Outcomes of definitive local therapy with intensity-modulated radiation therapy in elderly patients ≥70 years with HPV-associated oropharyngeal cancer

The incidence of human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) is increasing among elderly (≥70 years) patients and the optimal treatment approach is not known. In this study, we aimed to determine disease and toxicity outcomes in an elderly HPV-OPSCC population primarily treated with a chemoradiation (CRT) approach. We identified 70 elderly HPV-OPSCC patients who were treated with either surgery, radiotherapy, or CRT between 2011 and 2021. Time-to-event analysis for overall survival (OS), progression-free survival (PFS), and local control (LC) were conducted using the Kaplan-Meier method. Univariate and multivariable cox regression models were used to estimate the hazard ratio associated with covariates. The median follow-up for our cohort was 43.9 months. Of the 70 elderly patients, 55 (78.6%) receive CRT and 15 (22.4%) received RT alone. Two patients underwent TORS resection. Of the 55 patients treated with CRT, the most common systemic agents were weekly carboplatin/taxol (n = 18), cetuximab (n = 17), and weekly cisplatin (n = 11). The 5-year OS, PFS, and LC were 57%, 52%, and 91%, respectively. On univariate analysis, Eastern Cooperative Oncology Group performance status and Charlson Comorbidity Index (CCI) were significant predictors of OS, while on multivariate analysis only CCI was a significant predictor of OS (p = 0.006). The rate of late peg tube dependency, osteoradionecrosis, and aspiration was 10%, 4%, and 4%, respectively. Definitive local therapy in elderly HPV-OPSCC patients is associated with excellent LC and a low rate of late toxicities. Prospective studies are needed to further stratify subgroups of elderly patients who may benefit from aggressive definitive local therapy.

Otolaryngologists' radiological assessment of nasal septum deviation symptomatology

OBJECTIVES

Nasal Septal Deviation (NSD) is one of the most common causes of nasal obstruction. This study aims to further examine the clinical utility of imaging assessment in the workup and management of symptomatic nasal septal deviation, across all levels of medical training.

STUDY DESIGN

Cross-sectional survey.

METHODS

CT scans of 10 confirmed NSD patients and 36 healthy controls (HC) were mixed and emailed through anonymous REDCap surveys to otolaryngologists in the US. The HC had no reported sinonasal obstruction symptoms-NOSE (NSD: 62.2 ± 12.5; HC: 5.69 ± 5.99, p < 0.05); SNOT-22 (NSD: 31.4 ± 14.5; HC: 9.72 ± 10.76, p < 0.05). The images consisted of a coronal slice at each subject's most deviated location. Participants were instructed to choose the patients suspected to present with symptoms of sinonasal obstruction.

RESULTS

88 otolaryngologists responded to the survey. 18 were excluded due to incomplete responses. On average, they identified 64.2 ± 29.8% of symptomatic NSD subjects correctly, but misidentified 54.6 ± 34.6% of HC as symptomatic. Their decisions were strongly correlated to degree of NSD (r = 0.69, p < 0.05). There exists a significant degree of NSD among HC (38.7 ± 17.2%), which does not significantly differ from symptomatic subjects (51.0 + 18.7%, p = 0.09). Residents and fellows performed similarly, with responses correlated between levels of training (r = 0.84-0.96, p < 0.05).

CONCLUSIONS

The incorporation of a substantial number of otolaryngologists, large patient sample, and blind mixing with HC gives us greater insight to the relative contribution of the extent of septal deviation to symptoms of nasal obstruction. Although NSD is a common factor contributing to nasal obstruction, the results of this study suggest that it is difficult to reliably infer obstructive symptoms based on degree of NSD on CT.

LEVEL OF EVIDENCE

Three.

Comparative study of tissue adhesive therapy versus band ligation in control of actively bleeding esophageal varices

BACKGROUND AND STUDY AIMS

Bleeding esophageal varices is a common life-threatening emergency that carries a significant morbidity and mortality. Acute variceal bleeding is considered active when spurting and/or oozing varix is seen at the time of endoscopy, or inactive in the presence of large esophageal varices with blood in the stomach with no other bleeding source at the time of endoscopy. Aim: comparing endoscopic variceal ligation (EVL) versus cyanoacrylate injection (CI) in active esophageal variceal bleeding control.

PATIENTS AND METHODS

a retrospective single tertiary center study from April 2014 to February 2018, including 401 patients with active esophageal variceal bleeding.

RESULTS

Endoscopic hemostasis was achieved by both endoscopic variceal ligation in 182 patients (91.9%) and cyanoacrylate injection in 197 patients (97.05%) without significant difference (P value 0. 15). Re-bleeding occurred more frequently in EVL group 20 patients (10.1%) compared to 14 patients (6.9%) in CI (P value 0.01). Early six-week Mortality was higher among EVL group (20.7%) compared to CI (17.2%) without statistical significance (P value 0.3).

CONCLUSION

Both EVL and CI are almost as effective in achieving endoscopic hemostasis. CI is more effective, feasible, and could be used as a salvage therapy and/or spared for risky active bleeding esophageal varices.

Periodontal Tissue Engineering with a Multiphasic Construct and Cell Sheets

This study reports on scaffold-based periodontal tissue engineering in a large preclinical animal model. A biphasic scaffold consisting of bone and periodontal ligament compartments manufactured by melt and solution electrospinning, respectively, was used for the delivery of in vitro matured cell sheets from 3 sources: gingival cells (GCs), bone marrow-derived mesenchymal stromal cells (Bm-MSCs), and periodontal ligament cells (PDLCs). The construct featured a 3-dimensional fibrous bone compartment with macroscopic pore size, while the periodontal compartment consisted of a flexible porous membrane for cell sheet delivery. The regenerative performance of the constructs was radiographically and histologically assessed in surgically created periodontal defects in sheep following 5 and 10 wk of healing. Histologic observation demonstrated that the constructs maintained their shape and volume throughout the entirety of the in vivo study and were well integrated with the surrounding tissue. There was also excellent tissue integration between the bone and periodontal ligament compartments as well as the tooth root interface, enabling the attachment of periodontal ligament fibers into newly formed cementum and bone. Bone coverage along the root surface increased between weeks 5 and 10 in the Bm-MSC and PDLC groups. At week 10, the micro-computed tomography results showed that the PDLC group had greater bone fill as compared with the empty scaffold, while the GC group had less bone than the 3 other groups (control, Bm-MSC, and PDLC). Periodontal regeneration, as measured by histologically verified new bone and cementum formation with obliquely inserted periodontal ligament fibers, increased between 5 and 10 wk for the empty, Bm-MSC, and PDLC groups, while the GC group was inferior to the Bm-MSC and PDLC groups at 10 wk. This study demonstrates that periodontal regeneration can be achieved via the utilization of a multiphasic construct, with Bm-MSCs and PDLCs obtaining superior results as compared with GC-derived cell sheets.

Effects of estrogen on Survival and Neuronal Differentiation of adult human olfactory bulb neural stem Cells Transplanted into Spinal Cord Injured Rats.. [DOI: 10.1101/571950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

In the present study we developed an excitotoxic spinal cord injury (SCI) model using kainic acid (KA) to evaluate of the therapeutic potential of human olfactory bulb neural stem cells (h-OBNSCs) for spinal cord injury (SCI). In a previous study, we assessed the therapeutic potential of these cells for SCI; all transplanted animals showed successful engraftment. These cells differentiated predominantly as astrocytes, not motor neurons, so no improvement in motor functions was detected. In the current study we used estrogen as neuroprotective therapy before transplantation of OBNSCs to preserve some of endogenous neurons and enhance the differentiation of these cells towards neurons. The present work demonstrated that the h-GFP-OBNSCs were able to survive for more than eight weeks after sub-acute transplantation into injured spinal cord. Stereological quantification of OBNSCs showed approximately a 2.38-fold increase in the initial cell population transplanted. 40.91% of OBNSCs showed differentiation along the neuronal lineages, which was the predominant fate of these cells. 36.36% of the cells differentiated into mature astrocytes; meanwhile 22.73% of the cells differentiated into oligodendrocytes. Improvement in motor functions was also detected after cell transplantation.

Management and Surveillance of Frontal Sinus Violation following Craniotomy

Objectives  In the setting of craniotomy, complications after traversing the frontal sinus can lead to mucocele formation and frontal sinusitis. We review the etiology of frontal sinus violation, timeline to mucocele development, intraoperative management of the violated sinus, and treatment of frontal mucoceles. Design  Case series in conjunction with a literature review. Participants  A total of 35 patients were included in this meta-analysis. Nine of these patients were treated at a tertiary academic medical center between 2005 and 2014. The remaining patients were identified through a literature review for which 2,763 articles were identified, of which 4 articles met inclusion criteria. Main Outcomes Measures  Etiology of frontal violation, timeline to mucocele development, and method of management. Results  The overall interval from initial frontal sinus violation until mucocele identification was 14.5 years, with a range of 3 months to 36 years. The most common cause of mucocele formation was obstruction of the frontal recess with incomplete removal of the frontal sinus mucosa. The majority of patients were successfully managed with an endoscopic endonasal approach. Conclusions  Violation of the frontal sinus during craniotomy can result in mucocele formation as an early or late sequela. Image guidance may help avoid unnecessary frontal sinus violation. Mucoceles may develop decades after the initial frontal sinus violation, and long-term follow-up with imaging is recommended. While the endoscopic endonasal approach is usually the preferred method to treat these lesions, it may be necessary to perform obliteration or cranialization in unique situations.

Taeniectomy pouch as neorectum after low rectal resection

Background and purpose The functional outcomes of incontinence and high stool frequency resulting from restorative surgery are often criticised. The aim of this study was to assess the taeniectomy pouch in comparison with other pouches described in the literature. Material and methods This was a prospective cohort study. All patients who were candidate for low rectal resection presenting to the colorectal unit at Cairo University hospitals during the period February 2013 to February 2015 were included in the study (90 patients). Safety and feasibility of the new technique were assessed, including operative time, leakage, postoperative urgency, incontinence, number of daily motions and difficulty in evacuation. These parameters were assessed clinically, by means of defecography and anorectal manometry. Results The mean age of patients was 49.6 years. Percentages of postoperative mortality and leakage were 2.2% and 3.4%, respectively. Mean operative time was 117 minutes. Mean numbers of daily motions were 3.04 and 1.52 at 3 and 12 months, respectively. Mean Wexner score for continence at 3 and 12 months were 3.21 and 1.32, respectively. Mean resting pressure was 51.63 mmHg, squeeze pressure was 130.42 mmHg and mean threshold volume was 118.68 ml. Conclusions Taeniectomy is a novel technique for pouch formation after low rectal resection, which can be used as an alternative to other pouches, especially the widely used transverse coloplasty.

Environmental signatures and effects of an oil and gas wastewater spill in the Williston Basin, North Dakota

Wastewaters from oil and gas development pose largely unknown risks to environmental resources. In January 2015, 11.4ML (million liters) of wastewater (300g/L TDS) from oil production in the Williston Basin was reported to have leaked from a pipeline, spilling into Blacktail Creek, North Dakota. Geochemical and biological samples were collected in February and June 2015 to identify geochemical signatures of spilled wastewaters as well as biological responses along a 44-km river reach. February water samples had elevated chloride (1030mg/L) and bromide (7.8mg/L) downstream from the spill, compared to upstream levels (11mg/L and <0.4mg/L, respectively). Lithium (0.25mg/L), boron (1.75mg/L) and strontium (7.1mg/L) were present downstream at 5-10 times upstream concentrations. Light hydrocarbon measurements indicated a persistent thermogenic source of methane in the stream. Semi-volatile hydrocarbons indicative of oil were not detected in filtered samples but low levels, including tetramethylbenzenes and di-methylnaphthalenes, were detected in unfiltered water samples downstream from the spill. Labile sediment-bound barium and strontium concentrations (June 2015) were higher downstream from the Spill Site. Radium activities in sediment downstream from the Spill Site were up to 15 times the upstream activities and, combined with Sr isotope ratios, suggest contributions from the pipeline fluid and support the conclusion that elevated concentrations in Blacktail Creek water are from the leaking pipeline. Results from June 2015 demonstrate the persistence of wastewater effects in Blacktail Creek several months after remediation efforts started. Aquatic health effects were observed in June 2015; fish bioassays showed only 2.5% survival at 7.1km downstream from the spill compared to 89% at the upstream reference site. Additional potential biological impacts were indicated by estrogenic inhibition in downstream waters. Our findings demonstrate that environmental signatures from wastewater spills are persistent and create the potential for long-term environmental health effects.

ZIKA VIRUS STRATEGIC RESPONSE FRAMEWORK FOR THE GULF STATES-2016: AN URGENT NEED FOR COLLABORATION

The Zika virus (ZIKV) became the latest threat to global health security when WHO declared on 1t February 2016, that recently reported clusters of microcephaly and other neurological disorders in Brazil constitute a Public Health Emergency of International Concern (PHEIC). These clusters were reported concurrently with an outbreak of ZIKV, which has been ongoing in Brazil and other countries in the America region since 2015. A growing body of clinical and epidemiological data possibly leans towards a causal role for ZIKV as the occurrence of the clusters of microcephaly and other neurological disorders principally the Guillain-Barre' syndrome are associated in time and place with the ongoing ZIKV transmission in the America region. So far, Zika viral transmission has been documented in a total of 69 countries and territories with autochthonous transmission from 20I7 to 10 August 2016. The geographical range of ZIKV has been increasing steadily. Consid'ring the presence of competent vectors that transmit ZIKV in, some parts of the Gulf countries, and the close relationship with Brazil, a local transmission of the virus is plausible once the virus is introduced through travel. This review suggests the integration of epidemiologicalind entomological surveillance for monitoring and control of the vectors of ZIKV. The risks associated with ZIKV infection and the possible threat to the Gulf States was described. A strategic Zika response framework (SRF) for the Gulf States has been developed to meet'their,urgent need for a collaborative and coordinated response for prevention and spread of ZIKV infection. A coordinated response of all partners in the Gulf States across sectors and services at national, as well as, regional levels is required.

The extended nasoseptal flap for coverage of large cranial base defects

BACKGROUND

The nasoseptal flap (NSF) is commonly used to repair skull base defects via a transnasal endoscopic approach. The original description of the technique includes 2 parallel incisions that follow the sagittal plane of the septum. We describe a novel modification to the traditional NSF that allows coverage along the posterior wall of the frontal sinus.

METHODS

In addition to the 2 sagittal incisions, a third incision is made between these coursing along the maxillary crest from the posterior edge to the midportion of the flap. This provides an extension that can be rotated further anteriorly. We report 4 adult patients with skull base defects too large and anterior to cover with a traditional NSF, on whom we successfully reconstructed with the extended flap. We also performed the technique on six cadaver heads (11 flaps) to provide average measurements of the extension.

RESULTS

Our patients were successfully repaired with maintained flap survival. We were able to achieve an average of 1.9 cm, or 26.8%, of additional length on the cadaveric study.

CONCLUSION

The relaxing incision described here creates a flap that allows for reconstruction of a larger range of skull base defects.

An evaluation of invasive fungal sinusitis outcomes with subsite analysis and use of frozen section analysis

BACKGROUND

Invasive fungal sinusitis (IFS) is an aggressive mycosis of the nasal cavity with frequent extension to adjacent structures. Occurring more commonly in immunocompromised individuals, prognosis is typically poor despite aggressive treatment. This study aims to examine postoperative outcomes and survival of a cohort of fungal sinusitis patients at an academic center, as well as identify causes of death in IFS patients.

METHODS

This study was a retrospective chart review of patient charts and departmental records, yielding patient demographics, medical and surgical treatments, pathology records, and outcomes data.

RESULTS

Twenty-seven patients were identified from departmental records between 1998 and 2014. Twenty-one patients presented with Mucor infections, whereas the remaining 6 patients had Aspergillus. All patients were immunocompromised: diabetes (n = 14) and hematologic malignancy (n = 13). Three patients had multiple causes of immunosuppression. Most commonly involved subsites were the maxillary, ethmoid, and sphenoid sinuses. Nasal septum involvement was independently associated with mortality (p < 0.01). Overall mortality was 57.7% within 1 year, although 66.7% of fatalities occurred within 1 month of diagnosis.

CONCLUSION

Overall survival for IFS remains poor. Widespread disease and nasal septum involvement were associated with a negative clinical course. Early identification and aggressive surgical and antifungal therapy is warranted. Even despite intense therapy, comorbid conditions and drug toxicity increase mortality and complicate the clinical course.

Assessing environmental impacts of constructed wetland effluents for vegetable crop irrigation

The objective of this study was to monitor and assess environmental impacts of reclaimed wastewater (RW), used for irrigation of vegetable crops, on soil, crop quality and irrigation equipment. During 2013, effluents of a horizontal sub-surface flow constructed treatment wetland (TW) system, used for tertiary treatment of sanitary wastewater from a small rural municipality located in Eastern Sicily (Italy), were reused by micro-irrigation techniques to irrigate vegetable crops. Monitoring programs, based on in situ and laboratory analyses were performed for assessing possible adverse effects on water-soil-plant systems caused by reclaimed wastewater reuse. In particular, experimental results evidenced that Escherichia coli content found in RW would not present a risk for rotavirus infection following WHO (2006) standards. Irrigated soil was characterized by a certain persistence of microbial contamination and among the studied vegetable crops, lettuce responds better, than zucchini and eggplants, to the irrigation with low quality water, evidencing a bettering of nutraceutical properties and production parameters.

Surgical Techniques for Sinonasal Malignancies

Sinonasal malignancies are a rare subset of malignancies of the upper aerodigestive tract which had been traditionally approached via open techniques. This article primarily addresses a paradigm shift in endoscopic endonasal oncological resection utilizing principles of tumor disassembly and negative margins. The surgical steps to these endoscopic techniques are detailed, emphasizing principles of sound oncological resection.

Pulmonary hyperpolarized (129) Xe morphometry for mapping xenon gas concentrations and alveolar oxygen partial pressure: Proof-of-concept demonstration in healthy and COPD subjects

PURPOSE

Diffusion-weighted (DW) hyperpolarized (129) Xe morphometry magnetic resonance imaging (MRI) can be used to map regional differences in lung tissue micro-structure. We aimed to generate absolute xenon concentration ([Xe]) and alveolar oxygen partial pressure (pA O2 ) maps by extracting the unrestricted diffusion coefficient (D0 ) of xenon as a morphometric parameter.

METHODS

In this proof-of-concept demonstration, morphometry was performed using multi b-value (0, 12, 20, 30 s/cm(2) ) DW hyperpolarized (129) Xe images obtained in four never-smokers and four COPD ex-smokers. Morphometric parameters and D0 maps were computed and the latter used to generate [Xe] and pA O2 maps. Xenon concentration phantoms estimating a range of values mimicking those observed in vivo were also investigated.

RESULTS

Xenon D0 was significantly increased (P = 0.035) in COPD (0.14 ± 0.03 cm(2) /s) compared with never-smokers (0.12 ± 0.02 cm(2) /s). COPD ex-smokers also had significantly decreased [Xe] (COPD = 8 ± 7% versus never-smokers = 13 ± 8%, P = 0.012) and increased pA O2 (COPD = 18 ± 3% versus never-smokers = 15 ± 3%, P = 0.009) compared with never-smokers. Phantom measurements showed the expected dependence of D0 on [Xe] over the range of concentrations anticipated in vivo.

CONCLUSION

DW hyperpolarized (129) Xe MRI morphometry can be used to simultaneously map [Xe] and pA O2 in addition to providing micro-structural biomarkers of emphysematous destruction in COPD. Phantom measurements of D0 ([Xe]) supported the hypotheses that differences in subjects may reflect differences in functional residual capacity.

Decellularized periodontal ligament cell sheets with recellularization potential

The periodontal ligament is the key tissue facilitating periodontal regeneration. This study aimed to fabricate decellularized human periodontal ligament cell sheets for subsequent periodontal tissue engineering applications. The decellularization protocol involved the transfer of intact human periodontal ligament cell sheets onto melt electrospun polycaprolactone membranes and subsequent bi-directional perfusion with NH4OH/Triton X-100 and DNase solutions. The protocol was shown to remove 92% of DNA content. The structural integrity of the decellularized cell sheets was confirmed by a collagen quantification assay, immunostaining of human collagen type I and fibronectin, and scanning electron microscopy. ELISA was used to demonstrate the presence of residual basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), and hepatocyte growth factor (HGF) in the decellularized cell sheet constructs. The decellularized cell sheets were shown to have the ability to support recellularization by allogenic human periodontal ligament cells. This study describes the fabrication of decellularized periodontal ligament cell sheets that retain an intact extracellular matrix and resident growth factors and can support repopulation by allogenic cells. The decellularized hPDL cell sheet concept has the potential to be utilized in future "off-the-shelf" periodontal tissue engineering strategies.

Aerobic exercise increases hippocampal volume and improves memory in multiple sclerosis: preliminary findings

Multiple sclerosis leads to prominent hippocampal atrophy, which is linked to memory deficits. Indeed, 50% of multiple sclerosis patients suffer memory impairment, with negative consequences for quality of life. There are currently no effective memory treatments for multiple sclerosis either pharmacological or behavioral. Aerobic exercise improves memory and promotes hippocampal neurogenesis in nonhuman animals. Here, we investigate the benefits of aerobic exercise in memory-impaired multiple sclerosis patients. Pilot data were collected from two ambulatory, memory-impaired multiple sclerosis participants randomized to non-aerobic (stretching) and aerobic (stationary cycling) conditions. The following baseline/follow-up measurements were taken: high-resolution MRI (neuroanatomical volumes), fMRI (functional connectivity), and memory assessment. Intervention was 30-minute sessions 3 times per week for 3 months. Aerobic exercise resulted in 16.5% increase in hippocampal volume and 53.7% increase in memory, as well as increased hippocampal resting-state functional connectivity. Improvements were specific, with no comparable changes in overall cerebral gray matter (+2.4%), non-hippocampal deep gray matter structures (thalamus, caudate: -4.0%), or in non-memory cognitive functioning (executive functions, processing speed, working memory: changes ranged from -11% to +4%). Non-aerobic exercise resulted in relatively no change in hippocampal volume (2.8%) or memory (0.0%), and no changes in hippocampal functional connectivity. This is the first evidence for aerobic exercise to increase hippocampal volume and connectivity and improve memory in multiple sclerosis. Aerobic exercise represents a cost-effective, widely available, natural, and self-administered treatment with no adverse side effects that may be the first effective memory treatment for multiple sclerosis patients.

Acceptance and discomfort from atraumatic restorative treatment in secondary school students in Egypt

OBJECTIVES

To assess the level of acceptance and discomfort experienced by secondary school students when undergoing an atraumatic restorative treatment (ART) restoration.

SUBJECTS AND METHODS

Ninety secondary school students, aged 14 and 15 years, were included in the study. The ART restorations were prepared in 90 cavities and restored using an encapsulated high-viscosity glass ionomer. The depth of the cavities was judged from radiographs and clinically into outer, middle and inner third of dentine. Using a graded periodontal probe, cavity size was measured, into approximately half the width of the mesiodistal and buccolingual/palatal distance of the occlusal surface. The students were asked about the level of sensation experienced during cavity preparation immediately after completion of restoration. chi(2)-Test was used to test the effect of cavity depth and size on sensitivity from the teeth.

RESULTS

Of the 90 students, 6 (6.6%) and 26 (29.2%) experienced pain and discomfort, respectively, during cavity preparation, more often in large than in small cavities (p = 0.003) and in cavities extending into the inner third than in the middle and outer third of dentine (p < 0.0001). Only 1 student reported postoperative sensitivity.

CONCLUSIONS

The ART approach to treat dental cavities was well accepted by this group of secondary school students. Only a few reported pain during cavity instrumentation, and this was more prevalent in large cavities and in cavities with the floor close to the pulp.

Immunohistochemical distinction of follicular thyroid adenomas and follicular carcinomas

OBJECTIVES

To use immunohistochemical (IHC) evaluation of proteins encoded by genes that were differentially expressed in follicular thyroid adenomas (FAs) vs follicular thyroid carcinomas (FTCs) to distinguish benign vs malignant follicular thyroid lesions. Multiple gene microarray studies suggest that benign and malignant follicular thyroid neoplasms have different gene expression profiles.

DESIGN

Immunohistochemical analysis of thyroid neoplasms, including FA (n = 62), FTC (n = 62), and follicular variant of papillary thyroid carcinoma (n = 58), using tissue microarrays. We evaluated antibodies galectin-3, autotaxin, intestinal trefoil factor 3 (TFF3), extracellular matrix metalloproteinase inducer (EMMPRIN), and growth arrest and DNA damage-inducible protein 153 (GADD153). We analyzed data for quantitative differences in IHC intensity and the percentage of positive cells between FAs and combined follicular carcinomas. Sensitivity and specificity analysis are reported, along with a dual-protein clinical algorithm.

SETTING

Academic tertiary care center.

PATIENTS

Adults with known follicular and papillary thyroid lesions that were surgically resected during the past 15 years.

MAIN OUTCOME MEASURES

Sensitivity and specificity of individual and combined antibodies for detecting benign from malignant lesions.

RESULTS

Quantitative analysis showed IHC validation of the gene expression differences noted in previously published microarray reports. A significantly higher percentage of FTC cells stained with galectin-3, EMMPRIN, and GADD153. Galectin-3 and EMMPRIN also showed a significantly higher intensity of staining in FTC cells. Compared with malignant lesions, TFF3 stained a greater cell percentage in FAs. Galectin-3 (sensitivity, 0.72; specificity, 0.62) and EMMPRIN (sensitivity, 0.63; specificity, 0.49) had the most promising diagnostic potential with a dual-protein sensitivity of 0.80 and specificity of 0.70. Autotaxin and GADD153 had overall higher sensitivities (0.88 and 0.82, respectively) but very poor specificities (0.02 and 0.21, respectively).

CONCLUSIONS

Protein expression data validate the pooled gene expression results that differentiate FTC from FA. Our results show promise for multiple-protein IHC analysis algorithms and their diagnostic ability. Future studies should focus on clinical translation of these molecular differences for the diagnosis of follicular thyroid neoplasms.

Medical management of obesity: an update

Obesity is rapidly growing global epidemic with monumental impact on health and economics. It is associated with multiple adverse health consequences including hypertension, diabetes, dyslipidemia, coronary heart disease, heart failure and stroke to name a few. It is also associated with premature death. The economic impact of obesity is also striking and represents up to 6% of the total healthcare expenditure worldwide. Therefore, effective therapeutic strategies are desperately needed to curb the rising epidemic of obesity. In this review, we present the underlying cause of obesity, together with pathophysologic insights necessary for the practicing physician as basis for the medical therapeutic options available, that are presented in more details. We also discuss promising therapeutic agents that are under different stages of development.

How we do it: Switching from mechanical perforation to the CO2laser; audit results of primary small-fenestra stapedotomy in a district general hospital

The use of laser for stapedotomy was introduced in our department in the year 2002, and since then has taken over the mechanical technique. A total of 85 patients who had undergone primary stapedotomy with either technique are reported with regards to effectiveness and rate of side effects. Although footplate complications were reduced with the laser, short-term hearing outcomes were similar between the two techniques. In four occasions, the surgeon had to switch back to the mechanical technique unexpectedly. Stapedotomy will continue to be performed with the laser in our department, bearing in mind the occasional need for the older technique.

Role of oral anti-diabetic agents in modifying cardiovascular risk factors

Patients with type 2 diabetes have an increased risk for cardiovascular disease (CVD) and it accounts for up to 80% of excess deaths in these patients. It has been recognized that type 2 diabetes is associated with an increased prevalence of CVD risk factors, including hypertension, dyslipidemia, microalbuminuria, and altered hemostasis. The benefit of cardiovascular protection can only be partially explained by controlling hyperglycemia. Some of the oral agents used to treat hyperglycemia significantly modify other cardiovascular risk factors. This article will review oral agents used to treat type 2 diabetes and their effects on modifying CVD risk factors.

Use of the Hagen-Poiseuille law: a new mathematical approach for the integration and evaluation of anorectal physiological testing in patients with faecal incontinence and pelvic dyschezia and in normal controls

This work was done in order to study the possibility of using the Hagen-Poiseuille law for flow of fluids through tubes to integrate and quantitate the anorectal physiological parameters in patients suffering from faecal incontinence and functional pelvic outlet obstruction compared to normal controls. The Hagen-Poiseuille law was intended to be used in the explanation of the role played by different sensory and motor functions of the anorectal segment in maintaining continence and normal rectal evacuation. The intrarectal pressures during rest, coughing, attempted defaecation, rectal sensation, and rectal compliance at the point of first rectal sensation were measured using anorectal manometry. Anal canal length and diameter were measured using lateral defaecographic views during rest, squeeze, and attempted defaecation, and the anal sphincteric reflex contraction in response to coughing or Valsalva's manoeuver was measured using plug or needle electromyography. These factors were analyzed using the Hagen-Poiseuille law in order to determine anal canal resistance and flow to air, water, and BaSO4 during rest, coughing, and attempted defaecation in controls, during attempted defaecation in patients with functional pelvic outlet obstruction, and during rest and coughing in patients with faecal incontinence. The Hagen-Poiseuille law could detect anal continence in all controls and could also detect and quantitate functional pelvic dyschezia in all patients. The equation could detect and quantitate faecal incontinence in 8 of 14 patients (57.14%) during rest, in 11 of 14 (78.57%) during coughing, and in all 14 patients after correction for sensory and reflex deficits. Both the Hagen-Poiseuille law and the law of Laplace and their proposed hybrid law were successful in explaining some facts concerning factors affecting normal continence and defaecation. The Hagen-Poiseuille law is a useful new mathematical approach for the integration and quantitation of normal and abnormal continence and defaecation. It can be used to plan for treatment and to determine the outcome of patients suffering from functional anorectal disease.

Quantitative image analysis of F-actin in endothelial cells

OBJECTIVE

Filamentous actin (F-actin) plays a central role in maintaining endothelial barrier function. Thrombin and histamine, two inflammatory mediators that increase endothelial permeability, can alter F-actin production and distribution. In this study, we use a newly developed image analysis technique to show that these two inflammatory mediators differentially alter F-actin structure.

METHODS

Human umbilical vein endothelial cells were grown to confluence and treated with either histamine (1 microM), thrombin (1 microM) or the agonist's vehicle. The endothelium was stained with BODIPY-phallodin, and digitized images were taken of the treated cells. The digitized images of individual human umbilical vein endothelial cells (HUVEC) were imported into a F-actin image analysis program (FAAP) and converted to layers, each one pixel thick. The program then determined the mean gray level (which corresponded to the amount of F-actin) in each layer starting from the outside of the cell (layer 1) and progressing in one pixel layer increments towards the center of the cell (layer 32).

RESULTS

Both inflammatory mediators increased endothelial F-actin production, however, the distribution of the actin was different. Thrombin increased the presence of stress fibers, while also decreasing peripheral banding actin. In contrast, histamine had no effect on peripheral actin compared to control, but did increase the presence of F-actin stress fibers.

CONCLUSIONS

These results establish that thrombin and histamine alter endothelial F-actin production in different locations within the cell, which can be quantified using an image analysis program.

Obturator internus muscle autotransfer: a new concept for the treatment of anismus. Clinical experience

In this study 20 patients suffering from chronic constipation due to spastic anal sphincters were operated upon using a new surgical technique. The technique aimed at constructing an active anal dilator mechanism using the obturator internus muscles mobilized from both sides and sutured to the side wall of the anal canal in order to overcome the spastic anal sphincters during defaecation. This series included 3 failures (15%), 16 successful cases (80%), and 1 dissatisfied patient despite normal postoperative investigations (5%). Eleven patients (55%) showed immediate postoperative normalization of their defaecation. Five patients (25%) showed normalization of their defaecation after 10 sessions of electric stimulation of the transposed muscles given 1 month postoperatively for 10 successive days. All the successful cases (16 patients) maintained their good results during the period of follow-up which ranged from 16 to 45 months (average = 30.31 months). For the successful cases, follow-up was from 16 to 42 months (average = 26.72 months). Immediate postoperative complications included 3 cases of wound infection and 2 cases of transient incontinence to gases which responded completely to postoperative Faradic stimulation. No cases of persistent incontinence of any degree were detected among the 20 patients studied. The 3 failures were mainly due to avoidable technical problems. The technique was safe, easy, and physiological, using a strictly perineal approach.

Detection of irradiated fruits by gas-chromatographic methods

To detect those fruits which have been subjected to low-dose irradiation (0.5-3 kGy), two methods of chromatography (GC-MS and LC-LC-GC-FID) were used to determine the radiolytic compounds of lipids formed after irradiation, such as alkanes and alkenes. Extraction of volatile hydrocarbon compounds from some parts of irradiated fruits, e.g. the flesh (avocado), seeds (papaya) and kernels (mango and apricot) was carried out. The analysis of hydrocarbons by GC-MS proved the suitability of using C17:1, C16:2, C15:0 and C14:1 as markers for avocados irradiated with a low dose (0.75 kGy). The same indicators appeared following the analysis of papayas and mangoes irradiated with 1.5, and 3.0 kGy. Also, C15:0, C14:1 and C16:3 can be used to identify apricots irradiated with a low dose (0.5 kGy). The detection of alkenes was only improved by a more selective isolation, e.g. of dienes or trienes by LC-LC-GC-FID. Within a few minutes, apricots and avocados irradiated at low doses (0.5 and 0.75 kGy) can be recognized by the indicators C16:2, C17:2 and C16:3, without interfering peaks. In all cases, C16:1, C16:2, C16:3 as well as significant amounts of C17:2 can be used as markers for fruit irradiation.

Effect of L-glutamine supplementation on impaired glucose regulation during intravenous lipid administration

In contrast to L-glutamine, lipid emulsions are routinely administered to patients receiving nutritional support. The provision of fat during intravenous feeding is essential, but the potentially toxic byproducts of fatty acid oxidation may have adverse metabolic consequences. In the present study, we have examined the effect of L-glutamine, an inhibitor of fatty acid oxidation, on the development of defective blood glucose regulation caused by a 48-hour infusion of 10% intralipid in rats. Male Sprague-Dawley rats (200-290 g) were anesthetized with sodium pentobarbital, the right femoral vein cannulated, and baseline blood samples were taken. Each rat was placed in a metabolic cage with access to water, in the presence or absence of rodent chow. Two hours after waking, the rats were infused with 10% intralipid with either saline (control), 2% L-glutamine, or 2% L-alanine. After 48 hours, all animals were sacrificed and blood samples were again obtained. The mean +/- SEM plasma glucose levels before and after lipid infusion at the rate of 1 mL/hr in control rats fed ad libitum, were 125 +/- 13 and 170 +/- 5 mg/dL (p < 0.01, n = 7). Similarly, plasma free fatty acids (FFA) in these animals rose from 0.74 +/- 0.11 to 1.34 +/- 0.32 mmol/L (p < 0.05). Plasma insulin levels also increased from 337 +/- 44 to 1278 +/- 88 pg/mL (p < 0.01). Reduction of intralipid dose infusion did not prevent insulin resistance characterized by hyperglycemia and hyperinsulinemia. However, addition of L-glutamine to the high-dose lipid infusion with chow feeding prevented changes in plasma glucose, insulin levels, and FFA but not triglyceride levels. Also, glutamine but not alanine supplementation in intralipid infused rats without chow feeding prevented changes in plasma glucose, insulin, and malondialdehyde levels. In conclusion, these data show that glutamine supplementation during intravenous lipid administration in rats prevents the development of impaired glucose regulation associated with hyperlipidemia.

Laser welding of everted enterotomies in rats

OBJECTIVE

To assess the feasibility of welding everted enterotomies with laser.

DESIGN

Open study.

MATERIAL

21 Male albino rats (mean weight 152 g).

INTERVENTIONS

28 Full thickness enterotomies (involving 50% to complete circumference of the rat's small intestine) were welded with an Nd-YAG laser non-contact fibre. The bowel ends were everted and held tightly with simple non-toothed forceps during welding.

MAIN OUTCOME MEASURE

Success or failure judged by the naked eye.

RESULTS

Welding was successful in 14/20 (70%) enterotomies that involved half the circumference of the small bowel but in only 3/8 (38%) when the enterotomy extended further because of inadequate tissue opposition. A new visual end point of welding was noticed.

CONCLUSION

Laser welding of everted enterotomies is safe for small enterotomies as judged by the naked eye, but controlled studies are needed before the technique can be tested in humans.

One-week therapy with oral terbinafine in cases of tinea cruris/corporis

The use of oral terbinafine in the treatment of superficial dermatophyte infections has been extensively studied, using different treatment regimens. To evaluate the efficacy of short-term therapy with oral terbinafine in cases of tinea cruris/corporis, 22 patients (21 male and one female) with mycologically proven tinea cruris/corporis, were included in the present study. Each patient received one tablet of terbinafine 250 mg daily for 1 week. Patients were followed-up for 6 weeks after completion of treatment. Clinical and mycological assessments were performed at the end of treatment, and at the end of the follow-up period. The mean sum of scores of signs and symptoms in all patients decreased significantly from 12.36 before treatment to 0 at the end of the follow-up period, and mycological investigations were negative in all patients at the end of the follow-up period. Our results show that 1-week therapy with oral terbinafine is highly effective in the treatment of tinea cruris/corporis.