Well-being among survivors of out-of-hospital cardiac arrest: a cross-sectional retrospective study in Sweden

Objectives

The psychological outcome of out-of-hospital cardiac arrest (OHCA) has been studied more extensively in recent years. Still, not much is known about the well-being among OHCA survivors. In this retrospective cross-sectional study, we aim to investigate post-OHCA well-being among patients with a good neurological outcome, 3 months after the cardiac event. To assess well-being, we analyse the frequency of anxiety, depression, post-traumatic stress disorder (PTSD) and health within this group. Further, we aim to evaluate the importance of five prognostic factors for post-OHCA well-being.

Methods

Data collection took place between 2008 and 2012, and every OHCA survivor within one region of Sweden, with a cerebral performance category (CPC) score of ≤2 at discharge, was asked to participate. Survivors were identified through the Swedish Cardiopulmonary Resuscitation Registry, and postal questionnaires were sent out 3 months after the OHCA. The survey included Hospital Anxiety and Depression scale (HADS), PTSD Checklist Civilian version (PCL-C) and European Quality of Life 5 Dimensions 3 level (EQ-5D-3L).

Results

Of 298 survivors, 150 were eligible for this study and 94 responded. The mean time from OHCA to follow-up was 88 days. There was no significant difference between respondents and non-respondents in terms of sex, age, cardiac arrest circumstances or in-hospital interventions. 48 participants reported reduced well-being, and young age was the only factor significantly correlated to this outcome (p=0.02). Women reported significantly higher scores in HADS (p=0.001) and PCL-C (p<0.001). Women also reported significantly lower EQ-5D index values (p=0.002) and EQ-visual analogue scale scores (p=0.002) compared with men.

Conclusion

Reduced well-being is experienced by half of OHCA survivors with a CPC score ≤2, and young age is negatively correlated to this outcome. The frequency of anxiety and PTSD is higher among women, who also report worse health.

https://ift.tt/2JfuGgd

Feasibility study to assess the delivery of a lifestyle intervention (TreatWELL) for patients with colorectal cancer undergoing potentially curative treatment

Objectives

To assess the feasibility of delivering and evaluating a lifestyle programme for patients with colorectal cancer undergoing potentially curative treatments.

Study design

Non-randomised feasibility trial.

Setting

National Health Service (NHS) Tayside.

Participants

Adults with stage I–III colorectal cancer.

Intervention

The programme targeted smoking, alcohol, physical activity, diet and weight management. It was delivered in three face-to-face counselling sessions (plus nine phone calls) by lifestyle coaches over three phases (1: presurgery, 2: surgical recovery and 3: post-treatment recovery).

Primary outcome

Feasibility measures (recruitment, retention, programme implementation, achieved measures, fidelity, factors affecting protocol adherence and acceptability).

Secondary outcomes

Measured changes in body weight, waist circumference, walking and self-reported physical activity, diet, smoking, alcohol intake, fatigue, bowel function and quality of life.

Results

Of 84 patients diagnosed, 22 (26%) were recruited and 15 (18%) completed the study. Median time for intervention delivery was 5.5 hours. Coaches reported covering most (>70%) of the intervention components but had difficulties during phase 2. Evaluation measures (except walk test) were achieved by all participants at baseline, and most (<90%) at end of phase 2 and phase 3, but <20% at end of phase 1. Protocol challenges included limited time between diagnosis and surgery and the presence of comorbidities. The intervention was rated highly by participants but limited support from NHS staff was noted. The majority of participants (77%) had a body mass index>25 kg/m² and none was underweight. Physical activity data showed a positive trend towards increased activity overall, but no other changes in secondary outcomes were detected.

Conclusions

To make this intervention feasible for testing as a full trial, further research is required on (a) recruitment optimisation, (b) appropriate assessment tools, (c) protocols for phase 2 and 3, which can build in flexibility and (d) ways for NHS staff to facilitate the programme.

Trial registration number

ISRCTN52345929; Post-results.

https://ift.tt/2xRGmAo

Opioid prescribing for chronic musculoskeletal pain in UK primary care: results from a cohort analysis of the COPERS trial

Objective

To establish the level of opioid prescribing for patients with chronic musculoskeletal pain in a sample of patients from primary care and to estimate prescription costs.

Design

Secondary data analyses from a two-arm pragmatic randomised controlled trial (COPERS) testing the effectiveness of group self-management course and usual care against relaxation and usual care for patients with chronic musculoskeletal pain (ISRCTN 24426731).

Setting

25 general practices and two community musculoskeletal services in the UK (London and Midlands).

Participants

703 chronic pain participants; 81% white, 67% female, enrolled in the COPERS trial.

Main outcome measures

Anonymised prescribing data over 12 months extracted from GP electronic records.

Results

Of the 703 trial participants with chronic musculoskeletal pain, 413 (59%) patients were prescribed opioids. Among those prescribed an opioid, the number of opioid prescriptions varied from 1 to 52 per year. A total of 3319 opioid prescriptions were issued over the study period, of which 53% (1768/3319) were for strong opioids (tramadol, buprenorphine, morphine, oxycodone, fentanyl and tapentadol). The mean number of opioid prescriptions per patient prescribed any opioid was 8.0 (SD=7.9). A third of patients on opioids were prescribed more than one type of opioid; the most frequent combinations were: codeine plus tramadol and codeine plus morphine. The cost of opioid prescriptions per patient per year varied from £3 to £4844. The average annual prescription cost was £24 (SD=29) for patients prescribed weak opioids and £174 (SD=421) for patients prescribed strong opioids. Approximately 40% of patients received >3 prescriptions of strong opioids per year, with an annual cost of £236 per person.

Conclusions

Long-term prescribing of opioids for chronic musculoskeletal pain is common in primary care. For over a quarter of patients receiving strong opioids, these drugs may have been overprescribed according to national guidelines.

Trial registration number

ISRCTN24426731; Post-results.

https://ift.tt/2JhQGXN

Tackling the workforce crisis in district nursing: can the Dutch Buurtzorg model offer a solution and a better patient experience? A mixed methods case study

Despite policy intentions for more healthcare out of hospital, district nursing services face multiple funding and staffing challenges, which compromise the care delivered and policy objectives.

Objectives

What is the impact of the adapted Buurtzorg model on feasibility, acceptability and effective outcomes in an English district nursing service?

Design

Mixed methods case study.

Setting

Primary care.

Participants

Neighbourhood nursing team (Buurtzorg model), patients and carers, general practitioners (GPs), other health professionals, managers and conventional district nurses.

Results

The adapted Buurtzorg model of community nursing demonstrated feasibility and acceptability to patients, carers, GPs and other health professionals. For many patients, it was preferable to previous experiences of district nursing in terms of continuity in care, improved support of multiple long-term conditions (encompassing physical, mental and social factors) and proactive care. For the neighbourhood nurses, the ability to make operational and clinical decisions at team level meant adopting practices that made the service more responsive, accessible and efficient and offered a more attractive working environment. Challenges were reported by nurses and managers in relation to the recognition and support of the concept of self-managing teams within a large bureaucratic healthcare organisation. While there were some reports of clinical effectiveness and efficiency, this was not possible to quantify, cost or compare with the standard district nursing service.

Conclusions

The adapted Buurtzorg model of neighbourhood nursing holds potential for addressing issues of concern to patients, carers and staff in the community. The two interacting innovations, that is, a renewed focus on patient and carer-centred care and the self-managing team, were implemented in ways that patients, carers, other health professionals and nurses could identify difference for both the nursing care and also the nurses' working lives. It now requires longer term investigation to understand both the mechanism for change and also the sustainability.

https://ift.tt/2LrmXs6

Obesity and sickness absence: results from a longitudinal nationally representative sample from Germany

Objectives

The current study aimed at investigating the longitudinal association between obesity and sickness absence in women and men in Germany.

Methods

Data were derived from the German Socio-Economic Panel (GSOEP) which is a nationally representative, longitudinal study of private households in Germany. We draw on data from 2002 to 2012. Information on self-rated body mass index has been collected every second wave since 2002. Sick leave days (total number of working days missed due to illness in the past calendar year) and sick from work for more than 6 weeks in the preceding 12 months (yes/no) were used as outcome measures. Fixed-effects (FE) regression models were used for the total sample and stratified by sex. Gender differences were examined using interaction terms (sex x weight category).

Results

Controlling for several potential confounders, Poisson FE regression analysis showed that transitions from normal weight to obesity were associated with an increase in sick leave days in women (incidence rate ratio (IRR) 1.27, 95% CI 1.02 to 1.57) but not in men (IRR 0.85, 95 % CI 0.68 to 1.06)—with significant gender differences (sex x obesity, p<0.01). Moreover, conditional FE logistic regressions showed that transitions from normal weight to overweight were associated with an increase in the probability of long-term absenteeism in women (overweight, OR 1.41, 95% CI 1.08 to 1.85) but not in men (overweight, OR 0.84, 95% CI 0.65 to 1.09). Gender differences were significant (sex x overweight, p<0.01).

Conclusions

Our findings stress the longitudinal association between excess weight and increased likelihood of sick leave days as well as long-term absenteeism in women.

https://ift.tt/2Jl956g

Stressful life events and resilience among carers of Aboriginal children in urban New South Wales: cross-sectional findings from the Study of Environment on Aboriginal Resilience and Child Health (SEARCH)

Objective

In caregivers of urban Aboriginal children, to determine the frequency of major stressful life events, the proportion who meet criteria for resilience, and factors that are associated with resilience.

Design

Cross-sectional survey.

Setting

Four Aboriginal Community Controlled Health Services located in urban or regional areas in New South Wales, Australia.

Participants

574 caregivers of Aboriginal children participating in the Study of Environment on Aboriginal Resilience and Child Health.

Primary outcome measure

Resilience, defined as having experienced three or more stressful life events in the last 12 months, and having scores of ≤21 on the Kessler 10 Psychological Distress scale.

Results

Over half (315, 55%) of the caregivers reported three or more stressful life events—the most common being a close family member who was hospitalised with a serious medical problem (259, 45%). Of the participants who experienced three or more stressful life events, almost three-quarters (227, 72%) met the criteria for resilience. Using multivariable analysis, two factors were independently associated with resilience: not having a physical health problem that limited normal activities (adjusted OR (aOR) 4.3; 95% CI 2.0 to 9.0), and not having problems caused by alcohol within the home (aOR 5.3; 95% CI 2.2 to 12.8). Having a child whose behaviour placed a great deal of burden on the family was associated with less resilience (aOR 0.25; 95% CI 0.09 to 0.68).

Conclusions

Caregivers of urban Aboriginal children experienced a large number of stressful events, the most common being the poor health of close family members, but most exhibited resilience. Resilience was associated with stable family environments and good physical health. The high number of stressful life events that caregivers experience is reflective of broader inequalities that Aboriginal communities face. The availability of easily accessible and long-term health and support services may go some way to reducing this inequality and improving social and emotional well-being for Aboriginal families.

https://ift.tt/2LrmPsC

Cross-sectional survey on adult acute kidney injury in Chinese ICU: the study protocol (CARE-AKI)

Introduction

Acute kidney injury (AKI) is one of the most serious syndromes in intensive care unit (ICU) patients, and is a mysterious problem in clinical practice worldwide. Due to unknown aetiology and mechanism, awareness of AKI diagnosis and treatment in China varies, resulting in underestimated incidence and poor prognosis. To solve this problem, we design this national survey of AKI in adult ICUs. Various indexes are included and analysed to classify the epidemiology of adult AKI in Chinese ICUs, including AKI aetiology, risk factors, mortality, prognosis, therapeutic strategies and cognition of ICU medical staff.

Methods

A multicentre, cross-sectional survey, which will involve about 35 hospitals and 6147 patients from 23 provinces, 4 municipalities and 5 autonomous regions, is planned. All patients who meet the inclusion criteria are eligible to apply for enrolment in the study, which cover baseline demographics, clinical performance, and follow-up related to diagnosis and treatment.

Conclusion

The study is expected to fill the gap between China and developed countries, and to provide a theoretical foundation for developing more scientific and standardised approaches to AKI diagnosis and treatment.

Ethics and dissemination

Ethical approval was obtained from the ethics committee of Harbin Medical University Cancer Hospital (registration number KY2017-21). The findings of this review will be communicated through peer-reviewed publications and scientific presentations.

Trial registration number

ChiCTR-EOC-17013133; Pre-results.

https://ift.tt/2Jl8XDO

Cohort profile: the Coronary Artery disease Risk Determination In Innsbruck by diaGnostic ANgiography (CARDIIGAN) cohort

Purpose

The Coronary Artery disease Risk Determination In Innsbruck by diaGnostic ANgiography (CARDIIGAN) cohort is aimed to gain a better understanding of cardiovascular risk factors and their relation to the diagnosis and severity of coronary artery disease, as well as to the long-term prognosis in consecutive (including revascularised) patients referred for elective coronary angiography.

Participants

The included patients visited the University Clinic of Cardiology at Innsbruck (Austria), which fulfils a secondary and tertiary hospital function. Inclusion took place in the period between February 2004 and April 2008 and resulted in a total of 8296 patients aged 18–91 years; 65% of them were men.

Findings to date

There was one follow-up round on vital status through record linkage for 84% of the cohort (those with residence in Tyrol), resulting in a follow-up duration of over 5.5 to nearly 10.0 years among survivors. The data contain basic patient characteristics, cardiovascular risk factors, laboratory measurements, medications, detailed information on the extent and severity of coronary artery disease, revascularisation history, treatment strategy and mortality specifics. A few studies have already been published.

Future plans

Various diagnostic and prognostic studies are planned, also concerning complications, competing risks and cost-effectiveness. Collaboration with other research groups is welcomed.

https://ift.tt/2xQ8XWZ

Dissemination of evidence in paediatric emergency medicine: a quantitative descriptive evaluation of a 16-week social media promotion

Objectives

TRanslating Emergency Knowledge for Kids (TREKK) and Cochrane Child Health collaborate to develop knowledge products on paediatric emergency medicine topics. Via a targeted social media promotion, we aimed to increase user interaction with the TREKK and Cochrane Child Health Twitter accounts and the uptake of TREKK Bottom Line Recommendations (BLRs) and Cochrane systematic reviews (SRs).

Design

Quantitative descriptive evaluation.

Setting

We undertook this study and collected data via the internet.

Participants

Our target users included online healthcare providers and health consumers.

Intervention

For 16 weeks, we used Twitter accounts (@TREKKca and @Cochrane_Child) and the Cochrane Child Health blog to promote 6 TREKK BLRs and 16 related Cochrane SRs. We published 1 blog post and 98 image-based tweets per week.

Primary and secondary outcome measures

The primary outcome was user interaction with @TREKKca and @Cochrane_Child. Secondary outcomes were visits to TREKK's website and the Cochrane Child Health blog, clicks to and views of the TREKK BLRs, and Altmetric scores and downloads of Cochrane SRs.

Results

Followers to @TREKKca and @Cochrane_Child increased by 24% and 15%, respectively. Monthly users of TREKK's website increased by 29%. Clicks to the TREKK BLRs increased by 22%. The BLRs accrued 59% more views compared with the baseline period. The 16 blog posts accrued 28% more views compared with the 8 previous months when no new posts were published. The Altmetric scores for the Cochrane SRs increased by ≥10 points each. The mean number of full text downloads for the promotion period was higher for nine and lower for seven SRs compared with the 16-week average for the previous year (mean difference (SD), +4.0 (22.0%)).

Conclusions

There was increased traffic to TREKK knowledge products and Cochrane SRs during the social media promotion. Quantitative evidence supports blogging and tweeting as dissemination strategies for evidence-based knowledge products.

https://ift.tt/2Jjndg4

Identifying socioeconomic, epidemiological and operational scenarios for tuberculosis control in Brazil: an ecological study

Objectives

To identify scenarios based on socioeconomic, epidemiological and operational healthcare factors associated with tuberculosis incidence in Brazil.

Design

Ecological study.

Settings

The study was based on new patients with tuberculosis and epidemiological/operational variables of the disease from the Brazilian National Information System for Notifiable Diseases and the Mortality Information System. We also analysed socioeconomic and demographic variables.

Participants

The units of analysis were the Brazilian municipalities, which in 2015 numbered 5570 but 5 were excluded due to the absence of socioeconomic information.

Primary outcome

Tuberculosis incidence rate in 2015.

Data analysis

We evaluated as independent variables the socioeconomic (2010), epidemiological and operational healthcare indicators of tuberculosis (2014 or 2015) using negative binomial regression. Municipalities were clustered by the k-means method considering the variables identified in multiple regression models.

Results

We identified two clusters according to socioeconomic variables associated with the tuberculosis incidence rate (unemployment rate and household crowding): a higher socioeconomic scenario (n=3482 municipalities) with a mean tuberculosis incidence rate of 16.3/100 000 population and a lower socioeconomic scenario (2083 municipalities) with a mean tuberculosis incidence rate of 22.1/100 000 population. In a second stage of clusterisation, we defined four subgroups in each of the socioeconomic scenarios using epidemiological and operational variables such as tuberculosis mortality rate, AIDS case detection rate and proportion of vulnerable population among patients with tuberculosis. Some of the subscenarios identified were characterised by fragility in their information systems, while others were characterised by the concentration of tuberculosis cases in key populations.

Conclusion

Clustering municipalities in scenarios allowed us to classify them according to the socioeconomic, epidemiological and operational variables associated with tuberculosis risk. This classification can support targeted evidence-based decisions such as monitoring data quality for improving the information system or establishing integrative social protective policies for key populations.

https://ift.tt/2Lux0N6

Cancers, Vol. 10, Pages 188: Gain-of-Function (GOF) Mutant p53 as Actionable Therapeutic Target

Cancers, Vol. 10, Pages 188: Gain-of-Function (GOF) Mutant p53 as Actionable Therapeutic Target

Cancers doi: 10.3390/cancers10060188

Authors: Ramona Schulz-Heddergott Ute M. Moll

p53 missense mutant alleles are present in nearly 40% of all human tumors. Such mutated alleles generate aberrant proteins that not only lose their tumor-suppressive functions but also frequently act as driver oncogenes, which promote malignant progression, invasion, metastasis, and chemoresistance, leading to reduced survival in patients and mice. Notably, these oncogenic gain-of-function (GOF) missense mutant p53 proteins (mutp53) are constitutively and tumor-specific stabilised. This stabilisation is one key pre-requisite for their GOF and is largely due to mutp53 protection from the E3 ubiquitin ligases Mdm2 and CHIP by the HSP90/HDAC6 chaperone machinery. Recent mouse models provide convincing evidence that tumors with highly stabilized GOF mutp53 proteins depend on them for growth, maintenance, and metastasis, thus creating exploitable tumor-specific vulnerabilities that markedly increase lifespan if intercepted. This identifies mutp53 as a promising cancer-specific drug target. This review discusses direct mutp53 protein-targeting drug strategies that are currently being developed at various preclinical levels.

https://ift.tt/2JEU3Hw

Campylobacter jejuni and Pseudomonas coinfection in the setting of ulcerative colitis

A 66-year-old woman presented with 2 days of fever and severe diarrhoea. She has a history of ulcerative colitis (UC), well controlled with medication. She also has a history of Ehlers-Danlos syndrome, infective endocarditis following aortic valve replacement and pulmonary embolism. She had complained of passing stool with traces of blood about 30 times per day. Stool testing for Clostridium difficile, routine culture and microscopy was done. She was started on ceftriaxone. CT scan revealed thick-walled colon consistent with UC flare. Flexible sigmoidoscopy showed active continuous colitis extending from the rectum to the proximal descending colon. Campylobacter jejuni was isolated from the stool and blood cultures yielded Pseudomonas aeruginosa. The antibiotic was transitioned to intravenous piperacillin/tazobactam and azithromycin followed by 2 weeks of intravenous cefepime. Her diarrhoea was controlled, and she was discharged for follow-up in 2 months.

https://ift.tt/2JnYQdc

Cerebellar degeneration in primary Sjögren syndrome

Neurological manifestations are reported as a consequence of primary Sjögren syndrome (PSS). Any part of the brain and peripheral nervous system can be involved in PSS. However, cerebellar degeneration and atrophy associated with PSS have been rarely reported. Our report describes a 22-year-old woman who presented with cerebellar ataxia, arthritis and arthralgia. Evaluation of her symptoms, autoantibodies and salivary gland pathology was in favour of the diagnosis of Sjögren syndrome. Also, her brain MRI revealed cerebellar degeneration. There are only four patients reported to be affected by cerebellar atrophy associated with PSS. Administration of high doses of methylprednisolone and cyclophosphamide leads to substantial improvement in the cerebellar symptoms of this case. In addition, after 2 months of follow-up, the patient's ataxia recovered significantly. It could be concluded that in addition to neurological degenerative disorders, in some cases cerebellar atrophy could also be associated with autoimmune conditions such as PSS.

https://ift.tt/2sCs6qp

Lupus of the larynx: when bamboo nodes lead to diagnosis...

Description 

An 18-year-old patient consulted complaining of dysphonia for 3 months associated with severe weakness, headache and diffuse articular pain, with haematoma at the slightest trauma.

Laryngoscopy showed a submucosal oval lesion in the middle third of the two vocal folds resembling bamboo joint nodes (figure 1). Laboratory analysis showed the presence of antinuclear antibodies, antidouble-stranded DNA, antinucleosome, anti-SSA (117), anti-SSB (115) and anti-Sm (25) antibodies associated with thrombocytopaenia, haemolytic anaemia and severe ADAMTS-13 deficiency (under 5%). The patient was admitted to the hospital for monitoring, plasma exchange and glucocorticoid therapy. The diagnosis of systemic lupus erythematosus was made. The laryngeal lesions were bamboo nodes. The patient received Solu-Medrol 500 mg/day and prednisone 60 mg/day combined with speech therapy. The bamboo nodes partially regressed under treatment with a marked improvement of the voice. A few months later, laryngeal injection of triamcinolone 40 mg under local anaesthesia was performed with a favourable...

https://ift.tt/2LZqXBf

Small bowel obstruction caused by vas deferens: a first documented report

Small bowel obstruction (SBO) is one of the most common causes for an acute surgical admission. Most of the time SBO is a result of common causes such as postoperative adhesions. However, rare and unusual causes of SBO do exist which can be challenging for surgeons. We report a first documented case of SBO caused by a remnant of the vas deferens in a 24-year-old patient with a history of gastroschisis and left orchidectomy. Clinical presentation, investigations, imaging and management of this case are described. To summarise, clinicians should keep an open mind in dealing with patients with intestinal obstruction due to the rare and atypical causes.

https://ift.tt/2JoDD2E

Radiological appearance of primary extracranial meningioma of the pelvis in a middle-aged woman

Description 

A 47-year-old woman came with the complaints of on-and-off constipation for 6 months with the inability to pass stool for 2 days. She also complained of poor urinary stream and increased urine frequency for 1 year and had a history of hysterectomy with bilateral salpingo-oophorectomy. Her general and systemic examinations were unremarkable. Abdominal radiograph revealed diffuse opacification of the pelvis with left lateral displacement and compression of the rectal shadow (figure 1A). CT of abdomen and pelvis (figure 1B–F) revealed a large, well-defined heterogeneously enhancing lobulated lesion in the presacral region and central pelvis showing multiple coarse calcifications within. The lesion was abutting the distal sigmoid colon and rectum causing their left lateral displacement with luminal compression and loss of intervening fat plane. There was resultant dilatation of the large and distal small bowel loops suggestive of intestinal obstruction. The fat plane between the lesion and the...

https://ift.tt/2JnK1HH

Small intestinal bacterial overgrowth (SIBO) and vitamin K-responsive coagulopathy: a previously unrecorded association

A 17-year-old woman, with a history of three operations on the upper gut in early life and intermittent diarrhoea, presented with a history of epistaxis and leg ecchymosis for the previous 3 months. Initial investigation revealed mild anaemia, low serum albumin, moderately elevated aminotransferases and an exceedingly prolonged prothrombin time (PT) which was promptly shortened to normal by intravenous vitamin K. Additional investigations revealed a grossly abnormal glucose hydrogen breath test, a dilated duodenum and deficiencies of vitamins A, D and E. Repeated courses of antimicrobial agents caused prompt but transient shortening of PT and eventually a duodenal–jejunal anastomosis was performed. Since then, up to 36 months later, the patient has been in good general health and PT has been consistently normal with no vitamin K supplementation. Small intestinal bacterial overgrowth has previously been associated with several conditions but this is the first description of its association with vitamin K-responsive coagulopathy.

https://ift.tt/2M53lLt

Melanoma with rhabdomyosarcomatous differentiation

Melanoma with rhabdomyosarcomatous differentiation is an extremely rare observation with a review of the literature revealing fewer than 15 previously identified cases. The authors describe a case of a 72-year-old man with a cutaneous lesion of the left scalp that was diagnosed as malignant melanoma on biopsy and wide excision. One month later, a punch biopsy of the excisional area revealed rhabdomyosarcomatous proliferation. Re-examination of the wide-excision specimen with muscle markers revealed areas of neoplastic melanoma cells consistent with rhabdomyosarcomatous differentiation.

https://ift.tt/2JqBXpz

Lipschütz ulcer and group A streptococcal tonsillitis

Lipschütz ulcers (LU) are non-sexually related genital ulcers, rarely reported. We describe a healthy 11-year-old girl, who presented with fever and a painful vulvar ulcer associated with erythematous tonsillitis. Throat swab test for Group A Streptococcus (GAS) was positive. She was treated with amoxicillin. Further investigation was negative, including Herpes Simplex virus DNA from ulcer swab and serology for Epstein-Barr virus, cytomegalovirus and Mycoplasma pneumoniae. Antistreptolysin O titre was high. The ulcer healed in 2 weeks, with no recurrence in a 1 year follow-up period. The association of LU with GAS tonsillitis is very rare.

https://ift.tt/2sEWU9K

Ombitasvir/paritaprevir/ritonavir plus dasabuvir regimen may be used safely in combination with sirolimus for the treatment of chronic hepatitis C

The era of direct acting antivirals has revolutionised the management of chronic hepatitis C infection and improved patient outcomes. The optimal management of patients who require liver transplantation remains a matter of ongoing discussion. Treatment in the post-transplantation setting may be complicated by significant drug–drug interactions between antiviral agents and standard immune suppressive treatment regimens. We describe what we believe to be the first reported case of a patient successfully treated for CHC with ombitasvir/paritaprevir/ritonavir plus dasabuvir, while taking sirolimus following liver transplantation.

https://ift.tt/2sOs2ms

Isolated hepatobiliary tuberculosis: a diagnostic challenge

Hepatobiliary system involvement is frequently seen as part of disseminated tubercular infection. But primary isolated hepatobiliary tuberculosis with no evidence of tuberculosis elsewhere in the body is extremely rare. Isolated hepatobiliary tuberculosis can cause diagnostic dilemma as the clinical, laboratory and imaging features are non-specific in majority of the cases. We report the case of a 50-year-old woman who presented with hepatobiliary tuberculosis with no pulmonary or extra hepatic involvement. Liver function tests were abnormal and ultrasonography (USG), CT and MR cholangiopancreatography showed multiple focal lesions in the liver. The diagnosis of tuberculosis was confirmed by a USG-guided biopsy of the liver lesions. In endemic regions with the presence of supportive imaging findings, in the appropriate clinical setting, the possibility of hepatic tuberculosis should be considered and diagnosis has to be confirmed with histopathological examination.

https://ift.tt/2sCs1mB

IgG4-related periarteritis in the coronary artery and subclinical pericarditis assessed the presence and monitoring of therapy response by PET and CT scan

Description 

A 70-year-old woman suffered from bilateral lacrimal gland enlargement from 2 years ago (figure 1). Geranium-enhanced MRI disclosed diffuse enlargement of bilateral eyelids indicating IgG4-related disease (IgG4RD), especially Mikulicz's disease. Laboratory tests showed elevation of serum IgG4 concentration and histopathological findings of the lacrimal glands showed IgG4-positive cell infiltration and obliterated veins by inflammatory cells, which consist of lymphocytes and plasma cells (obliterative phlebitis).

Figure 1

Bilateral lacrimal gland enlargement with predominance of right ones observed as a representative pathophysiological finding in this patient with IgG4-related disease.

Then, she was diagnosed with IgG4RD. We performed chest CT as screening for comorbidities of Mikulicz's disease. Chest CT revealed left circumflex artery (LCX) wall thickening. Coronary CT showed thickening of the left anterior descending artery and LCX. For suppressing physiological myocardial uptake, the patient was asked to restrict carbohydrate intake 24 hours before...

https://ift.tt/2Jrvomo

Unexpected early complication of implantable-cardioverter defibrillator

A 41-year-old woman was visiting Oxford, where she had a sudden cardiac arrest. Cardiopulmonary resuscitation was started by a bystander until the paramedics arrived, who found her in ventricular fibrillation, and delivered three shocks. After 28 min she had return of spontaneous circulation. Emergency coronary angiography revealed normal coronary arteries. Echocardiography followed by a cardiac MRI showed non-dilated left ventricles with no evidence of late gadolinium enhancement. She had a single-chamber implantable-cardioverter defibrillator (ICD). A chest CT showed sternal fracture and subsegmental pulmonary embolism, for which she was anticoagulated and was discharged.

Several days later, the patient presented to another hospital with atypical chest pain and dizziness. She had haemodynamic instability and echocardiography showed the ICD lead perforating through the right ventricle, with a large pericardial effusion and tamponade, for which pericardiocentesis was done. Afterwards, the patient had repositioning of the ICD lead safely.

https://ift.tt/2M53n63

Stachydrine suppresses viability & migration of astrocytoma cells via CXCR4/ERK & CXCR4/Akt pathway activity

Future Oncology, Ahead of Print.


https://ift.tt/2sMOXPc

Safety of HTX-019 (intravenous aprepitant) and fosaprepitant in healthy subjects

Future Oncology, Ahead of Print.


https://ift.tt/2kVFwtk

Circulating Cytokine/Chemokine Concentrations Respond to Ionizing Radiation Doses but not Radiation Dose Rates: Granulocyte-Colony Stimulating Factor and Interleukin-18

Radiation Research, Volume 189, Issue 6, Page 634-643, June 2018.


https://ift.tt/2JA5VdX

NASA GeneLab Project: Bridging Space Radiation Omics with Ground Studies

Radiation Research, Volume 189, Issue 6, Page 553-559, June 2018.


https://ift.tt/2Jl19Oc

Dose-Modifying Factor of Radiation Therapy with Concurrent Cisplatin Treatment in HPV-Positive Squamous Cell Carcinoma: A Preclinical Study

Radiation Research, Volume 189, Issue 6, Page 644-651, June 2018.


https://ift.tt/2M4lclO

Identity Crisis – Rigor and Reproducibility in Human Cell Lines

Radiation Research, Volume 189, Issue 6, Page 551-552, June 2018.


https://ift.tt/2LpFx3N

DNA Topoisomerase IB as a Potential Ionizing Radiation Exposure and Dose Biomarker

Radiation Research, Volume 189, Issue 6, Page 652-660, June 2018.


https://ift.tt/2JwIdPQ

Mice Lacking RIP3 Kinase are not Protected from Acute Radiation Syndrome

Radiation Research, Volume 189, Issue 6, Page 627-633, June 2018.


https://ift.tt/2JrcY5C

Analysis of Radiation-Induced Chromosomal Aberrations on a Cell-by-Cell Basis after Alpha-Particle Microbeam Irradiation: Experimental Data and Simulations

Radiation Research, Volume 189, Issue 6, Page 597-604, June 2018.


https://ift.tt/2JxHrlM

A Novel Method to Extend a Partial-Body CT for the Reconstruction of Dose to Organs beyond the Scan Range

Radiation Research, Volume 189, Issue 6, Page 618-626, June 2018.


https://ift.tt/2JooBtK

Analysis of Gene Expression Changes in PHA-M Stimulated Lymphocytes – Unraveling PHA Activity as Prerequisite for Dicentric Chromosome Analysis

Radiation Research, Volume 189, Issue 6, Page 579-596, June 2018.


https://ift.tt/2M4sQN1

Behavioral Effects of Focal Irradiation in a Juvenile Murine Model

Radiation Research, Volume 189, Issue 6, Page 605-617, June 2018.


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Amelioration of Head and Neck Radiation-Induced Mucositis and Distant Marrow Suppression in Fanca–/– and Fancg–/– Mice by Intraoral Administration of GS-Nitroxide (JP4-039)

Radiation Research, Volume 189, Issue 6, Page 560-578, June 2018.


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Changes in spontaneous overt motor execution immediately after observing others’ painful action: two pilot studies

Abstract

Research has demonstrated that motor control is directly influenced by observation of others' action, stimulating the mirror neuron system. In addition, there is evidence that both emotion and empathy after observing a painful stimulus affects motor cortical excitability and reaction times. Aim of the present two pilot studies is a) to test for significant influence of observing other's painful bending of the trunk on execution of the same activity in a self-directed bending action (study 1) and to compare these results with a bending action according to a strict bending protocol (study 2). In addition to study 1, differences between Low Back Pain (LBP) patients versus healthy subjects are tested. Video footage of a (1) neutral, (2) painful, and (3) happy bending action was presented in random order. Changes in flexion–relaxation phenomenon (FRP) of back muscles were studied directly after watching the videos with surface EMG, in study 1 during a self-directed bending action in LBP patients and healthy subjects, in study 2 according to a strict bending protocol. FRP ratios were calculated by a custom-made analysis scheme tested for sufficient reliability prior to both studies. Evoked emotions were measured with an Emotional Questionnaire after each video. A Mixed Model ANOVA was used to test for the effect video and the difference between LBP and healthy subjects on the FRP-rs. Differences in evoked emotion will be tested with a Wilcoxon Signed Rank Test. In study 1, 24 healthy controls and 16 LBP patients FRP-rs were significantly influenced after observing a painful video in all subjects versus a happy and neutral video (p = 0.00). No differences were present between LBP and healthy controls. All subjects experienced more fear after observation of the painful video (p 0.05). In study 2, 6 healthy subjects followed the strict FRP bending protocol for three times after observing each video. No significant changes occurred in FRPs per video compared to FRPs of six healthy subjects carrying out the spontaneous bending activity. Observing a painful action in another person changes motor performance and increases fear in both people with and without back pain, during self-directed trunk flexion, but not during a protocolled trunk flexion.

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Turning the Tables — The New European General Data Protection Regulation

"Action required: Make sure you receive important information!" was the alarming message my Internet service provider recently sent me. It turned out they wanted me to review my privacy settings — or, really, to agree that they could continue using data about me just as they had before. People…

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Masthead

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In This Issue

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Table of Contents

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Should Low- and Middle-Income Countries Adopt Clinical Guidelines Developed in ‘Rich’ Countries?

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Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group

Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group

Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group, Published online: 07 June 2018; doi:10.1038/s41416-018-0090-1

Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group

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Online Consumer Ratings of Physicians Tend to Be Skewed

WEDNESDAY, June 6, 2018 -- Online physician reviews tend to be skewed positively, according to a study published in the May issue of the Journal of Medical Internet Research. Timothy Daskivich, M.D., from the Cedars-Sinai Medical Center in Los...

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Disparities for Risk of Recurrent Hemorrhagic Stroke Unexplained

WEDNESDAY, June 6, 2018 -- Black and Hispanic patients are at higher risk for stroke recurrence than white patients, according to a study published online June 6 in Neurology. Axana Rodriguez-Torres, M.P.H., from the University of California Irvine,...

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Post-Transplant Tx Reduces Wait for Kidney in Hep C+ Patients

WEDNESDAY, June 6, 2018 -- Post-transplant hepatitis C treatment increases access to transplant and reduces waitlist time among hepatitis C-positive patients awaiting kidney transplantation, according to a study published online May 14 in the...

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Lifetime Risks Temper Biomarker Tests for Alzheimer Dz Dementia

WEDNESDAY, June 6, 2018 -- The lifetime risks of Alzheimer's disease (AD) dementia vary considerably by age, gender, and the preclinical or clinical disease state, according to a study published online May 22 in Alzheimer's & Dementia. Ron...

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Mifepristone Pre-Tx Improves Management of Early Miscarriage

WEDNESDAY, June 6, 2018 -- Mifepristone pretreatment improves medical management of early pregnancy loss, according to a study published in the June 7 issue of the New England Journal of Medicine. Courtney A. Schreiber, M.D., M.P.H., from the...

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The advantage of Flash radiotherapy confirmed in mini-pig and cat-cancer patients

Background: Previous studies using FLASH radiotherapy (RT) in mice showed a marked increase of the differential effect between normal tissue and tumors. To stimulate clinical transfer, we evaluated whether this effect could also occur in higher mammals. Methods: Pig skin was used to investigate a potential difference in toxicity between irradiation delivered at ultra-high dose rate called FLASH-RT and irradiation delivered at conventional dose rate called Conv-RT. A clinical-phase-I single-dose escalation trial (25-41 Gy) was performed in six cat-patients with locally-advanced T2/T3N0M0 squamous-cell-carcinoma of the nasal planum, to determine the maximal tolerated dose and progression-free survival of single-dose FLASH-RT. Results: Using respectively depilation and fibronecrosis as acute and late endpoints, a protective effect of FLASH-RT was observed (≥ 20% dose-equivalent difference vs Conv-RT). Three cats experienced no acute toxicity, whereas three exhibited moderate/mild transient mucositis and all cats had depilation. With a median follow-up of 13.5 months, the progression free survival (PFS) at 16 months was 84%. Conclusion: Our results confirmed the potential advantage of FLASH-RT and provide a strong rational for further evaluating FLASH-RT in human patients.

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NF-{kappa}B-Dependent Lymphoid Enhancer Co-option Promotes Renal Carcinoma Metastasis [Research Articles]

Metastases, the spread of cancer cells to distant organs, cause the majority of cancer-related deaths. Few metastasis-specific driver mutations have been identified, suggesting aberrant gene regulation as a source of metastatic traits. However, how metastatic gene expression programs arise is poorly understood. Here, using human-derived metastasis models of renal cancer, we identify transcriptional enhancers that promote metastatic carcinoma progression. Specific enhancers and enhancer clusters are activated in metastatic cancer cell populations, and the associated gene expression patterns are predictive of poor patient outcome in clinical samples. We find that the renal cancer metastasis–associated enhancer complement consists of multiple coactivated tissue-specific enhancer modules. Specifically, we identify and functionally characterize a coregulatory enhancer cluster, activated by the renal cancer driver HIF2A and an NF-B–driven lymphoid element, as a mediator of metastasis in vivo. We conclude that oncogenic pathways can acquire metastatic phenotypes through cross-lineage co-option of physiologic epigenetic enhancer states.

SIGNIFICANCE: Renal cancer is associated with significant mortality due to metastasis. We show that in metastatic renal cancer, functionally important metastasis genes are activated via co-option of gene regulatory enhancer modules from distant developmental lineages, thus providing clues to the origins of metastatic cancer. Cancer Discov; 8(7); 1–16. ©2018 AACR.

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Genome Sequencing Detects Lung Cancer in Blood [News in Brief]

Three different assays use cell-free DNA to find the disease with high specificity, sensitivity.

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The influence of post-fixation on visualising vimentin in the retina using immunofluorescence method

Background: Post-fixation of sections is especially required for cryostat sections of fresh frozen tissues. Vimentin is an intermediate filament in both fibrillary and non-fibrillary form, expressed in Müller's cells and astrocytes of the retina. Our aim was to determine the best post-fixation method for visualising vimentin in archival mouse eyes.

Materials and methods: We used an archival mouse eye, slightly pre-fixed with paraformaldehyde and stored at –80°C for 4 years. We tried three fixatives (pa­raformaldehyde [PFA], alcohol/acetic acid [AAA] and methanol) for post-fixation of eye sections.

Results: We showed that post-fixation alters the labelling properties of vimentin expressed in the retina. In the sections with no post-fixation, vimentin positivity was observed in and around the nuclei in non-fibrillary form. In PFA post-fixed sections, the vimentin in the retina was not observed as fibrils. Positivity was observed in the nuclei and in perinuclear regions of the cells. In AAA post-fixed sections, positive labelling was observed around the nuclei as fibrils. In methanol post-fixed sections, labelling was observed around the nuclei as fibrils.

Conclusions: We conclude that post-fixation with AAA is more convenient for immunofluorescent labelling of vimentin in the retina for slightly PFA pre-fixed and long-term stored retina. (Folia Morphol 2018; 77, 2: 246–252)

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Does simulation-based training facilitate the integration of human anatomy with surgery? A report of a novel Surgical Anatomy Course

Background: Knowledge of gross anatomy, as a basic core subject, is fundamental for medical students and essential to medical practitioners, particularly for those intending a surgical career. However, both medical students and clinical teachers have found a significant gap in teaching basic sciences and the transition into clinical skills. The authors present a Surgical Anatomy Course developed to teach the anatomical basis of surgical procedures with particular emphasis on laparo­scopic skills while incorporating medical simulation.

Materials and methods: An evaluation of the students' satisfaction of the Surgical Anatomy Course was completed using a mix of multiple choice and open-ended questions, and a six-point Likert Scale. Questions were asked about the students' perceived improvement in surgical and laparoscopic skills. Manual skills were assessed using a laparoscopic simulator.

Results: Both evaluation of the course structure and the general impression of the course were positive. Most students believed the course should be an integral part of a modern curriculum. The course supported the traditional surgical classes and improved anatomical knowledge and strengthened students' confidentiality and facilitated understanding and taking surgical rotations.

Conclusions: A medical course combining the practical learning of anatomy and surgical-based approaches will bring out the best from the students. Medical students positively evaluated the Surgical Anatomy Course as useful and benefi­cial regarding understanding anatomical structure and relationship necessary for further surgical education. (Folia Morphol 2018; 77, 2: 279–285)

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Evaluation of the spatial arrangement of Purkinje cells in ataxic rat’s cerebellum after Sertoli cells transplantation

Background: Purkinje cells (PCs) pathology is important in cerebellar disorders like ataxia. The spatial arrangement of PCs after different treatments has not been studied extensively. Immunohistochemistry (IHC) analysis of cerebellum can give a proper tool for explaining the pathophysiology of PCs in ataxia. Here we stereologically analysed the 3-dimensional spatial arrangement of PCs in the cerebellum of rats after ataxia induction with 3-acetylpyridine (3-AP).

Materials and methods: Ataxia was induced in rats by intraperitoneal injection of 3-AP (65 mg/kg). Spatial arrangement of PCs for differences in ataxic rats with (3-AP-SC) or without (3-AP) Sertoli cells (SCs) transplantation was evaluated using second-order stereology. The IHC method by using antibodies to anti-calbindin in the cerebellum was applied.

Results: Our results showed that a random arrangement is at larger distances between PCs in 3-AP and 3-Ap-SC groups. Therefore the PCs are not normally arranged after 3-AP and SCs transplantation stored the spatial arrangements of the cells after ataxia induction in rats. IHC analyse shows that number of PCs was significantly improved after the SC transplantation.

Conclusions: Segregation of PCs can be observed at some areas in the ataxic rats' cerebellum. However, the spatial arrangement of PCs was unchanged in SCs transplanted rats. (Folia Morphol 2018; 77, 2: 194–200)

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Immunohistochemical study on roe deer haemal nodes

Background: The aim of this study was to investigate the immunohistochemical characteristics of the haemal nodes located in the abdominal and thoracic cavities in roe deer (Capreolus capreolus).

Materials and methods: In this study, 2 adult male and 2 adult female roe deers in addition to 2 roe deer foetuses at the late foetal stages were used. The avidin-biotin-peroxidase technique was applied to anti-CD3, anti-CD79acy, anti­-macrophage, anti-S100 primary antibodies.

Results: Positive results were gained for all the antibodies used. Many CD3 positive T-lymphocytes were seen in the lymphoid tissue areas of the foetal haemal nodes, in the germinal centre of the lymph follicles of the adult haemal nodes and in their lymphatic cords. CD79acy positive cells were less in number while S-100 protein was positive in both lymph follicles and in sinuses of the adult haemal nodes. In foetal haemal nodes, cells positive for S-100 protein were more prevalent in the sinuses. For the MAC387 primary antibody, there were positive macrophages seen in the capsule and trabeculae of the haemal nodes, located denser in males. Macrophage cells in the lymphoid structures and granulocytes in the sinuses of the haemal nodes of both adults and foetuses were positive for MAC387.

Conclusions: This study is the first one to define the detailed structural features immunohistochemically in the haemal nodes of the roe deer. Even it's concluded that the results were similar with the other ruminants, it's also pointed out that there are certain differences among the foetal, adult male and female haemal nodes of the roe deer. (Folia Morphol 2018; 77, 2: 266–271)

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Effect of valproic acid administration during pregnancy on postnatal development of cerebellar cortex and the possible protective role of folic acid

Background: Valproic acid (VPA), one of the most important antiepileptic drugs, proved to be inevitable for epileptic pregnant women to limit the hazards of convulsions on the foetuses and mothers. Periconceptional folic acid supple­mentation was investigated to protect against several birth defects. However, its role against VPA cerebellar toxicity was not properly investigated. The present study was conducted to evaluate the protective effect of folic acid against VPA cerebellar neurotoxicity.

Materials and methods: Twenty-four pregnant female albino rats were divided into three groups; group I (control group, did not receive any drugs), group II (given VPA at a dose of 50 mg/kg body weight once daily) and group III (given the same dose of VPA and 400 μg/kg of body weight folic acid once daily). Ten male offspring from each group were sacrificed at two ages: at 2 and 12 weeks after birth. Samples of cerebellar cortex were taken and prepared for light, electron microscopic examination, glial fibrillary acidic protein (GFAP) immunohistochemical study and histomorphometric analysis.

Results: The present study confirmed the neurotoxic effect of prenatal VPA on the cerebellar cortex, especially on Purkinje cells. The cells appeared shrunken, reduced in density, disorganised and surrounded by empty haloes. Nuclear damage and axon degeneration in the form of vacuolation, loss of organelles and absence of neurofilaments with myelin sheath depletion were detected. Concomitant supply of folic acid was shown to retain the normal architecture of Purkinje cells with their axons and nuclei. In many animals receiving folic acid, the thickness of all layers of the cortex increased up to that of the control groups, after being markedly reduced in VPA-treated groups. GFAP immunoreaction was also improved against the strong positive gliosis detected in VPA-treated groups.

Conclusions: The present study confirmed the protective role of folic acid against the cerebellar neurotoxic effects of VPA prenatal exposure. It is recommended that folic acid supplements should be given to every epileptic pregnant mother treated with VPA. (Folia Morphol 2018; 77, 2: 201–209)

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A comparative morphometric study of the myocardium during the postnatal development in normotensive and spontaneously hypertensive rats

Background: Differences in the size of cardiac muscle cells observed in normal and hypertrophic hearts have been assessed through different methodologies. Spontaneously hypertensive rats are often used as an experimental model of essential hypertension in humans, which allows researchers to study the relation between hypertension and cardiac hypertrophy. It has been shown that ventricular hypertrophy in mammals progresses and ventricular failure develops in the end stage of hypertrophy. The aim of the present study was to analyse a number of morphometric markers and compare them between male normotensive Wistar rats (WR) and male spontaneously hypertensive rats (SHR).

Materials and methods: The total number of male WR was 15, distributed in five age groups, each containing three animals: 2-week-old; 1-month-old; 3-month­-old; 6-month-old; 12-month-old. The male SHR were distributed in two age groups, each containing three animals: 1-month-old (young) and 6-month-old (adult).

Results: As aging progressed, both in male normotensive WR and in male SHR we noted a statistically significant increase in the morphometric parameters thickness of the free wall and the cross-sectional area of the cardiomyocytes and their nuclei and a decrease in the cardiomyocytic density in both ventricles. These changes were more pronounced and occurred at an earlier age in SHR.

Conclusions: The present study analyses in detail the alterations in the myocardium of the left and right ventricle, initiated by age-related hypertrophy, as well as hy­pertrophy induced by arterial hypertension. (Folia Morphol 2018; 77, 2: 253–265)

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Prevalence and morphometric analysis of idiopathic osteosclerosis in a Chilean population

Background: The aim of this study was to analyse the prevalence and morpho­metric parameters of idiopathic osteosclerosis (IO) in a Chilean population. IO is an intraosseous growth of compact, benign, unilocular, non-expandable bone that is referred to as an anatomical variation.

Materials and methods: A cross-sectional study was performed using 1000 digital panoramic radiographs of adults in which data on the location (maxillary/ mandibular, right/left hemiarcades), shape, position to the dental apex, and the prevalence of IOs were observed in relation to gender and age. The morphometric parameters evaluated were area, height, width, and the linear distances of the IO up to the midline and at the base of the mandible.

Results: The overall prevalence was 2.8% (27 individuals), with the majority of cases in women (66.7%) in the second, third, and fifth decades of life, but without significant differences. All cases were present in the mandible (100%), usually in the left hemiarcade (59.3%), molar (48.2%) and premolar (44.4%) regions; at the height of the dental apices (65.5%), with an irregular shape (40.7%) and round (37%). The area of the IOs was 33.9 ± 20.1 mm2, with a height of 7.7 ± ± 3.1 mm, width of 6.6 ± 3.1 mm, and the distance from the IO to the mandible median line was 26.6 ± 10.7 mm and 9.7 ± 3.7 mm to the mandibular base.

Conclusions: All the data observed corroborate with previous studies; the IO does not present a large difference in the Chilean population evaluated compared to pre­vious studies carried out in other populations. (Folia Morphol 2018; 77, 2: 272–278)

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N-acetylcysteine versus progesterone on the cisplatin-induced peripheral neurotoxicity

Background: Cisplatin-induced peripheral nerve neurotoxicity (CIPN) is the main obstacle in cisplatin treatment. The aim of this study was to compare the modulatory effects of N-acetylcysteine (NAC) and progesterone on CIPN, because there are scarce literature data on the protective effect of the proge­sterone on the CIPN.

Materials and methods: Twenty-four rats were divided into four groups: control, cisplatin-treated, concomitant cisplatin-treated and NAC-treated, and concomitant cisplatin-treated and progesterone-treated. Electron microscopic, immunohistochemical, real time polymerase chain reaction and histomorphome­tric analysis; oxidative/antioxidative markers (MDA/GSH and SOD), neurotoxic/ neuroprotective markers (iNOS/nNOS), inflammatory mediators (TNF-a and NF-kB) and BAX were done.

Results: The myelin sheath in the cisplatin-treated group elucidated infolding. The myelin was disfigured, degenerated, and extensively split with areas of focal loss. The axoplasm was atrophic. Ballooning and vacuolations of the mitochon­dria with alterations of Remak bundles structures were observed. Fewer of these changes were noted in the NAC and progesterone-treated groups. Decrease of the antioxidant SOD and GSH (81% and 64%) and increase of the oxidant MDA (9 folds), increment of the neurotoxic iNOS (1.9 folds) and decrement of the neuroprotective nNOS (64%) and elevation of the inflammatory mediators' TNF-a and NF-kB (8.3 and 11 folds) in the cisplatin-treated group. Increase of the antioxidant SOD (1.3 and 2.5 folds) and GSH (120% and 79%) and decrease of the oxidant MDA (69% and 88%), decrement of the neurotoxic iNOS (56% and 68%) and increment of the neuroprotective nNOS (1.6 and one folds) and elevation of the inflammatory mediators' TNF-a and NF-kB were observed in the NAC and progesterone-treated groups, respectively.

Conclusions: The toxic effect of CIPN might be attributed to either oxidative or severe inflammatory stress. Progesterone is efficient in ameliorating these effects; however, NAC is better. (Folia Morphol 2018; 77, 2: 234–245)

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The comparative anatomy of the folds, fossae, and adhesions around the duodenojejunal flexure in mammals

Background: Anatomical knowledge of the duodenojejunal flexure is necessary for abdominal surgeries, and also important for physiologic studies about the duodenum. But little is known about the anatomy of this region in mammals. Here, we examined comparative anatomy to understand the anatomical formation of the duodenojejunal flexure in mammals.

Materials and methods: The areas around the duonenojejunal flexure were ob­served in mouse, rat, dog, pig, and human, and the anatomical structures around the duodenojejunal junction in the animals were compared with those in human.

Results: The superior and inferior duodenal folds, and the superior and inferior duodenal fossae were identified in all examined humans. In pig, the structures were not clearly identified because the duodenum strongly adhered to the retroperitoneum and to the mesocolon. In mouse, rat, and dog, only the plica duodenocolica, which is regarded as the animal counterpart of the superior duo­denal fold in human, was identified, and other folds or fossae were not observed, probably because the duodenum was not fixed to the parietal peritoneum in those animals. Transection of the plica duodenocolica could return the normally rotated intestine back to the state of non-rotation in rat.

Conclusions: This study showed the anatomical similarities and dissimilarities of the duodenojejunal flexure among the mammals. Anatomical knowledge of the area is useful for duodenal and pancreatic surgeries, and for animal studies about the duodenum. (Folia Morphol 2018; 77, 2: 286–292)

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Morphometric study of lingual foramina in macerated mandibles to assist in implant placement in the anterior mandibular region

The object of our study was to contribute to anatomical knowledge of this region with data on the prevalence, number and location of lingual foramina (LF) in dentate and edentate macerated mandibles from Brazilian individuals, differen­tiating them by sex and race. In this way we hope to help dental surgeons with their planning prior to implant placement in the anterior mandibular region. 103 macerated mandibles were analysed. The prevalence, number and location of LF were analysed in the median (MLF) and lateral (LLF) regions and the median (AMLF) and lateral (ALLF) alveolar process regions. Measurements for their location were taken with a digital calliper. 99% of the mandibles presented at least 1 MLF, 82.5% at least 1 LLF, and the frequency of ALLF was 67%. In dentate mandibles, MLF were located in the region superior to the genial spine, and in edentate mandibles in the regions superior and inferior to the genial spine. LLF were located in the middle region in both dentate and edentate mandibles. The height of the symphysis was significantly greater in dentate than in edentate cases. The distance from the alveolar crest (AC) to the MLF was significantly greater in dentate than in edentate mandibles. LF are constant structures, with MLF found more frequently than LLF. Mandibles which present a smaller measured distance from the base of mandible to AC present MFL and LLF closer to AC, implying a greater risk of complication during implant placement. (Folia Morphol 2018; 77, 2: 310–322)

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An anatomical study of the origin, structure and insertion of the medial patellofemoral ligament

Background: Repair and reconstruction of the medial patellofemoral ligament
(MPFL) has been undertaken for the treatment of patellar instability. For successful
surgery detailed knowledge of the anatomy of the ligament is required. The aim
of this study was to describe the origin, structure and insertion of the MPFL.

Materials and methods: We studied cadaveric knees from 30 Chinese adults.
We studied the origin, course and insertion of the MPFL.

Results: We found that the MPFL was composed of two main strands, superficial
and deep. We also found that the insertion of the MPFL into the femur had three
common patterns. All three were located between the adductor tubercle and the
proximal part of superficial medial collateral ligament.

Conclusions: We have added to the anatomical knowledge of the structure of
the MPFL. Our study has implications for guiding bone tunnel positioning during
MPFL reconstruction surgery. (Folia Morphol 2018; 77, 2: 356–361)

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Elevated leukocyte count as a harbinger of systemic inflammation, disease progression, and poor prognosis: a review

Total leukocyte count increases significantly in response to infection, trauma, inflammation, and certain diseases. Factors affecting leukocyte count in healthy adults include sex, hormonal milieu, genetic inheritance, stress level, diet, nutrition, and lifestyle (e.g. tobacco-induced inflammatory changes, chronic psychological stress, etc.). To date, numerous studies have reported that high but normal leu­kocyte counts at baseline predict increased cardiovascular and noncardiovascular mortality in older adults. Recent findings suggest that elevated leukocyte count within the normal range, but especially neutrophil and monocyte counts, may be a harbinger of increased systemic inflammation and subclinical disease. Mo­reover, elderly people who tend to have high but normal leukocyte counts are at greater risk of cancer, cardiovascular disease, type 2 diabetes, some other age­-related conditions, and they also have increased all-cause mortality. These results indicate that strong and reliable inflammatory markers, such as leukocyte count, may reflect the rate of ageing and therefore can predict long-term survival in the elderly. Remarkably, leukocyte count correlates positively with genuine markers of systemic inflammation like C-reactive protein and interleukin 6. Interestingly, some authors conclude that leukocyte counts have a stronger prognostic ability with regard to total and cardiovascular mortality than total cholesterol or low­-density lipoproteins. The fact that these inflammatory markers are clinically useful predictors of long-term survival in the elderly is quite remarkable as these blood parameters are included in routine medical check-ups. Therefore, they can be used as simple and reliable morphological indicators of chronic systemic inflammation, disease progression, and poor prognosis, especially among individuals who are likely to develop age-related conditions. Nevertheless, the pathomechanism that links elevated but normal leukocyte counts to increased mortality remains poorly understood. This review summarises the most important findings on the links between leukocyte count, chronic systemic inflammation, and health outcomes in older adults. (Folia Morphol 2018; 77, 2: 171–178)

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Width of dental arches in patients with maxillary midline diastema

Background: The aims of the study were as follows: (1) to examine the width of the dental arches of patients with maxillary midline diastema and compare it with control group; (2) to investigate the impact of the width of upper dental arch on the width of diastema.

Materials and methods: Diagnostic orthodontic plaster models of 102 patients with permanent dentition were studied. Patients were divided into two groups: study group with diastema and control group without diastema. Patients with severe malocclusion, craniofacial diseases, hypodontia and microdontia and pa­tients with periodontal disease were excluded. The transpalatal width of palate, premolar and molar arch widths in Pont's points of upper and lower jaw were measured using digital calliper. The results were statistically analysed.

Results: Analysis showed a significant correlation between presence of diastema and premolar and molar width of the dental arches for both upper and lower jaw. Studied widths were larger in patients with diastema compared to the group without diastema. Analysis of the transpalatal width showed statistically significant differences between the study group and the control group. Analysis of widths of diastema and transpalatal widths showed that there was not statistically sig­nificant correlation.

Conclusions: Patients with diastema had increased in size in both the premolar and molar width of the dental arches. Increase the width affect to both upper and lower dental arch. Patients with diastema also were characterised by often occurrence of normal or increased of the transpalatal width but the width of the diastema did not correlate with the width of the palate. (Folia Morphol 2018; 77, 2: 340–344)

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Investigation of prevalence of dental anomalies by using digital panoramic radiographs

Background: This study was performed to evaluate the prevalence of all types and subtypes of dental anomalies among 6- to 40-year-old patients by using panoramic radiographs.

Materials and methods: This cross-sectional study was conducted by analysing digital panoramic radiographs of 1200 patients admitted to our clinic in 2014. Dental anomalies were examined under 5 types and 16 subtypes. Dental ano­malies were divided into 5 types: (a) number (including hypodontia, oligodontia and hyperdontia); (b) size (including microdontia and macrodontia); (c) structure (including amelogenesis imperfecta, dentinogenesis imperfecta and dentin dys­plasia); (d) position (including transposition, ectopia, displacement, impaction and inversion); (e) shape (including fusion-gemination, dilaceration and taurodontism).

Results: The prevalence of dental anomalies diagnosed by panoramic radiographs was 39.2% (46% in men and 54% in women). Anomalies of position (60.8%) and shape (27.8%) were the most common types of abnormalities and anomalies of size (8.2%), structure (0.2%) and number (17%) were the least in both genders. Anomalies of impaction (45.5%), dilacerations (16.3%), hypodontia (13.8%) and taurodontism (11.2%) were the most common subtypes of dental anomalies. Taurodontism was more common in the age groups of 13–19 years. The age range of the most frequent of all other anomalies was 20–29.

Conclusions: Anomalies of tooth position were the most common type of dental anomalies and structure anomalies were the least common in this Turkish po­pulation. The frequency and type of dental anomalies vary within and between populations, confirming the role of racial factors in the prevalence of dental ano­malies. Digital panoramic radiography is a very useful method for the detection of dental anomalies. (Folia Morphol 2018; 77, 2: 323–328)

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Examination of foramen tympanicum: an anatomical study using cone-beam computed tomography

Background: The foramen tympanicum (FT) is an osseous dehiscence of the temporal bone and usually closes by the age of 5 years. The foramen is located posteromedial to the temporomandibular joint and anteroinferior of the external auditory canal. The aim of this study is to define the prevalence, location and size of the foramen.

Materials and methods: We retrospectively examined 200 cone-beam computed tomography (CBCT) images (400 ears). We used a CBCT dental imaging system (GALILEOS, Sirona Dental Systems, Bensheim, Germany) working at 15–30 mA and 98 kV. We noted size and location (unilateral and bilateral) of the present FT.

Results: Foramen tympanicum was determined in 11.5% of 200 patients (they had FT at least on one side of the head). This was bilateral in 5 (2.5%) patients. Prevalence of the FT was significintly higher in females (8%) than in males (3.5%). FT was found more frequently on the left side (7.5%) than on the right side (4%). Mean axial diameter was 1.13 mm (range 0.23–4.43 mm), and mean sagittal diameter was 1.44 mm (range 0.22–3.99 mm).

Conclusions: Considering that FT was present in 11.75% of patients, radiologists and clinicians should be aware of the possible presence of this defect. It is known that this developmental dehiscence may cause herniation of temporomandibular joint, formation of salivary otorrhea, and spread of tumour or infection to the infratemporal fossa from external auditory canal. This study showed that CBCT may be preferred for imaging these conditions. (Folia Morphol 2018; 77, 2: 335–339)

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Comparison of type I collagens and MMP-2 proteins in temporomandibular joint of young and old mice

Background: The effects of ageing on the histopathological changes of tem­poromandibular joint (TMJ) and the existence and age related alterations of immunochemical expressions of type I collagen and matrix metalloproteinase-2 (MMP-2) proteins was aimed to be displayed.

Materials and methods: In this study, 14 Balb/C type white mice (50– –80 g) were included. Groups were organised as group 1 — 2-month-old young animals (n = 7) and group 2 — 18-month-old old animals (n = 7). Of the paraffin embedded tissues 4–5 μm thick sections were taken and immunohisto­chemical stainings of haematoxylin-eosin, type-1 collagen and MMP-2 were performed.

Results: Collagen bundles showed sagittal and oblique localisations in the young mice, which were comprised of compact collagen bundle layers positioned alterna­tely. While collagen bundle fragmentation was observed in the disks of old mice, some disk regions showed ruptures. In the old mice a decrease in blood vessels, structural impairments and dilatation in arterioles and venules were detected. In the TMJ tissues of the young mice type I collagen and MMP-2 expressions were increased, while they were decreased in old mice. In the MMP-2 H-score evaluation young mice showed significant increase compared to the old mice.

Conclusions: Occurrence of degenerations in the collagen structure of TMJ and decimation in the matrix metalloproteases were observed with age. (Folia Morphol 2018; 77, 2: 329–334)

https://ift.tt/2M25hnT

TP53 mutations in peripheral mature T and NK cell lymphomas: a whole-exome sequencing study with correlation to p53 expression

Peripheral mature T and NK cell lymphomas consist of a heterogeneous group of neoplasms with cytogenetic and molecular diversities. TP53 mutation is involved in the events of tumorigenesis and present in a variety of cancer subtypes. However, TP53 mutation in peripheral mature T and NK cell lymphomas has not been extensively investigated. In this study, fifty-seven formalin-fixed paraffin-embedded samples were collected for whole-exome sequencing and immunohistochemical study. Ten cases had TP53 mutation variant allele frequency (VAF) of more than 5%, predominantly in intestinal T-cell lymphoma (60%), peripheral T-cell lymphoma, not otherwise specified (22.2%), and extranodal nasal-type NK/T-cell lymphoma (21.7%).

https://ift.tt/2xPbkJt

Eosinophilic solid and cystic renal cell carcinoma mimicking epithelioid Angiomyolipoma: series of 4 primary tumors and 2 metastases

Eosinophilic solid and cystic renal cell carcinoma (ESC-RCC) is a novel entity of rare tumors with rather unique morphology and immunohistochemical profile. Until recently these tumors were characterized by indolent behavior. Herein we describe a series of six primary and metastatic ESC-RCCs morphologically and immunophenotypically mimicking epithelioid angiomyolipoma (eAML). Retrospective review of unclassified RCCs with oncocytic phenotype yielded several candidate cases, 4 of which fulfilled diagnostic criteria after additional work-up.

https://ift.tt/2JntYcS

Insulinoma-associated protein 1 is a novel sensitive and specific marker for small cell carcinoma of the prostate

The correct diagnosis of small cell carcinoma (SCC) of the prostate is critical because of its aggressive behavior and poor prognosis. The histopathologic diagnosis could be challenging without neuroendocrine markers, which currently has limitations. Insulinomaassociated protein 1 (INSM1), a zinc-finger transcription factor, is considered to play an important role in the development of several neuroendocrine precursor cells. Its diagnosis value has only recently been evaluated. In this study, we analyzed the expression of INSM in three high-throughput RNA sequencing data sets and performed INSM1 immunohistochemistry on a large series of prostatic SCCs and nonneuroendocrine prostate tissues.

https://ift.tt/2M3zWBj

Micropapillary urothelial carcinoma: evaluation of HER2 status and immunohistochemical characterization of the molecular subtype

Comprehensive molecular analyses of urothelial bladder cancer (UBC) have defined distinct subtypes with potential therapeutic implications. In this study, we focused on micropapillary urothelial carcinoma (MPUC), an aggressive, histomorphologically defined rare variant. Apart from genetic alterations shared with conventional UBC alterations of the HER2 gene have been reported in higher frequencies. However, only small cohorts of MPUCs have been analyzed and the real impact is still unclear. We collected a cohort of 94 MPUCs and immunohistochemically tested HER2, basal (CD44, CK5, EGFR, p63) and luminal (CD24, FOXA1, GATA3, CK20) markers to allocate MPUC to a molecular subtype.

https://ift.tt/2JkxxR2

Evaluation of miRNAs expression in medullary thyroid carcinoma tissue samples: miR-34a and miR-144 as promising overexpressed markers in MTC

Medullary Thyroid Carcinoma (MTC) is a rare neoplasia derived from neural parafollicular C cells. MicroRNAs (miRNAs) are small regulatory RNAs with essential roles in the biology of cancers such as MTC and can be applied as diagnostic markers. According to previous studies, miR-144 and miR-34 and their two oncogenes target, mammalian target of rapamycin (mTOR) and AXL receptor tyrosine kinase (AXL), were selected for further investigations in our study. Thirty MTC samples as well as thirty adjacent normal thyroid tissues were applied in this study including 28 Formalin-Fixed Paraffin-Embedded (FFPE) and 2 fresh-frozen MTC samples.

https://ift.tt/2M62OZV

B7H4 is associated with stemness and cancer progression in esophageal squamous cell carcinoma

B7H4 is overexpressed in human cancers and often correlates with poor clinical outcome. There is a lack of data on the role of B7H4 as a cancer stem cell (CSC) regulator in esophageal squamous cell carcinoma (ESCC) and its expression levels compared to other stemness genes in ESCC. In this study, we have assessed the expression of B7H4 and cancer stemness proteins in 156 paraffin embedded ESCC tissue samples using immunohistochemistry as well as in ESCC cell lines using western blotting and immunofluorescence imaging.

https://ift.tt/2JpQjqd

Evaluation of tumor-infiltrating lymphocytes using routine H&E slides predicts patient survival in resected non-small cell lung cancer

The presence of tumor-infiltrating lymphocytes (TILs) positively impacts the outcome of non-small cell lung cancer (NSCLC) patients. Most previous studies have assessed TILs using different immunohistochemical assays. The purpose of this study was to develop and validate a histopathological scoring model for the assessment of TILs in whole tissue hematoxylin and eosin (H&E)-stained section slides of NSCLC patients and to evaluate the model in an immunoscore setting. Therefore, TIL was evaluated manually on H&E slides from 537 surgical specimens of primary resected stage I-III NSCLC patients.

https://ift.tt/2M4dRmm

In situ analysis of mTORC1/2 and cellular metabolism-related proteins in human Lymphangioleiomyomatosis

Lymphangioleiomyomatosis (LAM) is a rare progressive cystic lung disease with features of a low-grade neoplasm. It is primarily caused by mutations in TSC1 or TSC2 genes. Sirolimus, an inhibitor of mTOR complex 1 (mTORC1), slows down disease progression in some, but not all patients. Hitherto, other potential therapeutic targets such as mTOR complex 2 (mTORC2) and various metabolic pathways have not been investigated in human LAM tissues. The aim of this study was to assess activities of mTORC1, mTORC2 and various metabolic pathways in human LAM tissues through analysis of protein expression.

https://ift.tt/2Jkxy7y

Mo1143 PREDICTORS OF FAILED CONSCIOUS SEDATION IN AN ACADEMIC OUTPATIENT GASTROENTEROLOGY LAB

In the United States, procedural sedation for gastrointestinal endoscopy is mostly performed as either endoscopist-directed administration of a benzodiazepine and an opiate (conscious sedation or CS) or that directed by an anesthesiology professional, typically using propofol (monitored anesthesia care or MAC.) MAC is usually reserved for patients deemed too medically unstable for CS or who are unlikely to achieve an appropriate level of sedation with CS. There are no clear guidelines to help triage patients to CS or MAC and there is little data about the rate of failure of CS.

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Mo1674 DIFFERENCES IN DETECTION OF POLYP PATHOLOGY BASED ON ENDOSCOPIST CHARACTERISTICS AND EXAMINATION OF THE ROLE OF WITHDRAWAL TIME IN EXPLAINING THESE DIFFERENCES

Previous studies have demonstrated adenoma detection (AD) to be operator dependent. In this study we examined endoscopist characteristics not only as they relate to AD, but also to sessile serrated adenoma detection (SSPD), and advanced adenoma detection (AAD--defined as ≥1cm diam., having villous component or high-grade dysplasia). Further, we examined the role of withdrawal time (amount of time spent viewing as colonoscope is withdrawn) as a possible explanation of these differences.

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Su1445 QUALITY EVALUATION AND CLINICAL IMPACT OF HISTOLOGY CORES OBTAINED WITH A NOVEL EUS-GUIDED FRONT-END BIOPSY NEEDLE ON SUBMUCOSAL TUMORS

Endoscopic-ultrasound (EUS) guided Fine-needle Aspiration (FNA) has been used to reach a pathology diagnosis in submucosal tumors (SMTs) with a low diagnostic yield. Standard and reverse bevel technology needles acquire cytology and cell-block that provide a sample adequate for a suspicion diagnosis but mostly inadequate for immunohistochemistry that is necessary to reach a definitive diagnosis in this kind of lesions. Histology needles have demonstrated a high yield and obtain cores adequate for immunohistochemistry in pancreatic lesions

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Mo1318 ROLE OF ENDOSCOPIC ULTRASOUND IN CASES WITH SUSPECTED PANCREATIC AND PERIAMPULLARY TUMORS WITH NONESPECIFIC OR NEGATIVE FINDINGS IN COMPUTED TOMOGRAPHY OR MAGNETIC RESONANCE IMAGING: MULTICENTRE AND PROSPECTIVE STUDY

Computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) are the first diagnostic methods used in patients with suspected pancreatic or periampullary tumors. However, when there is a strong clinical suspicion but the images are imprecise, another study must be performed. The results of a published meta-analysis about this diagnostic issue showed that the EUS had sensitivity (S) of 85%, specificity of 58% and precision of 75% for diagnosing pancreatic tumors.

https://ift.tt/2Jw37hT

Mo1079 THE USE OF OVER-THE-SCOPE-CLIP (OTSC) IMPROVES THE OUTCOMES OF TREATMENT OF HIGH-RISK ADVERSE OUTCOME (HR-AO) PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING (UGIB)

Endoscopic treatment of non-variceal UGIB lesions with HR-AO characteristics − large-caliber vessel or high-risk stigmata within deep penetrating and fibrotic ulcers located in the distribution of major arteries − has high-risk of failure. We studied the safety and efficacy of OTSC to treat HR-AO lesions and compared our results with those of standard treatment.

https://ift.tt/2LsvP0J

Mo1350 NEWLY DEVELOPED TREATMENT SYSTEM USING ENDOSCOPIC ULTRASOUND GUIDED HIGH INTENSITY FORCUSED ULTRASOUND

High-intensity focused ultrasound (HIFU) is a novel minimally invasive modality for ablation of various solid tumors including pancreatic cancer. Currently, the thermal effect of HIFU has been mainly used for tumor treatment. However, over coagulation may suppress effective delivery of anti-tumor drug. Recent studies also found that the mechanical effect of HIFU may help to enhance drug delivery although much higher acoustic intensity is necessary. For current HIFU therapy, large equipment is needed to obtain sufficient acoustic intensity and therefore it is often difficult to achieve an adequate acoustic window by extracorporeal transducer.

https://ift.tt/2LsvHhL

Mo1111 ROLE FOR LUMEN-APPOSING METAL STENTS IN THE MANAGEMENT OF SHORT-LENGTH GASTROINTESTINAL STRICTURES

Short length gastrointestinal (GI) strictures are seen at anastomotic sites following surgical resections, and in bowel that has been chronically inflamed or infiltrated by malignancy. Dilation and steroid injections are temporary treatments that lack long term efficacy. Fully covered self-expandable metal and plastic stents are too long for these strictures and migrate frequently. Our aim was to describe a role for lumen-apposing metal stents (LAMS) in the management of short-length GI strictures.

https://ift.tt/2LsvAml

Su1696 FLEXIBLE SIGMOIDOSCOPY MAY BE ADEQUATE FOR EVALUATION OF HEMATOCHEZIA IN PATIENTS UNDER 40 YEARS OLD

Hematochezia is a common presenting symptom in adults under the age of 40, and may be due to a variety of benign pathology but occasionally may signal underlying malignancy. The diagnostic approach to this patient group is debatable but often begins with a flexible sigmoidoscopy (FS). In this study, we aimed to see if an initial FS is adequate for ruling out malignancy by using a large national endoscopy database.

https://ift.tt/2Jwkwam

Mo1722 OVERWEIGHT AND RISK FOR PROXIMAL COLORECTAL ADENOMA: A MULTI-CENTER STUDY FROM THAILAND

An increased body mass index (BMI) is a risk factor for colorectal adenoma (CRA). However the association of overweight and proximal CRA is still lacking. The aim of this study was to evaluate the association between overweight and proximal CRA.

https://ift.tt/2LucnjQ

Mo1690 CHROMOENDOSCOPY POST-EMR REDUCES THE RATE OF INCOMPLETE POLYP RESECTION

The completeness of a polyp resection is an important determinant of quality and efficient colonoscopy, and may reduce the incidence of interval cancers. Incomplete resection rates (IRR) vary widely and range from 6.5% to 22.7% in the published literature. Residual disease is more likely with larger polyps, for sessile serrated adenomas, and with more proximal lesions. The 5 year interval cancer rate is reportedly as high as 8%. The odds ratio for developing interval cancer is 1.6 for a history of previous polyps.

https://ift.tt/2JAJ2XV

Mo1366 A NOVEL ELECTROCAUTERY-ENHANCED DELIVERY SYSTEM FOR ONE STEP EUS-GUIDED DRAINAGE AND ACCESS BY USING LUMEN-APPOSING METAL STENT: A PORCINE STUDY

EUS-guided transmural drainage (EUS-GTD) using lumen-apposing, self-expandable metal stents (LAMS) is effective, but involved multi-steps of procedures increasing chances of adverse events and failure. One step EUS-GTD can increase effectiveness. In this study, we evaluated the technical feasibility and safety of the newly developed electrocautery-enhanced delivery system comparing with conventional delivery system for EUS-TD using LAMS.

https://ift.tt/2Lqm8Qo

Mo1334 TIME FOR CHANGING OF GUARD: FROM MINIMALLY INVASIVE SURGERY TO ENDOSCOPIC DRAINAGE FOR MANAGEMENT OF WALLED-OFF PANCREATIC NECROSIS

About 20% of patients with acute pancreatitis develop necrosis of the pancreatic parenchyma and peripancreatic tissue leading to prolonged course along with a high risk of complications, organ failure and death. Endoscopic drainage (ED) with or without necrosectomy, and minimally invasive surgical necrosectomy (MISN) have been increasingly utilized for treatment of symptomatic sterile and infected walled-off pancreatic necrosis (WON).

https://ift.tt/2JA9v7K

Mo1302 THE ACCURACY AND AGREEMENT OF CT/MRI AND EUS IN IDENTIFICATION OF WORRISOME FEATURES WHEN COMPARED TO SURGICAL PATHOLOGY IN MUCINOUS PANCREAS CYSTS

The ideal management of patients with mucinous pancreas cysts is controversial. Non-invasive imaging modalities including CT/MRI and EUS have been utilized to select patients appropriate for surgical resection via identification of worrisome features (WF). It remains unclear, however, if WF on CT/MRI or EUS is accurate.

https://ift.tt/2LsvMBO

Mo1269 SOLID TUMOR METASTESES TO PANCREAS DAIGNOSED BY FNA

Endoscopic ultrasound guidedfine-needle aspiration (EUS-FNA) is useful for diagnosing pancreatic masses including metastases to the pancreas, which represent up to 7.6% of pancreatic masses.

https://ift.tt/2JxWzzr

Mo1127 DEVELOPING A TERTIARY ENDOSCOPIC PROGRAM FOR COLON ADENOMA RESECTION IN A COMMUNITY SETTING: REVIEW OF OUTCOMES, PITFALLS, AND PEARLS

This study was conducted to determine outcomes for patients that have undergone endoscopic mucosal resection (EMR) of colorectal polyps at a large tertiary referral center.

https://ift.tt/2LuAyi7

Mo1095 THE SMSA SCORE IS NOT ASSOCIATED WITH SUCCESS OF ENDOSCOPIC RESECTION AND IS NOT AN INDEPENDENT PREDICTOR OF OUTCOMES IN A LARGE SERIES OF ENDOSCOPIC RESECTIONS AT A TERTIARY CENTRE

A predictive score to stratify the difficulty of endoscopic resection (ER) of large colorectal superficial neoplastic lesions (CSNL) and predict outcomes would be valuable. The SMSA score assigns a numerical score based on size, morphology, site and ease of access and stratifies lesions into 4 groups of increasing complexity. It has been recommended in several international guidelines on colorectal ER and SMSA level 4 is reportedly associated with incomplete resection and increased complications.

https://ift.tt/2JA9twE

Sleep Spindle Reduction Precedes Seizures by Several Epochs

Sleep and epilepsy have a dynamic reciprocal relationship. Epileptiform discharges are more common in sleep (Malow et al. 1998) and the occurrence of seizures depends on sleep stage (Minecan et al. 2002). We had previously shown that the amount of sleep spindles is reduced before epileptic seizures (Tezer et al. 2014). To understand the time dynamic of this process, we now investigated how long before the seizure this reduction begins.

https://ift.tt/2M3O1P2

Characteristics and Outcomes of Psychology Referrals in Palliative Care Department

Psychologists can provide unique contributions to interdisciplinary palliative care. Despite research indicating high distress in palliative care cancer patients, little has been reported regarding the feasibility and practice of psychology in this setting.

https://ift.tt/2Hq6SQV

Validity, reliability and responsiveness of the Thai Palliative Care Outcome Scale staff and patient versions among cancer patients

Palliative care is now part of Universal Health Coverage goals. Measurement of person-centred outcomes is central to determining quality and effectiveness. Guidance in psychometrics requires tools applied in new settings to have their properties tested.

https://ift.tt/2sLZ1bg

An Examination of State Level Personality Variation and Physician Aid in Dying Legislation

Physician aid in dying is a controversial topic in the United States, and legislation exists in some states. Personality traits are associated with preferences for end of life care, and also tend to cluster systematically across states and other geographic regions. Such clustering of personality traits could relate to legislation including physician aid in dying.

https://ift.tt/2JhT2WI

The Future of Artificial Intelligence in Radiation Oncology

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Simulation as More Than a Treatment Planning Tool: A Systematic Review of the Literature on Radiation Oncology Simulation-Based Medical Education

This study systematically reviewed the literature to characterize the role of simulation-based medical education (SBME) in radiation oncology and develop a framework for future SBME interventions. Most studies meeting inclusion criteria described successful learning outcomes with a minority self-identifying as SBME. The majority of studies targeted attending physicians and residents as learners and focused on contouring. There is opportunity for expansion and increased awareness of SBME in the context of radiation oncology curriculum development.

https://ift.tt/2sJnmOQ

Radiation Therapy Is Associated With An Increased Incidence Of Cardiac Events In Small-Cell Lung Cancer Patients

Among small-cell lung cancer patients, we found baseline rates of cardiac events are about 40% at 5-years in the US population. Treatment with radiation therapy contributes to an absolute increase in this rate of cardiac events at 5-years of approximately 5% for all patients (limited-stage and extensive-stage both), and up to 10% for the limited-stage population.

https://ift.tt/2kRu01T

Radiation in Central Nervous System Leukemia: Guidelines from the International Lymphoma Radiation Oncology Group

Durable control of systemic disease in blood and bone marrow has significantly improved survival among patients with leukemia, but extramedullary relapse in the central nervous system can still pose therapeutic challenges for which radiation therapy can have an important role. The objective of this document is to discuss the current role of radiation therapy for patients with leukemia in the central nervous system.

https://ift.tt/2sJjJsd

Clinical Course of a Patient With Kidney Failure Due to Isolated Bilateral Renal Extramedullary Plasmacytomas

Plasmacytomas are rare immunoproliferative monoclonal plasma cell diseases of lymphoid lineage that may present in an isolated or systemic manner. Systemic involvement is much more common than occurrences isolated to a particular organ, and for this reason, it is imperative to rule out systemic involvement for osseous and nonosseous isolated neoplasms. These neoplasms present unique challenges due to their location, extent of involvement, vague presentation, and dearth of treatment protocol. We report the case of a 69-year-old man who developed chronic kidney disease stage 4 between 2009 and 2012.

https://ift.tt/2Jg412Q

Serum Calcitriol Concentrations and Kidney Function Decline, Heart Failure, and Mortality in Elderly Community-Living Adults: The Health, Aging, and Body Composition Study

Lower 25-hydroxyvitamin D concentrations have been associated with risk for kidney function decline, heart failure, and mortality. However, 25-hydroxyvitamin D requires conversion to its active metabolite, calcitriol, for most biological effects. The associations of calcitriol concentrations with clinical events have not been well explored.

https://ift.tt/2sJjwFr

miR-570 Inhibits Proliferation, Angiogenesis, and Immune Escape of Hepatocellular Carcinoma

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


https://ift.tt/2M73KNp

HER2-Based Immunotherapy for Breast Cancer

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


https://ift.tt/2xNVYVP

Prevalence of Brain Injuries among Children with Special Healthcare Needs

To investigate differences in brain injury prevalence among US children by special healthcare needs status, accounting for sociodemographic and family characteristics, and to examine correlated health conditions among children with special healthcare needs (CSHCN).

https://ift.tt/2JpygjX

Motivational Interviewing in Preventing Early Childhood Caries in Primary Healthcare: A Community-based Randomized Cluster Trial

To assess the effectiveness of motivational interviewing in preventing early childhood caries compared with conventional oral health education.

https://ift.tt/2JhF4UM

Early Childhood Health Interventions in the Primary Care Setting Promote Developmental Outcomes

The science of early childhood development has exploded in recent years. There is no period in the human lifespan that matches the rapid brain development of the first years of life. Synaptogenesis occurs at a rate of 1 million per second in infancy, and early development provides the circuitry that becomes the foundation for more complex subsequent development.1 This development does not occur in a vacuum—each child's development occurs in the context of the complex interactions among biology, culture, and experiences, particularly caregiving experiences, with different interactions conferring risk or resilience to the developing child.

https://ift.tt/2JjgBi1

Epidemiology of Pediatric Tuberculosis in Kenya and Risk Factors for Mortality during Treatment: A National Retrospective Cohort Study

To describe the epidemiology of childhood tuberculosis (TB) in Kenya, assess the magnitude of TB/human immunodeficiency virus (HIV) co-infection and identify risk factors for mortality during TB treatment.

https://ift.tt/2Jn1qQG

CARDIOSAVE Hybrid Intra-aortic Balloon Pump by Maquet Datascope Corp.: Class I Recall - Due to Fluid Ingress that May Affect Device Operation and Interrupt or Delay Therapy

[Posted 06/26/2018] AUDIENCE: Cardiology, Risk Management, Surgery ISSUE: Maquet Datascope Corp. is recalling the IABP due to a design issue that allows fluid (such as saline) to seep into the device. The fluid can cause corrosion of internal...

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Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department

Agitation in the emergency department (ED) can pose a threat to patient and provider safety; therefore, treatment is indicated. The purpose of this study is to compare haloperidol, olanzapine, midazolam, and ziprasidone to treat agitation.

https://ift.tt/2JpbrN8

Muscle Mass and Mortality After Cardiac Transplantation

Background Frailty assessment is recommended to evaluate the candidacy of adults referred for orthotopic heart transplantation (OHT). Psoas muscle area (PMA) is an easily measured biomarker for frailty. There has yet to be a study examining the prognostic impact of PMA in OHT patients. Methods In this retrospective study, pre and postoperative CT scans were retrieved for adults transplanted between 2000-2015 at a tertiary care hospital. PMA was measured on a single axial image. Outcomes of interest were all-cause mortality over 6 years and a composite of in-hospital mortality or major morbidity (prolonged ventilation, stroke, dialysis, mediastinitis, or reoperation). Results Of 161 adult patients transplanted, 82 had at least 1 abdominal CT scan. At baseline, mean PMA was 25.7±5.8 cm2 in men and 16.0±3.6 cm2 in women, and decreased by 8% from the first to the last available CT scan. Adjusting for age, sex, body mass index, and cardiomyopathy etiology, every 1 cm2 increase in PMA was found to be associated with a 9% reduction in long-term mortality (HR 0.91; 95% CI 0.83, 0.99; p=0.031) and a 17% reduction in in-hospital mortality or major morbidity (OR 0.83; 95% CI 0.72, 0.96; p=0.014). When PMA was smaller than the sex-specific median, the risk of mortality or major morbidity increased 4-fold (OR 4.29; 95% 1.19, 15.46; p=0.026). Conclusion Muscle mass is an independent predictor of mortality and major morbidity after OHT. Further research is needed to determine whether frail OHT patients with low PMA may benefit from muscle-building interventions to improve outcomes.fa Cosenior authors, Nadia Giannetti MD, Jonathan Afilalo MD, MSc ADDRESS FOR CORRESPONDENCE: Jonathan Afilalo, MD, MSc, FACC, FRCPC, Jewish General Hospital, 3755 Cote Ste Catherine Rd, E-222, Montreal, QC H3T 1E2, E-mail: jonathan.afilalo@mcgill.ca Author Contributions Lior Bibas: conception and design of study, collection of data, interpretation of data, primary authorship of manuscript. Eli Saleh, Samah Al-Kharji, Jessica Chetrit: collection of data, interpretation of data, coauthorship and revision of manuscript. Louis Mullie: software development for collection of data, coauthorship and revision of manuscript. Marcelo Cantarovich, Renzo Cecere: interpretation of data, coauthorship and revision of manuscript. Nadia Giannetti: conception and design of study, collection of data, interpretation of data, cosenior authorship of manuscript. Jonathan Afilalo: conception and design of study, software development for collection of data, statistical analysis, interpretation of data, cosenior authorship of manuscript. Author Disclosures Drs. Afilalo and Mullie developed the CoreSlicer.com software but do not hold any patents or financial incentives relating to its use. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding The costs related to data retrieval and extraction were funded by Dr. Nadia Giannetti's Heart Failure Research Fund. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Therapeutic Human IgG Preparations Contain Mixture of HLA Antibodies to Native HLA Antigens and Cryptic Epitopes with Little Clinical Significance

Background Human immunoglobulins (H-Ig) are widely used in solid organ transplantation for IgG replacement and for desensitization and treatment of antibody mediated rejection. They are obtained from plasma pools and may contain HLA antibodies that can be detrimental to transplant recipients. The goal of this study was to evaluate HLA antibodies in multiple lots of 2 commercial H-Ig preparations by. Luminex single antigen bead (SAB) and cell-based crossmatch assays. Methods Thirty lots of 2 commercial H-Ig products (CSL Behring, King of Prussia, PA.) were evaluated: 6 Hizentra® and 24 Privigen®. All were adsorbed and diluted 1:10 prior to testing. HLA immunoglobulin G (IgG) antibodies were determined by 2 Luminex SAB kits and C1q screen for complement binding capability. Lots were tested for the presence of antibody to denatured vs. intact Class I HLA alleles using acid-treated SAB. Surrogate T and B cell flow cytometry crossmatches (FCXM) were performed with peripheral blood lymphocytes from 2 healthy donors. Results Twenty-two lots (73%) at 1:10 showed SAB reactivity with MFI ≥2000 for HLA Class I, 67% (20/30 lots) for Class II. The reactivity pattern was similar using both SAB kits. Acid treatment revealed antibodies to denatured class I: the majority of HLA-C, half of HLA-B and few HLA-A alleles. No C1q reactivity was observed. Surrogate FCXM results were positive (>150 MCS), but were 4-8 fold lower than expected. Conclusions The H-Ig products tested consisted of low titer, noncomplement binding HLA Class I and Class II antibodies; most of the observed Class I HLA reactivity was towards denatured HLA antigens. Authorship Participated in research design: Massimo Mangiola, PhD Marilyn Marrari, BA Adriana Zeevi, PhD Participated in writing the paper: Massimo Mangiola, PhD Marilyn Marrari, BA Christopher Ensor, PharmD Martin O. Spycher, PhD Mel Berger, MD Adriana Zeevi, PhD Participated in the performance of the research: Massimo Mangiola, PhD Marilyn Marrari, BA Adriana Zeevi, PhD Contributed new reagents or analytic tools: Martin O. Spycher, PhD Mel Berger, MD Participated in the data analysis: Massimo Mangiola, PhD Marilyn Marrari, BA Adriana Zeevi, PhD CONFLICT OF INTEREST DISCLOSURE: Massimo Mangiola, PhD received support from CSL Behring LLC in form of reagents and supplies to conduct research Marilyn Marrari, BA received support from CSL Behring LLC in form of reagents and supplies to conduct research Christopher Ensor, PharmD received support from CSL Behring LLC in form of reagents and supplies to conduct research Martin O. Spycher, PhD Amployed by CSL Behring AG Mel Berger, MD Amployed by CSL Behring LLC Adriana Zeevi, PhD received support from CSL Behring LLC in form of reagents and supplies to conduct research Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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