Prehospital pathways of occipital stroke patients with mainly visual symptoms

Objectives

Occipital ischemic strokes typically cause homonymous visual field defects, for which means of rehabilitation are limited. Intravenous thrombolysis is increasingly and successfully used for their acute treatment. However, recognition of strokes presenting with mainly visual field defects is challenging for both patients and healthcare professionals. We studied prehospital pathways of occipital stroke patients with mainly visual symptoms to define obstacles in their early recognition.

Materials & methods

This observational, retrospective, registry-based study comprises occipital stroke patients with isolated visual symptoms treated at the neurological emergency department of Helsinki University Central Hospital in 2010-2015. We analyzed their prehospital pathways, including time from symptom onset to admission at the neurological emergency department (ODT), the number of points of care, the percentage of patients with ODT≤4.5 hours, and factors associated with delay.

Results

Among 245 patients, only 20.8% arrived within 4.5 hours and 6.5% received IV thrombolysis. Delayed arrival was most often due to patients' late contact to health care. Of the patients, 27.3% arrived through at least two points of care, and differential diagnostics to ophthalmologic disorders proved particularly challenging. ODT≤4.5 hours was associated with EMS utilization, direct arrival, and atrial fibrillation; a visit at an ophthalmologist and initial misdiagnosis were associated with ODT>4.5 hours. After multivariable analysis, only direct arrival predicted ODT≤4.5 hours.

Conclusions

Occipital stroke patients with visual symptoms contact health care late, are inadequately recognized, and present with complex prehospital pathways. Consequently, they are often ineligible for IV thrombolysis. This presents a missed opportunity for preventing permanent visual field defects.

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Epilepsy surgery of “low grade epilepsy associated neuroepithelial tumors”: A retrospective nationwide Italian study

Summary

Objective

To analyze the attitude and results of Italian epilepsy surgery centers in the surgical management of "low grade epilepsy associated neuroepithelial tumors" (LEATs).

Methods

We conducted a retrospective study enrolling 339 consecutive patients with LEATs who underwent surgery between January 2009 and June 2015 at eight Italian epilepsy surgery centers. We compared demographic, clinical, pathologic, and surgical features of patients with favorable (Engel class I) and unfavorable (Engel class II, III, and IV) seizure outcome. In addition, we compared patients with tumor-associated focal cortical dysplasia (FCD) and patients with solitary tumors to identify factors correlated with FCD diagnosis.

Results

Fifty-five (98.2%) of 56 patients with medically controlled epilepsy were seizure-free after surgery, compared to 249 (88.0%) of 283 patients with refractory epilepsy. At multivariate analysis, three variables independently predict unfavorable seizure outcome in the drug-resistant group. Age at surgery is largely the most significant (p = 0.001), with an odds ratio (OR) of 1.04. This means that the probability of seizure recurrence grows by 4% for every waited year. The resection site is also significant (p = 0.039), with a relative risk (RR) of 1.99 for extratemporal tumors. Finally, the completeness of tumor resection has a trend toward significance (p = 0.092), with an RR of 1.82 for incomplete resection. Among pediatric patients, a longer duration of epilepsy was significantly associated with preoperative neuropsychological deficits (p < 0.001). A statistically significant association was observed between FCD diagnosis and the following variables: tailored surgery (p < 0.001), temporal resection (p = 0.001), and surgical center (p = 0.012).

Significance

Our nationwide LEATs study gives important insights on factors predicting seizure outcome in refractory epilepsy and determining variability in FCD detection. Timely surgery, regardless of pharmacoresistance and oriented to optimize epileptologic, neuropsychological, and oncologic outcomes should be warranted.

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Consolidative Proton Therapy after Chemotherapy for Patients with Hodgkin Lymphoma

Abstract

Background: We investigated early outcomes for patients receiving chemotherapy followed by consolidative proton therapy (PT) for the treatment of Hodgkin lymphoma (HL).Patients and Methods: From June 2008 through August 2015, 138 patients with HL enrolled on either IRB-approved outcomes tracking protocols or registry studies received consolidative PT. Patients were excluded due to relapsed or refractory disease. Involved-site radiotherapy field designs were used for all patients. Pediatric patients received a median dose of 21 Gy(RBE) (range, 15-36 Gy[RBE]); adult patients received a median dose of 30.6 Gy(RBE) (range, 20-45 Gy[RBE]). Patients receiving PT were young (median age, 20 years; range 6 – 57). Overall, 42% were pediatric (≤18 years) and 93% were under the age of 40 years. Thirty-eight percent of patients were male and 62% female. Stage distribution included 73% with I/II and 27% with III/IV disease. Patients predominantly had mediastinal involvement (96%) and bulky disease (57%), while 37% had B symptoms. The median follow-up was 32 months (range, 5–92 months).Results: The 3-year relapse-free survival rate was 92% for all patients; it was 96% for adults and 87% for pediatric patients (p = 0.18). When evaluated by PET/CT scan response at the end of chemotherapy, patients with a partial response had worse 3-year progression-free survival compared with other patients (78% vs. 94%; p = 0.0034). No grade 3 radiation-related toxicities have occurred to date.Conclusion: Consolidative PT following standard chemotherapy in HL is primarily used in young patients with mediastinal and bulky disease. Early relapse-free survival rates are similar to those reported with photon radiation treatment, and no early grade 3 toxicities have been observed. Continued follow-up to assess late effects is critical.

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Issue Cover (August 2017)

Cover image by Dr. Natalie Doig (MRC Brain Network Dynamics Unit, Department of Pharmacology, Oxford). The cover image is of a frontal section of mouse brain showing many regions of the basal ganglia. The section was triple-immunostained to reveal tyrosine hydroxylase (TH; cyan), parvalbumin (PV; green) and choline acetyltransferase (magenta).

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Expert forum releases roadmap for drug reform [News]

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Human papillomavirus in oropharyngeal cancer in Canada: analysis of 5 comprehensive cancer centres using multiple imputation [Research]

BACKGROUND:

The incidence of oropharyngeal cancer has risen over the past 2 decades. This rise has been attributed to human papillomavirus (HPV), but information on temporal trends in incidence of HPV-associated cancers across Canada is limited.

METHODS:

We collected social, clinical and demographic characteristics and p16 protein status (p16-positive or p16-negative, using this immunohistochemistry variable as a surrogate marker of HPV status) for 3643 patients with oropharyngeal cancer diagnosed between 2000 and 2012 at comprehensive cancer centres in British Columbia (6 centres), Edmonton, Calgary, Toronto and Halifax. We used receiver operating characteristic curves and multiple imputation to estimate the p16 status for missing values. We chose a best-imputation probability cut point on the basis of accuracy in samples with known p16 status and through an independent relation between p16 status and overall survival. We used logistic and Cox proportional hazard regression.

RESULTS:

We found no temporal changes in p16-positive status initially, but there was significant selection bias, with p16 testing significantly more likely to be performed in males, lifetime never-smokers, patients with tonsillar or base-of-tongue tumours and those with nodal involvement (p < 0.05 for each variable). We used the following variables associated with p16-positive status for multiple imputation: male sex, tonsillar or base-of-tongue tumours, smaller tumours, nodal involvement, less smoking and lower alcohol consumption (p < 0.05 for each variable). Using sensitivity analyses, we showed that different imputation probability cut points for p16-positive status each identified a rise from 2000 to 2012, with the best-probability cut point identifying an increase from 47.3% in 2000 to 73.7% in 2012 (p < 0.001).

INTERPRETATION:

Across multiple centres in Canada, there was a steady rise in the proportion of oropharyngeal cancers attributable to HPV from 2000 to 2012.

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Anesthetic neurotoxicity and the developing brain [Commentary]

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Living kidney donation [Practice]

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Dramatic budget increase for hepatitis treatment in federal prisons [News]

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Thrombosed persistent sciatic artery presenting with pain in the buttock [Practice]

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The authors respond to "Adverse health outcomes in transgender people" [Letters]

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"Hunger was never absent": How residential school diets shaped current patterns of diabetes among Indigenous peoples in Canada [Humanities]

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July Effect? Maybe not [News]

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Adverse health outcomes in transgender people [Letters]

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"I didnt know I needed a poet" [Coda]

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Colonoscopic surveillance: quality, guidelines and effectiveness

Colonoscopic surveillance in patients with a personal or family history of colorectal carcinoma or colonic polyps represents a significant workload for endoscopy services. Effective colonoscopic surveillance relies on quality endoscopic examination and appropriate surveillance interval. This review will discuss quality in colonoscopy and review guidelines for surveillance.

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Laparoscopic hepatectomy combined with endoscopic papillary balloon dilation for complex bile duct stones

Background

We evaluated the feasibility and efficacy of laparoscopic hepatectomy (LH) combined with endoscopic papillary balloon dilation (EPBD) for removing intra- and extrahepatic bile duct stones.

Methods

A total of 26 patients with intra- and extrahepatic bile duct stones underwent LH and EPBD. Selective hemi-hepatic vascular occlusion was used to complete the LH. EPBD was performed under the guidance of a guidewire, and stones were removed with a stone basket or balloon.

Results

A one-stage LH with EPBD lithotomy was successfully performed in 26 cases. No residual bile duct stones, intestinal or bile duct perforations were found. In addition, no severe post-operative bleeding, severe pancreatitis or mortality occurred. Post-operative hyperamylasemia was observed in five cases and bile leakage in one case. Post-operative hospital stays lasted 7–11 days.

Conclusion

LH combined with EPBD applied to intra- and extrahepatic bile duct stones was feasible, effective and safe, resulting in rapid recovery and few post-operative complications.

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Prospective comparison between magnetic resonance imaging and computed tomography in colorectal cancer staging

Background

Diffusion-weighted (DW) imaging is a functional magnetic resonance imaging (MRI) technique that detects lesions with high cellularity, such as malignant tumours. This prospective study was performed to compare the accuracy of DW-MRI with multidetector computed tomography (MDCT) in staging of colorectal cancer.

Methods

Thirty patients with histologically proven colorectal cancer were prospectively recruited. Each patient underwent both MDCT and DW-MRI of the abdomen–pelvis for primary staging. Images were evaluated for nodal and distant metastases. The reference standard was histopathological findings for nodal involvement and surveillance imaging for suspected hepatic metastases.

Results

The primary cancers were located in the rectum (n = 16, 53.3%), sigmoid colon (n = 9, 30%) and right colon (n = 5, 16.6%). For nodal metastases, the sensitivity and specificity of DW-MRI were 84.6% (95% confidence interval (CI): 54.6–98.1%) and 20.0% (95% CI: 2.5–55.6%) compared with 84.6% (95% CI: 54.6–98.1%) and 40.0% (95% CI: 12.2–73.8%) for MDCT. For liver metastases, the sensitivity and specificity for DW-MRI were 100.0% (95% CI: 63.1–100.0%) and 100% (95% CI: 84.6–100%) compared with 87.5% (95% CI: 47.4–99.7%) and 95.5% (95% CI: 77.2–99.9%) for MDCT. DW imaging altered the clinical management in three (10.0%) patients by detecting missed hepatic metastases in two patients and accurately diagnosing another patient with a hepatic cyst, mistaken for metastasis on MDCT.

Conclusion

DW-MRI is more accurate for detecting hepatic metastases in colorectal cancer compared with MDCT.

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Development of a proficiency-based virtual reality simulation training curriculum for laparoscopic appendicectomy

Background

Proficiency-based virtual reality (VR) training curricula improve intraoperative performance, but have not been developed for laparoscopic appendicectomy (LA). This study aimed to develop an evidence-based training curriculum for LA.

Methods

A total of 10 experienced (>50 LAs), eight intermediate (10–30 LAs) and 20 inexperienced (<10 LAs) operators performed guided and unguided LA tasks on a high-fidelity VR simulator using internationally relevant techniques. The ability to differentiate levels of experience (construct validity) was measured using simulator-derived metrics. Learning curves were analysed. Proficiency benchmarks were defined by the performance of the experienced group. Intermediate and experienced participants completed a questionnaire to evaluate the realism (face validity) and relevance (content validity).

Results

Of 18 surgeons, 16 (89%) considered the VR model to be visually realistic and 17 (95%) believed that it was representative of actual practice. All 'guided' modules demonstrated construct validity (P < 0.05), with learning curves that plateaued between sessions 6 and 9 (P < 0.01). When comparing inexperienced to intermediates to experienced, the 'unguided' LA module demonstrated construct validity for economy of motion (5.00 versus 7.17 versus 7.84, respectively; P < 0.01) and task time (864.5 s versus 477.2 s versus 352.1 s, respectively, P < 0.01). Construct validity was also confirmed for number of movements, path length and idle time. Validated modules were used for curriculum construction, with proficiency benchmarks used as performance goals.

Conclusion

A VR LA model was realistic and representative of actual practice and was validated as a training and assessment tool. Consequently, the first evidence-based internationally applicable training curriculum for LA was constructed, which facilitates skill acquisition to proficiency.

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Serum carbohydrate antigen 19-9 in pancreatic adenocarcinoma: a mini review for surgeons

The optimal management of oncological conditions is reflected by the careful interpretation of investigations for screening, diagnosis, staging, prognostication and surveillance. Serum tumour markers are examples of commonly requested tests in conjunction with other imaging and endoscopic tests that are used to help clinicians to stratify therapeutic decisions. Serum carbohydrate antigen 19-9 (CA19-9) is a key biomarker for pancreatic cancers. Although this biomarker is considered clinically useful and informative, clinicians are often challenged by the accurate interpretation of elevated serum CA19-9 levels. Recognizing the pitfalls of normal and abnormal serum CA19-9 concentrations will facilitate its appropriate use. In this review, we appraised the biomarker, serum CA19-9, and highlighted the clinical utility and limitations of serum CA19-9 in the investigation and management of pancreatic cancers.

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FDA Warns of Potential Contamination in Multiple Brands of Drugs, Dietary Supplements

August 11, 2017 -- The U.S. Food and Drug Administration is advising consumers and health care professionals not to use any liquid drug or dietary supplement products manufactured by PharmaTech LLC of Davie, Florida, and labeled by Rugby...

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HEPACONTROL. A program that reduces early readmissions, mortality at 60 days, and healthcare costs in decompensated cirrhosis

Decompensated cirrhosis patients have an elevated incidence of early readmission, mortality and economic burden. The aims of HEPACONTROL were to reduce early readmission and to evaluate its impact on mortality and emergency department visits.

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Recombinant α- β- and γ-Synucleins Stimulate Protein Phosphatase 2A Catalytic Subunit Activity in Cell Free Assays

This publication presents a protocol showing how to measure the activity of recombinant protein phosphatase 2A catalytic subunit (PP2Ac) in response to recombinant α-synuclein, β-synuclein, or γ-synuclein proteins using a simple colorimetric assay. We show findings regarding α-synuclein specificity toward PP2Ac in mouse brain.

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Surgical Angiogenesis in Porcine Tibial Allotransplantation: A New Large Animal Bone Vascularized Composite Allotransplantation Model

Currently any kind of vascularized composite allotransplantation depends on long-term-immunosuppression, difficult to support for non-life-critical indications. We present a new porcine tibial VCA model that can be used to study bone VCA and demonstrate the use of surgical angiogenesis to maintain bone viability without the need of long-term immune-modulation.

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Effects of Combined Far-Infrared Radiation and Acupuncture at ST36 on Peripheral Blood Perfusion and Autonomic Activities

Using four-channel photoplethysmography (PPG) for acquiring peripheral arterial waveforms, this study investigated vascular and autonomic impacts of combined acupuncture-far infrared radiation (FIR) in improving peripheral circulation. Twenty healthy young adults aged were enrolled for 30-minute measurement. Each subject underwent four treatment strategies, including acupuncture at ST36 (Zusanli), pseudoacupuncture, FIR, and combined acupuncture-FIR at different time points. Response was assessed at 5-minute intervals. Area under arterial waveform at baseline was defined as AreaBaseline, whereas AreaStim referred to area at each 5-minute substage during and after treatment. AreaStim/AreaBaseline was compared at different stages and among different strategies. Autonomic activity at different stages was assessed using low-to-high frequency power ratio (LHR). The results demonstrated increased perfusion for each therapeutic strategy from stage 1 to stage 2 (all ). Elevated perfusion was noted for all treatment strategies at stage 3 compared to stage 1 except pseudoacupuncture. Increased LHR was noted only in subjects undergoing pseudoacupuncture at stage 3 compared to stage 1 (). Reduced LHR at stage 2 compared to stage 1 was found only in combined treatment group (). In conclusion, the results support clinical benefits of combined acupuncture-FIR treatment in enhancing peripheral perfusion and parasympathetic activity.

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Synergistic Antitumor Effects of Berbamine and Paclitaxel through ROS/Akt Pathway in Glioma Cells

In our preliminary study, Berbamine (BA), one of the most commonly used traditional Chinese medicines, was effective in inducing the intracellular ROS levels. Since the regulation of cellular antioxidant capacity is crucial to the sensitivity of Ptx, it is feasible to propose that sensitizing cells to Ptx can be achieved through increasing the antioxidant capacity by codelivering BA. Cytotoxicity test demonstrates that either single or combinational treatment of BA and Ptx dose-dependently inhibits the proliferation of U-87 cells. Median-effect analysis clearly proves the synergistic anticancer effect between BA and Ptx. Combinational treatment of both drugs induced more intracellular ROS generation than either of the drugs did. Cotreatment of NAC could partially reverse the ROS generation and ameliorate the cytotoxicity induced by BA plus Ptx. Moreover, sequential activation of ROS-dependent phosphor-Akt expression was dose-dependently inhibited by the combinational application of BA and Ptx, which was more significantly effective than the single treatment of either BA or Ptx. Additionally, the coadministration of BA and Ptx shows the strongest tumor delaying effect in a U87 xenograft model, demonstrating the synergism between two drugs. Therefore, BA is a promising adjuvant to traditional chemotherapy, especially in combination with Ptx, to treat malignant glioma.

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Ameloblastic Fibroodontoma: Uncommon Case Presentation in a 6-Year-Old Child with Review of the Literature

Ameloblastic fibroodontoma is a benign mixed odontogenic neoplasm considered in patients with asymptomatic swelling and unerupted teeth that exhibit histologic features between ameloblastic fibroma and complex odontoma. Radiographically, this lesion appears as radiolucency admixed with focal radio opaque masses of irregular shapes and sizes. This lesion is confirmed by the presence of proliferating odontogenic epithelium, ectomesenchyme, and dental hard tissue formation on pathological analysis supplementing clinical and radiographic findings. As this tumour is less commonly seen in routine clinical practice, ameloblastic fibroodontoma with detailed orofacial features and periodic approach to its diagnosis is discussed. This paper reports a case of ameloblastic fibroodontoma of the mandible in a 6-year-old male patient with an uncommon case presentation and review of the literature.

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Severe Hepatopulmonary Syndrome in a Child with Caroli Syndrome

Hepatopulmonary Syndrome (HPS) is a potential complication of chronic liver disease and is more commonly seen in the adult population. Caroli Syndrome is a rare inherited disorder characterized by intrahepatic ductal dilation and liver fibrosis that leads to portal hypertension. In children with liver disease, HPS should be considered in the differential diagnosis of prolonged, otherwise unexplained, hypoxemia. The presence of HPS can improve patient priority on the liver transplantation wait list, despite their Pediatric End-Stage Liver Disease (PELD) score. We present a 6-year-old girl with Caroli Syndrome and End-Stage Renal Disease who presented with persistent hypoxemia. The goal of this report is to increase awareness of HPS in children.

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Contrast Microsphere Destruction by a Continuous Flow Ventricular Assist Device: An In Vitro Evaluation Using a Mock Circulation Loop

Objectives. Transthoracic echocardiography (TTE) is fundamental in managing patients supported with ventricular assist devices (VAD). However imaging can be difficult in these patients. Contrast improves image quality but they are hydrodynamically fragile agents. The aim was to assess contrast concentration following passage through a VAD utilising a mock circulation loop (MCL). Methods. Heartware continuous flow (CF) VAD was incorporated into a MCL. Definity® contrast was infused into the MCL with imaging before and after CF-VAD. 5 mm2 regions of interest were used to obtain signal intensity (decibels), as a surrogate of contrast concentration. Results. Four pump speeds revealed significant reduction in contrast signal intensity after CF-VAD compared to before CF-VAD (all ). Combined pre- and postpump data at all speeds showed a 22.2% absolute reduction in contrast signal intensity across the CF-VAD (14.8 ± 0.8 dB prepump versus 11.6 ± 1.4 dB postpump; ). Mean signal intensity reduction at each speed showed an inverse relationship between speed and relative reduction in signal intensity. Conclusion. Contrast microsphere transit through a CF-VAD within a MCL resulted in significant reduction in signal intensity, consistent with destruction within the pump. This was evident at all CF-VAD pump speeds but relative signal drop was inversely proportional to pump speed.

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Deviation of the Fecal Stream in Colonic Bowel Segments Results in Increased Numbers of Isolated Lymphoid Follicles in the Submucosal Compartment in a Novel Murine Model of Diversion Colitis

Introduction. Diversion colitis is a significant health problem due to its high incidence in patients with diverting enterostomy. This mucosal inflammation presents characteristic histopathological features allowing for the differentiation of this entity from other inflammatory bowel diseases. The pathophysiology of this disease remains ill-defined, in part due to the lack of appropriate animal models. The present study was performed in order to develop and characterize a murine model of diversion colitis. Methods. A diverting loop colostomy was performed in C57BL/6 mice either in the ascending colon or in the transverse colon. Animals were assessed for clinical and histopathological parameters during short-term and long-term survival. Results. Animals with a colostomy in the transverse colon showed a good long-term survival and developed a mild colitis in the bypassed bowel closely resembling the human pathology on a histopathological level. Conclusion. This model is a promising tool to further elucidate the pathomechanism leading to impaired mucosal homeostasis in bypassed colonic segments. Moreover, the establishment of the model in the C57BL/6 background allows the combination of this colitis model with various transgenic mouse strains to investigate the effect of locally deregulated mucosal immunity on systemic immune homeostasis and to develop specific therapeutic strategies.

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Renal Function Improvement by Telbivudine in Liver Transplant Recipients with Chronic Kidney Disease

Chronic renal failure is a frequent complication in liver transplantation. Telbivudine, anti-hepatitis B virus (HBV) nucleoside, can improve renal function. It is interesting if using telbivudine for prophylaxis of HBV recurrence has additional value on renal function improvement. 120 liver transplant recipients with lamivudine prophylaxis for HBV recurrence were 1 : 1 randomized into lamivudine-continuous () and telbivudine-replacement () groups. Fifty-eight patients in lamivudine-continuous group and 54 in telbivudine-replacement group completed the study. In telbivudine-replacement group, the estimated glomerular filtration rate (eGRF) was improved from 63.0 ± 16.3 ml/min to 72.8 ± 21.1 ml/min at 12 months after telbivudine administration ( = 0.003). Stratifying the patients according to renal function staging, the eGRF was improved from 74.7 ± 6.9 ml/min to 84.2 ± 16.6 ml/min ( = 0.002) in 32 stage II patients and from 48.2 ± 7.3 ml/min to 59.7 ± 11.8 ml/min in 20 stage III patients after 12 months of telbivudine administration (). Eleven (18.3%) patients with telbivudine developed polyneuritis during the trial and post hoc following-up. In conclusion, renal function was improved by telbivudine in liver transplant recipients with long-term chronic kidney disease. However, the high incidence of polyneuritis induced by telbivudine has to be closely monitored. This trial is registered with ClinicalTrials NCT02447705.

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Solasodine inhibits human colorectal cancer cells via suppression of AKT/GSK-3β/β-catenin pathway

Summary

Solasodine is a main active component isolated from Solanum incanum L, who performs a wide range of functions containing anti-oxidant, anti-infection and neurogenesis promotion. In this study, we explored the influence of solasodine on three types of human colorectal cancer (CRC) cell lines. The consequences displayed that solasodine apparently prohibited CRC cell proliferation dose- and time-dependently and impeded CRC cell motility by downregulating Matrix metalloprotease (MMPs). Besides, solasodine was investigated to fuel caspase-cascade reaction and increase the ratio between Bax and Bcl-2 so as to induce CRC cell apoptosis. When cells got pretreated with AKT activator (IGF-1) followed by solasodine application, solasodine-induced apoptosis was partially confronted by IGF-1. Moreover, Solasodine hindered tumor development and stimulated similar mechanisms in vivo. In general, our study provides the first evidence that solasodine has a suppressive efficient on CRC cells and that this agent may have potency to be a novel therapeutic drug for CRC treatment.

This article is protected by copyright. All rights reserved.

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Atractylodin Induces Myosin Light Chain Phosphorylation and Promotes Gastric Emptying through Ghrelin Receptor

Atractylodin is one of the main constituents in the rhizomes of Atractylodes lancea Thunb., being capable of treating cancer cachexia-anorexia and age-related diseases as an agonist of growth hormone secretagogue receptor (GHSR). GHSR was herein expressed in human gastric smooth muscle cells (HGSMCs) and activated by ghrelin receptor agonist L-692,585. Like L-692,585, atractylodin also increased Ca2+ and enhanced the phosphorylation of myosin light chain (MLC) through GHSR in HGSMCs. In addition, atractylodin promoted gastric emptying and MLC phosphorylation in the gastric antrum of mice also through GHSR. Collectively, atractylodin can activate GHSR in gastric smooth muscle, as a potential target in clinical practice.

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Genetic Association Study of KCNQ5 Polymorphisms with High Myopia

Identification of genetic variations related to high myopia may advance our knowledge of the etiopathogenesis of refractive error. This study investigated the role of potassium channel gene (KCNQ5) polymorphisms in high myopia. We performed a case-control study of 1563 unrelated Han Chinese subjects (809 cases of high myopia and 754 emmetropic controls). Five tag single-nucleotide polymorphisms (SNPs) of KCNQ5 were genotyped, and association testing with high myopia was conducted using logistic regression analysis adjusted for sex and age to give values, and multiple comparisons were corrected by permutation test to give values. All five noncoding SNPs were associated with high myopia. The SNP rs7744813, previously shown to be associated with refractive error and myopia in two GWAS, showed an odds ratio of 0.75 (95% CI 0.63–0.90; = 0.0058) for the minor allele. The top SNP rs9342979 showed an odds ratio of 0.75 (95% CI 0.64–0.89; = 0.0045) for the minor allele. Both SNPs are located within enhancer histone marks and DNase-hypersensitive sites. Our data support the involvement of KCNQ5 gene polymorphisms in the genetic susceptibility to high myopia and further exploration of KCNQ5 as a risk factor for high myopia.

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Constructive Aspects of Biosemiotics

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Candidemia in the Neonatal Intensive Care Unit: A Retrospective, Observational Survey and Analysis of Literature Data

We evaluated the epidemiology of Candida bloodstream infections in the neonatal intensive care unit (NICU) of an Italian university hospital during a 9-year period as a means of quantifying the burden of infection and identifying emerging trends. Clinical data were searched for in the microbiological laboratory database. For comparative purposes, we performed a review of NICU candidemia. Forty-one candidemia cases were reviewed (overall incidence, 3.0 per 100 admissions). Candida parapsilosis sensu stricto (58.5%) and C. albicans (34.1%) were the most common species recovered. A variable drift through years was observed; in 2015, 75% of the cases were caused by non-albicans species. The duration of NICU hospitalization of patients with non-albicans was significantly longer than in those with C. albicans (median days, 10 versus 12). Patients with non-albicans species were more likely to have parenteral nutrition than those with C. albicans (96.3% versus 71.4%). Candida albicans was the dominant species in Europe and America (median, 55% and 60%; resp.); non-albicans species predominate in Asia (75%). Significant geographic variation is evident among cases of candidemia in different parts of the world, recognizing the importance of epidemiological data to facilitate the treatment.

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Erratum to “miR319, miR390, and miR393 Are Involved in Aluminum Response in Flax (Linum usitatissimum L.)”

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MiR-219-5p Inhibits the Growth and Metastasis of Malignant Melanoma by Targeting BCL-2

Malignant melanoma is a very dangerous tumor which is resistant to conventional therapy. MicroRNA exerts a vital function in promoting or inhibiting tumor development. The research has investigated the expression and function of miR-219-5p in melanoma. As a result, miR-219-5p expression was distinctly reduced in melanoma tissues and cell lines and was negatively correlated with Bcl-2 protein level in melanoma. Patients with low miR-219-5p level represented obviously a low overall survival in comparison with patients with high miR-219-5p level. The upregulation of miR-219-5p inhibited melanoma growth and metastasis and strengthened melanoma cells chemosensitivity by targeting Bcl-2. Therefore, the modulation of miR-219-5p expression may be a novel treatment strategy in melanoma.

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Age-Related Variations of Rabbit Corneal Geometrical and Clinical Biomechanical Parameters

Purpose. To study the variations in corneal clinical biomechanical parameters (CCBP) and corneal geometrical parameters of rabbit in relation to age. Methods. Rabbits aged 3, 7, 12, 18, and 24 months were enrolled. Each eye of the rabbits was tested with Ocular Response Analyzer (ORA), Optical Coherence Tomography (OCT), and Pachymeter to obtain the intraocular pressure (IOP): Goldmann-correlated IOP (IOPg) and Corneal Compensated Intraocular Pressure (IOPcc); CCBP: Corneal Hysteresis (CH) and Corneal Resistance Factor (CRF); corneal geometric parameters: corneal curvature radius (CCR) and central corneal thickness (CCT). Results. The IOP of the rabbits changes slightly from 3 to 7 months of age, while it significantly decreases from 7 to 18 months of age and increases from 18 to 24 months of age; CH and CRF decrease with the increase of age; CCT increases from 7 to 18 months and decreases from 3 to 7 months of age and from 18 to 24 months of age; CCR presents an upward trend from 3 to 18 months and a significant decrease between 18 and 24 months of age. Conclusion. CH and CRF are negatively correlated with age. CCT and CCR are positively correlated with age.

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Effective Heart Disease Detection Based on Quantitative Computerized Traditional Chinese Medicine Using Representation Based Classifiers

At present, heart disease is the number one cause of death worldwide. Traditionally, heart disease is commonly detected using blood tests, electrocardiogram, cardiac computerized tomography scan, cardiac magnetic resonance imaging, and so on. However, these traditional diagnostic methods are time consuming and/or invasive. In this paper, we propose an effective noninvasive computerized method based on facial images to quantitatively detect heart disease. Specifically, facial key block color features are extracted from facial images and analyzed using the Probabilistic Collaborative Representation Based Classifier. The idea of facial key block color analysis is founded in Traditional Chinese Medicine. A new dataset consisting of 581 heart disease and 581 healthy samples was experimented by the proposed method. In order to optimize the Probabilistic Collaborative Representation Based Classifier, an analysis of its parameters was performed. According to the experimental results, the proposed method obtains the highest accuracy compared with other classifiers and is proven to be effective at heart disease detection.

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Rewriting the tip apex distance for the proximal femoral nail anti-rotation

Publication date: August 2017
Source:Injury, Volume 48, Issue 8
Author(s): Michael Yam, Anuj Chawla, Ernest Kwek
IntroductionThe proximal femur nail anti-rotation (PFNA-II) (Synthes GmbH, Oberdorf, Switzerland) is the most commonly used implant for intramedullary nailing of unstable intertrochanteric fractures in our centre. However, mechanical failure of the bone with respect to the implant is a cause of concern due to its significant morbidity especially in the elderly. To date, factors for fixation failures are not well defined in the literature. This study aims to evaluate the factors that predispose to cut out of the PFNA implant and to provide a guide for surgical fixation.Patients and methodsThis study was a retrospective analysis of 340 patients who underwent PFNA-II insertion from 2011 to 2013 in our centre.Intraoperative image intensifier images were used for calculation of tip apex distance, neck shaft angles, determination of Cleveland zones. Demographic data was collected on patients age and gender. The fractures were classified based on AO-OTA classification (Marsh et al., 2007) [1]. Patients were followed up for a minimum of 4 months and union of the fracture or until a complication occurred. Risk ratio for cut out was also compared with each statistically significant variable to determine the cut-off point.ResultsThe incidence of cut out was 6.7% Tip apex distance, neck shaft angles and female gender were statistically significant for cut out. The study found that tip apex distance beyond 27mm increased the risk of cut out. Neck shaft angles less than 128° also increased the risk of cut out. Posterior and superior blade position in the femoral head and AO 31A3 fractures trended towards significance for cut out but were not statistically significant.ConclusionTo avoid cut out, one should aim for a tip apex distance of not more than 27mm and preserve a neck shaft angle of more than 128°. Risk stratification of the patient allows the surgeon to take greater caution in the post-operative period to detect early cut out.



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Mediastinal injury is the strongest predictor of mortality in mounted blast amongst UK deployed forces: Methodological issues

Publication date: Available online 12 August 2017
Source:Injury
Author(s): Erfan Ayubi, Saeid Safiri




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Fixation of quadrilateral plate fractures of the acetabulum using the buttress screw: A novel technique

Publication date: August 2017
Source:Injury, Volume 48, Issue 8
Author(s): Mahmoud Abdel Karim, Ahmed Hazem Abdelazeem, Mohamed Youness, Walid A. El Nahal
IntroductionQuadrilateral plate fractures constitute one of the most challenging components of acetabular fractures. The objective of this study is to describe and evaluate the novel technique of buttress screw fixation of the quadrilateral plate component of the acetabular fractures.Patients & methodsForty cases of acetabular fracture with associated quadrilateral plate component were included in the study. Mean age was 35 years (range, 16−68years), with a mean follow-up 16.4 months (range, 9−36months). Fixation of the quadrilateral plate was achieved by one or more buttress screws. The screws were inserted through the reconstruction plate, and placed close to the edge of the pelvic brim. To effectively achieve the 3-point fixation principle, the screw was inserted through the plate hole then outside the bone rubbing on the pelvic surface of the quadrilateral plate.ResultsAnatomical reduction of the quadrilateral plate component of the fractures was achieved in all but one patient. The modified Merle D'Aubigné and Postel score was excellent in 13 cases, good in 23 cases, fair in three cases, and poor in one case. No screw displacement or failures were observed during follow-up evaluation. No major complications related to this technique were observed in this series.ConclusionButtress screw fixation of the quadrilateral plate fracture component in associated acetabular fractures is a safe and effective technique for reduction and fixation of these challenging fractures with no major complications related to this novel technique.



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Editorial Board/Publication Information

Publication date: August 2017
Source:Injury, Volume 48, Issue 8





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Recruitment rates in orthopaedic trauma trials: Zen or the art of riding dead horses

Publication date: August 2017
Source:Injury, Volume 48, Issue 8
Author(s): Dirk Stengel, Cyril Mauffrey, Ian Civil, A.C. Gray, C. Roberts, Hans-Christoph Pape, C. Evans, Bridget Kool, O.J. Mauffrey, Peter Giannoudis




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Investigation of perioperative hidden blood loss of unstable intertrochanteric fracture in the elderly treated with different intramedullary fixations

Publication date: August 2017
Source:Injury, Volume 48, Issue 8
Author(s): Xu Yang, Qiang Wu, Xin Wang
ObjectiveOur aim was to investigate perioperative hidden blood loss (PHBL) of unstable intertrochanteric fracture (UIF) in the elderly treated with different intramedullary fixations.Patients and methods120 consecutive elderly patients with UIF treated by intramedullary nails between January 2013 and September 2016 were enrolled in the retrospective study, including 52 patients (mean age 79.6±6.3) for the Third generation Gamma Nail (TGN), 51 patients (mean age 79.3±7.4) for the Proximal Femoral Nail Anti-rotation (PFNA), 17 patients (mean age 76.2±5.8) for the Intertrochanteric Antegrade Nail (InterTan). The PHBL and total blood loss (TBL) were calculated based on the haematocrit change from admission to 72h after the operation. The differences of perioperative visible blood loss (PVBL), PHBL, and TBL among TGN, PFNA, and InterTan were compared. The statistical analysis was made using One-way ANOVA for comparison among groups, and Mann-Whitney U test was conducted to a direct comparison between two procedures.ResultsThe mean TBL of all patients was 911.3mL (range, 446.8-1697.3mL), whereas the mean PHBL was 771.8mL (range, 331.5–1756.5mL), being about 84.5% of TBL. The PVBL in the TGN group was 201.4±101mL, the TBL was 871.3±196.1mL, the PHBL was 709.4±181mL. In the PFNA group, the PVBL was 147.3±81.6mL, the TBL was 892.6±234.8mL, and the PHBL was 787.7±250.9mL. The InterTan group had a PVBL of 246.5±89.7mL, the TBL was 1086.1±198.1mL where the PHBL was 910±167.9mL. The patients in the InterTan group had the largest amount of PHBL and TBL among three groups (P<0.01), there was no difference between TGN and PFNA group (P=0.2141).ConclusionsElderly patients with UIF treated by intramedullary fixations always have a significant amount of PHBL, which is much greater than that observed intra-operatively. Regular perioperative measurements of full blood count are necessary to avoid anaemia. InterTan nail is associated with a significantly higher PHBL than that of TGN and PFNA, which needs to be monitored carefully in usual clinical practice.



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Biomechanical evaluation of the tension band wiring principle. A comparison between two different techniques for transverse patella fracture fixation

Publication date: August 2017
Source:Injury, Volume 48, Issue 8
Author(s): Ivan Zderic, Karl Stoffel, Christoph Sommer, Dankward Höntzsch, Boyko Gueorguiev
PurposeThe aim of this study was to investigate the validity of the dynamic compression principle of tension band wiring in two techniques for patella fracture treatment.MethodsTwelve human cadaveric knees with simulated transverse patella fractures were assigned to two groups for treatment with tension band wiring using either Kirschner (K-) wires or cannulated screws. Biomechanical testing was performed over three knee movement cycles between 90° flexion and 0° full extension. Pressure distribution in the fracture gap and fracture site displacement were evaluated at the 3^rd cycle in 15° steps, namely 90°–75°–60°–45°–30°–15°–0° extension phase and 0°–15°–30°–45°–60°–75°–90° flexion phase.ResultsMean anterior / posterior interfragmentary pressure in the groups with K-wires and cannulated screws ranged within 0.16–0.40MPa / 0.12–0.35MPa and 0.37–0.59MPa / 0.10–0.30MPa, respectively. These changes remained non-significant for both groups and loading phases (P≥0.171). Mean anterior / posterior fracture site displacement for K-wires and cannulated screws ranged within −0.01–0.53mm / 0.11–0.74mm and 0.11–0.55mm / –0.10–0.50mm, respectively. Anterior displacement remained without significant changes for both groups and loading phases (P≥0.112). However, posterior displacement underwent a significant increase in the course of knee extension for K-wires (P≤0.047), but not for cannulated screws (P≥0.202). Significantly smaller displacement at the posterior fracture site was detected in the group with cannulated screws compared to K-wires at 60° and 75° extension phase (P≤0.017), as well as at 45°, 60° and 75° flexion phase (P≤0.018). The critical value of 2mm displacement at the posterior fracture site was not reached for any specimen and fixation technique. Knee extension was accompanied by synchronous increase in quadriceps pulling force.ConclusionsTension band wiring fulfills from a biomechanical perspective the requirements for sufficient stability of transverse patella fracture fixation. It should, however, rather be considered as a static fixation principle than a dynamic one. Tension band wiring with cannulated screws was found advantageous over Kirschner wires in terms of interfragmentary movements at the posterior fracture site.



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Prediction of esophageal stricture in patients administered locoregional triamcinolone injections immediately after endoscopic submucosal dissection

Abstract

Background and Aim

Esophageal endoscopic submucosal dissection (ESD) to resect widespread lesions has increased the incidence of strictures, and some patients develop strictures despite receiving prophylactic locoregional triamcinolone injections. This study evaluated the predictive factors for esophageal stricture formation in patients administered prophylactic triamcinolone injections after ESD.

Methods

This was a retrospective observational study. Of 552 consecutive patients who underwent ESD, those who received prophylactic triamcinolone injections immediately after ESD were enrolled. The primary outcome was the predictive factors for esophageal stricture formation in patients administered prophylactic triamcinolone injections.

Results

We evaluated 101 en bloc resections involving 144 lesions in 96 patients. Strictures occurred following 17 (16.8%) resections. Wider circumferential mucosal defect (odds ratio [OR] 2.42, 95% confidence interval [CI]: 1.01–5.80; p = 0.048) was an independent predictive factor for stricture development. The cut-off value associated with stricture formation was five-sixths of the circumferential mucosal defect. Propensity analysis determined that the frequency of esophageal strictures increased in patients with circumferential mucosal defects of more than five-sixths compared with those less than five-sixths (OR 5.70, 95% CI: 1.61–20.18; p = 0.007).

Conclusions

Resections involving circumferential mucosal defects of more than five-sixths increased the likelihood of stricture formation in patients administered prophylactic locoregional triamcinolone injections after esophageal ESD.

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Corrigendum to “Ciprofloxacin Controlled-Solid Lipid Nanoparticles: Characterization, In Vitro Release, and Antibacterial Activity Assessment”

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