP) and Hunsuck/Epker (HE), as well as to investigate the relationship between lateral bone cut ending or angle and the incidence of unfavorable/bad splits. Postoperative cone-beam computed tomograms of 124 splits according to ODP and 60 according to HE were analyzed. ODP led to 75.8% and HE led to 60% lingual fractures with mandibular foramen contact. Horizontal fractures were found in 9.7% and 6.7%, respectively, and unfavorable/bad splits were found in 11.3% and 10%, respectively.

http://ift.tt/2lWmxkF

The versatile use of revisited de-epithelialization concept in superficial circumflex iliac and anterolateral thigh perforator free flap for head and neck reconstructions

Although the perforator free flap is now a standard choice for head and neck reconstruction, problems such as microvascular complications, insufficient volume support for the defect, and fistula formation occur. We revisited a de-epithelialized concept for superficial circumflex iliac artery and anterolateral thigh perforator free flap to overcome these problems.

http://ift.tt/2kUNbWU

The histological and histomorphometric changes in the mandible after radiotherapy: An animal model

Osteoradionecrosis (ORN) of the mandible is a severe complication after radiotherapy (RT) and develops in approximately 2%-22% of head and neck cancer patients and most often in the mandible (Teng and Futran, 2005). The most accepted definition for ORN is that 'irradiated bone becomes devitalized and is exposed through the overlying skin or mucosa, without tumor recurrence, and does not heal within 3 months' (Lyons and Ghazali, 2008). The current non-surgical treatment options for ORN, such as hyperbaric oxygen therapy and medical treatment, are based on controversial theories and on a limited number of studies (Delanian et al., 2005; Shaw and Dhanda, 2011).

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The effect of optimizing EABR parameters in artificial cochlear implantation for auditory rehabilitation

OBJECTIVE: The objective of the present study was to observe the relationship between V extraction rate and threshold value of electrically evoked auditory brainstem response (EABR) waves in artificial cochlear implantation, in order to optimize EABR parameters for improving auditory rehabilitation.

PATIENTS AND METHODS: Thirty patients without residual hearing and treated with artificial cochlear implants were selected. The experimental group included 17 cases with normal cochlear morphology, four with large vestibular aqueduct syndrome (LVAS), six with Mondini malformation, and three with internal auditory canal stenosis. Thirty patients with residual hearing and approximate conditions, treated with artificial cochlear implantation to conduct matching were taken as the control group. For artificial cochlear implantation, Remolded Cochlear Freedom artificial cochleas and platinum-iridium alloy spheroid electrodes were used to provide electric stimulation of different pulse widths (50 μs, 100 μs, and 200 μs) to patients in the two groups. A Bio-logic Navigator Pro auditory evoked potentiometer was used to record V extraction rate and threshold value of EABR waves under the different pulse widths.

RESULTS: There were no significant differences in V extraction rates of EABR waves at pulse widths of 50 μs, 100 μs, and 200 μs (p >0.05). All EABR threshold values in the experimental group were higher than those in the control group, and the differences were statistically significant (p <0.05).

CONCLUSIONS: The monopole stimulation within the cochlea can induce good EABR waves and EABR threshold values of patients without residual hearing were significantly higher than those of patients with residual hearing (p <0.05). Waveform differentiation of pulse width 100 μs was better, dynamic range was broader, and it was necessary to increase stimulation when the malformation was serious.

L'articolo The effect of optimizing EABR parameters in artificial cochlear implantation for auditory rehabilitation sembra essere il primo su European Review.

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New Developments in Imaging of Laryngeal Cancer

Abstract

Purpose of Review

To critically review the recent literature about laryngeal cancer imaging using a clinically oriented perspective and focusing on technical innovations.

Recent Findings

A number of articles have been recently published on cartilage invasion assessment. Inaccuracy of CT in assessing major cartilage invasion and extralaryngeal spread has emerged. Imaging of paraglottic and preepiglottic space invasion has been less investigated. MR can outperform CT, but optimization of MR protocols is crucial. Dual-energy/spectral CT and diffusion-weighted MR are promising techniques, but their clinical utility needs to be confirmed. Tumor volume is usually overestimated with CT and MR compared to that of histopathology. Follow-up, especially after (chemo) radiation, is challenging, and MR with diffusion-weighted sequences seems superior to CT in discriminating recurrence from inflammatory changes.

Summary

CT is a well-established technique, with known limitations. MR potential needs to be exploited using a state-of-the-art technique. Specific relevant issues for planning mini invasive surgery need to be further investigated.

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Current Philosophy in the Surgery for Chronic Rhinosinusitis

Abstract

Purpose of Review

Despite the paucity of level I evidence from meta-analysis of randomized, controlled trials, physicians have to make decisions regarding the surgical management of chronic rhinosinusitis (CRS). In this review we attempt to summarize the current state of knowledge regarding surgery for CRS.

Recent Findings

A well known, often repeated adage is that the extent of surgery must be tailored to the extent of disease. At the same time, there is an increasing body of evidence that more extended procedures are associated with better overall outcomes. Adverse predictive factors include the presence of acetylsalicylic acid (ASA) intolerance, cystic fibrosis (CF), biofilms, osteitis, and immunodeficiency. Overall, about 10–20% of patients submitted to sinus surgery with simultaneous medical therapy will not avoid a revision procedure. The use of balloon catheters as a valid alternative to standard ESS techniques is not supported by current evidence.

Summary

Advantages of endoscopic sinus surgery include safety and the capacity to improve both symptom scores (especially nasal obstruction) and objective measures. Improvement in distribution of topical therapy is a major method of action.

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Classical Hodgkin lymphoma masquerading as chronic recurrent multifocal osteomyelitis: a case report

Hodgkin lymphoma is a hematologic malignancy usually confined to lymphatic structures and commonly associated with constitutional symptoms. Bony involvement and musculoskeletal symptoms are uncommon and typica...

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The risk of depression, suicidal ideation, and suicide attempt in patients with psoriasis, psoriatic arthritis, or ankylosing spondylitis

Abstract

Background

Sparse information is available concerning mental health issues in psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS) patients.

Objective

To estimate risk of depression, suicidal ideation, and suicide attempt in patients with psoriasis, PsA, and AS, respectively, compared with the general population.

Methods

This population-based cohort study analyzed 36,214 psoriasis patients, 5,138 PsA patients, and 1,878 AS patients who were frequency-matched with a general population cohort. Annual incidence rate of depression, suicidal ideation, and suicide attempt was calculated separately for psoriasis, PsA and AS.

Results

There was an increased risk of depression in the three cohorts; adjusted IRR: psoriasis, 1.14 (95% CI, 1.11, 1.17); PsA, 1.22 (95% CI, 1.16, 1.29); AS, 1.34 (95% CI, 1.23, 1.47). There was no significantly increased risk for suicidal ideations or suicide attempt among psoriasis, PsA, or AS patients.

Limitations

Patients were not excluded if previously diagnosed with depression, suicidal ideation, or suicide attempt. Suicide attempt and completed suicide analyses were not adjusted for presence of depression. Use of systemic psoriasis treatment to measure severe psoriasis could lead to psoriasis severity misclassification.

Conclusion

The risk of depression, but not suicidal ideation or suicide attempt, was significantly increased in patients with psoriasis, PsA, and AS.

This article is protected by copyright. All rights reserved.

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The value of reflectance confocal microscopy in diagnosis of flat pigmented facial lesions: a prospective study

Abstract

Background

Flat pigmented facial lesions are difficult to diagnose even with dermatoscopy. It is controversial how additional information obtained by in vivo reflectance confocal microscopy (RCM) impacts the diagnosis and management.

Objective

To examine what in vivo reflectance confocal microscopy of flat pigmented facial lesions adds to clinical examination using dermatoscopy including digital dermatoscopic monitoring.

Methods

We prospectively collected 70 cases of flat pigmented facial lesions and recorded diagnoses and management decisions by experts based on direct clinical examination aided by dermatoscopy including digital dermatoscopic monitoring and by remote experts who reviewed the corresponding confocal images. The expert confocal readers were blinded to the clinical and dermatoscopic appearance of the lesion.

Results

The sensitivity of dermatoscopy plus digital dermatoscopic monitoring was 95.0% (95% CI 75.13% to 99.87%) and the specificity 84.0% (95% CI 70.89% to 92.83%). The sensitivity of RCM was 95.0% (95% CI 75.13% to 99.87%) and the specificity 82.0% (95% CI 68.56% to 91.42%).

Conclusion

Although most flat pigmented facial lesions can be managed by clinical examination and dermatoscopy alone, confocal microscopy is a useful adjunct in selected lesions. If RCM is not correlated with clinical and dermatoscopic information there is risk of overdiagnosis of actinic keratosis, however.

This article is protected by copyright. All rights reserved.

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Allergic contact cheilitis from anethole-containing toothpastes: a practical solution

Abstract

In patients presenting with therapy-resistant cheilitis, especially when extending to the perioral skin, patch tests should be performed, even in longstanding cases^1-2. A 55-year-old woman suffered from an oozing cheilitis for three months with erythema, edema and crusting of the lips and perioral skin (Fig. 1). An intra-oral burning sensation, loss of taste and a dry mouth were also present. Microbiological swabs and a blood analysis did not reveal any abnormalities, and the application of topical corticosteroids brought only temporary relief.

This article is protected by copyright. All rights reserved.

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In reply

I would like to thank Dr. Marcelo S. Ramos et al. for their valuable comments and the interest shown in our article recently published in JCA [1].

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Paraneoplastic pemphigus associated with Castleman disease: Progression from mucous to mucocutaneous lesions with epitope-spreading phenomena

Abstract

Paraneoplastic pemphigus (PNP) is a frequently fatal autoimmune blistering disease of the skin and mucous membranes.¹ PNP is commonly associated with malignant neoplasms or haematological disorders like Castleman disease (CD). The eruptions may resemble those seen in various other conditions such as lichen planus (LP), graft-versus-host disease, erythema multiforme (EM), bullous pemphigoid and pemphigus vulgaris (PV).²

This article is protected by copyright. All rights reserved.

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Aged rats under zoledronic acid therapy and oral surgery

Publication date: Available online 17 February 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Mariza Akemi Matsumoto, Elisa Mara de Abreu Furquim, Alaíde Gonçalves, Joel Ferreira Santiago-Júnior, Patrícia Pinto Saraiva, Camila Lopes Cardoso, Marcelo Salles Munerato, Roberta Okamoto
IntroductionAging brings a number of health conditions that can compromise the healing process in elderly individuals, significantly when it comes to bone tissue. The aim of the present study was to analyze the effects of zoledronic acid (ZL) therapy on socket healing of aged male rats.Materials and methodsTwenty-four Wistar male rats, 20 months old, underwent surgical procedures for the extraction of the upper right incisor and were divided into two groups according to the treatment: Control (C) – intravenous (IV) 0.9% saline, ZL – 0.035 mg/Kg of IV zoledronic acid, both every 15 days. At the fifth dose of both substances, tooth extractions were performed and the animals were euthanized after 14 and 28 days.ResultsIV administration of ZL caused OPG-RANKL system imbalance, resulting in deficient bone formation and remodeling and alteration of osteoclast morphology, as well as maintaining persistent inflammation during the healing period.ConclusionsIV administration of ZL delayed extracted dental socket healing of aged rats, but not enough to cause osteonecrosis, raising a question about different responses to IV BP therapy considering animal age.



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Computer assisted positioning of the proximal segment after sagittal split osteotomy of the mandible: preclinical investigation of a novel electromagnetic navigation system

Publication date: Available online 17 February 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Igor Nova, Sebastian Kallus, Moritz Berger, Oliver Ristow, Urs Eisenmann, Christian Freudlsperger, Jürgen Hoffmann, Hartmut Dickhaus
IntroductionModifications of the temporomandibular joint position after mandible osteotomy are reluctantly accepted in orthognathic surgery. To tackle this problem, we developed a new navigation system using miniaturized electromagnetic sensors. Our imageless navigation approach is therefore optimized to avoid complications of previously proposed optical approaches such as the interference with established surgical procedures and the line of sight problem.Material and methodsHigh oblique sagittal split osteotomies were performed on 6 plastic skull mandibles in a laboratory under conditions comparable to the operating theater. The subsequent condyle reposition was guided by an intuitive user interface and performed by electromagnetic navigation. To prove the suitability and accuracy of this novel approach for condyle navigation, the positions of 3 titanium marker screws placed on each of the proximal segments were compared using pre- and postoperative Cone Beam Computed Tomography (CBCT) imaging.ResultsGuided by the electromagnetic navigation system, positioning of the condyles was highly accurate in all dimensions. Translational discrepancies up to 0,65mm and rotations up to 0,38° in mean could be measured postoperatively. There were no statistically significant differences between navigation results and CBCT measurements.ConclusionThe intuitive user interface provides a simple way to precisely restore the initial position and orientation of the proximal mandibular segments. Our electromagnetic navigation system therefore yields a promising approach for orthognathic surgery applications.



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A Quick Look Into the Future: Focused Cardiovascular Ultrasound (FCU)

No abstract available

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Acute Normovolemic Hemodilution: Picking More Apples and Oranges

No abstract available

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Acute Normovolemic Hemodilution Reduces Allogeneic Red Blood Cell Transfusion in Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Trials

BACKGROUND: To better understand the role of acute normovolemic hemodilution (ANH) in a surgical setting with high risk of bleeding, we analyzed all randomized controlled trials (RCTs) in the setting of cardiac surgery that compared ANH with standard intraoperative care. The aim was to assess the incidence of ANH-related number of allogeneic red blood cell units (RBCu) transfused. Secondary outcomes included the rate of allogeneic blood transfusion and estimated total blood loss. METHODS: Twenty-nine RCTs for a total of 2439 patients (1252 patients in the ANH group and 1187 in the control group) were included in our meta-analysis using PubMed/MEDLINE, Cochrane Controlled Trials Register, and EMBASE. RESULTS: Patients in the ANH group received fewer allogeneic RBCu transfusions (mean difference = −0.79; 95% confidence interval [CI], −1.25 to −0.34; P = .001; I2 = 95.1%). Patients in the ANH group were overall transfused less with allogeneic blood when compared with controls (356/845 [42.1%] in the ANH group versus 491/876 [56.1%] in controls; risk ratio = 0.74; 95% CI, 0.62 to 0.87; P

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Autologous, Not Hemorrhage! The Use of ANH in Cardiac Surgery

No abstract available

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Be FoCUSed: The Time Is Now!

No abstract available

http://ift.tt/2lgV3TS

The Nuts and Bolts of Performing Focused Cardiovascular Ultrasound (FoCUS)

The benefit of focused cardiovascular ultrasound as an adjunct to physical examination has been shown in numerous specialties and in diverse clinical settings. Although the value of these techniques to the practice of anesthesiology is substantial, they have only begun to be incorporated. This article reviews the basic techniques required to perform a bedside focused cardiovascular ultrasound (ie, FoCUS examination). This includes a discussion of patient positioning, breath control, probe position, and manipulation and was supplemented by normal and abnormal examples for review.

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Why Anesthesiologists Must Incorporate Focused Cardiac Ultrasound Into Daily Practice

The size, availability, cost, and quality of modern ultrasound devices have, for the first time in modern medicine, enabled point-of-care ultrasound by the noncardiologist physician. The appropriate application of focused cardiac ultrasound (FoCUS) by anesthesiologists has the potential to alter management and affect outcomes for a wide range of patients. In this article, the indications, benefits, and limitations of FoCUS are described. The training and equipment required to perform FoCUS are also discussed.

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Dysregulation of Metabolic Pathways in a Mouse Model of Allergic Asthma

Abstract

Background

Asthma is a complex lung disease resulting from the interplay of genetic and environmental factors. To understand the molecular changes that occur during the development of allergic asthma without genetic and environmental confounders, an experimental model of allergic asthma in mice was used. Our goals were to (1) identify changes at the small molecule level due to allergen exposure, (2) determine perturbed pathways due to disease, and (3) determine whether small molecule changes correlate with lung function.

Methods

In this experimental model of allergic asthma, matched bronchoalveolar lavage (BAL) fluid and plasma were collected from three groups of C57BL6 mice (control vs sensitized and/or challenged with ovalbumin, n=3-5/group) 6h, 24h, and 48h after the last challenge. Samples were analyzed using liquid chromatography mass spectrometry-based metabolomics. Airway hyperresponsiveness (AHR) measurements and differential cell counts were performed.

Results

In total, 398 and 368 dysregulated metabolites in the BAL fluid and plasma of sensitized and challenged mice were identified, respectively. These belonged to four, interconnected pathways relevant to asthma pathogenesis: sphingolipid metabolism (p=6.6x10^-5), arginine and proline metabolism (p=1.12x10^-7), glycerophospholipid metabolism (p=1.3x10^-10), and the neurotrophin signaling pathway (p=7.0x10^-6). Furthermore, within the arginine and proline metabolism pathway, a positive correlation between urea-1-carboxyate and AHR was observed in plasma metabolites, while ornithine revealed a reciprocal effect. In addition, agmatine positively correlated with lung eosinophilia.

Conclusion

These findings point to potential targets and pathways that may be central to asthma pathogenesis and can serve as novel therapeutic targets.

This article is protected by copyright. All rights reserved.

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The skin barrier function gene SPINK5 is associated with challenge proven IgE-mediated food allergy in infants

Abstract

Background

A defective skin barrier is hypothesised to be an important route of sensitisation to dietary antigens, and may lead to food allergy in some children. Missense mutations in the Serine peptidase inhibitor kazal type 5 (SPINK5) skin barrier gene have previously been associated with allergic conditions.

Objective

To determine whether genetic variants in and around SPINK5 are associated with IgE mediated food allergy.

Method

We genotyped 71 'tag' single nucleotide polymorphisms (tag-SNPs) within a region spanning ~263 kilobases (kb) including SPINK5 (~61kb) in n=722 (n=367 food allergic, n=199 food sensitised, tolerant and n=156 non-food allergic controls) 12-month infants (discovery sample) phenotyped for food allergy with the gold standard oral food challenge (OFC). Transepidermal water loss (TEWL) measures were collected at 12-months from a subset (n=150) of these individuals. SNPs were tested for association with food allergy using the Cochran-Mantel-Haenszel test adjusting for ancestry strata. Associations analyses were replicated in an independent sample group derived from four paediatric cohorts, total n=533 (n=203 food allergic, n=330 non-food allergic), mean age 2.5 years, with food allergy defined by either clinical history of reactivity, 95% positive predictive value (PPV) or challenge, corrected for ancestry by principal components.

Results

SPINK5 variant rs9325071 (A⟶G) was associated with challenge proven food allergy in the discovery sample (P=0.001 | OR=2.95 | CI=1.49-5.83). This association was further supported by replication (P=0.007 | OR=1.58 | CI=1.13-2.20) and by meta-analysis (P=0.0004 | OR=1.65). Variant rs9325071 is associated with decreased SPINK5 gene expression in the skin in publicly available genotype-tissue expression data, and we generated preliminary evidence for association of this SNP with elevated TEWL also.

Conclusions

We report, for the first time, association between SPINK5 variant rs9325071 and challenge-proven IgE-mediated food allergy.

This article is protected by copyright. All rights reserved.

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Short- and Long-Term Outcome After Lung Transplantation From Circulatory-Dead Donors: A Single-Center Experience.

BACKGROUND: Donation after cardiac death (DCD) to overcome the donor organ shortage is well accepted in the clinical setting, although long-term outcome after DCD lung transplantation (LTx) remains largely unknown. METHODS: In this retrospective study, DCD LTx recipients (n=59) were compared with a cohort of donation after brain-death (DBD) LTx recipients (n=331) transplanted between February 2007 and September 2013; follow-up was until January 1st 2016. Short-term (duration of mechanical ventilation, ICU stay, hospital stay and highest PGD score within 72 hours) and long-term (CLAD-free and overall survival) follow-up were compared over a median follow-up of 50.5 (+/-3.7) months for DCD and 66.8 (+/-1.5) months for DBD. RESULTS: There were no differences between groups with regard to patient characteristics: age (p=0.78), underlying disease (p=0.30) and type of type of LTx (p=0.10), except gender where more males were transplanted with a DCD donor (62.7%) vs (48.3%, p=0.048). There was no difference in time on mechanical ventilation (p=0.59), ICU stay (p=0.74), highest PGD score (p=0.67) and hospital stay (p=0.99). Moreover, CLAD-free (p=0.86) and overall survival (p=0.15) did not differ between the DBD and DCD group. CONCLUSION: In our experience, both short- and long-term outcome in DCD lung recipients is comparable to that of DBD lung recipients. Therefore, DCD lung transplantation can be considered a safe strategy that significantly increased our transplant activity. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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HCV Antiviral Therapy In Liver Transplant Candidates and Recipients with Renal Insufficiency.

Hepatitis C virus (HCV) remains the leading indication for liver transplant in much of the world, and has traditionally been associated with diminished posttransplant survival due to recurrent HCV-related liver disease. This field has been dramatically changed by the advent of safe and effective directly active antiviral (DAA) therapy, such that most patients can be cured in the pre or posttransplant setting. In addition, there are now DAA regimens specifically approved for use in patients with severe renal insufficiency. However, patients with pre or posttransplant severe renal insufficiency remain more difficult to treat, due to mechanisms of drug metabolism in hepatic and renal failure, as well as posttransplant drug-drug interactions. Treatment options are even more restricted in non-1 HCV genotypes. As renal insufficiency is common among patients with HCV, with decompensated cirrhosis, and in the post-ransplant setting, this difficult scenario is relatively common. However, ongoing development of pangenotypic regimens with improved safety profiles, as well as additional data on dosing and safety among patients with severe renal insufficiency, will continue to expand options for cure even in these most difficult to treat patients. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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PD-1 and PD-L1 antibodies in cancer: current status and future directions

Abstract

Immunotherapy has moved to the center stage of cancer treatment with the recent success of trials in solid tumors with PD-1/PD-L1 axis blockade. Programmed death-1 or PD-1 is a checkpoint molecule on T cells that plays a vital role in limiting adaptive immune responses and preventing autoimmune and auto-inflammatory reactivity in the normal host. In cancer patients, PD-1 expression is very high on T cells in the tumor microenvironment, and PD-L1, its primary ligand, is variably expressed on tumor cells and antigen-presenting cells within tumors, providing a potent inhibitory influence within the tumor microenvironment. While PD-L1 expression on tumors is often regarded as a negative prognostic factor, it is clearly associated with a positive outcome for treatment with PD-1/PD-L1 blocking antibodies, and has been used to select patients for this therapy. Responses of long duration, a minority of patients with atypical responses in which progression may precede tumor shrinkage, and a pattern of autoimmune side effects often seen with this class of drugs characterize therapy with PD-1/PD-L1 blocking drugs. While excellent efficacy has been seen with a limited number of tumor types, most epithelial cancers do not show responses of long duration with these agents. In the current review, we will briefly summarize the scientific background data supporting the development of PD-1/PD-L1 blockade, and then describe the track record of these antibodies in multiple different histologies ranging from melanoma and lung cancer to less common tumor types as well as discuss biomarkers that may assist in patient selection.

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Repeatability Study of Angular and Linear Measurements on Facial Morphology Analysis by Means of Stereophotogrammetry.

The aim of this study was to analyze the repeatability in a stereophotogrammetry digital system used for the evaluation of facial morphology. Thirty healthy Brazilian, 18 to 45 years old (26.71 +/- 6.53), had 11 reference landmarks marked on their faces by the same examiner and were photographed with an interval of 1 week by the VECTRA M3. Nine angular measurements (nasolabial, mentolabial, nasofrontal, maxillofacial, nasal, maxillary, mandibular, facial convexity, full facial convexity) and 2 linear measurements (middle facial height and lower facial height) were taken. Repeatability was analyzed by the mean absolute differences, relative error of magnitude, technical error of measurement, intraclass correlation coefficient, and Bland-Altman analysis. Paired t test sought any systematic errors between the acquisitions. Associations among body mass index, age, and the error in the measurements were made using the Pearson correlation coefficient. For the technical error of measurement, the nasolabial and mentolabial angles showed values >2[degrees] (clinical limit set for this study). For the relative error of measurement, most of the measures were rated between good and excellent. The maxillofacial angle was only moderate. There was a systematic error for middle facial height. The nasolabial, mentolabial, facial convexity, full facial convexity, maxillofacial, and nasofrontal angles presented intraclass correlation coefficient values rated as excellent. The relationship between age/body mass index and the error found between measurements was not confirmed. The nasolabial and mentolabial angles should be interpreted with caution due to the variability showed. The results found stereophotogrammetry to be repeatable, giving accurate measures within the references established for this study. (C) 2017 by Mutaz B. Habal, MD.

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Extracranial Meningioma Presenting as an Eyebrow Mass.

Meningiomas originate in the central nervous system and are the most common intracranial benign tumor. However, although rarely, they can develop extracranially. Primary extracranial meningiomas are frequently misdiagnosed, resulting in inappropriate clinical management. The most common sites of extracranial meningiomas include the skull, scalp, orbit, nose, paranasal sinuses, middle ear, neck, and skin. A 77-year-old woman presented with a mass on her left eyebrow. Computed tomography revealed an enhancing soft tissue mass in the left frontal area. The differential diagnoses included benign and malignant tumors. The patient underwent surgical excision by a direct approach, with dissection through the galea plane. Histological examination showed tumor cells arranged in sheets or whorls, with occasional psammoma bodies. The margins were free of tumor. The mass measured 2.1 x 1.1 x 2 cm, and was diagnosed as an extracranial meningioma. The patient had no recurrence 1 year later. Extracranial meningiomas are rare; nonetheless, ectopic meningioma should be considered in the differential diagnosis of any mass lesion in the eyebrow region. (C) 2017 by Mutaz B. Habal, MD.

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Functional Endoscopic Surgery After Facial Trauma.

The present study describes 3 patients of previous facial trauma who have subsequently been treated with functional endoscopic sinus surgery. The authors want pay attention on the possible correlation between facial trauma and sinusitis. Such fractures can be the cause of onset of paranasal sinusitis or of worsening of a previous sinusitis. The correlation between these 2 pathologies could be due to the fact that facial fractures concern the anatomic structures of paranasal sinuses. The damage to these structures during the facial trauma and tissue regeneration after injury or surgical treatment subverts the anatomy and function of the sinuses in a basically compromised situation. (C) 2017 by Mutaz B. Habal, MD.

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Comparison of the Speech Results After Correction of Submucous Cleft Palate With Furlow Palatoplasty and Pharyngeal Flap Combined With Intravelar Veloplasty.

Submucous cleft palate (SMCP) is a relatively rare variant of the common pathology of cleft palate with specific anatomic and clinical features. Even though there are many surgical options defined previously to correct the SMCP, correction of the velopharyngeal insufficiency and obtaining ideal speech results remains as a challenge. The aim of this article was to compare the speech benefits of Furlow double opposing Z plasty and posterior pharyngeal flap operation combined with intravelar veloplasty for the correction of SMCP using objective assessment tools. This study reviewed 29 patients who underwent either superiorly based posterior pharyngeal flap combined with intravelar veloplasty or Furlow palatoplasty for submucous cleft palate repair between years 2005 and 2011. The mean standard deviation age at palate repair was 123.6 +/- 65.8 months and the mean follow-up period was 31.2 +/- 15.9 months. The postoperative results demonstrated that in both groups significantly correction has been achieved in means of velopharygeal closure (P values for Furlow and pharyngeal flap groups are 0.012 and 0.001 respectively). The correction of the nasalance scores obtained depending on the surgical procedure for /sa/ and /ka/ syllables demonstrated significantly more benefit with pharyngeal flap combined with intravelar veloplasty than Furlow palatoplasty (P = 0.026 for each). In the treatment of submucous clefts, both Furlow palatoplasty and pharyngeal flap procedure combined with intravelar veloplasty appear to be effective whereas for the patients having significant signs of hypernasality, contribution of pharyngeal flap may be taken into consideration. (C) 2017 by Mutaz B. Habal, MD.

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Surgical Management of Mandibular Intraosseous Schwannomas.

Intraosseous schwannomas of the mandible are rare tumors that usually arise from peripheral nerve sheaths of the main trunk or branches of the inferior alveolar nerve (IAN). A systematic review of the English literature through PubMed was conducted from 1945 to 2016. Forty-nine patients of mandibular intraosseous schwannomas were identified. The most common location of the tumor was the posterior mandible (61.2%). There were 28 patients in whom the tumor involved the IAN (57.1%). The most commonly performed procedures included enucleation through a mucoperiosteal flap and a bone window (73%), curettage (10%), segmental mandibulectomy (10%), and sagittal split ramus osteotomy (6%). The recurrence rate was 6%: all 3 recurrent patients occurred in the posterior area. The authors report a 72-year-old female with a schwannoma of the IAN which was removed through a sagittal split of the mandible, although there was a bony defect of the external cortex after biopsy of the lesion. The nerve was reconstructed with a sural nerve graft. Due to the slow growing nature and encapsulation of schwannomas, surgical resection seems the best treatment with optimal functional outcomes and low recurrence rate even with a minimally invasive approach. Sagittal split ramus osteotomy and segmental mandibulectomy are reserved to large or posterior lesions to aid with radical resection or improve exposure and reconstruction. (C) 2017 by Mutaz B. Habal, MD.

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Endoscopically Assisted Intraoral Removal of an Ectopic Third Molar in the Mandibular Subcondylar Region.

The ectopic placement of mandibular third molars in the subcondylar region is an uncommon phenomenon. Most patients are asymptomatic but can present with acute infection or associated pathology necessitating surgical intervention. Surgical approaches have been described utilizing both extraoral and intraoral approaches to the region. This paper presents a clinical report of a patient presenting with acute fascial space infection arising from an ectopic third molar in the mandibular subcondylar region, managed with surgical removal via an endoscopically assisted intraoral approach. (C) 2017 by Mutaz B. Habal, MD.

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Endoscopic Removal of a Dental Implant From Maxillary Sinus.

The displacement of a dental implant into the maxillary sinus during surgery or after a period of use is a complication defined in the dental implant clinical practice. This complication arises primarily from inadequate bone height and peri-implant infection. Specifically, foreign objects in the maxillary sinus can cause sinusitis via impaired mucociliary flow and foreign body reactions, so they must be removed. Caldwell-Luc, transnasal, and intraoral endoscopic sinus surgeries have all been used to remove such foreign bodies and lesions from maxillary sinuses. In this article, the authors present the case of a patient whose dental implant slipped into the right maxillary sinus after a period of use and describe the endoscopic removal of said implant via an intraoral approach. The endoscopic removal of the dental implant from the maxillary sinus proved to be a safe, reliable, and minimally invasive method. (C) 2017 by Mutaz B. Habal, MD.

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Periorbital Soft Tissue Anthropometric Analysis of Young Adults.

The authors aim to determine the periorbital soft tissue anthropometric norms for Turkish young adults for right and left eyes using a noninvasive two-dimensional photogrammetric analysis. Anthropometric measurements of the periorbital soft tissue were taken from 172 female and 56 male Turkish adults aged between 18 and 24 years. The periorbital soft tissue profiles (ocular and palpebral) for males and females were digitally analyzed using linear measurements made with standardized photographic records, taken in a natural head position. Statistically significant differences were found for ocular soft tissue measurements according to gender except inner intercanthal distance (P = 0.125) and right horizontal palpebral aperture (P = 0.240). Statistically significant differences were found for palpebral soft tissue measurements according to gender except right pretarsal skin height (P = 0.112) and left pretarsal skin height (P = 0.056). Results were compared with other ethnic groups. Normal periorbital soft tissue measurements are fundamental anatomical parameters utilized in ophthalmology, optometry, ophthalmic industry, oculoplastic surgery, clinical genetics, dermatocosmetology. Further, normal anthropometric measurements generate reference data for studies in craniofacial dysmorphology, oculoplastic surgery, dermatocosmetology, and comparative physical anthropology. (C) 2017 by Mutaz B. Habal, MD.

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A Research of Soft Tissue Lipoma Genesis Factor With Immunohistochemical Analysis.

Introduction: Lipoma is the most familiar soft-tissue tumor. But the etiology of lipoma remains imprecise. Sex steroid hormones such as estrogen have effects on muscle and adipose tissue development. There is now significant evidence that sex steroids are involved in the site specificities of adipose tissue metabolism. This association of adipose tissue metabolism between sex steroid hormones suggests a possible role for sex steroids in the pathogenesis of lipoma. Methods: To investigate this concept, the authors evaluated the expression of the estrogen receptor (ER) and the progesterone receptor (PR) in soft tissue lipoma in this study. In addition, angiogenesis and the production of angiogenic factors are fundamental for tumor progression in the form of growth, invasion, and metastasis. Epidermal growth factor receptor (EGFR) is involved in a signaling cascade that influences proliferation and other tumor-promoting activities. In this respect, the authors tried to define the correlation of soft tissue lipoma tumor cell and specific 2 immunohistologic markers, vascular endothelial growth factor (VEGF) and EGFR. The study population included patients who diagnosed with soft tissue lipoma, 20 independent patients were selected. All specimens were stained with hematoxylin and eosin. All slides were examined by a pathologist under a microscope. ER, PR, VEGF, and EGFR expression was analyzed by immunohistochemistry. Result: ER, PR, and EGFR of tumor cell had significantly more negative than positive. And VEGF of tumor cell had significantly more positive than negative. There was no significantly difference between site of tumor and immunohistochemical stain. Discussion and Conclusion: There are only a few studies for ER and PR in soft tissue related tumors. The authors estimated that the abnormal local proliferation and accumulation of adipocyte in soft tissue lipoma is related to sex steroid hormone action, especially estrogen and progesterone. But ER and PR of tumor cell had significantly more negative than positive in this study. The authors concluded that estrogen and progesterone are not impact factor of pathogenesis of soft tissue lipoma. Vascular endothelial growth factor of tumor cell had significantly more positive than negative. Angiogenesis is an essential factor for tumor growth. The VEGF expression of soft tissue lipoma can be understood in the same context. The authors need more study to reveal an association between lipoma and EGFR, because some patients of lipoma were positive to EGFR in this study. (C) 2017 by Mutaz B. Habal, MD.

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Filaggrin loss-of-function mutations, atopic dermatitis and risk of actinic keratosis: results from two cross-sectional studies

Abstract

Background

Common loss-of-function mutations in filaggrin gene (FLG) represent a strong genetic risk factor for atopic dermatitis (AD). Homozygous mutation carriers typically display ichthyosis vulgaris (IV) and many have concomitant AD. Previously, homozygous, but not heterozygous, filaggrin gene mutations have been associated with squamous cell carcinomas.

Objective

The first objective was to examine the association between FLG mutations and actinic keratosis (AK). The second objective was to investigate the occurrence of AK in patients with IV and AD, respectively.

Methods

FLG mutation status in patients with AK was compared with controls from the general population. Furthermore, based on nationwide data from Danish registers, we compared the risk of AK in patients with IV, AD, and psoriasis, respectively.

Results

The prevalence of homozygous FLG mutations was significantly higher in the AK group (n= 4, 0.8%) in comparison to the control group (n=18, 0.2%), whereas the prevalence of heterozygous FLG mutations was lower. In hospital registry data, patients with AD exhibited an increased risk of AK than did psoriasis controls (adjusted OR 1.46; [95% CI 1.12-1.90]) whereas no difference in risk was observed between patients with IV and AD.

Conclusions

This study indicates an increased susceptibility to AK in individuals with homozygous, but not heterozygous, FLG mutations, and in patients with AD compared to psoriasis. Whether a reduction or absence of epidermal filaggrin could contribute to the susceptibility to AK in patients with IV and AD is unknown and additional research is needed to further explore this relationship.

This article is protected by copyright. All rights reserved.

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Laryngo-onycho-cutaneous (-like) syndrome due to mutated Plectin

Abstract

Laryngo-onycho-cutaneous syndrome (LOC) is a rare autosomal recessive genodermatosis that has been mainly described in the offspring of consanguineous families with origin in the Punjabi region of Pakistan and India [1]. Founder mutations affecting the LAMA3A gene on chromosome 18q11.2 have been implicated to underlie this syndrome [1,2]. Based on its molecular and clinical features, LOC was recently classified as a subtype of junctional Epidermolysis bullosa (JEB) [1].

This article is protected by copyright. All rights reserved.

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Stroke and Intraoperative Hypotension: To Sleep, Perchance to Stroke—Ay, There’s the Rub: Erratum

No abstract available

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A Quick Look Into the Future: Focused Cardiovascular Ultrasound (FCU)

No abstract available

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Enhanced Recovery for Major Abdominopelvic Surgery, 1st Edition

No abstract available

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Point-of-Care Ultrasound: Novel Technology to Routine Perioperative Assessment Tool

No abstract available

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The Use of Ultrasound Guidance for Perioperative Neuraxial and Peripheral Nerve Blocks in Children: A Cochrane Review

BACKGROUND: Objectives were to determine whether the use of ultrasound guidance offers any clinical advantage in the performance of neuraxial or peripheral nerve blocks in children in terms of increasing the success rate or decreasing the rate of complications. METHODS: We searched the following databases to March 2015: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OvidSP), EMBASE (OvidSP), and Scopus (to January 2015). We included all parallel randomized controlled trials that evaluated the effect of ultrasound guidance to perform a regional blockade technique in children. We assessed the selected studies for risk of bias with the Cochrane collaboration tool. We graded the level of evidence for each outcome according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group scale. RESULTS: We included 20 studies (1241 participants). Ultrasound guidance increases the success rate by decreasing the occurrence of a failed block: risk difference −0.11 (95% confidence interval [CI], −0.17 to −0.05); I2 64%; number needed for additional beneficial outcome for peripheral nerve blocks 6 (95% CI, 5–8). The younger the child, the greater the benefit. From 8 studies (414 participants), pain scores at 1 hour in the postanesthesia care unit were reduced when ultrasound guidance was used; however, the clinical relevance of the difference was unclear (equivalent to −0.2 on a scale from 0 to 10). From 8 studies (358 participants), block duration was longer when ultrasound guidance was used: standardized mean difference (SMD) 1.21 (95% CI, 0.76–1.65: I2 73%; equivalent to 62 minutes). Here again, younger children benefited the most from ultrasound guidance. Time to perform the procedure was reduced when ultrasound guidance was used for prescanning before a neuraxial block (SMD −1.97; 95% CI, −2.41 to −1.54; I2 0%; equivalent to 2.4 minutes) or as an out-of-plane technique (SMD −0.68; 95% CI, −0.96 to −0.40; I2 0%; equivalent to 94 seconds). From 2 studies (122 participants), ultrasound guidance reduced the number of needle passes required to perform the block: SMD −0.90 (95% CI, −1.27 to −0.52; I2 0%; equivalent to 0.6 needle pass per participant). From 2 studies (204 participants), we could not demonstrate a difference in the incidence of bloody puncture when ultrasound guidance was used for neuraxial blockade, but we found that the number of participants was well below the optimal information size (risk difference −0.07, 95% CI, −0.19 to 0.04). No major complications were reported for any of the 1241 participants. We rated the quality of evidence as high for success, pain scores at 1 hour, block duration, time to perform the block, and number of needle passes. We rated the quality of evidence as low for bloody punctures. CONCLUSIONS: Ultrasound guidance seems advantageous, particularly in young children, for whom it improves the success rate and increases block duration. Additional data are required before conclusions can be drawn on the effect of ultrasound guidance in reducing the rate of bloody puncture.

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Preprocedure Ultrasonography Before Initiating a Neuraxial Anesthetic Procedure

No abstract available

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In Response

No abstract available

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Be FoCUSed: The Time Is Now!

No abstract available

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Using Lean Six Sigma Methodology to Improve Quality of the Anesthesia Supply Chain in a Pediatric Hospital

Six Sigma and Lean methodologies are effective quality improvement tools in many health care settings. We applied the DMAIC methodology (define, measure, analyze, improve, control) to address deficiencies in our pediatric anesthesia supply chain. We defined supply chain problems by mapping existing processes and soliciting comments from those involved. We used daily distance walked by anesthesia technicians and number of callouts for missing supplies as measurements that we analyzed before and after implementing improvements (anesthesia cart redesign). We showed improvement in the metrics after those interventions were implemented, and those improvements were sustained and thus controlled 1 year after implementation.

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Reducing the Shock of Acute Respiratory Distress Syndrome: Is Veno-Venous ECMO a Viable Therapy in the Hemodynamically Unstable Patient?

No abstract available

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Remote Effects of Electromagnetic Millimeter Waves on Experimentally Induced Cold Pain: A Double-Blinded Crossover Investigation in Healthy Volunteers

BACKGROUND: The hypoalgesic effect of electromagnetic millimeter waves (MW) is well studied in animal model; however, the results of human research are controversial. The aim of this study was to evaluate the effects of various frequency ranges of MW on hypoalgesia using the cold pressor test (CPT). METHODS: Experimental pain was induced using standardized CPT protocols in 20 healthy male volunteers. The skin of the lower part of sternum was exposed to MW with a frequency of 42.25 GHz (active generator); MW within 50–75 GHz frequency range (noise generator); or an inactive MW device (placebo generator) in a random crossover double-blinded manner. Pain threshold, measured using the CPT, was the primary outcome. Other CPT parameters, heart rate, blood pressure, incidence of subjective sensations (paresthesia) during exposure, as well as quality of volunteers' blinding were also recorded. The end points of the condition with exposure to 42.25 GHz, were compared with baseline; exposure to noise 50-75 GHz; and placebo generators. RESULTS: Pain threshold increased during exposure to the 42.25 GHz generator when compared with baseline: median difference (MD), 1.97 seconds (95% confidence interval [CI], 0.35–3.73) and noise generator: MD, 1.27 seconds (95% CI, 0.05–2.33) but not compared with the placebo generator. Time to onset of cold and increasing pain sensations as well as diastolic blood pressure increased under the exposure to the 42.25 GHz generator when compared with baseline and noise generator. Other outcome measures were comparable among the study conditions. CONCLUSIONS: We were able to partially confirm the previously suggested hypoalgesic effects of low-intensity electromagnetic MW. However, the effect was indistinguishable from the placebo condition in our investigation.

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The Statistical Checklist and Statistical Review: Two Essential Yet Challenging Deliverables

No abstract available

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Missing Catheter Tip: The Ghost Fragment

No abstract available

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Who Should Provide Investigators With Direction on How to Conduct Clinical Trials of Procedural Sedation?

No abstract available

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In Response

No abstract available

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The 2017 Virginia Apgar Collection Part II: Maternal Safety and Abstract Reasoning

No abstract available

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Autologous, Not Hemorrhage! The Use of ANH in Cardiac Surgery

No abstract available

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Acute Normovolemic Hemodilution: Picking More Apples and Oranges

No abstract available

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Associations Between Impaired Cerebral Blood Flow Autoregulation, Cerebral Oxygenation, and Biomarkers of Brain Injury and Postoperative Cognitive Dysfunction in Elderly Patients After Major Noncardiac Surgery

BACKGROUND: Increasing evidence links postoperative cognitive dysfunction (POCD) to surgery and anesthesia. POCD is recognized as an important neuropsychological adverse outcome in surgical patients, particularly the elderly. This prospective cohort study aimed to investigate whether POCD is associated with impaired intraoperative cerebral autoregulation and oxygenation, and increased levels of biomarkers of brain injury. METHODS: Study subjects were patients ≥65 years of age scheduled for major noncardiac surgery. Cognitive function was assessed before and 1 week after surgery. POCD was diagnosed if a decline of >1 standard deviation of z-scores was present in ≥2 variables of the test battery. The incidence of POCD 1 week after surgery was modeled as a multivariable function of the index of autoregulation (MxA) and tissue oxygenation index (TOI), adjusting for baseline neuropsychological assessment battery (Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery [CERAD-NAB]) total score and the maximum C-reactive protein (CRP) concentration. The biomarkers of brain injury neuron-specific enolase and S100β protein, age, and level of education were included in secondary multivariable logistic regression analyses. RESULTS: Of the 82 patients who completed the study, 38 (46%) presented with POCD 1 week after surgery. In the multivariable regression analysis, higher intraoperative MxA (odds ratio [OR; 95% confidence interval (CI)], 1.39 [1.01–1.90] for an increase of 0.1 units, P = .08 after Bonferroni adjustment), signifying less effective autoregulation, was not associated with higher odds of POCD. The univariable logistic regression model for MxA yielded an association with POCD (OR [95% CI], 1.44 [1.06–1.95], P = .020). Tissue oxygenation index (1.12 [0.41–3.01] for an increase of 10%, P = 1.0 after Bonferroni adjustment) and baseline CERAD-NAB total score (0.80 [0.45–1.42] for an increase of 10 points, P = .45) did not affect the odds of POCD. POCD was associated with elevated CRP on postoperative day 2 (median [interquartile range]; 175 [81–294] vs 112 [62–142] mg/L, P = .033); however, the maximum CRP value (OR [95% CI], 1.35 [0.97–1.87] for a 2-fold increase, P = .07) had no distinct effect on POCD. CONCLUSIONS: Impairment of intraoperative cerebral blood flow autoregulation is not predictive of early POCD in elderly patients, although secondary analyses indicate that an association probably exists.

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Surveying the Literature: Synopsis of Recent Key Publications

No abstract available

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