Medicine by Alexandros G. Sfakianakis: 12/06/17

Wednesday, December 6, 2017

Excess pneumonia and influenza mortality attributable to seasonal influenza in subtropical Shanghai, China

Disease burden attributable to influenza is substantial in subtropical regions. Our study aims to estimate excess pneumonia and influenza (P&I) mortality associated with influenza by subtypes/lineages in Shang...

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2B8hoxu

GSE102226 Gene co-expression networks drive and predict reproductive effects in Daphnia in response to environmental disturbances

Contributors : Jana Asselman ; Michael E Pfrender ; Jacqueline A Lopez ; Joseph R Shaw ; Karel A De Schamphelaere
Series Type : Expression profiling by array
Organism : Daphnia pulex

ncreasing effects of anthropogenic stressors and those of natural origin on aquatic ecosystems have intensified the need for predictive and functional models of their effects. Here, we use gene expression patterns in combination with weighted gene co-expression networks and generalized additive models to predict effects on reproduction in the aquatic microcrustacean Daphnia. We developed models to predict effects on reproduction upon exposure to different cyanobacteria, different insecticides and binary mixtures of cyanobacteria and insecticides. Models developed specifically for groups of stressors (e.g. either cyanobacteria or insecticides) performed better than general models developed on all data. Furthermore, models developed using in silico generated mixture gene expression profiles from single stressor data were able to better predict effects on reproduction compared to models derived from the mixture exposures themselves. Our results highlight the potential of gene expression data to quantify effects of complex exposures at higher level organismal effects without prior mechanistic knowledge or complex exposure data.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2AiHJco

Pedicled iliac crest bone flap transfer for the treatment of upper femoral shaft fracture nonunion: An anatomic study and clinical applications

Purpose

We present the results of a study on the anatomy of the ascending branch of the lateral circumflex femoral artery (AB-LCFA) and the use of the pedicled iliac bone flap transfer perfused by AB-LCFA combined with external fixation for the treatment of the nonunion of upper femoral shaft fractures.

Methods

The orientation, diameter, length, and distribution of the AB-LCFA from 40 lower limbs of adult cadavers were dissected and measured. From 2000 to 2012, 13 patients with nonunion of upper femoral shaft fractures underwent pedicled iliac bone flap transfer perfused by the AB-LCFA combined with external fixation. The time of bone fracture union was recorded based on X-ray examination. The functional results of the femoral shaft were evaluated by the Klemm classification.

Results

The lateral circumflex femoral artery (LCFA) divided into ascending, transverse, and descending branches in 32 specimens (80%). The diameter of the AB-LCFA at the origin was 3.15 ± 0.9 mm and the length of the AB-LCFA was 8.51 ± 3.06 cm. The postoperative course of the procedure was uneventful in all 13 patients. The average follow-up was 15 months. Bone union was achieved in all patients and the average union time was 5.3 months. 12 patients achieved excellent or good functional results based on the Klemm classification.

Conclusion

The AB-LCFA has a consistent orientation and abundant blood flow. The transfer of the iliac crest bone flap perfused by the AB-LCFA while combined with external fixation could be an option for treating the nonunion of upper femoral shaft fractures.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2Bb9SCc

New Breast Cancer Drug May Benefit Younger Women, Too

(Source: The Doctors Lounge - Oncology)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2zUKFHV

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2jorQ9z

Long-term stability of dental adhesive incorporated by boron nitride nanotubes

Publication date: Available online 6 December 2017
Source:Dental Materials
Author(s): Felipe Weidenbach Degrazia, Vicente Castelo Branco Leitune, Fernanda Visioli, Susana Maria Werner Samuel, Fabrício Mezzomo Collares
ObjectiveThe aim of this study was to evaluate physicochemical properties, long-term microtensile bond strength and cytotoxicity of methacrylate-based adhesive containing boron nitride nanotubes (BNNTs) as fillers.MethodsA dental adhesive was formulated using BisGMA/HEMA, 66/33wt% (control). Inorganic BNNT fillers were incorporated into the adhesive at different concentrations (0.05, 0.075, 0.1 and 0.15wt%). Analyses of degree of conversion (DC), polymerization rate [Rp.(s⁻¹)], contact angle (CA) on dentin, after 24h and 6 months microtensile bond strength (μTBS-24h and 6 months) were assessed. Cytotoxicity was performed through viability of fibroblast cells (%) by sulforhodamine B (SRB) colorimetry.ResultsDC and max. polymerization rate increased (p<0.05) after incorporating 0.075 and 0.1wt% BNNT. The contact angle on dentin increased (p<0.05) after incorporating 0.15wt% BNNT. The μTBS-24h showed no changes (p>0.05) after incorporating up to 0.15wt% BNNT comparing to control. After 6 months, μTBS decreased (p<0.05) for control and 0.15wt% BNNT and BNNT groups up to 0.15wt% showed higher μTBS than control (p<0.05). No difference of fibroblast growth was found among adhesives (p>0.05) and up to 19% of cell viability was found comparing 0.05wt% BNNT to positive control group (100%).SignificanceIncorporating boron nitride nanotubes up to 0.1wt% into dental adhesive increased the long-term stability to dentin without decreasing viability of fibroblast cell growth. Thus, the use of BNNTs as filler may decrease failure rate of current dentinal adhesives.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2AfomAN

Sigmoidocolocystoplasty for neurogenic bladder reviewed after 20 years

We report the current status of patients who underwent augmentation cystoplasty (AC) at least 20years previously.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2AAFYWE

2017 Reviewer Acknowledgement

At the conclusion of Volume 52 of the Journal of Pediatric Surgery, the Editors wish to express their gratitude and appreciation for the important editorial consultation and assistance of the members of the Editorial Board and to the representatives of the associations and organizations for which the Journal is the official publication. Their names are listed with the Editorial Board in the front of this issue of the Journal.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2jnmHyw

Announcements of Future Meetings

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2AAhFID

Does clinic visit education within a multidisciplinary center improve health literacy scores in caregivers of children with complex colorectal conditions?

Health literacy is low in an estimated one-third of the US population. Little is known about the health literacy of caregivers of children with colorectal conditions. The objective of this study was to investigate whether a timed health literacy intervention could improve health literacy in this population.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2AypnD4

The bowel function and quality of life of Hirschsprung disease patients who have reached 18 years of age or older – the long-term outcomes after undergoing the transabdominal soave procedure

Hirschsprung disease (HD) is considered curable, but the postoperative bowel function is not always satisfactory. In this study, we evaluated the general condition, bowel function, and social performance in adults who were older than 17years of age who had undergone definitive operations in childhood.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2jnCsWs

Revisiting lip shave: a solution for disorders of the vermilion border

Actinic keratosis, leukoplakia, carcinoma in situ, and superficially invasive carcinomas of the lower lip are caused mainly by the cumulative effects of exposure of the vermilion of the lower lip to ultraviolet radiation. Current treatments all have limitations: cryosurgery or electrosurgery is suitable to treat only focal lesions; topical chemotherapy, which is an option for diffuse actinic damage, yields unreliable results; and laser treatment fails to rejuvenate the vermilion. However, "lip shave", which involves full-thickness excision of the damaged vermilion and reconstruction with an advancement labial mucosal flap, will produce a fresh mucosal lining to the vermilion border. (Source: The British Journal of Oral and Maxillofacial Surgery)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2zVmb14

Effectiveness of irrigation with chlorhexidine after removal of mandibular third molars: a randomised controlled trial

To evaluate the effect of postoperative irrigation with chlorhexidine on inflammatory complications after the extraction of lower third molars under local anaesthesia, we recruited 100 patients to participate in a controlled, single-blind, randomised clinical trial. They were assigned to one of two groups: the intervention group (postoperative irrigation of the surgical site with chlorhexidine for seven days) or the control group (postoperative chlorhexidine mouth rinse for seven days). The primary outcome variables were pain, swelling, trismus, infection, and alveolar osteitis. (Source: The British Journal of Oral and Maxillofacial Surgery)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2nAvB0f

The composite palatal island flap: modification of an existing technique to reconstruct the maxillary alveolus

We describe a new technique to reconstruct the hard and soft tissues of the maxillary alveolus simultaneously, by incorporating an island of palatine bone into a submucosal flap. (Source: The British Journal of Oral and Maxillofacial Surgery)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2zVsYIc

Three-dimensional superimposition for patients with facial palsy: an innovative method for assessing the success of facial reanimation procedures

In this study we aimed to test a new method for assessing facial movements based on 3-dimensional analysis of the facial surfaces. Eleven patients aged between 42 and 77 years who had recently been affected by facial palsy (onset between 6 and 18 months) were treated by an operation based on triple innervation: the masseteric to temporofacial nerve branch, 30% of the hypoglossal fibres to the cervicofacial nerve branch, and the contralateral facial nerve through two cross-face sural nerve grafts. (Source: The British Journal of Oral and Maxillofacial Surgery)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2nAgBiZ

Re: Pentoxifylline: a review of its use in osteoradionecrosis

We read with great interest the recent paper by Lyons and Brennan that reviewed the use of pentoxifylline in the management of osteoradionecrosis.1 This promising regimen has had success within our local practice and across several reported case series. (Source: The British Journal of Oral and Maxillofacial Surgery)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2zUU3v3

Histoplasmosis, una micosis endémica emergente

Publication date: Available online 6 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): A. Pulido Pérez

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2nBZgGy

Granuloma aséptico facial idiopático: hallazgos clínicos y ecográficos de 3 casos

Publication date: Available online 6 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): A.I. Rodríguez-Bandera, M. Feito-Rodríguez, R. Maseda-Pedrero, R. de Lucas-Laguna
El granuloma aséptico facial idiopático es una entidad propia de la infancia que se caracteriza por la presencia de uno o varios nódulos asintomáticos en la mejilla. Aunque su patogenia no está clara, se ha sugerido que pueda pertenecer al espectro de la rosácea infantil. Resuelve espontáneamente pero puede plantear dudas diagnósticas con otras lesiones que sí requieren tratamiento.Presentamos los hallazgos clínicos y ecográficos y la evolución, tanto clínica y ecográfica, de 3 nuevos casos. En 2 pacientes, la lesión se presentó en el contexto de una rosácea infantil. En ecografía, el granuloma aséptico facial idiopático mostró un patrón característico, con variaciones en función del momento evolutivo.La ecografía de alta frecuencia puede facilitar el diagnóstico diferencial, evitando biopsias o extirpaciones innecesarias.Idiopathic facial aseptic granuloma is a typical childhood disease characterized by the presence of one or more asymptomatic nodules on the cheek. Although pathogenesis remains unclear, the disease is thought to be a type of childhood rosacea. It resolves spontaneously, yet it could be confused with other lesions that require treatment.We present clinical and ultrasound findings and outcome from 3 new cases. In 2 cases, the lesion presented as childhood rosacea. Ultrasound revealed a characteristic pattern, with variations depending on the stage of development.High-frequency ultrasound can facilitate the differential diagnosis and thus obviate unnecessary biopsy or excision.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2zXnCfr

Mucormicosis cutánea primaria por Rhizopus arrhizus en una niña de 8 años

Publication date: Available online 6 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): M.F. Albízuri-Prado, A. Sánchez-Orta, A. Rodríguez-Bandera, M. Feito-Rodríguez

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2nB83IR

Proceso de traducción y adaptación cultural de instrumentos de medición en salud

Publication date: Available online 6 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): S. Ortiz-Gutiérrez, A. Cruz-Avelar

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2zUTGk9

Búsqueda de nuevas pautas terapéuticas de imiquimod 5% para el tratamiento de las queratosis actínicas

Publication date: Available online 6 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): R. Salido Vallejo

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2nBzhPs

Pitiriasis liquenoide y varioliforme aguda asociada al virus herpes humano tipo 7

Publication date: Available online 6 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): M. Costa-Silva, A. Calistru, J. Sobrinho-Simões, C. Lisboa, F. Azevedo
Tanto la pitiriasis liquenoide y varioliforme aguda como la pitiriasis liquenoide crónica representan 2 extremos de un espectro de enfermedad de etiología desconocida. En este trabajo se describen 2 casos de pitiriasis liquenoide y varioliforme aguda, en los que se detectó ADN de virus herpes humano tipo 7 en muestras de piel mediante la metodología de reacción en cadena de la polimerasa, una asociación no descrita previamente. Este manuscrito puede apoyar la participación de la infección viral en la etiopatogenia de esta enfermedad.Pityriasis lichenoides et varioliformis acuta and pityriasis lichenoides chronica represent 2 ends of a disease spectrum of unknown etiology. Herein we describe 2 cases of pityriasis lichenoides et varioliformis acuta, in which human herpesvirus 7 DNA was detected in skin samples by polymerase chain reaction methodology, an association not previously described. This report may support the involvement of viral infection in the etiopathogeny of this disease.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2zWlYL8

Un caso de poroqueratosis diseminada eruptiva en un paciente oncológico tratado con trastuzumab y exemestano: ¿fenómeno asociado al cáncer o inducido por fármacos?

Publication date: Available online 6 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): C. Mangas, V. Espeli, R. Blum

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2nCTRyL

La investigación clínica en las secciones territoriales de la Academia Española de Dermatología y Venereología (AEDV)

Publication date: Available online 6 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): Á. Iglesias-Puzas, A. Batalla, Á. Flórez
IntroducciónLa investigación clínica (IC) se centra en el estudio de los pacientes para mejorar su atención. Nuestro objetivo fue conocer qué porcentaje de las comunicaciones presentadas a las reuniones de tres secciones territoriales de la AEDV cumplen criterios de IC, su nivel de evidencia y su evolución temporal.Material y métodosSe revisaron las comunicaciones científicas de las reuniones territoriales gallega, astur-cántabro-castellano-leonesa (ACL) y andaluza publicadas en los suplementos de la revista Actas Dermosifiliográficas (años 2000-2015). Utilizando una definición de IC previamente validada, se estableció cuáles de los resúmenes se ajustaban a dicha definición, se determinó su nivel de evidencia y la evolución temporal del porcentaje de estudios de investigación.ResultadosDe las 1.188 comunicaciones analizadas, el 29,6% cumplieron criterios de IC. La mayoría correspondían a un nivel de evidencia4 (95,2%), distribuidos en un 44,2% de estudios transversales y un 55,8% de series de casos. La prevalencia de la IC en las secciones gallega, ACL y andaluza fue del 26,6% (94,7%, nivel 4), del 22,7% (97,6%, nivel 4) y del 37,2% (94,3%, nivel 4), respectivamente. El porcentaje de trabajos de IC aumentó significativamente a lo largo de los años.ConclusionesLa IC representa el 29,6% de las comunicaciones en las reuniones evaluadas. La mayoría de los trabajos corresponden a series de casos y estudios transversales. Los territorios estudiados muestran diferencias en cuanto al porcentaje de IC, pero siguen una distribución similar de los niveles de evidencia. En el periodo de tiempo evaluado, el porcentaje de comunicaciones sobre IC se ha incrementado.IntroductionClinical research is the study of patients with the aim of improving care. Our objectives were to calculate the percentage of presentations at territorial section meetings of the Spanish Academy of Dermatology and Venereology (AEDV) that described clinical research, to assess the level of evidence the research provided, and to analyze change in clinical research volume over time.Material and methodsWe reviewed supplements of the journal Actas Dermosifiliográficas for 2000 through 2015 that contained abstracts of presentations given at the AEDV section meetings in Galicia; the area comprising Asturias, Cantabria, and Castile-Leon (ACCL); and Andalusia. We selected abstracts that met a previously validated definition of clinical research and categorized each according to level of evidence. We also analyzed how the weight of clinical research presentations changed over time.ResultsOf the total of 1,188 presentations, 29.6% met the criteria that defined clinical research. Most provided level-4 evidence (95.2%); 44.2% of those presentations reported cross-sectional studies and 55.8% analyzed case series. Clinical research accounted for 26.6% of the presentations in Galicia (94.7% of them, level 4), 22.7% of those at the ACCL meeting (97.6%, level 4), and 37.2% of those in Andalusia (94.3%, level 4). The proportion of clinical research increased significantly over the years studied.ConclusionsClinical research accounted for 29.6% of the communications presented at the meetings we reviewed. Most of these presentations concerned case series or cross-sectional studies. The prevalence of clinical research presentations differed between the 3 territories studied, but the levels of evidence were similar. The proportion of clinical research in the programs of these meetings has increased over time.

Graphical abstract

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2zWlJjc

Adoption of clean cookstoves after improved solid fuel stove programme exposure: a cross-sectional study in three Peruvian Andean regions

This study examined measures of clean cookstove adoption after improved solid fuel stove programmes in three geographically and culturally diverse rural Andean settings and explored factors associated with these measures. A questionnaire was administered to 1200 households on stove use and cooking behaviours including previously defined factors associated with clean cookstove adoption. Logistic multivariable regressions with 16 pre-specified explanatory variables were performed for three outcomes; (1) daily improved solid fuel stove use, (2) use of liquefied petroleum gas stove and (3) traditional stove displacement. Eighty-seven percent of households reported daily improved solid fuel stove use, 51% liquefied petroleum gas stove use and 66% no longer used the traditional cookstove. Variables associated with one or more of the three outcomes are: education, age and civil status of the reporting female, household wealth and size, region, encounters of problems with the improved solid fuel stove, knowledge of somebody able to build an improved solid fuel stove, whether stove parts are obtainable in the community, and subsidy schemes. We conclude that to be successful, improved solid fuel stove programmes need to consider (1) existing household characteristics, (2) the household's need for ready access to maintenance and repair, and (3) improved knowledge at the community level.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2ACvEeU

Medical use of cannabis in Switzerland: analysis of approved exceptional licences

In recent years, the Swiss Federal Office of Public Health (FOPH) granted exceptional licenses for the medical use of cannabinoids, typically for 6 months with possible extensions. A systematic review of cannabinoids for medical use commissioned by the FOPH supports the use of cannabinoids for the treatment of chronic pain and spasticity. However, little is known about the patients treated with cannabinoids. We aimed to study medical uses of cannabinoids as part of the FOPH's programme of exceptional licenses.; We examined all requests for medical use of cannabinoids sent to FOPH in 2013 and 2014. A standardised data sheet was developed to extract data from the files of approved requests. We extracted the duration of the licence, the year it was granted, and the payer of the therapy. At the level of the patient we collected the date of birth, sex, region of residence, diagnosis and the indication. Ethical approval was granted by the Ethics Committee of the Canton of Bern.; We analysed 1193 patients licenced for cannabinoid treatment in 2013 or 2014. During 2013, 542 patients were treated under the exceptional licencing programme (332 requesting physicians) compared with 825 in 2014 (446 physicians). Over half of patients (685; 57%) were women. The mean age was 57 years (standard deviation 15.0), chronic pain (49%) and spasticity (40%) were the most common symptoms, and co-medication was reported for 39% of patients. Seventy-eight different diagnoses were recorded, including multiple sclerosis (257 patients, 22%), soft tissue disorders (119, 10%), dorsalgia (97, 8.1%), spinal muscular atrophy (65, 5.5%) and paraplegia/tetraplegia (62, 5.2%). Licence extensions were granted to 143 patients (26.4%) in 2013 and 324 patients (39.3%) in 2014. There were substantial regional variations of the rates of patients treated with cannabinoids. On average, eight patients per 100 000 residents received an exceptional licence. Most patients (1083, 91%) paid out of pocket.; Exceptional licences for medical use of cannabinoids have increased substantially in Switzerland, with the programme including patients with a wide range of conditions.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2AZsKn5

The recurrent campylobacteriosis epidemic over Christmas and New Year in European countries, 2006-2014

Campylobacteriosis is the most frequently reported foodborne disease in Europe with a notification rate of 71 per 100,000 population in the European Union in 2014. Surveillance data show a clear seasonality whereby case numbers peak during summer months in entire Europe and at the turn of the year, especially in Germany and Switzerland. A detailed description of European surveillance data by country at the turn of the year was missing so far. The objectives of the presented work were to describe national surveillance data of The European Surveillance System for 14 countries during winter times and to generate hypotheses for the observed seasonality of campylobacteriosis cases.; The analysis included 317,986 cases notified between calendar weeks 45 and 8 of winter seasons 2006/2007-2013/2014. Winter peaks in weekly case notifications and notification rates were observed for Austria, Belgium, Finland, Germany, Luxembourg, The Netherlands, Switzerland and Sweden while for Denmark, France, Ireland, Italy, Norway and the United Kingdom no unusual increase was observed. Generally, weekly notification rates peaked in calendar week 1 or 2 after a strong decline in the last week of December and reached values of a multiple of the observed notification rates in the weeks before or after the peak e.g. up to 6.5 notifications per 100,000 population per week in Luxembourg. Disease onset of cases notified during winter peaks occurred predominantly in calendar weeks 52 and 1 and point towards risk exposures around Christmas and New Year. The consumption of meat fondue or table top grilling poses such a risk and is popular in many countries with an observed winter peak. Additionally, increased travel activities over the festive season could foster campylobacteriosis transmission. Surveillance artefacts (e.g. reporting delays due to public holidays) should be excluded as causes for country-specific winter peaks before investigating risk exposures.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2ACLgyU

Steroid Alkaloids from Holarrhena africana with Strong Activity against Trypanosoma brucei rhodesiense

In our continued search for natural compounds with activity against Trypanosoma brucei, causative agent of human African trypanosomiasis (HAT, "sleeping sickness"), we have investigated extracts from the leaves and bark of the West African Holarrhenaafricana (syn. Holarrhena floribunda; Apocynaceae). The extracts and their alkaloid-enriched fractions displayed promising in vitro activity against bloodstream forms of T. brucei rhodesiense (Tbr; East African HAT). Bioactivity-guided chromatographic fractionation of the alkaloid-rich fractions resulted in the isolation of 17 steroid alkaloids, one nitrogen-free steroid and one alkaloid-like non-steroid. Impressive activities (IC50 in µM) against Tbr were recorded for 3β-holaphyllamine (0.40 ± 0.28), 3α-holaphyllamine (0.37 ± 0.16), 3β-dihydroholaphyllamine (0.67 ± 0.03), N-methylholaphyllamine (0.08 ± 0.01), conessimine (0.17 ± 0.08), conessine (0.42 ± 0.09), isoconessimine (0.17 ± 0.11) and holarrhesine (0.12 ± 0.08) with selectivity indices ranging from 13 to 302. Based on comparison of the structures of this congeneric series of steroid alkaloids and their activities, structure-activity relationships (SARs) could be established. It was found that a basic amino group at position C-3 of the pregnane or pregn-5-ene steroid nucleus is required for a significant anti-trypanosomal activity. The mono-methylated amino group at C-3 represents an optimum for activity. ∆(5,6) unsaturation slightly increased the activity while hydrolysis of C-12β ester derivatives led to a loss of activity. An additional amino group at C-20 engaged in a pyrrolidine ring closed towards C-18 significantly increased the selectivity index of the compounds. Our findings provide useful empirical data for further development of steroid alkaloids as a novel class of anti-trypanosomal compounds which represent a promising starting point towards new drugs to combat human African trypanosomiasis.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2AX7Chk

Quantifying the prognostic significance in glioblastoma of seizure history at initial presentation: A systematic review and meta-analysis

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Victor M. Lu, Toni R. Jue, Kevin Phan, Kerrie L. McDonald
The role of prognostic factors in the management of glioblastoma (GBM) is very important given the stasis in improving its clinical outcomes. Patients who initially present with a positive seizure history at diagnosis have anecdotally experienced superior survival outcomes. The aim of this review was to perform a systematic review and meta-analysis to quantify the potential prognostic significance of positive seizure history in GBM patients. A search strategy was performed using the PRISMA guidelines for article identification, screening, eligibility and inclusion. Relevant articles were identified from six electronic databases from their inception to August 2017. These articles were screened against established criteria for inclusion into this study. Meta-analysis was conducted by pooling results with multivariate-adjusted hazard ratios (HRs). After screening, 6 relevant studies were included for analysis. There was a total cohort of 1836 GBM patients, of which 488 (27%) had a positive seizure history at initial presentation. There was a significant association found between positive seizure history in GBM patients and less mortality events, with an overall HR of 0.71 (95%CI=0.63–0.81, p<0.00001, I²=4%). Positive seizure history at initial presentation of GBM can be associated with improved prognosis. However, there are a number of variables that need to be considered further, including genetic profiling, lead time bias, and anti-epileptic drug (AED) therapy. This review represents the highest level of evidence to date, and its result will be validated by future, prospective study of larger cohorts.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2zXxdDd

Practical prognostic score for predicting the extent of resection and neurological outcome of gliomas in the sensorimotor area

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Giannantonio Spena, Federico D'Agata, Pier Paolo Panciani, Luciano Buttolo, Michela Buglione di Monale Bastia, Marco Maria Fontanella
ObjectiveIn this prospective study, we assessed the utility of a novel prognostic score (PS) in guiding the surgical strategy of patients with sensorimotor area gliomas.Patients and methodsForm December 2012 to April 2016, we collected data from patients diagnosed with brain gliomas in the sensorimotor area. All the patients had intraoperatively confirmed contiguity or continuity with sensorimotor cortical and subcortical structures. Several clinical and radiological factors were analyzed to generate a PS for each patient (range 1–8). The end-points included the extent of resection (EOR) and neurological outcome (modified Rankin Score; mRS). We assessed the predictive power of the PS using different analyses. Crosstabs analyses and Fisher's exact test (Fet) were used to evaluate the possible predictive parameters, and for the classification of positive or negative outcomes for the chosen proxies; the significance threshold was set at p<0.05.ResultsUsing independent t-tests, we compared the mRS at different time points (pre, post, and at 6 months) for 2 subgroups from the total sample using a cut-off PS value of 4. For the EOR, a PS value of ≥5 was predictive of successful outcome, a value of 4 indicated an uncertain outcome, and a value of ≤3 predicted a worse outcome.ConclusionsThis PS value can be easily used in clinical settings to help predict the functional outcome and EOR in sensorimotor area tumors. Integration with information from fMRI, DTI, and TMS, along with MRI spectroscopy could further enhance the value of this PS.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2nDPJyI

Clinical outcomes of primary intracranial malignant melanoma and metastatic intracranial malignant melanoma

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Joonho Byun, Eun Suk Park, Seok Ho Hong, Young Hyun Cho, Young-Hoon Kim, Chang Jin Kim, Jeong Hoon Kim, Seungjoo Lee
ObjectivesPrimary intracranial malignant melanoma (PIMM) is extremely rare central nervous system (CNS) tumor and known for only composed 0.07% of the CNS tumors. PIMM composed only 1% of malignant melanoma and accordingly their clinical behavior and prognosis are not well documented. So, herein, we report our experience of pathologically proven PIMM, and compared their clinical characteristics and outcome with metastatic intracranial malignant melanoma (MIMM).Patients and methodsOur institutional database was reviewed for patients who diagnosed as PIMM and MIMM pathologically between 1996–2016. As a result, a total of 6 patients of PIMM and 18 patients of MIMM were identified and analyzed. All these patients' clinical, radiological, histopathological and surgical records were obtained and reviewed.ResultsThe median age of PIMM patients at initial surgery was 54.5 years (range, 30–60 years). During the mean follow-up of 12.8 months (range: 9–21 months), tumor recurrence occurred in 5 patients (83.3%). The overall survival rates of PIMM at 6, 9, 12 and 18 months were 100%, 83%, 50% and 25%. The PFS rates of PIMM at 3,6,9 and 12 months were 66.7%, 50%, 16.7% and 16.7%. The overall survival rates and progression-free survival rate difference between PIMM and MIMM were not statistically significant. (p=0.723 and p=0.6, respectively).ConclusionAccording to our experience, PIMM is very aggressive malignant tumor. Its median survival was less than 1year. We suggest that maximal safe resection plus adjuvant RT and CTX for intracranial malignant melanoma considering highly aggressive clinical course of this tumors.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2zUTxx7

Brain tumors associated with psychogenic non-epileptic seizures: Case series

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Catherine R. Garcia, Gulam Q. Khan, Amy M. Morrow, Priyanka Yadav, Donita D. Lightner, Frank G. Gilliam, John L. Villano
ObjectiveThe association of psychogenic non-epileptic seizures (PNES) with primary or secondary brain tumors has not been well described in the literature. We aim to discuss their association, and their impact in brain tumor treatment.Patients and methodsWe identified four patients retrospectively from our practice. The diagnosis of PNES was based on clinical suspicion and standard EEG, supplemented with video-EEG recording in 2 patients.ResultsThe initial diagnosis of brain tumor was associated with a new onset seizure prior to diagnosis. The majority of the patients presented with ES followed by recurrent PNES during the course of their disease. Patients were treated with multiple anti-epileptic drugs, requiring frequent schedule adjustments. The preferred tumor treatment modality was chemotherapy, followed by surgical resection. The patients were offered psychological consultation achieving partial control of their events. These patients manifested recurrent disabling clinical events that required multiple medical consultations. None of these patients presented clinical evidence of tumor progression at the time of PNES presentation.ConclusionA high index of suspicion and early psychological consultation referral will likely mitigate the quality of life impact of PNES in these patients.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2nDPELq

A right amygdalohippocampectomy: A diagnostic challenge

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Frank Jonker, Cees Jonker, Laura Bronzwaer, Erik Scherder
ObjectiveAmygdalohippocampectomy (AHE) is the resective surgery for medically intractable mesial temporal lobe epilepsy. To date no study has investigated a wide range of neuropsychiatric symptoms in right AHE outpatients.Patients and methodsThree patients with right AHE participated in this study. The control group are patients with cognitive complaints with no history of epilepsy or neurological impairment and no structural abnormalities on the MRI/CT. We expected no difference in verbal memory compared to the controls. Concerning affective Theory of Mind (ToM) we expect a difference between controls and AHE patients. In terms of behavior it is expected that coping and behavioral questionnaires do not significantly differ between AHE and controls, but that proxies of AHE patients do report more behavioral/psychiatric symptoms.ResultsNo significant difference was found between groups concerning the cognitive functions. For affective ToM we did find a significant difference (p=0.044). A significant difference for the use of more reassuring thoughts (p=0.006) and a trend for less passive reactions on the coping questionnaire, suggesting an 'active coping style'. Overall, AHE patients report fewer problems the self- reported questionnaires. Proxies of the AHE patients reported a trend for more behavioral disinhibition compared to proxy ratings of the control group.ConclusionRight AHE patients underestimate their behavioral and emotional changes due to self-awareness deficits. Ratings of significant others are of immense importance for the detection of psychiatric and behavioral problems. Lesions in the amygdala- orbitofrontal cortex connection disrupt the emotional network, which might explain our results.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2zXWMUE

Trends in peri-operative performance status following resection of high grade glioma and brain metastases: The impact on survival

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Chirag K. Patel, Ravi Vemaraju, James Glasby, Joanne Shires, Tessa Northmore, Malik Zaben, Caroline Hayhurst
ObjectivesMaximal surgical resection of high grade brain tumours is associated with improved overall survival (OS). It carries the risk of neurological deterioration leading to worsening performance status (PS), which may affect overall survival and preclude patients from adjuvant therapy. We aim to review the changes in performance status of patients undergoing resection of high grade tumours and metastases and the impact of changes on overall survival.Patients and methodsA prospective study of the perioperative performance status of 75 patients who underwent primary resection of malignant primary brain tumour or solitary metastasis in a single centre. Data on patients' demographics, tumour histology and overall survival were also collected. WHO performance status was recorded pre-operatively and at intervals following surgery.ResultsOf the 75 patients (35 males, 40 females, median age 61 years at diagnosis), 50 had primary malignant brain tumours, 25 had metastasis. Although PS dropped at postoperative day 1 in 14 patients (18.7%), 28% improved by day 5 and there was significant improvement by day 14 (41%, p=0.02). The number of patients with PS 3 or worse changed from 4% pre-operatively (n=3) to 8% (n=6). Overall survival is better in those whose PS remained improved or unchanged at 2 weeks after surgery compared to those whose PS deteriorated; high grade glioma median survival 15.67 vs. 2.4 months (p=0.005) and metastasis median survival 8.53 vs.2.33 months (p=0.001).ConclusionOur data demonstrates that although PS may deteriorate immediately after surgery, the majority of patients regain their baseline PS or improve by 2 weeks postoperatively; decisions on fitness for adjuvant treatment should therefore be delayed until then. In those patients whose PS declines following surgery overall survival is poor.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2jnEwOa

Spinal muscular atrophy with progressive myoclonic epilepsy linked to mutations in ASAH1

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Edibe Pembegül Yildiz, Gözde Yesil, Gonca Bektas, Mine Caliskan, Burak Tatlı, Nur Aydinli, Meral Ozmen
Spinal muscular atrophy with progressive myoclonic epilepsy (SMA-PME), a rare disorder caused by mutation in the ASAH1 gene, is characterized by progressive muscle weakness and intractable epilepsy. The literature about SMA-PME is very rare and most of the time limited to case reports. Mutation in the ASAH1 gene is also found in another rare syndrome which is Farber disease. We report a case of a 13.5-year-old girl with SMA-PME associated with ASAH1 gene mutation. She presented with progressive muscle weakness, tremor, seizure, and cognitive impairment. Clinical features and electrophysiological investigations revealed a motor neuron disease and generalized epilepsy. The marked difference in disease manifestations may explain why Farber and SMA-PME diseases were not suspected of being allelic conditions. SMA-PME cases with ASAH1 mutation could be treated using therapeutic studies regarding Farber disease. In patients with undefined PME or lower motor neuron disease cases, ASAH1 mutation scans should be studied.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2AyD6cZ

Circadian rhythm in idiopathic normal pressure hydrocephalus

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Andreas Eleftheriou, Martin Ulander, Fredrik Lundin
ObjectivesThe pathogenesis of idiopathic normal pressure hydrocephalus (iNPH) takes place in structures close to the cerebral ventricular system. Suprachiasmatic nucleus (SCN), situated close to the third ventricle, is involved in circadian rhythm. Diurnal disturbances are well-known in demented patients. The cognitive decline in iNPH is potentially reversible after a shunt operation. Diurnal rhythm has never been studied in iNPH. We hypothesize that there is a disturbance of circadian rhythm in iNPH-patients and the aim was to study any changes of the diurnal rhythm (mesor and circadian period) as well as any changes of the diurnal amplitude and acrophase of the activity in iNPH-patients before and after a shunt operation.Patients and methodsTwenty consecutive iNPH-patients fulfilling the criteria of the American iNPH-guidelines, 9 males and 11 females, mean age 73 (49–81) years were included. The patients underwent a pre-operative clinical work-up including 10m walk time (w10mt) steps (w10ms), TUG-time (TUGt) and steps (TUGs) and for cognitive function an MMSE score was measured. In order to receive circadian rhythm data actigraphic recordings were performed using the SenseWear 2 (BodyMedia Inc Pittsburgh, PA, USA) actigraph. Cosinor analyses of accelerometry data were performed in "R" using non-linear regression with Levenburg- Marquardt estimation. Pre- and post-operative data regarding mesor, amplitude and circadian period were compared using Wilcoxon-Mann-Whitney test for paired data.ResultsTwenty patients were evaluated before and three month post-operatively. Motor function (w10mt, w10ms, TUGt, TUGs) was significantly improved while MMSE was not significantly changed. Actigraphic measurements (mesor, amplitude and circadian period) showed no significant changes after shunt operation.ConclusionThis is the first systematic study of circadian rhythm in iNPH-patients. We found no significant changes in circadian rhythm after shunt surgery. The conceptual idea of diurnal rhythm changes in hydrocephalus is still interesting from a theoretical standpoint and warrants further studies that could include a combination of better designed actigraphic studies in combination with neuroendocrine markers and imaging methods

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2jobQEJ

Bilateral facial nerve palsies secondary to chronic inflammatory demyelinating polyneuropathy following adalimumab treatment

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Anthony Yao, Helen Chan, Richard A.L. Macdonell, Neil Shuey, Jwu Jin Khong
PurposeChronic Inflammatory Demyelinating Polyneuropathy (CIDP) presents uncommonly with cranial nerve involvement with ophthalmological implications.MethodsWe report the case of a 37year-old man who developed CIDP which manifested as progressive and relapsing bilateral facial nerve palsy with lagophthalmos and exposure keratopathy, in the setting of treatment of Crohn's disease with the anti-TNF-alpha agent adalimumab.ResultsSymptoms gradually improved over the course of several months following withdrawal of adalimumab and treatment with intravenous immunoglobulin (IVIg) and oral prednisolone.ConclusionBilateral facial nerve involvement occurs uncommonly as a feature of CIDP in its classic form. The prognosis is good for recovery of facial nerve function with discontinuation of anti-TNF-alpha therapy and concurrent use of steroid and intravenous immunoglobulin in this case.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2AyVtyA

Cerebral Arterio-Venous Malformations in the Paediatric Population: Angiographic Characteristics, Multimodal Treatment Strategies and Outcome

Publication date: Available online 5 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Klaus-Peter Stein, Bernd-Otto Huetter, Sophia Goericke, Neriman Oezkan, Rebecca Leyrer, I. Erol Sandalcioglu, Michael Forsting, Ulrich Sure, Oliver Mueller
ObjectivesCerebral arterio-venous malformations (AVM) are considered congenital lesions, emerging as an important cause of haemorrhagic stroke in children. The potential influence of age on clinical presentation and angio-architecture have been analysed extensively in the last years. Yet, comparative studies comprising ascending age groups may be limited in their conclusions, especially when comparing young children and adults. It is the aim of this study to evaluate characteristic clinical and angiographic features of AVM within a paediatric subgroup and their correlation to age at presentation.Patients and MethodsBetween 1990–2015, 46 children harbouring AVMs were treated at our institution. Clinical presentation, radiological data, treatment strategies and outcome were evaluated retrospectively.ResultsOf 46 consecutive patients, 18 were male and 28 female patients. Mean age was 11.6±4.3years, ranging from 2–17 years. 35 patients (76%) presented with haemorrhage. Seizures were found in 6 patients (13%) and progressive or transient focal neurological deficits in 4 individuals (9%). There was one incidental patient, only. Mean age of children presenting with haemorrhage was significantly lower as compared to those without a history of intracranial bleeding (p=0.1). The size of the AVM was small (n=27, 59%), corresponding a grade I AVM in the majority of patients (N=28, 61%). 41 patients (89%) underwent treatment of their AVM by an interdisciplinary approach achieving complete elimination of the lesion in 34 patients (83%). 34 patients (83%) showed at least a favourable outcome (mRS≤2) at last follow-up. An excellent recovery (mRS 0-1) was noted in 28 patients (68%).ConclusionFrom our data we suggest that patients' age impacts the clinical presentation. Particularly young children seem to bear a higher risk for haemorrhage from their AVM. Treatment of paediatric AVMs can be achieved safely in experienced hands with a high rate of complete elimination and good clinical outcome.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2jnEdmu

Quantitative texture analysis in the prediction of IDH status in low-grade gliomas

Publication date: Available online 5 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Asgeir Store Jakola, Yi-Hua Zhang, Anne J. Skjulsvik, Ole Solheim, Hans Kristian Bø, Erik Magnus Berntsen, Ingerid Reinertsen, Sasha Gulati, Petter Förander, Torkel B. Brismar
ObjectivesMolecular markers provide valuable information about treatment response and prognosis in patients with low-grade gliomas (LGG). In order to make this important information available prior to surgery the aim of this study was to explore if molecular status in LGG can be discriminated by preoperative magnetic resonance imaging (MRI).Patients and MethodsAll patients with histopathologically confirmed LGG with available molecular status who had undergone a preoperative standard clinical MRI protocol using a 3T Siemens Skyra scanner during 2008-2015 were retrospectively identified. Based on Haralick texture parameters and the segmented LGG FLAIR volume we explored if it was possible to predict molecular status.ResultsIn total 25 patients (nine women, average age 44) fulfilled the inclusion parameters. The textural parameter homogeneity could discriminate between LGG patients with IDH mutation (0.12, IQR 0.10-0.15) and IDH wild type (0.07, IQR 0.06-0.09, p=0.005). None of the other four analyzed texture parameters (energy, entropy, correlation and inertia) were associated with molecular status. Using ROC curves, the area under curve for predicting IDH mutation was 0.905 for homogeneity, 0.840 for tumor volume and 0.940 for the combined parameters of tumor volume and homogeneity. We could not predict molecular status using the four other chosen texture parameters (energy, entropy, correlation and inertia). Further, we could not separate LGG with IDH mutation with or without 1p19q codeletion.ConclusionsIn this preliminary study using Haralick texture parameters based on preoperative clinical FLAIR sequence, the homogeneity parameter could separate IDH mutated LGG from IDH wild type LGG. Combined with tumor volume, these diagnostic properties seem promising.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2AxN9Po

Clinical and radiographic comparison of cervical disc arthroplasty with Prestige-LP Disc and anterior cervical fusion: a minimum 6-year follow-up study

Publication date: Available online 5 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Junfeng Zeng, Hao Liu, Beiyu Wang, Yuxiao Deng, Chen Ding, Hua Chen, Yi Yang, Ying Hong, Ning Ning
ObjectivesTo retrospectively compare the long-term clinical and radiographic outcomes of cervical disc arthroplasty (CDA) with Prestige-LP Disc and anterior cervical discectomy and fusion (ACDF) for single-level cervical degenerative disc disease.Patients and MethodsNinety-eight patients (45 CDA and 53 ACDF) with a minimum 6-year follow-up were included. Clinical evaluations included Japanese Orthopedic Association (JOA), visual analogue scale (VAS), and Neck Disability Index (NDI) scores. Radiographic evaluations included sagittal alignment, range of motion (ROM) at the index and adjacent level, adjacent segment degeneration (ASD), and heterotopic ossification (HO).ResultsAt the final follow-up, there were no significant differences in JOA, VAS neck, and VAS arm scores between the two groups. However, NDI scores improved more in the CDA group than in the ACDF group. The sagittal alignment was maintained in both groups. The ROM at the index level in the CDA group was decreased from 9.6±4.3° at baseline to 7.8±4.7° at the final follow-up. The ROM at the cranial adjacent level in the ACDF group was increased. The incidence of ASD was lower in the CDA group than in the ACDF group (26.7% vs 49.1%, p=0.023). HO was observed in 46.7% of the patients but did not influence the clinical outcome.ConclusionBoth CDA with Prestige-LP Disc and ACDF showed good clinical outcomes at a minimum 6-year follow-up. Compared with ACDF, CDA preserved the motion and reduced the incidence of ASD.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2jnE3vo

Prediction of Persistent Hemodynamic Depression after Carotid Angioplasty and Stenting using Artificial Neural Network Model

Publication date: Available online 5 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Jin Pyeong Jeon, Chulho Kim, Byoung-Doo Oh, Sun Jeong Kim, Yu-Seop Kim
ObjectivesTo assess and compare predictive factors for persistent hemodynamic depression (PHD) after carotid artery angioplasty and stenting (CAS) using artificial neural network (ANN) and multiple logistic regression (MLR) or support vector machines (SVM) models.Patients and MethodsA retrospective data set of patients (n=76) who underwent CAS from 2007 to 2014 was used as input (training cohort) to a back-propagation ANN using TensorFlow platform. PHD was defined when systolic blood pressure was less than 90mmHg or heart rate was less 50 beats/min that lasted for more than one hour. The resulting ANN was prospectively tested in 33 patients (test cohort) and compared with MLR or SVM models according to accuracy and receiver operating characteristics (ROC) curve analysis.ResultsNo significant difference in baseline characteristics between the training cohort and the test cohort was observed. PHD was observed in 21 (27.6%) patients in the training cohort and 10 (30.3%) patients in the test cohort. In the training cohort, the accuracy of ANN for the prediction of PHD was 98.7% and the area under the ROC curve (AUROC) was 0.961. In the test cohort, the number of correctly classified instances was 32 (97.0%) using the ANN model. In contrast, the accuracy rate of MLR or SVM model was both 75.8%. ANN (AUROC: 0.950; 95% CI [confidence interval]: 0.813–0.996) showed superior predictive performance compared to MLR model (AUROC: 0.796; 95% CI: 0.620–0.915, p<0.001) or SVM model (AUROC: 0.885; 95% CI: 0.725-0.969, p<0.001).ConclusionsThe ANN model seems to have more powerful prediction capabilities than MLR or SVM model for persistent hemodynamic depression after CAS. External validation with a large cohort is needed to confirm our results.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2AxMwpb

Comparison of dynamic cervical implant versus anterior cervical discectomy and fusion for the treatment of single-level cervical degenerative disc disease: a five-year follow-up

Publication date: Available online 5 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Ce Zhu, Xi Yang, Lei Wang, Bo-wen Hu, Li-min Liu, Lin-nan Wang, Hao Liu, Yue-ming Song
ObjectiveTo compare clinical and radiographic outcomes of dynamic cervical implant(DCI) with anterior cervical discectomy and fusion(ACDF) in the treatment of single-level cervical degenerative disc disease (CDDD) 5 years after surgery.Patients and MethodsForty-three patients with DCI were matched one-to-one with patients with ACDF based on age, gender, and operative segment in this retrospective study. All patients had been followed up for more than 5 years. Radiological assessments included heterotopic ossification(HO), adjacent segment degeneration (ASD), intervertebral height (IH), range of motion (ROM) at C2-7, the implanted level and adjacent levels. Clinical parameters included Visual Analogue Scale (VAS), Japanese Orthopedic Association (JOA) scores, Neck Disability Index (NDI) and Short Form-36 scores(SF-36). Patients were also asked to rate their postoperative satisfaction at final follow-up.ResultsThe postoperative ROM of C2-7 and ROM at the implanted level in the DCI group were higher than those in the ACDF group. The ROM at the implanted level in the DCI group was maintained at 2 years postoperatively but decreased at final follow-up (10.7° vs 4.5°). The rate of HO in the DCI group was 46.5% (20/43). The rate of ASD was comparable between the two groups (16.3% vs 20.9%). The JOA, VAS, NDI, and SF-36 scores were comparable between two groups and improved postoperatively. However, the proportion of patients who reported their level of satisfaction as being very satisfied, or somewhat satisfied was larger in the ACDF group than that in the DCI group (95.3% vs 79.1%).ConclusionsDCI resulted in better ROM of C2-7 and the implanted level than ACDF did. The clinical outcomes were similar between two groups. However, the ROM at the implanted level decreased at final follow-up in the DCI group, which may contribute to patient dissatisfaction. The long-term outcomes were not that satisfactory especially due to the deviation from its original intention as a non-fusion technique. As such, we have not used DCI in the past 2 years.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2jobkXj

SMART coils for intracranial aneurysm embolization: Initial outcomes

Publication date: Available online 2 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Adeel Ilyas, Thomas J. Buell, Ching-Jen Chen, Dale Ding, Daniel Raper, Davis G. Taylor, Jennifer D. Sokolowski, Kenneth C. Liu
ObjectivesEndovascular technology for the treatment of intracranial aneurysms continues to rapidly evolve. The SMART coil (Penumbra Inc., Alameda, CA, USA) is a novel microcoil designed to enhance deliverability. The aim of this single-center, retrospective cohort study is to assess the initial outcomes after aneurysm embolization using SMART coils.Patients and methodsWe reviewed consecutive patients with intracranial aneurysms who underwent endovascular embolization using SMART coils from June 2016 to January 2017. Baseline and initial outcomes data were analyzed.ResultsThe study cohort was comprised of 32 patients with 33 aneurysms. The mean age was 55.8 years. The majority (85%) of aneurysms were located in the anterior circulation. The mean aneurysm maximum diameter and neck width were 6.0mm and 3.1mm, respectively. Dome irregularity and fusiform aneurysm morphology were noted in 33% and 9% of aneurysms, respectively, and 15% presented with subarachnoid hemorrhage. No serious procedural complications occurred, including microcatheter prolapse, intraprocedural aneurysm rupture, or thromboembolism. Device malfunction occurred in one case (3%). The mean packing density was 25%, and the degree of immediate post-embolization aneurysm occlusion was a modified Raymond-Roy grade I, II, IIIa, and IIIb in 48%, 27%, 18%, and 6%, respectively.ConclusionOur preliminary findings suggest that the SMART coil has a favorable initial risk to benefit profile for the embolization of appropriately selected aneurysms. Additional studies of larger cohorts are necessary to determine the mid-term and long-term clinical and angiographic outcomes of aneurysm patients treated with the SMART coil.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2AxMuxz

Intraventricular hemorrhage related to AVM rupture: description, outcomes and impact of intraventricular fibrinolysis

Publication date: Available online 2 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Vianney Gilard, Thomas Metayer, Clement Gakuba, Olivier Langlois, François Proust, Evelyne Emery, Thomas Gaberel
ObjectivesArteriovenous malformation (AVM) rupture could lead to intraventricular hemorrhage (IVH), a particularly severe form of intracranial bleeding. The epidemiology, presentation, management and outcomes of IVH related to AVM rupture have not been clearly addressed yet. The aim of the present study was to investigate the characteristics of IVH related to AVM rupture, with particular attention paid to functional outcomes and to the impact of intraventricular fibrinolysis (IVF).Patients and MethodsBetween 2011 and 2015, all patients suffering from IVH admitted in two tertiary neurosurgical centers were included in a prospective register. Patient with IVH related to AVM rupture were identified (n=29) and their data retrospectively collected. Particular attention was paid on patients who received IVF. We also compared them to 29 apparied aneurysmal IVH.ResultsIVH related to AVM rupture often occurred in young patients. In most cases, intracerebral hemorrhage was associated to IVH. 17% of the patients died, and functional outcome at 6 months was similar to those with aneurysmal IVH. Interestingly, 5 patients received IVF and none experienced any rebleeding.ConclusionIVH related to AVM rupture is a severe form of hemorrhagic stroke, with a poor neurologic prognosis. IVF seems to be safe and may be considered in this particular form of IVH.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2jnCyxj

Insights from Australians with respiratory disease living in the community with experience of self-managing through an emergency department 'near miss for breathlessness: a strengths-based qualitative study

Objectives

Breathlessness 'crises' in people with chronic respiratory conditions are a common precipitant for emergency department (ED) presentations, many of which might be avoided through improved self-management and support. This study sought insights from people with experience of ED 'near misses' where they considered going to the ED but successfully self-managed instead.

Design and methods

A qualitative approach was used with a phenomenological orientation. Participants were eligible if they reported breathlessness on most days from a diagnosed respiratory condition and experience of ≥1 ED near miss. Recruitment was through respiratory support groups and pulmonary rehabilitation clinics. Semistructured interviews were conducted with each participant via telephone or face-to-face. Questions focused on ED-related decision-making, information finding, breathlessness management and support. This analysis used an integrative approach and independent coding by two researchers. Lazarus and Cohen's Transactional Model of Stress and Coping informed interpretive themes.

Results

Interviews were conducted with 20 participants, 15 of whom had chronic obstructive pulmonary disease. Nineteen interviews were conducted via telephone. Analysis identified important factors in avoiding ED presentation to include perceived control over breathlessness, self-efficacy in coping with a crisis and desire not to be hospitalised. Effective coping strategies included: taking a project management approach that involved goal setting, monitoring and risk management; managing the affective dimension of breathlessness separately from the sensory perceptual and building three-way partnerships with primary care and respiratory services.

Conclusions

In addition to teaching non-pharmacological and pharmacological management of breathlessness, interventions should aim to develop patients' generic self-management skills. Interventions to improve self-efficacy should ensure this is substantiated by transfer of skills and support, including knowledge about when ED presentation is necessary. Complementary initiatives are needed to improve coordinated, person-centred care. Future research should seek ways to break the cyclical relationship between affective and sensory-perceptual dimensions of breathlessness.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2nAEZAZ

Social networks, leisure activities and maximum tongue pressure: cross-sectional associations in the Nagasaki Islands Study

Objectives

Social environment is often associated with health outcomes, but epidemiological evidence for its effect on oral frailty, a potential risk factor for aspiration, is sparse. This study aimed to assess the association between social environment and tongue pressure, as an important measure of oral function. The study focused on family structure, social networks both with and beyond neighbours, and participation in leisure activities.

Design

A population-based cross-sectional study.

Setting

Annual health check-ups in a rural community in Japan.

Participants

A total of 1982 participants, all over 40 years old. Anyone with missing data for the main outcome (n=14) was excluded.

Outcome measures

Tongue pressure was measured three times, and the maximum tongue pressure was used for analysis. A multivariable adjusted regression model was used to calculate parameter estimates (B) for tongue pressure.

Results

Having a social network involving neighbours (B=2.43, P=0.0001) and taking part in leisure activities (B=1.58, P=0.005) were independently associated with higher tongue pressure, but there was no link with social networks beyond neighbours (B=0.23, P=0.77). Sex-specific analyses showed that for men, having a partner was associated with higher tongue pressure, independent of the number of people in the household (B=2.26, P=0.01), but there was no association among women (B=–0.24, P=0.72; P-interaction=0.059).

Conclusions

Having a social network involving neighbours and taking part in leisure activities were independently associated with higher tongue pressure. Marital status may be an important factor in higher tongue pressure in men.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2zYh28n

Definite stent thrombosis after drug-eluting stent implantation in coronary bifurcation lesions: A meta-analysis of 3,107 patients from 14 randomized trials

Abstract

Background

Bifurcation percutaneous coronary intervention (PCI) is a challenging procedure, but there are currently inadequate data about definite stent thrombosis (ST) rates of single-stent versus double-stent strategies (SS and DS, respectively).

Methods and results

Randomized clinical trials (RCTs) comparing SS and DS strategies were searched through PubMed, Embase, and the Cochrane Central Register of Controlled Trials. Fourteen RCTs involving 3,107 patients were analyzed. Owing to the high crossover rate (16.49%), both intention-to-treat (ITT) and as-treated (AT) analyses were performed. In the ITT population, there was a significantly lower rate of early definite ST in the SS group (0.26%; DS group 1.14%; P = 0.021). Similarly, in the AT population, there was a significantly lower rate of early definite ST in the SS group (0.23%, DS group 1.07%; P = 0.042). True bifurcation subgroup analysis also showed a significantly lower early definite ST in the SS group (OR = 0.36, 95% CI = 0.15–0.86, P = 0.042) in the ITT population. There was no significant difference of overall, acute, subacute, and late definite ST between the 2 groups.

Conclusions

Early definite ST is reduced when a SS strategy is used in bifurcation lesions.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2B8bz3n

Coronary artery disease, revascularization, and clinical outcomes in transcatheter aortic valve replacement: Real-world results from the East Denmark Heart Registry

Abstract

Transcatheter aortic valve replacement (TAVR) has become an established therapeutic option for patients with symptomatic, severe aortic stenosis. The optimal treatment strategy for concomitant coronary artery disease (CAD) has not been tested prospectively in a randomized clinical trial. This study aimed to describe the degree of CAD, revascularization strategies, and long-term clinical outcomes in a large-scale all-comers TAVR-population. Nine hundred and forty-four consecutive patients underwent TAVR. Obstructive CAD was reported in 224 patients (23.7%)—of these, 150 (66.9%) presented with one-vessel disease (1-VD), 51 (22.8%) with 2-VD, and 23 (10.3%) with 3-VD. Two-thirds underwent coronary revascularization before TAVR; half of those patients with 1-VD and only one-third of those with multivessel disease were completely revascularized. In general, borderline stenoses (50%–70%) were more frequently revascularized in proximal coronary segments than in more distal segments. Long-term survival rates by Kaplan–Meier analysis of the total TAVR population at 5 and 9 years were 64.7% and 54.1%, respectively. A diagnostic coronary angiography was performed in 16.5% of patients within 5 years after TAVR; only 4.8% underwent consequent percutaneous coronary intervention (PCI). There was no difference in survival and need for revascularization post-TAVR between those patients with or without obstructive CAD ± revascularization. Neither was there a survival difference between those with or without previous CABG and/or chronic total occlusion(s). In conclusion, CAD is prevalent in TAVR patients and pre-TAVR coronary revascularization is typically focused on treating proximal and high-grade stenosis. A selective pre-TAVR PCI strategy results in favorable clinical outcomes with very low rates of post-TAVR coronary revascularization.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2Aiu596

Stent graft treatment for infra-inguinal arterial disease for either instent-restenosis and denovo lesions associated with very high rates of failure

Background

FDA approved the Gore Viabahn (WL Gore, Flagstaff, AZ, USA) stent for both femoro-popliteal arterial denovo and instent restenosis (ISRS) lesions. To date there is little data on Viabahn stent graft outcomes in ISRS arterial disease.