Medicine by Sfakianakis G. Alexandros: 11/26/18

Monday, November 26, 2018

Management of spontaneous temporal bone cerebrospinal fluid leak: A 30-year experience.

Management of spontaneous temporal bone cerebrospinal fluid leak: A 30-year experience.

Am J Otolaryngol. 2018 Sep 26;:

Authors: Cheng E, Grande D, Leonetti J

Abstract
PURPOSE: The goal of this study was to describe the incidence of and our long-term results in the management of spontaneous temporal bone CSF leak and to determine if there is any association with an increase in body mass index (BMI).
METHODS: This was an Institutional Review Board (IRB) approved retrospective review of 58 patients who underwent repair of spontaneous temporal bone CSF leaks by a single surgeon at a tertiary care academic medical center between 1988 and 2017. Patients with CSF leaks due to trauma, iatrogenic injury, or chronic infection were excluded. Surgical approaches included middle cranial fossa, transmastoid, or a combination of both. Cases were divided into three decades. Patient demographics, clinical features, audiologic results, imaging studies, operative findings, complications, and long-term results were reviewed with a specific emphasis on the potential correlation with BMI.
RESULTS: The average BMI was 32. There was a statistically significant increase in BMI between the two most recent decades (p = 0.044). The middle cranial fossa was the most commonly utilized approach. Multiple tegmen defects were often noted on imaging and intraoperatively.
CONCLUSION: There is an increase in the incidence of spontaneous CSF leaks possibly associated with an increase in BMI in the United States over the last 30 years.

PMID: 30472121 [PubMed - as supplied by publisher]

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Endoscopic evaluation of middle ear anatomic variations in autopsy series: analyses of 204 ears.

Endoscopic evaluation of middle ear anatomic variations in autopsy series: analyses of 204 ears.

Braz J Otorhinolaryngol. 2018 Nov 03;:

Authors: Şahin B, Orhan KS, Aslıyüksek H, Kara E, Büyük Y, Güldiken Y

Abstract
INTRODUCTION: Microsurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy. Preoperative assessment of the middle ear cavity is limited by the permeability of eardrum and temporal bone density. Therefore, middle ear exploration is an extremely useful method to identify structural abnormalities and anatomical variations.
OBJECTIVE: The aim of this study is to determine anatomic variations of the middle ear in an autopsy series.
METHODS: All evaluations were performed in the Forensic Medicine Institute Morgue Department. The cases over 18 years of age, with no temporal bone trauma and history of otologic surgery included in this study.
RESULTS: One hundred and two cadavers were included in the study. The mean age was 49.08±17.76 years. Anterior wall prominence of the external auditory canal was present in 27 of all cadavers (26.4%). The tympanic membrane was normal in 192 ears (94%) while several eardrum pathologies were detected in 12 ears (6%). Agenesis of the pyramidal eminence and stapedial tendon was found in 3 ears. While the ponticulus was bony ridge-shaped in 156 of 204 ears (76.4%), it was bridge-shaped in 25 ears (12.3%). The ponticulus was absent in 23 ears (11.3%). While complete subiculum was present in 136 of all ears (66.7%), incomplete subiculum was present in 21 ears (10.3%). Subiculum was absent in 47 ears (23%). Facial dehiscence was found in 32 ears and the round window niche was covered by a pseudomembrane in 85 ears (41.6%). A fixed footplate was present in 7.4% of all ears, and no persistent stapedial artery was seen in any cases.
CONCLUSION: The pseudomembrane frequency covering the round window niche was found different from reports in the literature. In addition, the frequency of the external auditory canal wall prominence has been reported for the first time.

PMID: 30472004 [PubMed - as supplied by publisher]

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A call for mentorship in otolaryngology.

A call for mentorship in otolaryngology.

Braz J Otorhinolaryngol. 2018 Nov 08;:

Authors: Hwang PH

PMID: 30472005 [PubMed - as supplied by publisher]

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Endoscopic evaluation of middle ear anatomic variations in autopsy series: analyses of 204 ears.

Endoscopic evaluation of middle ear anatomic variations in autopsy series: analyses of 204 ears.

Braz J Otorhinolaryngol. 2018 Nov 03;:

Authors: Şahin B, Orhan KS, Aslıyüksek H, Kara E, Büyük Y, Güldiken Y

PMID: 30472004 [PubMed - as supplied by publisher]

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Effects of oral isotretinoin therapy on the nasal cavities.

Effects of oral isotretinoin therapy on the nasal cavities.

Braz J Otorhinolaryngol. 2018 Nov 12;:

Authors: Tasli H, Yurekli A, Gokgoz MC, Karakoc O

Abstract
INTRODUCTION: Isotretinoin (13 cis-retinoic acid) is the most effective treatment for acne vulgaris and is the only treatment option that can provide either remission or a permanent cure.
OBJECTIVE: The aim of this study was to use both subjective and objective methods to assess the nasal complaints of patients with severe acne who received oral isotretinoin therapy.
METHODS: Fifty-four subjects were enrolled in the study. All the subjects were assessed with subjective (NOSE and VAS questionnaires) and objective (rhinomanometry and saccharine) tests to determine the severity of their nasal complaints.
RESULTS: The mean severity scores (min: 0; max: 100) for nasal dryness/crusting and epistaxis were 0.47±1.48 (0-5); 0.35±1.30 (0-5) at admission, 3.57±4.45 (0-10); 2.26±4.71 (0-20) at the first month, and 4.28±6 (0-20); 2.26±4.71 (0-20) at the third month of the treatment respectively. Total nasal resistance of 0.195±0.079 (0.12-0.56)Pa/cm3/s at admission, 0.21±0.084 (0.12-0.54)Pa/cm3/s at the first month, and 0.216±0.081 (0.14-0.54)Pa/cm3/s at the third month.
CONCLUSION: Oral isotretinoin therapy can cause the complaint of nasal obstruction. In addition, nasal complaints, such as dryness/crusting and epistaxis, significantly increase in patients during the therapy schedule.

PMID: 30472003 [PubMed - as supplied by publisher]

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Whole-genome resequencing of a world-wide collection of rapeseed accessions reveals genetic basis of their ecotype divergence.

Whole-genome resequencing of a world-wide collection of rapeseed accessions reveals genetic basis of their ecotype divergence.

Mol Plant. 2018 Nov 22;:

Authors: Wu D, Liang Z, Yan T, Xu Y, Xuan L, Tang J, Zhou G, Lohwasser U, Hua S, Wang H, Chen X, Wang Q, Zhu L, Maodzeka A, Hussain N, Li Z, Li X, Shamsi IH, Jilani G, Wu L, Zheng H, Zhang G, Chalhoub B, Shen L, Yu H, Jiang L

Abstract
Rapeseed (Brassica napus L.), an important oilseed crop, has adapted to diverse climate zones and latitudes by forming three main ecotype groups, namely winter, semi-winter and spring types. Genomic variations underlying these ecotypes are largely unknown. Here, we report the global pattern of genetic polymorphisms of rapeseed by resequencing a world-wide collection of 991 germplasm accessions. A total of 5.56 or 5.53 million single nucleotide polymorphisms (SNPs) and 1.86 or 1.92 million InDels were identified by mapping reads to the reference genomes of 'Darmor-bzh' or 'Tapidor', respectively. We generated allelic drifting paths that show splits and mixtures of the main populations. The genetic diversity and linkage disequilibrium parameters indicate an asymmetric evolution of the two subgenomes of B. napus. The selective-sweep analysis revealed genetic changes in genes orthologous to those regulating various aspects of plant development and response to stresses. Further genome-wide association study identified SNPs in promoter regions of FLOWERING LOCUS T and FLOWERING LOCUS C orthologs, which specifically corresponded to different rapeseed ecotypes. Our study provides important insights into genomic footprints of the evolution of rapeseed and the flowering time divergence among three ecotypes, and will facilitate screening of molecular markers for accelerating rapeseed breeding.

PMID: 30472326 [PubMed - as supplied by publisher]

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Antimicrobial and cytotoxic effects of the Copaifera reticulata oleoresin and its main diterpene acids.

Antimicrobial and cytotoxic effects of the Copaifera reticulata oleoresin and its main diterpene acids.

J Ethnopharmacol. 2018 Nov 22;:

Authors: Barbosa ALP, Wenzel-Storjohann A, Barbosa JD, Zidorn C, Peifer C, Tasdemir D, Çiçek SS

Abstract
ETHNOPHARMACOLOGICAL RELEVANCE: The oleoresin of Copaifera reticulata is a traditional Brazilian remedy used for the treatment of skin and urinary tract infections, respiratory diseases, rheumatism, ulcer and tumours; thus, playing an important role in the primary health care of the indigenous population.
AIM: As most previous pharmacological tests used the crude oleoresin and only a few studies so far dealt with enriched fractions or pure chemically defined compounds, the aim of this study was to evaluate systematically the antimicrobial and cytotoxic properties of the Copaifera reticulata oleoresin and to assign traditional uses to specific secondary metabolites.
MATERIALS AND METHODS: The oleoresin as well as its neutral and acidic fractions were tested for their activity against six cancer cell lines, two clinically relevant bacterial strains, and two dermatophytes. Both fractions were analysed by GC-MS and UHPLC-ELSD, respectively. The antibacterial acidic phase was further fractionated by preparative chromatography to purify and characterize the compounds responsible for the observed pharmacological effect.
RESULTS: Whereas the use in anticancer treatment was not supported by our results, the crude oleoresin and its acidic fraction showed antibacterial activity against Enterococcus faecium (IC50 values of 4.2 and 4.8µg/mL, respectively) and methicillin-resistant Staphylococcus aureus (MRSA, IC50 values 5.3 and 7.2µg/mL, respectively). Purification of the acidic fraction resulted in the isolation of two dicarboxylic diterpene acids and the four main diterpene acids of the C. reticulata oleoresin, comprising three different diterpene scaffolds. Interestingly, the activity was not restricted to a particular diterpene-type but rather depended on the compounds' lipophilicity, with the most active constituent showing IC50 values of 1.6 (E. faecium) and 2.5µg/mL (MRSA), respectively. Furthermore, ent-polyalthic acid, the major diterpenoid, was significantly active against dermatophytes with IC50 values of 6.8µg/mL (Trichophyton rubrum) and 4.3µg/mL against (T. mentagrophytes).
CONCLUSION: The present study proved the antimicrobial effects of the C. reticulata oleoresin and its diterpenoid constituents, confirming its wide use in folk medicine for the treatment of skin and urinary tract infections. The inhibitory activity of copaiba diterpenoids against dermatophytic fungi as well as the gram-positive bacteria E. faecium and MRSA is being reported for the first time, providing potential lead structures for the treatment of these clinically relevant bacterial strains.

PMID: 30472403 [PubMed - as supplied by publisher]

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Genus Tetradium L.: a comprehensive review on traditional uses, phytochemistry, and pharmacological activities.

Genus Tetradium L.: a comprehensive review on traditional uses, phytochemistry, and pharmacological activities.

J Ethnopharmacol. 2018 Nov 22;:

Authors: Zhao Z, He X, Han W, Chen X, Liu P, Zhao X, Wang X, Zhang L, Wu S, Zheng X

Abstract
ETHNOPHARMACOLOGICAL RELEVANCE: The dried fruit of Tetradium ruticarpum is frequently utilized as a common traditional medicine in China, Japan and Korea. It has been widely used for the treatment of various diseases such as headache, menorrhalgia, dermatophytosis, celialgia, emesis and aphtha and so on.
AIM OF THIS REVIEW: Despite the wide biological activities of Tetradium plants, there is no current review summarizing medicinal properties of the genus of plants; thus, this review aims to systematically summarize studies on botanical characteristics, traditional uses, phytochemical ingredients, quality control, pharmacokinetics, pharmacological activities and toxicity of Tetradium species to demonstrate their therapeutic capacity.
MATERIALS AND METHODS: Information and materials related to Tetradium species were obtained from scientific databases such as Google Scholar, Wikipedia, Web of Science, PubMed, ScienceDirect, ACS Publications, SciFinder. Information was also gathered from International Plant Names Index, Global Biodiversity Information Facility, Chinese Pharmacopoeia and Traditional Chinese Medicine classics, etc. All studies of this genus were included in this review until July 2018.
RESULTS: Tetradium is widely assessed regarding its phytochemistry and biological activities. Approximately 131 chemical compounds, including alkaloids, saponins, phenols and other compounds, have been isolated from Tetradium plants. Among these components, alkaloid evodiamine is the most representative active ingredients of Tetradium plants. These compounds isolated from Tetradium plants exhibit a wide range of biological activities in vitro and in vivo including antitumor, antibacterial, anti-inflammatory, insecticide, cardioprotective and lipid-lowering, treating CNS disorders, digestive system regulation and endocrine system improving activities. Furthermore, alkaloids could be used as markers for quality identification and evaluation of medicinal materials and their preparations. Information on evaluating the safety and pharmacokinetics of Tetradium often focuses on the alkaloids, thus further study and clinical data are required to enable the drug safety of the utilization of Tetradium plants.
CONCLUSIONS: Phytochemical and pharmacological studies of Tetradium plants have proved Tetradium plants are important medicinal herb resource. However, well-designed randomized clinical trials are necessary to confirm the therapeutic benefits of this genus in clinical settings.

PMID: 30472402 [PubMed - as supplied by publisher]

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Anti-obesity effect of garlic oil on obese rats via Shenque point administration.

Anti-obesity effect of garlic oil on obese rats via Shenque point administration.

J Ethnopharmacol. 2018 Nov 22;:

Authors: Zhang Y, Xu L, Ding M, Su G, Zhao Y

Abstract
ETHNOPHARMACOLOGICAL RELEVANCE: Shenque is an acupoint located in the umbilicus and connected with the meridians. Thus, acupoint herbs applied at Shenque plays a pivotal role in the Chinese traditional medicine due to its sensitivity, permeability, and absorption. Many studies reported the use of Shenque point as a successful therapeutic approach. However, the effect of garlic oil (GO) applied at Shenque point to combat obesity is unmet. Consequently, we investigated the potential benefit of GO applied at Shenque point against obesity.
AIM OF THE STUDY: To investigate GO effects on obese rats applied at Shenque acupoint and orally administered, and to identify the chemical constituents of GO.
MATERIALS AND METHODS: Rats were randomly divided into 2 groups: naive and model group. The model group rats were fed with a high fat diet for 7 weeks to induce obesity, and then they were randomly divided into 5 groups: model, GO Shenque point treated groups (25, 50 and 100mg/kg/day) and oral group (50mg/kg/day). Biochemical indexes in the serum, weight of adipose tissue and liver histopathology were evaluated after 6 weeks of GO treatment using a Hitachi 7080 analyzer (Hitachi, Japan). Moreover, GO chemical components were detected by gas chromatography-mass spectrometer (GC-MS).
RESULTS: Compared with the naive rats, model rats exhibited higher body and liver weight, increased fat deposition, higher triglyceride concentration and alveolar development. In contrast, GO Shenque point treated groups showed a substantial decrease in body weight (P = 0.358, 0.028, 0.031, respectively), fat mass, cholesterol (P = 0.004, 0.041, 0.001, respectively), triglyceride (P = 0.001, 0.001, 0.001, respectively), and low density lipoprotein concentrations (P = 0.001, 0.000, 0.001, respectively). The effect was more remarkable than the GO orally administered. In addition, twelve GO organosulfur compounds were identified by GC-MS and diallyl trisulfide (DATS) was detected as the main compound, with a 32.08% concentration.
CONCLUSIONS: These findings demonstrated that GO had a significant anti-obesity effect on obese rats by reducing the body weight and protecting the liver from damage, and the effect of Shenque point treatment was better than oral administration, suggesting that GO was an effective weight-loss drug and Shenque point administration might be considered as a new anti-obesity approach.

PMID: 30472401 [PubMed - as supplied by publisher]

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Electrochemotherapy - A locoregional therapy with well-established palliative effect in patient with large recurrent lesion of head and neck.

Electrochemotherapy - A locoregional therapy with well-established palliative effect in patient with large recurrent lesion of head and neck.

J Craniomaxillofac Surg. 2018 Oct 26;:

Authors: Pichi B, Raul P, Giuseppe S

Abstract
BACKGROUND: Electrochemotherapy (ECT) is a well established treatment strategy for skin tumors of different histology. The aim of this study was to evaluate the feasibility and efficacy of electrochemotherapy in the palliative setting in patients with head and neck malignancies, already treated with surgery and/or radio-chemotherapy with no other therapeutic option.
METHODS: Thirty-six patients with a loco-regional M0/M1 relapse with no other therapeutic option not suitable for a cure with a radical intent by surgery or RT and not suitable for systemic therapy and/or already treated with it, were admitted to electrochemotherapy (ECT) protocol treatment. ECT was performed according ESOPE guidelines. Clinical features, treatment response, and adverse effects were evaluated 15, 30 days and then every months after the treatment.
RESULTS: An overall response of 100% was observed. Only 3 patients out 36 showed a CR. Overall survival probability at 12 months was 41.6% (median OS: 9 months). In all patient, an improvement of quality of life in terms of pain, bleeding events were observed, while need for medical assistance or dressing was significantly reduced 1 month after electrochemotherapy (p < 0.001).
CONCLUSIONS: Electrochemotherapy is an effective palliative treatment of non-resectable head and neck malignancies able. Due to the ECT limited side effects, its early use would be desirable to obtain a better local control of the disease and improve quality of life of patients.

PMID: 30471938 [PubMed - as supplied by publisher]

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Treatment of end stage temporomandibular joint disorder using a temporomandibular joint total prosthesis: The Slovenian experience.

Treatment of end stage temporomandibular joint disorder using a temporomandibular joint total prosthesis: The Slovenian experience.

J Craniomaxillofac Surg. 2018 Nov 07;:

Authors: Balon P, Vesnaver A, Kansky A, Kočar M, Prodnik L

Abstract
PURPOSE: The aim of this study was to analyse treatment results after alloplastic temporomandibular joint replacement surgery.
MATERIALS AND METHODS: Twelve patients who met the inclusion criteria underwent operation between the years 2012 and 2016 at the Department of Maxillofacial and Oral Surgery of the University Medical Centre Ljubljana, Slovenia. Seven patients had posttraumatic sequelae, 4 osteoarthritis and 1 psoriatic arthritis. We inserted 12 temporomandibular joint prostheses (Biomet- Lorenz). A retrograde analysis of the patients, subjective assessment of the pre- and postoperative temporomandibular pain, opening the mouth, the ability to chew food, and quality of life (VAS scale, 0-10) was performed. Additionally, we evaluated the inter-incisal distance pre- and postoperatively. Complications that occurred were also included in our evaluation.
RESULTS: During final examinations, at least 15 months after the surgery (on average 39.5 months), we observed an improved ability to open the mouth in all patients. The average preoperative inter-incisal distance was 22 mm (15-30 mm); the average postoperative distance was 37.5 mm (32.3-1.8 mm), (p < 0.001). The analysis of pain and other subjective variables (opening the mouth, the ability to chew, quality of life) showed a statistically significant improvement (p < 0.001).
CONCLUSION: According to our initial experience, replacement of the temporomandibular joint with a total prosthesis is a safe and effective treatment method.

PMID: 30471937 [PubMed - as supplied by publisher]

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Evaluation of accuracy and sensory outcomes of mandibular reconstruction using computer-assisted surgical simulation.

Evaluation of accuracy and sensory outcomes of mandibular reconstruction using computer-assisted surgical simulation.

J Craniomaxillofac Surg. 2018 Oct 11;:

Authors: Zhou Z, Zhao H, Zhang S, Zheng J, Yang C

Abstract
PURPOSE: To introduce a modified protocol for mandibular reconstruction and evaluate the protocol using a standardized assessment method.
METHOD: This retrospective study involved a case series of nine patients who underwent mandibular reconstruction between 2015 and 2017. The modular protocol comprised three novel modifications in terms of computer-assisted surgical simulation (CASS); surgical template (ST), and surgical procedure. The standardized postoperative evaluation consisted of operation time, part comparison analysis (PCA), facial symmetry, and mechanical quantitative sensory testing.
RESULTS: The surgery successfully removed the affected mandible and preserved the inferior alveolar neurovascular bundle (IANB). PCA revealed that the mean error and standard deviation were 0.92 and 0.96 mm, respectively, for all mandibular surface sites. Follow-up results showed good facial symmetry, existence of sensation in lower lip, and no significant differences in pulp vitality between both sides (p = 0.181). Also, the results showed a reduction in the overall operating time.
CONCLUSION: The modified mandibular reconstruction method used in this study could repair lateral mandibular defects and preserve the sensory function of the chin and lower lip.

PMID: 30471936 [PubMed - as supplied by publisher]

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"Flip-over flap" in two-stage cleft palate repair.

"Flip-over flap" in two-stage cleft palate repair.

J Craniomaxillofac Surg. 2018 Nov 06;:

Authors: Mommaerts MY, Gundlach KK, Tache A

Abstract
PURPOSE: This study served to evaluate a two-stage concept in cleft palate repair, including key use of a triangular hinge ("flip-over") flap, in order to prevent palatal fistulae. It uses data from a prospective registry established in 1991.
MATERIALS AND METHODS: The concept entails Furlow soft palate repair (at 1 year of age) and hard palate closure (at 4 years) by a three-pronged approach [paring of the edges with or without postero-lateral relaxing incisions, peninsula (Veau) flap(s)], plus a triangular hinge flap. The latter is elevated from the oral layer of the already-repaired soft palate, stays based anteriorly, and is flipped over to close the posterior nasal layer defect. The case series is compared with data from the literature.
RESULTS: The palatal fistula rate for Veau II to IV types (two-stage surgeries) was 4.3%. The overall fistula rate in the cleft population (Veau I-IV) was 2.9%. Meta-analyses describe 4.9 and 8.6% on average. There was no difference between sample A in which the flip-over flaps were used only when modified Veau flaps were indicated (until 2006) and sample B in which it was used regardless of the technique of hard palate closure applied (2006-2018). The fistula rate decreased to zero after 2010, which may reflect also an influence of other factors such as the interpositioning of a collagen membrane and also of improved surgical judgment.
CONCLUSIONS: Using a flip-over flap in two-stage cleft palate repair may contribute to prevent fistula formation at the hard/soft palate junction.
LEVEL OF EVIDENCE: III.

PMID: 30471935 [PubMed - as supplied by publisher]

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Determination of Normal Breast and Areolar Skin Elasticity Using Shear Wave Elastography.

Determination of Normal Breast and Areolar Skin Elasticity Using Shear Wave Elastography.

J Ultrasound Med. 2018 Nov 25;:

Authors: Şendur HN, Gültekin S, Salimli L, Cindil E, Cerit M, Şendur AB

Abstract
OBJECTIVES: In this study, we aimed to determine reference values for normal breast and areolar skin elasticity using shear wave elastography.
METHODS: The right breasts of 200 female participants were evaluated. The age, weight, body mass index, menopausal status, and parity number of all participants were noted. The elasticity values and thickness of the areolar skin and 4 quadrants of the breast skin of all participants were measured. To assess the reproducibility of shear wave elastography, a randomly selected subgroup of 35 participants was reevaluated by a second observer.
RESULTS: The mean age of the participants ± SD was 48.79 ± 10.74 years (range, 18-79 years). The mean elasticity measurements for the superior, inferior, lateral, and medial regions of the breast and areolar skin were 33.54, 29.84, 30.16, 29.20, and 31.35 kPa, respectively. The mean of the 4-quadrant measurements of breast skin elasticity was 30.68 ± 9.11 kPa. Age had a moderate negative correlation with breast skin elasticity (r = -0.353; P < .001) and a weak negative correlation with areolar skin elasticity (r = -0.237; P = .001). The parity number had weak negative correlations with breast (r = -0.150; P = .034) and areolar (r = -0.207; P < .001) skin elasticity. The interobserver agreement varied from good to excellent (intraclass correlation coefficients, 0.67-0.91) for the breast and areolar skin elasticity measurements.
CONCLUSIONS: Shear wave elastography is a reproducible imaging modality for evaluations of breast and areolar skin elasticity, and our results may provide important pilot data for evaluations of clinical entities that affect the breast and areolar skin structures.

PMID: 30472800 [PubMed - as supplied by publisher]

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Ultrasound-Guided Therapeutic Scapulothoracic Interval Injections.

Ultrasound-Guided Therapeutic Scapulothoracic Interval Injections.

J Ultrasound Med. 2018 Nov 25;:

Authors: Walter WR, Burke CJ, Adler RS

Abstract
Scapulothoracic pain is a common ailment, but the underlying cause can be difficult to diagnose in a timely manner, and treatment options are limited. We retrospectively review our experience using ultrasound-guided therapeutic scapulothoracic interval steroid injections to treat scapulothoracic pain and review correlative magnetic resonance imaging findings over a 5-year period. Although a variety of structural causes are known to cause scapulothoracic pain, in our experience, most cases lack correlative imaging findings. Ultrasound-guided scapulothoracic interval injections provide a safe, easily performed diagnostic and therapeutic tool for treating patients with periscapular pain, providing at least short-term symptom relief.

PMID: 30472731 [PubMed - as supplied by publisher]

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Exploring the relationship between Endothelin-1 and peripheral inflammation in multiple sclerosis.

Exploring the relationship between Endothelin-1 and peripheral inflammation in multiple sclerosis.

J Neuroimmunol. 2018 Nov 15;326:45-48

Authors: Rocha NP, Colpo GD, Bravo-Alegria J, Lincoln JA, Wolinsky JS, Lindsey JW, Teixeira AL, Freeman L

Abstract
BACKGROUND: Identifying pathways linking neuroinflammation and neurodegeneration is essential to help prevent disability progression in people with multiple sclerosis (MS). Endothelin-1 (ET-1) is a potent vasoconstrictor thought to contribute to cerebral hypoperfusion and tissue damage in MS. Its link with the neuroinflammatory process remains poorly investigated.
OBJECTIVES: To determine plasma ET-1 levels in treatment-naïve people with MS and controls, and the relationship between ET-1 and other peripheral immune mediator levels as potential markers of the disease process.
METHODS: This is a retrospective study that included specimens previously collected from 35 treatment-naïve patients with clinically isolated syndrome highly suggestive of MS or definite MS and 35 sex- and age-matched controls. ET-1 plasma levels were measured by enzyme-linked immunosorbent assay (ELISA), and plasma cytokine levels [interleukin (IL)-1beta, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12(p70), IL-13, interferon (IFN)-γ and tumor necrosis factor (TNF)-α] were simultaneously measured by Multiplex assay.
RESULTS: ET-1 levels were significantly increased in MS patients compared to controls. No significant difference in cytokine levels between the groups were found. However, a significant increase in IFN-γ/IL-4 ratio was observed in patients with MS in comparison with controls, suggestive of Th1 skewed response. Binary logistic regression was performed to ascertain the effects of age, sex, ET-1 and cytokine levels on the likelihood of MS diagnosis. In the final model, ET-1, IL-4 and IFN-γ levels remained as predictors of MS. There was no significant correlation between ET-1 and cytokine levels.
CONCLUSIONS: Patients with MS presented increased levels of ET-1 and an immune response biased towards a Th1 profile. Although both ET-1 and Th1 cytokine profile were predictors of MS diagnosis, ET-1 levels were not associated with peripheral immune markers, suggesting that these changes may occur independently.

PMID: 30472305 [PubMed - as supplied by publisher]

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The cerebral endothelial cell as a key regulator of inflammatory processes in sterile inflammation.

The cerebral endothelial cell as a key regulator of inflammatory processes in sterile inflammation.

J Neuroimmunol. 2018 Oct 26;326:38-44

Authors: Ludewig P, Winneberger J, Magnus T

Abstract
Cerebral endothelial cells accomplish numerous tasks connected to the maintenance of homeostasis of the central nervous system. They create a barrier between the central nervous system and peripheral blood and regulate mechanotransduction, vascular permeability, rheology, thrombogenesis, and leukocyte adhesion. In pathophysiological conditions (e.g., stroke or ischemia-reperfusion injury) the endothelial functions are impaired, leading to increased vascular permeability, vascular inflammation, leukocyte-endothelium interactions, and transendothelial migration, driving CNS inflammation and neuronal destruction. This review describes the current knowledge on the regulatory roles of endothelial cells in neuroinflammatory processes.

PMID: 30472304 [PubMed - as supplied by publisher]

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Reproducibility of Voice Parameters: The Effect of Room Acoustics and Microphones.

Reproducibility of Voice Parameters: The Effect of Room Acoustics and Microphones.

J Voice. 2018 Nov 21;:

Authors: Bottalico P, Codino J, Cantor-Cutiva LC, Marks K, Nudelman CJ, Skeffington J, Shrivastav R, Jackson-Menaldi MC, Hunter EJ, Rubin AD

Abstract
INTRODUCTION: Computer analysis of voice recordings is an integral part of the evaluation and management of voice disorders. In many practices, voice samples are taken in rooms that are not sound attenuated and/or sound-proofed; further, the technology used is rarely consistent. This will likely affect the recordings, and therefore, their analyses.
OBJECTIVES: The objective of this study is to compare various acoustic outcome measures taken from samples recorded in a sound-proofed booth to those recorded in more common clinic environments. Further, the effects from six different commonly used microphones will be compared.
METHODS: Thirty-six speakers were recorded while reading a text and producing sustained vowels in a controlled acoustic environment. The collected samples were reproduced by a Head and Torso Simulator and recorded in three clinical rooms and in a sound booth using six different microphones. Newer measures (eg, Pitch Strength, cepstral peak prominence, Acoustic Voice Quality Index), as well as more traditional measures (eg Jitter, Shimmer, harmonics-to-noise ratio and Spectrum Tilt), were calculated from the samples collected with each microphone and within each room.
RESULTS: The measures which are more robust to room acoustic differences, background noise, and microphone quality include Jitter and smooth cepstral peak prominence, followed by Shimmer, Acoustic Voice Quality Index, harmonics-to-noise ratio, Pitch Strength, and Spectrum Tilt.
CONCLUSIONS: The effect of room acoustics and background noise on voice parameters appears to be stronger than the type of microphone used for the recording. Consequently, an appropriate acoustical clinical space may be more important than the quality of the microphone.

PMID: 30471944 [PubMed - as supplied by publisher]

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Comparison of predictive powers of functional and anatomic dosimetric parameters for radiation-induced lung toxicity in locally advanced non-small cell lung cancer.

Comparison of predictive powers of functional and anatomic dosimetric parameters for radiation-induced lung toxicity in locally advanced non-small cell lung cancer.

Radiother Oncol. 2018 Nov;129(2):242-248

Authors: Xiao L, Yang G, Chen J, Yang Y, Meng X, Wang X, Wu Q, Huo Z, Yu Q, Yu J, Kong FS, Yuan S

Abstract
PURPOSE: To investigate the predictive value of the perfusion (Q) single-photon emission computed tomography (SPECT)-weighted dose-function histogram (DFH) obtained mid-treatment (mid-Tx) with radiotherapy (RT) for radiation-induced lung toxicity (RILT) in patients with non-small cell lung cancer (NSCLC).
MATERIALS AND METHODS: The study population consisted of NSCLC patients who were undergoing RT treatment and enrolled in prospective imaging studies. Q-SPECT was performed prior to and during RT (at ∼40-45 Gy). A baseline dose-volume histogram (DVH) and mid-Tx DVH based on simulation CT as well as a baseline DFH and mid-Tx DFH based on Q-SPECT were calculated. Only patients with stage III NSCLC and visible functional lung (FL) changes on the mid-Tx scan were eligible for this enriched analysis. RILT was graded according to a reported scale.
RESULTS: Forty-two stage III NSCLC patients met the criteria for inclusion. The accumulative incidence of grade ≥2 RILT was 31% in this high-risk population. Significant differences in functional metrics such as functional lung volume FV5-FV20 at increments of 5 Gy and functional MLD (FMLD) were observed between patients with and without grade ≥2 RILT (p < 0.05). Similar results were also obtained for anatomical metrics from V5-V20 and MLD (p < 0.05). The areas under the receiver operating characteristic curves (AUCs) ranged from 0.724to 0.812 for baseline DVH parameters, from 0.745 to 0.830 for mid-Tx DVH parameters, from 0.764 to 0.878 for baseline DFH parameters, and from 0.767 to 0.891 for mid-Tx DFH parameters. Further principal components analysis showed that the AUCs were 0.814/0.817 and 0.790/0.857 for baseline/mid-Tx DVH and baseline/mid-Tx DFH, respectively.
CONCLUSIONS: Mid-Tx DFH parameters based on Q-SPECT were significantly elevated in patients with grade ≥2 RILT in this study population. Among the metrics compared, mid-Tx DFH seemed to have better predictive accuracy, but this difference did not reach statistical difference.

PMID: 30471708 [PubMed - in process]

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Interleukin-4-induced posttranscriptional gene regulation of CCL26 by the RNA-binding protein HuR in primary human nasal polyp-derived epithelial cells.

Interleukin-4-induced posttranscriptional gene regulation of CCL26 by the RNA-binding protein HuR in primary human nasal polyp-derived epithelial cells.

Int Forum Allergy Rhinol. 2018 Nov 24;:

Authors: Tian P, Ou H, Wu F, Ma Y, Liu X, Chen Q, Dang H, Zou H

Abstract
BACKGROUND: Much attention on the pathophysiology of nasal polyp (NP) has focused on eosinophils. Interleukin (IL)-4 and eotaxin-3 (C-C motif chemokine ligand 26, or CCL26) levels have been reported to be increased in eosinophilic nasal polyps. The aim of this study was to characterize CCL26 posttranscriptional regulation by the RNA-binding protein HuR in primary human nasal polyp-derived epithelial cells (hNPDECs) challenged with IL-4.
METHODS: A prospective, observational study was conducted. Nasal polyp tissues were obtained from eosinophilic (n = 12) and non-eosinophilic (n = 10) NP patients, and inferior turbinate (IT) tissues were taken from control subjects (n = 9) and cultured into hNPDECs. Expression of HuR and CCL26 were measured by immunohistochemistry, Western blot analysis, enzyme-linked immunoassay, and real-time polymerase chain reaction (PCR). The nucleocytoplasmic shuttling of HuR in hNPDECs was detected by immunofluorescence. Posttranscriptional regulation of CCL26 by HuR was tested by ribonucleoprotein immunoprecipitation assay (RIP) and dual-luciferase reporter assay. CCL26 mRNA stabilization was measured by quatititative PCR after treatment with actinomycin D. Student's t test and one-way analysis of variance were used.
RESULTS: Immunohistochemical data show that both HuR and CCL26 were highly expressed in NP tissues, especially eosinophilic NP tissues (p < 0.05). IL-4 stimulation increased CCL26 mRNA stability, and overexpression and knockdown of HuR affected CCL26 expression. Immunofluorescence data indicate that IL-4 altered the subcellular distribution of HuR. The RIP and dual-luciferase reporter assay results supply strong evidence for HuR binding to CCL26.
CONCLUSION: Our results provide strong support for the hypothesis that IL-4-induced expression of CCL26 in hNPDECs relies partly on CCL26 mRNA stabilization mediated by the interaction of HuR with CCL26 3'UTR.

PMID: 30472791 [PubMed - as supplied by publisher]

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Ivacaftor improves rhinologic, psychologic, and sleep-related quality of life in G551D cystic fibrosis patients.

Ivacaftor improves rhinologic, psychologic, and sleep-related quality of life in G551D cystic fibrosis patients.

Int Forum Allergy Rhinol. 2018 Nov 24;:

Authors: McCormick J, Cho DY, Lampkin B, Richman J, Hathorne H, Rowe SM, Woodworth BA

Abstract
BACKGROUND: Ivacaftor is a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator that improves pulmonary function in cystic fibrosis (CF) patients with at least 1 copy of the G551D CFTR mutation. The purpose of this study is to evaluate the impact of ivacaftor on chronic rhinosinusitis (CRS) symptoms in this population.
METHODS: The G551D Observational (GOAL) study was a multicenter prospective cohort study enrolling CF patients ≥6 years with at least 1 G551D mutation. Subjects were provided 20-item Sino-Nasal Outcome Test (SNOT-20) questionnaires prior to ivacaftor therapy and at 1, 3, and 6 months afterward. The impact on rhinologic (R), psychological (P), sleep (S), and ear/facial (E) quality of life (QOL) domains was evaluated separately.
RESULTS: Of 153 subjects, 129 (84%) completed all questionnaires. Typical baseline symptom burden was low (75% with scores <1) and degree of improvement (ie, reduced scores) was greater with higher baseline scores. SNOT-20 decreased, reflecting improvement, at all follow-up intervals (1 month: [mean change ± standard deviation] -0.25 ± 0.53, p < 0.01; 3 months; -0.29 ± 0.58, p < 0.01; 6 months: -0.21 ± 0.58, p = 0.02), but less than the prespecified minimal clinically important difference (0.8). Significant improvement was observed at 1, 3, and 6 months in the R domain (1 month: -0.24, p < 0.01; 3 months: -0.34, p < 0.01; 6 months: -0.25, p < 0.01) and P domain (1 month: -0.25, p < 0.01; 3 months: -0.32, p < 0.01; 6 months: -0.26, p < 0.01), and 1 and 3 months in the S domain (1 months: -0.35, p < 0.01; 3 months: -0.32, p < 0.01; 6 months: -0.18, p = 0.07). There was no improvement in the E domain at any time point.
CONCLUSION: Ivacaftor improves QOL in the R, P, and S domains in G551D CF patients, although QOL instruments validated for CRS may not translate well to CF CRS patients because symptom burden was surprisingly low.

PMID: 30472785 [PubMed - as supplied by publisher]

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Therapeutic use of steroids in non-chronic rhinosinusitis olfactory dysfunction: a systematic evidence-based review with recommendations.

Therapeutic use of steroids in non-chronic rhinosinusitis olfactory dysfunction: a systematic evidence-based review with recommendations.

Int Forum Allergy Rhinol. 2018 Nov 24;:

Authors: Yan CH, Overdevest JB, Patel ZM

Abstract
BACKGROUND: Olfactory loss is a common and debilitating disease with limited treatment options, particularly for olfactory dysfunction not related to sinonasal inflammation. Both topical and systemic steroids have been used as treatments for olfactory loss. This study systematically reviews the literature on the efficacy of steroids for non-chronic rhinosinusitis (CRS)-related olfactory loss and provides recommendations.
METHODS: A literature search of PubMed, Ovid, EMBASE, and the Cochrane Database was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Inclusion criteria included original data, English-language articles on steroid treatment (topical and systemic) for olfactory loss unrelated to sinonasal inflammation. Data was collected on study design, olfaction dysfunction etiology, clinical outcomes, and level of evidence. Two investigators reviewed all articles independently, with a third acting as a mediator for any disagreements in recommendation.
RESULTS: Of 866 abstracts identified, only 15 studies met inclusion criteria and were systematically reviewed. Level 4 evidence suggests oral steroids can improve olfactory loss. Level 1B evidence demonstrates topical steroid rinses improve olfactory dysfunction in a select group of patients. Topical steroid sprays show no improvement across several levels of evidence.
CONCLUSION: There is a paucity of high-quality studies demonstrating efficacy of either topical or oral steroids for olfactory dysfunction unrelated to sinonasal disease. The only level 1 evidence suggests using steroid rinses to improve olfactory outcomes in select patients, with weaker evidence supporting use of oral steroids. Topical steroid sprays do not improve olfactory dysfunction in this patient population and are not recommended.

PMID: 30472771 [PubMed - as supplied by publisher]

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Accuracy and reliability of mandibular digital model registration with use of the mucogingival junction as the reference.

Accuracy and reliability of mandibular digital model registration with use of the mucogingival junction as the reference.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Oct 16;:

Authors: Ioshida M, Muñoz BA, Rios H, Cevidanes L, Aristizabal JF, Rey D, Kim-Berman H, Yatabe M, Benavides E, Alvarez MA, Volk S, Ruellas AC

Abstract
OBJECTIVE: The aim of the study was to validate a method of mandibular digital model (DM) registration, acquired from an intraoral scanner, compared with high-resolution voxel-based cone beam computed tomography (CBCT) registration with use of the mucogingival junction as the reference.
STUDY DESIGN: Pre- and post-treatment CBCT and DM images from 12 adults were randomly selected from an initial sample of 40 patients who had undergone orthodontic treatment. The DM registration was performed in 6 steps: (1) construction of 3-dimensional (3-D) volumetric label maps of CBCT scans, (2) voxel-based registration of CBCT scans, (3) prelabeling of CBCT images, (4) approximation and registration of DM models to the corresponding CBCT models, (5) mucogingival-junction registration of pretreatment and post-treatment DM images, and (6) measurements. The Mann-Whitney U test was used to calculate the significance of differences between the CBCT and DM registrations. The intraclass correlation coefficient (ICC) was performed to assess reproducibility of the registration method.
RESULTS: When registered CBCT models and registered DM models were compared, no statistically significant differences in the measurements were found (right-left P = .267; anterior-posterior P = .238; superior-inferior P = .384; and 3-D P = .076). ICC showed excellent intra- and inter-rater correlation (ICC > 0.90).
CONCLUSIONS: The method of DM registration of the mandible with use of the mucogingival junction as the reference is accurate, reliable, and reproducible.

PMID: 30472195 [PubMed - as supplied by publisher]

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Peri-electrode edema after deep brain stimulation.

Peri-electrode edema after deep brain stimulation.

J Clin Neurosci. 2018 Nov 21;:

Authors: Saitoh T, Enatsu R, Mikami T, Suzuki Y, Kanno A, Kitagawa M, Mikuni N

Abstract
Peri-electrode edema can occur after deep brain stimulation (DBS). The diagnosis and management of peri-electrode edema may be challenging. We herein report non-infectious peri-electrode edema after the placement of DBS electrodes in patients with Parkinson's disease (PD). Fifteen patients who underwent DBS surgery between 2010 and 2018 at Sapporo Medical University were included to identify post-operative peri-electrode edema. Pre- and post-operative CT and MRI were retrospectively analyzed. Six patients showed hyperintensity around the electrodes on FLAIR/T2 MRI without neurological deficits. Two patients showed limited FLAIR and DWI hyperintensities in deep white matter, and microvessels may have been occluded in these patients. In five patients, MRI revealed extensive FLAIR or T2 hyperintensity in surface white matter around the electrodes without vessel injury, whereas DWI showed no abnormal signals. The eosinophil count was increased in one of these five patients. Peri-electrode edema after DBS surgery is not an uncommon phenomenon, and includes two types: (1) limited edema in deep white matter and (2) extensive edema in surface white matter. Different mechanisms may be associated with these types of edemas.

PMID: 30472347 [PubMed - as supplied by publisher]

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Peroxisome proliferator-activated receptor-γ activation attenuates harmaline-induced cognitive impairments in rats.

Peroxisome proliferator-activated receptor-γ activation attenuates harmaline-induced cognitive impairments in rats.

J Clin Neurosci. 2018 Nov 21;:

Authors: Aghaei I, Hajali V, Haghani M, Vaziri Z, Moosazadeh M, Shabani M

Abstract
Cognitive and motor disturbances are serious concerns of the tremors induced by motor disorders. Despite the lack of effective clinical treatment, some potential therapeutic agents have been used to alleviate the cognitive symptoms in the animal models of tremor. Recent studies have shown that PPAR-γ agonists have neuroprotective effects. In the current study, the effects of pioglitazone (PIO), a peroxisome proliferator-activated receptor gamma agonist, on harmaline-induced motor and cognitive impairment were studied. Male Wistar rats were divided into vehicle (normal saline), PIO (20 mg/kg i.p.), harmaline (10 mg/kg, i.p.) and PIO + harmaline (PIO injected 2 h before harmaline) groups. Open field, rotarod, wire grip, foot print and Morris water maze tests were used to evaluate the motor and cognitive performance. The results indicated that administration of PIO attenuated harmaline-induced locomotor, anxiety-like behaviors, and spatial learning and memory impairments, but it partially decreased the tremor score. The neuroprotective and anxiolytic effects of PIO demonstrated in the current study can offer the PPAR-γ receptor agonism as a potential therapeutic agent in the treatment of patients with tremor that manifest mental dysfunction.

PMID: 30472346 [PubMed - as supplied by publisher]

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Glioblastoma with bilateral extraocular muscle infiltration preceded by evidence of vascular tropism.

Glioblastoma with bilateral extraocular muscle infiltration preceded by evidence of vascular tropism.

J Clin Neurosci. 2018 Nov 21;:

Authors: Ruff MW, Kizilbash SH

Abstract
We present a case of bilateral synchronous orbital muscle infiltration of extra-neural glioblastoma metastases with evidence of focal treatment response. The orbital infiltration was preceded by evidence of leptomeningeal disease, and followed by further symptomatic perineural spread of tumor along the second and third division of the trigeminal nerve and into the masticator space.

PMID: 30472340 [PubMed - as supplied by publisher]

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Clinical-radiographic correlates of Artery of Percheron infarcts in a case series of 6 patients.

Clinical-radiographic correlates of Artery of Percheron infarcts in a case series of 6 patients.

J Clin Neurosci. 2018 Nov 21;:

Authors: Agarwal S, Chancellor B, Howard J

Abstract
Bilateral thalamic strokes due to Artery of Percheron (AOP) occlusion are rare but have been previously reported in the literature. It is due to a rare anatomic variant where a solitary arterial trunk from the proximal segment of either posterior cerebral artery (PCA) supplies bilateral thalami and midbrain. Despite its description in the literature, these strokes are usually missed and patient's symptoms are not thought to be secondary to a vascular etiology. Through this report we aim to describe the clinical and radiographic features seen in these patients. We describe a series of 6 patients who present with varying levels of somnolence and oculomotor nerve palsies who had an occlusion of the AOP with bilateral thalamic infarcts with midbrain involvement. These clinical presentations, combined with the "V" sign on MRI are important in making the diagnosis.

PMID: 30472345 [PubMed - as supplied by publisher]

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Outcomes of intraparenchymal hemorrhage after direct oral anticoagulant or vitamin K antagonist therapy: A systematic review and meta-analysis.

Outcomes of intraparenchymal hemorrhage after direct oral anticoagulant or vitamin K antagonist therapy: A systematic review and meta-analysis.

J Clin Neurosci. 2018 Nov 21;:

Authors: DiRisio AC, Harary M, Muskens IS, Yunusa I, Gormley WB, Aglio LS, Smith TR, Connors JM, Mekary RA, Broekman MLD

Abstract
Direct Oral Anticoagulants (DOAC) are increasingly used as an alternative to vitamin-K antagonists (VKA) for anticoagulation and have shown lower rates of intracranial hemorrhage; however, there is disagreement in the literature over the outcomes of the intraparenchymal hemorrhages (IPH) associated with DOACs, and clinical concern regarding the lack of standardized reversal strategies for DOACs. Thus, the aim of this meta-analysis was to compare mortality, hematoma volume, and risk of hematoma expansion in patients who developed an IPH on DOACs versus VKA. A systematic review of the literature was conducted in accordance with the PRISMA guidelines. Studies were selected that reported on mortality, hematoma expansion, and hematoma volume in DOAC-associated IPH. Pooled risk ratios (RR) were calculated for mortality and hematoma expansion and pooled mean difference (MD) was calculated for hematoma volume (ml) using random-effect models. 15 studies reporting on 1238 patients were included in the systematic review. Eleven of these compared DOAC-IPH to VKA-IPH and were pooled quantitatively. DOAC-IPH was not associated with increased mortality risk (RR: 0.95, 95%-CI: 0.72 -1.27) or increased hematoma expansion risk (RR: 0.92; 95%-CI: 0.75-1.12) compared to VKA-IPH. The hematoma volume of DOAC- IPH was statistically significantly smaller than VKA-IPH (MD: -12.14 ml; 95%-CI: -15.38; -8.89). In conclusion, DOAC-IPH was not associated with increased mortality or hematoma expansion compared to VKA-IPH and may be associated with a smaller hematoma volume.

PMID: 30472344 [PubMed - as supplied by publisher]

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Cervical paraspinal muscle compartment pressure after laminoplasty: A cadaveric study.

Cervical paraspinal muscle compartment pressure after laminoplasty: A cadaveric study.

J Clin Neurosci. 2018 Nov 21;:

Authors: Singhatanadgige W, Suebsombut Y, Riew KD, Tanavalee C, Yingsakmongkol W, Limthongkul W

Abstract
Axial neck pain is a common complaint after cervical laminoplasty and the causes are still not well-understood. We hypothesized that abnormal paracervical muscle compartment pressures might be one of them. The cervical paraspinal muscle compartment pressures of 10 cadavers were measured in six different areas under four different conditions. The posterior cervical area was divided into two sides: open side and hinge side. Then each side was divided into upper, middle, and lower areas. The compartment pressures of each area were measured under four different conditions: before and after dissection of posterior paravertebral (paraspinal) muscles, after laminoplasty and after laminoplasty with removal of the spinous processes. There was a statistically significant difference between the pressures after dissection versus after laminoplasty on the hinge side at all upper, middle and lower areas [p < 0.01, <0.001 and =0.009 respectively]. There was a difference in the pressures after laminoplasty between the open and hinge sides [p < 0.001, <0.001 and =0.023 respectively]. We also found the following significant differences: the pressures between before dissection and after laminoplasty on the hinge side, as well as between after laminoplasty and after removal of the spinous process on the hinge side in the upper and middle areas [p < 0.001, =0.0016 and p = 0.002, =0.023 respectively]. Cervical paraspinal muscle compartment pressures on the hinge side were significantly increased after laminoplasty. This may be a contributor to axial neck pain following laminoplasty. The pressure was then significantly decreased after removal of the spinous processes.

PMID: 30472343 [PubMed - as supplied by publisher]

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Evaluating the suitability of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computerized neurocognitive battery for short-term, serial assessment of neurocognitive functioning.

Evaluating the suitability of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computerized neurocognitive battery for short-term, serial assessment of neurocognitive functioning.

J Clin Neurosci. 2018 Nov 21;:

Authors: Elbin RJ, Fazio-Sumrok V, Anderson MN, D'Amico NR, Said A, Grossel A, Schatz P, Lipinski D, Womble M

Abstract
BACKGROUND: Computerized Neurocognitive Testing (CNT) is frequently used for serial assessment of athletes following concussion. The Immediate Post-Concussion Assessment for Cognitive Testing (ImPACT) is a commonly used CNT with well-documented test-retest reliability in healthy samples for intervals ranging from one month to two years. However, previous research has not explored use of ImPACT for other serial testing methodologies such as immediately before and after an experimental trial/intervention where administration on the same day may be necessary.
PURPOSE: To examine the suitability of ImPACT for short-term, serial assessment of neurocognitive functioning.
STUDY DESIGN: Prospective, repeated measures research design.
METHODS: Forty-two healthy, college-aged individuals completed ImPACT twice, with a one-hour break between assessments. Reliability was assessed using Pearson correlation coefficients, intraclass correlation coefficients (ICCs), reliable change indices (RCIs) and regression-based methods (RBM).
RESULTS: No significant increases in mean ImPACT composite or symptom scores were observed between assessments. ICCs ranged from 0.34 to 0.74 (single)/0.51 to 0.85 (average). Across two test administrations, 92-100% and 93-98% of participants' change scores fell within cutoffs when utilizing the RCI and RBM, respectively.
CONCLUSION: The ICCs for ImPACT composite and factor scores across the one-hour administration were consistent with previous studies. Only a small percentage of scores fell outside of RCI and RBM cutoffs. These statistical metrics suggest that ImPACT has sufficient reliability when repeating administration within one-hour.

PMID: 30472342 [PubMed - as supplied by publisher]

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Neuroendoscopic hematoma removal with a small craniotomy for acute subdural hematoma.

Neuroendoscopic hematoma removal with a small craniotomy for acute subdural hematoma.

J Clin Neurosci. 2018 Nov 21;:

Authors: Ichimura S, Takahara K, Nakaya M, Yoshida K, Mochizuki Y, Fukuchi M, Fujii K

Abstract
The present study evaluated the safety and effectiveness of neuroendoscopic hematoma removal with a small craniotomy for the treatment of acute subdural hematoma (ASDH). Five patients (4 men and 1 woman) with ASDH underwent neuroendoscopic surgery with a small-size craniotomy between October 2016 and June 2018. The mean age was 87.4 years (range, 82-94). The eligibility criteria were as follows: 1) the presence of symptoms; 2) no moderate or massive brain contusion or edema; and 3) inability to use a large craniotomy because of poor general condition or absence of an anesthesiologist. After performing the small craniotomy, a 4-mm rigid endoscope was inserted and the hematoma was evacuated. Endoscopic surgery was performed under general or local anesthesia. The bleeding origin was a cortical artery in 2 cases, a bridging vein in 2 cases, and unknown in 1 case. The hematoma was completely removed without re-bleeding and the procedure was lifesaving in all cases. Three patients were discharged with independent gait following rehabilitation whereas 2 patients died due to causes unrelated to ASDH. Despite some surgical limitations, neuroendoscopic hematoma evacuation of ASDH is a safe and effective method that minimizes operative complications in some cases. Small craniotomy was sufficient for inserting and maneuvering ordinal neurosurgical instruments. This technique should be considered carefully before surgery in cases of ASDH.

PMID: 30472341 [PubMed - as supplied by publisher]

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Splitting of the semispinalis capitis muscle as a less invasive approach for atlantoaxial fusion - A technical note.

Splitting of the semispinalis capitis muscle as a less invasive approach for atlantoaxial fusion - A technical note.

J Clin Neurosci. 2018 Nov 21;:

Authors: Spiessberger A, Stauffer A, Baumann F, Marbacher S, Kothbauer K, Fandino J, Moriggl B

Abstract
PURPOSE: Atlantoxial fusion with screw rod constructs traditionally requires subperiostal dissection of the C1/C2 muscle attachments, which may lead to postoperative axial neck pain and intraoperative blood loss. We evaluate a potentially less invasive, muscle splitting approach for atlantoaxial fusion in a cadaver model.
METHODS: A technical feasibility study was performed in a human cadaveric specimen with standard surgical instruments and an operating microscope. Surgically relevant anatomical structures as well as final exposure of the C1, C1/C2 and C2 screw entry points are demonstrated.
RESULTS: Following a midline skin incision, blunt mobilization and downward retraction of the trapezius and splenius capitis muscle is followed by a longitudinal split of the semispinalis capitis muscle. At the lower border of the rectus capitis posterior major and the obliquus capitis inferior muscle the entry points for C1 lateral mass, C1/C2 transarticular and C2 pedicle screw are exposed.
CONCLUSION: Minimal invasive splitting of the semispinalis capitis muscle allows adequate exposure of the screw entry points of C1, C1/C2 and C2 while preserving the intrinsic muscles of the back at the craniocervical junction.

PMID: 30472339 [PubMed - as supplied by publisher]

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Primary intraspinal non-Hodgkin's lymphoma: Case report and review of literature.

Primary intraspinal non-Hodgkin's lymphoma: Case report and review of literature.

J Clin Neurosci. 2018 Nov 21;:

Authors: Beume LA, Wolf K, Urbach H, Klingler JH, Staszewski O, Marks R, Weiller C, Rauer S, Hosp JA

Abstract
We present the unique case of an 67-year-old female patient with primary intraspinal B-cell non-Hodgkin's lymphoma without cerebral manifestation mimicking myelitis in clinical presentation and neuroradiological diagnostic. It illustrates the broad spectrum of differential diagnoses for paraplegia and the importance of rapid interdisciplinary diagnostic work-up since the neurologic status after treatment mainly depends on the delay of treatment. Review of existing literature suggests combined radio- and chemotherapy as well as high-dose intravenous methotrexate or rituximab. The rising incidence of spinal lymphomas especially in patients with acquired immunodeficiency underlines the importance of fast diagnosis and initiation of treatment of this rare entity.

PMID: 30472338 [PubMed - as supplied by publisher]

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0.075% capsaicin lotion for the treatment of painful diabetic neuropathy: A randomized, double-blind, crossover, placebo-controlled trial.

0.075% capsaicin lotion for the treatment of painful diabetic neuropathy: A randomized, double-blind, crossover, placebo-controlled trial.

J Clin Neurosci. 2018 Nov 21;:

Authors: Kulkantrakorn K, Chomjit A, Sithinamsuwan P, Tharavanij T, Suwankanoknark J, Napunnaphat P

Abstract
OBJECTIVE: A randomized, double-blinded, crossover, placebo controlled trial was conducted to evaluate the efficacy and safety of 0.075% capsaicin lotion for treating painful diabetic neuropathy (PDN).
PATIENTS AND METHODS: PDN subjects were randomized to receive 0.075% capsaicin/placebo for 8 weeks, then crossing over to the other treatment after a 4-weeks washout period. Primary endpoint was the change in visual analog scale score of pain severity. Secondary outcomes were score changes in Neuropathic Pain Scale, short-form McGill Pain Questionnaires, and proportions of patients with pain score reductions of 30% and 50%, and adverse events.
RESULTS: A total of 42 subjects were enrolled, 27 completed at least an 8-week treatment period. Intention-to-treat analysis showed no significant improvement in pain control with capsaicin lotion compared with placebo for all pain measures and proportion of patients who had 30% or 50% pain relief, respectively. Per protocol analysis were consistent. Capsaicin lotion was well tolerated but local skin reactions were common.
CONCLUSION: In patients with PDN, the efficacy of 0.075% capsaicin lotion was similar to placebo but was well tolerated. More work is needed to assess different capsaicin formulations.

PMID: 30472337 [PubMed - as supplied by publisher]

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Psychiatric symptoms in migraine patients and their attitudes towards psychological support on stigmatization.

Psychiatric symptoms in migraine patients and their attitudes towards psychological support on stigmatization.

J Clin Neurosci. 2018 Nov 21;:

Authors: Korkmaz S, Kazgan A, Korucu T, Gönen M, Yilmaz MZ, Atmaca M

Abstract
OBJECTIVE: Although migraine patients experience more psychological problems when compared to the general population, they are usually not treated. The reasons for non-treatment of these problems are not clear. The anxiety and concern of migraine patients about stigmatization may also prevent them to express psychological symptoms. The present study aimed to investigate the attitudes and behavior of migraine patients about receiving psychological help and their concerns about stigmatization.
MATERIAL AND METHOD: The study group included 50 18-49 years old patients diagnosed with migraine in the neurology clinic and the control group included 50 healthy individuals with similar age, gender socio demographic characteristics with the study group. Attitude Scale Towards Seeking Professional Help (ASPH-SF), Self-Stigma in Seeking Professional Help Scale (SSPHS), Intentions to Seek Psychological Help Scale (ISHP), Stigma Scale for Receiving Psychological Help (SSRPH) and Symptom Checklist (SCL-90-R) were applied to all participants.
FINDINGS: The comparison of the patient and control groups based on SCL-90-R findings demonstrated that the patient group scores in somatization, anxiety (p = 0.000), depression (p = 0.003), anger (p = 0.02), interpersonal sensitivity (p = 0.006), phobia (p = 0.001), paranoid thoughts (p = 0.012), psychosis (p = 0.031) subscales and additional subscale (p = 0.014) and general symptom index (p = 0.001) scores were higher. Based on SCL 90, it was found that patients with higher levels of symptoms had higher social stigma scores when compared to patients with lower symptom levels (p = 0.007). Migraine patients with high symptom levels were found to have significantly lower rates of seeking psychiatric help (14% vs 33%) when compared to the control group. There was no difference between the patient and control groups based on ASPH-SF, SSPHS, ISPH and SSRPH scale scores.
CONCLUSION: Although migraine patients exhibit higher levels of psychiatric symptoms when compared to healthy individuals, it was determined that only a minority of these patients receive psychiatric treatment. Especially patients with high level of psychiatric symptoms could have sought less psychiatric help due to the concerns of stigmatization.

PMID: 30472336 [PubMed - as supplied by publisher]

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Hypoglossal schwannomas: A systematic review of the literature.

Hypoglossal schwannomas: A systematic review of the literature.

J Clin Neurosci. 2018 Nov 21;:

Authors: Bindal S, El Ahmadieh TY, Plitt A, Aoun SG, Neeley OJ, El Tecle NE, Barnett S, Gluf W

Abstract
BACKGROUND: Schwannomas of the hypoglossal nerve are rare and account for a very small percentage of non-vestibular schwannomas.
OBJECTIVES: In this systematic review of the literature, we examined the epidemiology, symptomatology, management, and outcomes of patients with hypoglossal schwannomas.
METHODS: The electronic database Pubmed was searched for all reports of hypoglossal schwannomas with descriptions of symptoms, management, and outcome characteristics. Data was extracted from each study and compiled in a spreadsheet. Continuous variables were reported as means and medians. Categorical variables were reported as proportions. Additional analysis was not done due to inconsistent reporting of outcomes and small sample sizes.
RESULTS: A total of 59 studies (94 total individual cases) were included. 64% of patients were female with mean age of 44.6 years. The majority were intracranial/extracranial (50%). The most common symptoms were tongue deviation or speech disturbance (38%) and headaches (33%). Hypoglossal nerve dysfunction was present in 80% of patients. Surgical excision was performed in 93%, with a 15% complication rate. Evidence of residual mass after surgery was noted in 29%. Permanent hypoglossal nerve deficits occurred in 67%. Recurrence of tumor burden was reported in 6 studies, with median time to recurrence of 16.5 months.
CONCLUSION: Current evidence suggests overall favorable outcomes with surgical resection of hypoglossal schwannomas, with a large percentage of patients experiencing mild and usually well-tolerated neurologic deficit. Limitations of this study include the use of retrospective data taken from case reports/series with highly selected patients, selective reporting, and absence of control groups.

PMID: 30472335 [PubMed - as supplied by publisher]

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Crestal bone loss around dental implants placed in head and neck cancer patients treated with different radiotherapy techniques: a prospective cohort study.

Crestal bone loss around dental implants placed in head and neck cancer patients treated with different radiotherapy techniques: a prospective cohort study.

Int J Oral Maxillofac Surg. 2018 Nov 21;:

Authors: Papi P, Brauner E, Di Carlo S, Musio D, Tombolini M, De Angelis F, Valentini V, Tombolini V, Polimeni A, Pompa G

Abstract
The aim of this prospective cohort study was to evaluate how the radiation technique can affect crestal bone loss and the implant survival rate in head and neck cancer patients treated with radiotherapy. In this study, the type of radiotherapy treatment, i.e. three-dimensional conformal radiotherapy (3D-CRT) or intensity modulated radiation therapy (IMRT), was the predictor variable. The primary outcome variable was crestal bone loss, recorded at implant placement and after 3, 6, 12, and 24 months. A descriptive analysis and ANOVA test were performed; significance was set at P<0.05. Thirty-two patients were enrolled and a total of 113 dental implants placed in irradiated residual bone. There was no statistically significant difference in crestal bone loss levels between the groups at any of the intervals (P>0.05), except after 6 months (P=0.028). The cumulative dental implant survival rate was 94.7%. After 24 months, the mean marginal bone loss was 0.83±0.12mm in the 3D-CRT group and 0.74±0.15mm in the IMRT group (P=0.179). The data suggest that the different radiation techniques did not affect the outcomes of implant-supported prosthetic rehabilitation, as related to crestal bone loss and implant survival. However, long-term follow-up studies are necessary to evaluate the real influence of the radiotherapy technique on dental implants.

PMID: 30471831 [PubMed - as supplied by publisher]

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Continuous access to snacks from weaning onwards in female rats causes weight gain, insulin insensitivity, and sustained leptin resistance in adulthood.

Continuous access to snacks from weaning onwards in female rats causes weight gain, insulin insensitivity, and sustained leptin resistance in adulthood.

Physiol Behav. 2018 Nov 22;:

Authors: Clawson RC, Dela Cruz LN, Allen S, Wolgemuth T, Maner A, Dorsett A, I'Anson H

Abstract
A large part of the daily intake of children in the U.S. consists of snacks, with the average child consuming three snacks per day. Despite this, little research has been conducted to determine the metabolic and behavioral effects of snacking. Using a developing female rat model, our studies aimed to determine the effects of snacking during development before the protective effects of estrogen on weight gain would be relevant. Additionally, to determine if snack composition is important, we created one healthy and one unhealthy snacking group provided with chow and three snacks each in addition to a chow-only group. We found that both snacking groups experienced increased weight gain, elevated abdominal fat pad mass, prolonged leptin resistance into adulthood, and insulin insensitivity that was not observed in their non-snacking counterparts. These physiological differences were measured despite both snacking groups having a similar caloric intake as the chow-only group throughout the study. In addition to physiological changes, both snacking groups showed a preference for snacks over chow and ate more often during the inactive light phase than typical for rats, with the unhealthy snacking group presenting this behavioral change earlier than the healthy snacking group. Our results suggest that constant access to palatable snacks, which is often the case for children in western countries, alters feeding behaviors in relation to food choice and time of day when eating occurs. Snacking during development seemed to promote signs of metabolic syndrome in adulthood even when excess caloric intake was not observed. Our work further suggests that development is a vulnerable time for palatable snack presentation when prepubertal females lack the protective effects of estrogen and exhibit reduced leptin feedback on food intake. Thus snacking from weaning onward could be a contributor to the current childhood obesity crisis.

PMID: 30472395 [PubMed - as supplied by publisher]

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Aggressive behavior and stress response after oxytocin administration in male Norway rats selected for different attitudes to humans.

Aggressive behavior and stress response after oxytocin administration in male Norway rats selected for different attitudes to humans.

Physiol Behav. 2018 Nov 22;:

Authors: Gulevich R, Kozhemyakina R, Shikhevich S, Konoshenko M, Herbeck Y

Abstract
Oxytocin (OXT) is known to influence on social behaviors, including intermale aggression and hypothalamic-pituitary-adrenal (HPA) axis activity. However, there are no data on the effects of oxytocin on intermale aggression and HPA axis activity in rats selected for elimination and enhancement of aggressiveness towards humans. The aim of this study is to elucidate the role of oxytocin in expression of aggressive behavior and stress response in Norway rats selected for elimination (tame) and enhancement (aggressive) of an aggressive-defensive reaction to humans. Oxytocin was administered to males via nasal applications once or for 5 days (daily). Resident-intruder test showed that in aggressive males, single oxytocin administration caused an increase in the latent period of aggressive interactions and a decrease in the percentage of direct aggression time (not including the time of lateral threat postures) as compared to the control aggressive rats administered with saline. After a 5-day oxytocin administration, aggressive animals demonstrated shorter time of aggressive interactions compared to the control rats. Resident-intruder test revealed no significant changes in behavior of tame rats after single oxytocin administration, while multiple administration caused an increase in aggressive behavior in tame rats. Oxytocin applications caused an elevation of corticosterone level after restriction in aggressive males, but did not affect expression of Crh, Crh1 and Crhr2 genes in hypothalamus in either tame or aggressive rats. The data obtained indicate significant role of oxytocinergic system in the behavior formed in the process of selection by reaction to humans.

PMID: 30472394 [PubMed - as supplied by publisher]

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Mutations in Outer Dynein Arm Heavy Chain DNAH9 Cause Motile Cilia Defects and Situs Inversus.

Mutations in Outer Dynein Arm Heavy Chain DNAH9 Cause Motile Cilia Defects and Situs Inversus.

Am J Hum Genet. 2018 Nov 20;:

Authors: Fassad MR, Shoemark A, Legendre M, Hirst RA, Koll F, le Borgne P, Louis B, Daudvohra F, Patel MP, Thomas L, Dixon M, Burgoyne T, Hayes J, Nicholson AG, Cullup T, Jenkins L, Carr SB, Aurora P, Lemullois M, Aubusson-Fleury A, Papon JF, O'Callaghan C, Amselem S, Hogg C, Escudier E, Tassin AM, Mitchison HM

Abstract
Motile cilia move body fluids and gametes and the beating of cilia lining the airway epithelial surfaces ensures that they are kept clear and protected from inhaled pathogens and consequent respiratory infections. Dynein motor proteins provide mechanical force for cilia beating. Dynein mutations are a common cause of primary ciliary dyskinesia (PCD), an inherited condition characterized by deficient mucociliary clearance and chronic respiratory disease coupled with laterality disturbances and subfertility. Using next-generation sequencing, we detected mutations in the ciliary outer dynein arm (ODA) heavy chain gene DNAH9 in individuals from PCD clinics with situs inversus and in one case male infertility. DNAH9 and its partner heavy chain DNAH5 localize to type 2 ODAs of the distal cilium and in DNAH9-mutated nasal respiratory epithelial cilia we found a loss of DNAH9/DNAH5-containing type 2 ODAs that was restricted to the distal cilia region. This confers a reduced beating frequency with a subtle beating pattern defect affecting the motility of the distal cilia portion. 3D electron tomography ultrastructural studies confirmed regional loss of ODAs from the distal cilium, manifesting as either loss of whole ODA or partial loss of ODA volume. Paramecium DNAH9 knockdown confirms an evolutionarily conserved function for DNAH9 in cilia motility and ODA stability. We find that DNAH9 is widely expressed in the airways, despite DNAH9 mutations appearing to confer symptoms restricted to the upper respiratory tract. In summary, DNAH9 mutations reduce cilia function but some respiratory mucociliary clearance potential may be retained, widening the PCD disease spectrum.

PMID: 30471717 [PubMed - as supplied by publisher]

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Preoperative Vascular Interventions to Improve Donor Leg Perfusion: A Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction.

Preoperative Vascular Interventions to Improve Donor Leg Perfusion: A Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction.

J Oral Maxillofac Surg. 2018 Nov 01;:

Authors: Kim RY, Burkes JN, Broker HS, Williams FC

Abstract
PURPOSE: For reconstruction of head and neck defects, the fibula free flap is the first choice at many institutions. The main contraindication for fibula harvest is the lack of 3-vessel runoff, which leads to postoperative vascular compromise of the lower extremity. Atherosclerosis is the most common disease, which can limit the use of this donor site. In general, vascular interventions, which include angioplasty, atherectomy, and stenting, have been used to fix arterial supplies using endovascular methods. The purpose of this study was to report on the outcome of a preliminary cohort of patients after vascular interventions to re-establish vessel patency to allow safe use of the free fibula free flap in head and neck reconstruction.
MATERIALS AND METHODS: A single-institution retrospective case review using electronic medical records was designed. The study population was composed of patients who underwent a fibula free flap procedure for head and neck reconstruction from 2015 through 2017. Inclusion criteria were patients who underwent conventional angiography and required vascular interventions. There were no specific exclusion criteria. The primary outcome of interest was vascular compromise of the donor site. Additional variables of interest included success of reconstruction and perioperative donor or recipient site complications.
RESULTS: Two patients who underwent preoperative vascular interventions of the superficial femoral artery and posterior tibial artery were identified. The mean age was 65 years, and these patients underwent resection and reconstruction for mandibular carcinoma. For these patients, fibula flaps were harvested from the left lower extremity and included skin paddles. The fibula flaps survived and the donor feet maintained adequate perfusion. One patient had poor take of the split-thickness skin graft. No long-term functional deficit was noted.
CONCLUSIONS: Vascular interventions could be a safe method to re-establish vascular flow and 3-vessel runoff for select patients initially unable to undergo fibula free flap harvest.

PMID: 30471961 [PubMed - as supplied by publisher]

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Preoperative Vascular Interventions to Improve Donor Leg Perfusion: A Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction.

Preoperative Vascular Interventions to Improve Donor Leg Perfusion: A Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction.

J Oral Maxillofac Surg. 2018 Nov 01;:

Authors: Kim RY, Burkes JN, Broker HS, Williams FC

PMID: 30471961 [PubMed - as supplied by publisher]

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[Efficacy and toxicity of immune checkpoint inhibitors in elderly patients - 5th edition of the congress of pharmacology of anticancer drugs].

[Efficacy and toxicity of immune checkpoint inhibitors in elderly patients - 5th edition of the congress of pharmacology of anticancer drugs].

Bull Cancer. 2018 Nov 21;:

Authors: Gaultier De Saint Basile H, Poisson C, Arrondeau J, Boudou-Rouquette P, Goldwasser F, Tartour E, De Guillebon E

Abstract
Physiological aging causes qualitative or quantitative immune system decline, also called immunosenescence. Older people with cancer are often ineligible for chemotherapy. The new immunotherapies (with PD1, PDL1 and CTLA4 checkpoint inhibitors) have proven their effectiveness in many tumor types regardless of age and are often better tolerated than chemotherapy. In the older population, the subgroup data from the different pivotal studies show fairly reassuring efficacy and safety data, despite the frequent lack of power given the small population included. There remains, however, some doubt that age may be a risk factor for hyperprogression. Studies focusing on older subjects and dedicated meta-analysis seem necessary to obtain more accurate data.

PMID: 30471959 [PubMed - as supplied by publisher]

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Greetings from the new editor-in-chief of human pathology.

Greetings from the new editor-in-chief of human pathology.

Hum Pathol. 2018 Nov 22;:

Authors:

PMID: 30472254 [PubMed - as supplied by publisher]

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Should we be imaging soft tissue masses of the hand and wrist?

Should we be imaging soft tissue masses of the hand and wrist?

J Plast Reconstr Aesthet Surg. 2018 Nov 13;:

Authors: Plonczak AM, Niruttan K, Jain A

PMID: 30472047 [PubMed - as supplied by publisher]

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Donor limb assessment after vascularized groin lymph node transfer for the treatment of breast cancer-related lymphedema: Clinical and lymphoscintigraphy findings.

Donor limb assessment after vascularized groin lymph node transfer for the treatment of breast cancer-related lymphedema: Clinical and lymphoscintigraphy findings.

J Plast Reconstr Aesthet Surg. 2018 Nov 03;:

Authors: Liu HL, Pang SY, Lee CC

Abstract
INTRODUCTION: Vascularized lymph node transfer is an established treatment for secondary lymphedema. Different donor sites of lymph node flap have been described. In our institute, vascularized groin lymph node (VGLN) flap is the workhorse flap for treating breast cancer-related lymphedema (BCRL). Potential complications of VGLN flap harvesting include seroma formation, thigh dysaesthesia, and iatrogenic lymphedema.
METHODS: Between August 2013 and June 2016, 30 consecutive patients with a mean age of 60 years underwent VGLN transfer for BCRL. Reverse mapping of lower limb lymphatics with patent blue solution was performed in all cases. The donor limb conditions were assessed clinically with limb circumference measurement and radiologically with lymphoscintigraphy. Postoperative lymphoscintigraphy findings and transport indexes were compared between the donor and nonoperated limbs.
RESULTS: The mean follow-up period was 22.11 ± 7.83 months. Three (10%) patients developed groin seroma and 18 (60%) patients complained of transient thigh dysaesthesia. There was no clinically detectable donor limb lymphedema. Lymphoscintigraphy was performed at a mean of 13 months after operation. The mean transport indexes of the nonoperated limbs and donor limbs were 2.04 and 3.32, respectively. For the donor limbs, all patients had normal distribution pattern of contrast uptake. No dermal backflow pattern was demonstrated.
CONCLUSION: With good knowledge of groin anatomy and meticulous surgical skills, VGLN flap can be harvested without causing major consequence to the donor limb.

PMID: 30472046 [PubMed - as supplied by publisher]

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Microscope assisted surgery for dupuytrens disease.

Microscope assisted surgery for dupuytrens disease.

J Plast Reconstr Aesthet Surg. 2018 Nov 13;:

Authors: Nikkhah D, Blair J

PMID: 30472045 [PubMed - as supplied by publisher]

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Shear wave elastography of median nerve at wrist and forearm. Heterogeneity of normative values: Response to authors.

Shear wave elastography of median nerve at wrist and forearm. Heterogeneity of normative values: Response to authors.

J Plast Reconstr Aesthet Surg. 2018 Nov 13;:

Authors: Paluch L, Pietruski P, Walecki J, Noszczyk BH

PMID: 30472044 [PubMed - as supplied by publisher]

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Erratum to "Surgical outcomes in the treatment of temporal bone cerebrospinal fluid leak: A systematic review" [Auris Nasus Larynx 45 (2018) 903-910].

Erratum to "Surgical outcomes in the treatment of temporal bone cerebrospinal fluid leak: A systematic review" [Auris Nasus Larynx 45 (2018) 903-910].

Auris Nasus Larynx. 2018 Nov 21;:

Authors: Gioacchini FM, Cassandro E, Alicandri-Ciufelli M, Kaleci S, Cassandro C, Scarpa A, Re M

PMID: 30472083 [PubMed - as supplied by publisher]

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The number and ratio of positive lymph nodes are independent prognostic factors for patients with major salivary gland cancer: Results from the surveillance, epidemiology, and End Results dataset.

The number and ratio of positive lymph nodes are independent prognostic factors for patients with major salivary gland cancer: Results from the surveillance, epidemiology, and End Results dataset.

Eur J Surg Oncol. 2018 Nov 15;:

Authors: Qian K, Sun W, Guo K, Zheng X, Sun T, Chen L, Xiang J, Li D, Wu Y, Ji Q, Wang Z

Abstract
INTRODUCTION: To investigate whether the positive lymph node number (PLNN) and positive lymph node ratio (PLNR) could predict the prognosis of patients with major salivary gland cancer (MSGC) and to identify the optimal cutoff points for these variables that stratify patients according to their risk of survival.
METHODS: We used the Surveillance, Epidemiology, and End Results (SEER) database to identify all patients with MSGC between 1988 and 2014. A logistic regression analysis was carried out to evaluate the risk factors for lymph node metastasis (LNM) in MSGC. The X-tile program was used to identify the cutoff values for the PLNN and PLNR in MSGC patients with LNM. Cox proportional hazards regression models were performed to identify the predictors of cancer-specific survival (CSS).
RESULTS: In the SEER database, 8668 eligible patients were identified and 3046 of them had LNM. The logistic regression analysis indicated that older age, male sex, larger tumor size, higher grade, tumor extension and high-risk pathology were associated with LNM. The X-tile program showed that a PLNN>4 and a PLNR>0.15 were prognostic indicators of CSS. A multivariable analysis indicated that, after the factors that might potentially affect the prognosis were adjusted for, the PLNN and PLNR were still associated with CSS.
CONCLUSIONS: Our Results demonstrated that the PLNN and PLNR were independent prognostic indicators for MSGC patients with lymph node metastasis.

PMID: 30472214 [PubMed - as supplied by publisher]

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Monday, November 26, 2018