Pediatric Radiology

Correction to: Plea for a standardized imaging approach to disorders of sex development in neonates: Consensus proposal from European Society of Paediatric Radiology task force
The above article was published online with an incorrect author name.
Physeal separation in pediatric osteomyelitis

Abstract

In children, acute osteomyelitis, an infection of the bone, is most commonly hematogeneous in origin. Osteomyelitis is most often diagnosed with magnetic resonance imaging (MRI) and findings may include marrow signal changes on T1 and T2, with abnormal enhancement after gadolinium. Imaging helps detect any associated intraosseous or subperiosteal abscesses, which may require orthopedic drainage. In this pictorial essay, we demonstrate the association of acute pediatric osteomyelitis with physeal separation, resulting in what may be confused for simple trauma, although there was no known history of trauma in any of the cases we researched. All of the cases had a large subperiosteal fluid collection with marked separation of the epiphysis from the metaphysis. It is important to recognize this potential association in osteomyelitis, as it is readily visible by radiographs and may lead to diagnostic uncertainty.

A portrait of pediatric leadership: Dr. Benjamin Spock
A novel percutaneous approach to retrieve an ingested extra-esophageal foreign body

Abstract

We report a case of an 8-year-old boy who presented to our emergency department with progressive onset of dysphagia and odynophagia after eating barbecued steak that evening. Radiographs revealed a metal bristle from a barbecue brush at the level of the proximal esophagus. The otolaryngologist attempted to retrieve this bristle using flexible esophagoscopy, but unfortunately it pushed the bristle extra-esophageal. In order to avoid major open surgery with associated morbidity, a novel percutaneous image-guided minimally invasive percutaneous approach was used to successfully retrieve the bristle.

Hermes
Plea for a standardized imaging approach to disorders of sex development in neonates: consensus proposal from European Society of Paediatric Radiology task force

Abstract

This consensus article elaborated by the European Society for Paediatric Radiology task force on gastrointestinal and genitourinary imaging is intended to standardize the imaging approach in newborns with disorders of sex development. These newborns represent a difficult and stressful situation necessitating a multidisciplinary team approach. Imaging plays an important role in the work-up but needs to be optimized and customized to the patient. Ultrasound plays the central role in assessing the genital anatomy. The examination must be conducted in a detailed and systematic way. It must include transabdominal and transperineal approaches with adapted high-resolution transducers. The pelvic cavity, the genital folds, the inguinal areas and the adrenals must be evaluated as well as the rest of the abdominal cavity. A reporting template is proposed. The indications of magnetic resonance imaging and cysto- and genitography are discussed as well as they may provide additional information. Imaging findings must be reported cautiously using neutral wording as much as possible.

Pediatric postmortem computed tomography: initial experience at a children’s hospital in the United States

Abstract

Postmortem CT might provide valuable information in determining the cause of death and understanding disease processes, particularly when combined with traditional autopsy. Pediatric applications of postmortem imaging represent a new and rapidly growing field. We describe our experience in establishing a pediatric postmortem CT program and present a discussion of the distinct challenges in developing this type of program in the United States of America, where forensic practice varies from other countries. We give a brief overview of recent literature along with the common imaging findings on postmortem CT that can simulate antemortem pathology.

Minimally invasive treatment of pediatric head and neck dermoids: percutaneous drainage and radiofrequency coblation

Abstract

Background

Dermoids are common benign head and neck cysts in children containing a variety of different skin elements. Current standard treatment is surgical removal that sometimes requires extensive dissection to ensure complete resection and often leaves unwanted facial scarring. A minimally invasive treatment alternative should offer a similar rate of success with a decrease in operative complexity, recovery time and postoperative scarring.

Objective

To assess the outcomes of our minimally invasive percutaneous treatment of head and neck dermoids, we reviewed our 9-year interventional radiology (IR) department experience.

Materials and methods

The medical records, imaging and procedural details were reviewed from a cohort of pediatric patients with dermoids treated in our IR department from January 2009 through February 2018. Patients in the study underwent ultrasound (US)-guided cyst puncture, 3% Sotradecol (sodium tetradecyl sulfate [STS]) emulsification of the thick cyst contents allowing complete drainage, and radiofrequency coblation of the cyst wall.

Results

In this retrospective study, we report on 22 dermoids in 21 patients. The average patient age was 3 years. Twenty-one of the 22 dermoids were successfully treated for an overall success rate of 95%. Four intraosseous dermoids were successfully treated using computed tomography (CT) guidance instead of, or in addition to, US. Average follow-up time was 22 months.

Conclusion

The combination of percutaneous cyst drainage using STS as an emulsifying agent followed by radiofrequency coblation is a safe, effective, minimally invasive treatment for pediatric patients with head and neck dermoids.

Proximal radius fractures in children: evaluation of associated elbow fractures

Abstract

Background

Additional fractures occur in association with proximal radius fractures, but the extent of these secondary injuries has not been systematically assessed.

Objective

To ascertain the frequency and nature of additional fractures associated with proximal radius injuries in a large pediatric cohort.

Materials and methods

Radiographs meeting search criteria for proximal radius fracture during a 5-year period were reviewed. Fracture characteristics and the coexistence of additional elbow fractures were recorded and analyzed. The retrospective review was compared with initial interpretation and a blinded review by two pediatric musculoskeletal radiologists.

Results

Four hundred ninety-four proximal radius fractures were included. The radial neck was the most common fracture site (89%). Neck fractures occurred in younger patients (mean: 7.3 years) than head fractures (mean: 13.3 years) (P<0.001). Additional elbow fractures occurred in 39%, most commonly at the olecranon (22%). Additional fractures occurred in younger patients (mean: 7.2 years) than isolated proximal radius fractures (mean: 8.5 years) (P<0.001). Elbow joint effusion and complete or displaced radius fractures were each associated with additional elbow fractures (P<0.001). When compared with initial interpretation, 25% of additional fractures were not identified on initial radiographs, of which 44% were occult retrospectively. Fracture identification demonstrated excellent inter-reader reliability (interclass correlation coefficient [ICC]: 0.88, 0.94), but joint effusion interobserver agreement was only fair (ICC: 0.52, 0.41).

Conclusion

Proximal radius fractures in children often occur in association with other elbow fractures, most commonly involving the olecranon. Enhanced awareness of these fracture patterns, especially in the setting of joint effusion or complete and displaced radius fractures, may improve detection to guide appropriate management.

Clinico-radiologic features of pleuroparenchymal fibroelastosis in children

Abstract

Background

Pleuroparenchymal fibroelastosis (PPFE) may be underdiagnosed clinically and radiographically in children with a remote history of cancer, leading to a delay in care and unnecessary lung biopsies.

Objective

To describe the characteristic clinical and radiologic findings of PPFE in a cohort of children to facilitate recognition and noninvasive diagnosis.

Materials and methods

Clinical presentation, history of chemotherapy or radiation therapy, lung or bone marrow transplantation, and lung function testing and outcome were retrospectively extracted from the electronic medical records of eight children treated at our institution’s pulmonary medicine clinic with histopathology confirmation of PPFE from 2008 to 2018. Two pediatric radiologists evaluated the chest imaging studies for the presence or absence of published radiologic findings of PPFE in adults, including platythorax, pneumothorax, upper lobe predominant pleural and septal thickening, and bronchiectasis. Platythorax indices were calculated from the normal chest CT exams of eight age- and gender-matched individuals obtained via the radiology search engine.

Results

The mean presentation age was 12.9 years (range: 7–16 years). Seven of the eight had a history of chemotherapy and radiation therapy for cancer. Three of the eight had undergone bone marrow transplantation and none had undergone lung transplantation. The mean time between chemotherapy, radiation therapy, and/or bone marrow transplantation and the presentation of PPFE was 8.4 years (range: 5.6–12.1 years). Most of the patients presented with dyspnea (63%), cough (50%) and/or pneumothorax (38%). The mean percentage of predicted FEV1 (forced expiratory volume in one second) was 14.1 (range: 7.7–27.5). All eight patients demonstrated platythorax, bronchiectasis, pleural and septal thickening (upper lobes in four, upper and lower lobes in four) and six had pneumothorax. Five underwent lung biopsies, four of whom developed pneumothoraces.

Conclusion

Clinical and radiologic findings of pediatric PPFE are similar to those in adults, although a majority of the former have a history of treated cancer. Clinical presentation of restrictive lung disease, dyspnea, cough or spontaneous pneumothorax years after treatment for childhood cancer combined with platythorax, upper lobe pleural and septal thickening and traction bronchiectasis on chest CT establishes a presumptive diagnosis of PPFE.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Pediatric Radiology

Rheumatology

Editorial introductions
imageNo abstract available
Implications of juvenile idiopathic arthritis genetic risk variants for disease pathogenesis and classification
imagePurpose of review We assess the implications of recent advances in the genetics of juvenile idiopathic arthritis (JIA) for the evolving understanding of inflammatory arthritis in children. Recent findings JIA exhibits prominent genetic associations with the human leukocyte antigen (HLA) region, extending perhaps surprisingly even to the hyperinflammatory systemic JIA category. Some HLA associations resemble those for adult-onset inflammatory arthritides, providing evidence for pathogenic continuity across the age spectrum. Genome-wide association studies have defined an increasing number of JIA-linked non-HLA loci, many again shared with adult-onset arthritis. As most risk loci contain only noncoding variants, new experimental methods such as SNP-seq and innovative big-data strategies help identify responsible causative mutations, termed functional SNPs (fSNPs). Alternately, gene hunting in multiplex families implicates new genes in monogenic childhood arthritis, including MYD88 and the intriguing innate immune gene LACC1. Summary Genetic data indicate a continuity between JIA and adult arthritis poorly reflected in current nomenclature. Advancing methodologies will help to identify new pathogenic mechanisms that inform the understanding of biologic subdivisions within JIA. Resulting insights will facilitate the application of lessons learned across the age spectrum to the treatment of arthritis in children and adults.
Cutaneous manifestations of pediatric lupus
imagePurpose of review To review recent evidence on cutaneous manifestations of lupus, with a focus on evidence for pediatric patients. Recent findings Cutaneous manifestations of SLE are common and may precede signs or symptoms of systemic disease. Early recognition and initiation of therapy improves quality of life by reducing cutaneous disease activity. Antimalarials are first line for moderate-to-severe disease. Photo protection is a critical component of therapy and perhaps the only modifiable risk factor for SLE. Recognition of cutaneous vasculopathy may reduce mortality from vascular occlusion. Summary There is a critical need for better understanding of pathogenesis, risk factors and outcomes in cutaneous lupus to determine optimal treatment and surveillance strategies. Correlation of clinical phenotypes with biomarkers may help to stratify patients, optimize targeted interventions, and influence prognosis.
Interleukin-18 in pediatric rheumatic diseases
imagePurpose of review IL-18 is a pleiotropic cytokine involved in the regulation of innate and adaptive immune responses. IL-18 pro-inflammatory activities are finely regulated in vivo by the inhibitory effects of the soluble IL-18-binding protein (IL-18BP). The elevation of circulating levels of IL-18 has been described in children with systemic juvenile idiopathic arthritis (sJIA). In the recent years, the role of IL-18 in the pathogenesis of secondary haemophagocytic lymphohistiocytosis (sHLH), also referred to as macrophage activation syndrome (MAS), in the context of autoinflammatory diseases, including sJIA, is emerging. Recent findings A large number of studies in patients and animal models pointed to the imbalance in IL-18/IL-18BP levels, causing increased systemic levels of free bioactive IL-18, as a predisposing factor in the development of MAS. Although the exact mechanisms involved in the development of MAS are not clearly understood, increasing evidence demonstrate the role of IL-18 in upregulating the production of interferon (IFN)-γ. Summary On the basis of the first emerging data on the possibility of blocking IL-18, we here discuss the scientific rationale for neutralizing the IL-18/IFNγ axis in the prevention and treatment of sHLH and MAS.
Treatment of juvenile idiopathic arthritis: what’s new?
imagePurpose of review The present review highlights the advances in disease outcome achieved with currently available biologic medications and future perspectives for JIA management. Recent findings In the last two decades, the management of juvenile idiopathic arthritis (JIA) has been revolutionized by appropriate legislative initiatives, the existence of very large collaborative networks and the increased availability of the novel biologic medications. Summary A more rational approach to the management of JIA is being fostered by the recent publication of therapeutic recommendations, consensus treatment plans and for a treat-to-target strategy.
Predicting disease severity and remission in juvenile idiopathic arthritis: are we getting closer?
imagePurpose of review To summarize current research on the prediction of severe disease or remission in children with juvenile arthritis, and define further steps needed towards developing prediction tools with sufficient accuracy for clinical use. Recent findings High disease activity, poor patient-reported outcomes, ankle or wrist involvement, and a longer time from onset to the start of treatment herald a severe disease course and a low chance of remission. Other studies confirmed that age less than 7 years and positive ANA are the strongest predictors of uveitis development. Preliminary evidence suggests ultrasound findings may predict flare in patients with clinically inactive disease, and several new biomarkers show promise. A few prediction tools that combine predictors to estimate the chance of remission or a severe disease course in the medium-term to long-term have shown good accuracy when internally validated in the population in which they were developed. Summary Promising candidate tools for predicting disease severity and long-term remission in juvenile arthritis are now available. These tools need external validation in other populations, and ideally formal trials to assess whether their use in practice improves patient outcomes. We are definitively getting closer, but we are not there yet.
The role of epigenetics in paediatric rheumatic disease
imagePurpose of review Autoimmune/inflammatory disorders can be stratified along a spectrum based on the primary involvement of innate vs. adaptive mechanisms. Stratifying patients based on molecular mechanisms rather than clinical phenotypes may allow for target-directed and individualized treatment. Recent findings Epigenetic events are gene regulatory mechanisms that contribute to inflammation across inflammatory diseases and resemble shared mechanisms that may be used as disease biomarkers and treatment targets. Significant progress has been made dissecting the epigenome in paediatric rheumatic diseases and identifies associations with clinical phenotypes, treatment responses and disease outcomes. Here, we will summarize and discuss epigenetic patterns in autoimmune/inflammatory disorders, underlying molecular alterations and their effects on gene expression and immune phenotypes. Summary Structured investigation of epigenetic events, their causes and effects on immune phenotypes in autoimmune/inflammatory, will improve our understanding of disease, deliver new diagnostic tools and treatment options.
Update on the treatment and outcome of systemic lupus erythematous in children
imagePurpose of review Provide an update of studies published in last 2 years on the outcomes and therapies in childhood-onset systemic lupus erythematous (cSLE). Recent findings Additional evidence has been provided about the benefits of universal hydroxychloroquine in SLE patients, although antimalarial maculopathy may be more prevalent than previously thought. Recent studies support lower glucocorticoid doses than used in the past may provide comparable therapeutic benefits, and cSLE patients can mount adequate immunogenic response and sustain long-term seroprotective titers when vaccinated. Long-term studies of adults with cSLE confirmed that damage accrual increases with disease duration. Cardiovascular disease, renal transplants, replacement arthroplasties, and myocardial infarctions occur between 20 and 40 years of age. Higher prednisone doses predicted higher damage trajectory and antimalarial exposure was protective. There were no prospective clinical trials published in pediatric patients with cSLE, but positive results from phase II trials with bariticinib and ustekinumab in adult SLE may raise the expectation that these drugs could be beneficial when used in cSLE. Summary The dire need for more clinical trials and licensed medications for cSLE persist as well as decreasing damage accrual.
Microbiome and autoimmune diseases: cause and effect relationship
imagePurpose of review The human body is the host of trillions of different prokaryotic microorganisms that colonize the skin and the mucosae. The interaction between human cells and these organisms is mediated by the immune system, sustaining a very complex and fragile balance. The immune cells need to prevent uncontrolled growth of pathogenic microbes and promote tolerance toward the existence of the beneficial ones. Growing evidence associates the disruption of this symbiotic relationship with the development of autoimmune diseases. Recent findings Human studies led to the identification of gut dysbiosis patterns in patients with rheumatoid arthritis, lupus and multiple sclerosis. Interestingly, the inoculation of pathogenic bacteria in animal models was associated with the development of these autoimmune diseases. Summary A better understanding of the microbiota–human interaction will enable the development of novel treatment choices. Currently, new molecules using helminth compounds are under investigation and have already revealed promising results.
The role of Epstein–Barr virus infection in primary Sjögren’s syndrome
imagePurpose of review The purpose of this article is to draw attention to the role of Epstein–Barr virus (EBV) virus in the pathogenesis of the primary Sjögren’s syndrome. The article introduces the problem of consequences of EBV acute infection, and its reactivation, in association with the immune response modulation by the virus and with an increased risk of developing systemic autoimmune diseases and EBV-associated cancers. Recent findings The knowledge about the mechanisms by which the virus may stay for years in a latent phase, unrecognized by the host response immune cells is constantly expanding. There are several mechanisms and theories about EBV influence on the autoimmune process in Sjogren’s syndrome (pSS), including the similarity (molecular mimicry) between viral EBNA-2 protein and Ro-60 antigen or EBER-1 and EBER-2 viral proteins and La antigen. Summary The influence of EBV infection on the development and course of pSS has been proven. It has also been established that both EBV and pSS result in the increased risk of tumor (especially lymphoma) development. In the light of these findings, new ways to manage EBV infections are being sought. Optimal methods for assessing EBV infection status are being devised. Research also aims at finding therapies, which target EBV through the inhibition of the autoimmune process and of viral activity. The present article is an attempt to discuss the most important phenomena and elements linking EBV infection to the primary Sjögren’s syndrome.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Rheumatology

Anaesthesiology

Analgesic efficacy of ultrasound-guided interscalene block vs. supraclavicular block for ambulatory arthroscopic rotator cuff repair: A randomised noninferiority study
BACKGROUND Ultrasound-guided interscalene block (ISB) is the reference technique for pain control after ambulatory upper limb surgery, but supraclavicular block (SCB) is an alternative. OBJECTIVES The aim of this study was to compare the efficacy of SCB vs. ISB in patients undergoing ambulatory arthroscopic rotator cuff repair (ARCR), with the hypothesis of noninferiority of SCB analgesia compared with ISB. DESIGN A randomised, single-blind, noninferiority study. SETTING Hôpital Privé Jean Mermoz, Centre Paul Santy, Lyon, France. PATIENTS Ambulatory ARCR patients. INTERVENTION Patients were randomly allocated (1 : 1) to receive a single injection SCB or ISB, as well as general anaesthesia. All patients received a postoperative analgesic prescription for home use before leaving hospital (including fast-acting oral morphine sulphate). Patients completed a telephone questionnaire on days 1 and 2 postsurgery. MAIN OUTCOME MEASURES Primary endpoint was oral morphine consumption (mg) during the first 2 days postsurgery. If the difference between mean morphine consumption in the SCB vs. ISB group was less than 30 mg, noninferiority of SCB compared with ISB would be demonstrated. Secondary evaluation criteria included pain scores (numerical rating scale), duration of motor and sensory blockade, and satisfaction with treatment. RESULTS The per-protocol cohort included 103 patients (SCB = 52, ISB = 51) (57% men, median age 58 years). Mean morphine consumption in the 48 h postsurgery was 9.4 vs. 14.7 mg in the SCB and ISB groups, respectively (difference −5.3, P < 0.001). The upper limit of the 95% CI was less than 30 mg, demonstrating noninferiority of SCB compared with ISB. No difference was observed between the two groups in terms of pain scores or the duration of motor or sensory blockade. Overall, 98% of patients in the SCB group vs. 90% in the ISB group were satisfied with their treatment. CONCLUSION SCB is as effective as ISB in terms of postoperative analgesia based on oral morphine consumption in patients undergoing ambulatory ARCR. Trial registration: EudraCT number: 2016-A00747-47. Correspondence to Julien Cabaton, MD, Department of Anaesthesiology, Hôpital Privé Jean Mermoz, Centre Paul Santy, 24, avenue Paul Santy, Lyon 69008, France E-mail: cabaton.md This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 © 2019 European Society of Anaesthesiology
Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: A randomised controlled trial
BACKGROUND Pre-operative anxiety in children is very common and is associated with adverse outcomes. OBJECTIVE The aim of this study was to investigate if virtual reality exposure (VRE) as a preparation tool for elective day care surgery in children is associated with lower levels of anxiety, pain and emergence delirium compared with a control group receiving care as usual (CAU). DESIGN A randomised single-blind controlled trial. SETTING A single university children’s hospital in the Netherlands from March 2017 to October 2018. PATIENTS Two-hundred children, 4 to 12 years old, undergoing elective day care surgery under general anaesthesia. INTERVENTION On the day of surgery, children receiving VRE were exposed to a realistic child-friendly immersive virtual version of the operating theatre, so that they could get accustomed to the environment and general anaesthesia procedures. MAIN OUTCOME MEASURES The primary outcome was anxiety during induction of anaesthesia (modified Yale Preoperative Anxiety Scale, mYPAS). Secondary outcomes were self-reported anxiety, self-reported and observed pain, emergence delirium, need for rescue analgesia (morphine) and parental anxiety. RESULTS A total of 191 children were included in the analysis. During induction of anaesthesia, mYPAS levels (median [IQR] were similar in VRE, 40.0 [28.3 to 58.3] and CAU, 38.3 [28.3 to 53.3]; P = 0.862). No differences between groups were found in self-reported anxiety, pain, emergence delirium or parental anxiety. However, after adenoidectomy/tonsillectomy, children in the VRE condition needed rescue analgesia significantly less often (55.0%) than in the CAU condition (95.7%) (P = 0.002). CONCLUSION In children undergoing elective day care surgery, VRE did not have a beneficial effect on anxiety, pain, emergence delirium or parental anxiety. However, after more painful surgery, children in the VRE group needed rescue analgesia significantly less often, a clinically important finding because of the side effects associated with analgesic drugs. Options for future research are to include children with higher levels of anxiety and pain and to examine the timing and duration of VRE. TRIAL REGISTRATION Netherlands Trial Registry: NTR6116 (e.utens This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 © 2019 European Society of Anaesthesiology
Comparison of neostigmine vs. sugammadex for recovery of muscle function after neuromuscular block by means of diaphragm ultrasonography in microlaryngeal surgery: A randomised controlled trial
BACKGROUND Postoperative residual neuromuscular blockade or curarisation (PORC) is a risk directly related to the use of neuromuscular blocking agents during surgical procedures. Acceleromyography is distressing for conscious patients when assessing PORC. Diaphragm ultrasonography could be a valid alternative. OBJECTIVES The primary objective was to achieve a 28% lower incidence of PORC in patients who, after rocuronium administration, received neostigmine or sugammadex at 30 min after surgery. To assess PORC, diaphragm ultrasonography was used, and thickening fractioning [the difference of thickness at the end of inspiration (TEI) and at the end of expiration (TEE), normalised for TEE (TEI − TEE/TEE)] was measured. PORC was defined as thickening fractioning of 0.36 or less. The secondary object was the comparison, in the two treatment groups, of the return to baseline thickening fractioning at 30 min after surgery (ΔTF30). DESIGN Prospective, double-blind, single-centre randomised study. SETTING University Hospital Careggi, Florence, Italy. PATIENTS Patients of American Society Anesthesiologists’ physical status 1 or 2, 18 to 80 years, receiving rocuronium during microlaryngeal surgery. INTERVENTIONS At the end of surgery participants were randomised to receive neostigmine (NEO group) or sugammadex (SUG group) as the reversal drug. Thickening fractioning and ΔTF30 were evaluated at baseline and at 0, 10 and 30 min after surgery. MAIN OUTCOME MEASURES TEE and TEI at each time point. RESULTS A total of 59 patients with similar demographic characteristics were enrolled. An association between lack of recovery (thickening fractioning ≤0.36) and drug treatment was only observed at 0 min (SUG vs. NEO, P < 0.05). Concerning ΔTF, at 30 min more patients in the SUG group returned to baseline than those in the NEO group (P < 0.001), after adjusting for side (P = 0.52), baseline thickening fractioning (P < 0.0001) and time of measurement (P < 0.01). CONCLUSION We found an early (0 min) but not long-lasting (30 min) association between diaphragm failure and treatment allocation; a full recovery in baseline diaphragm function was observed only in patients receiving sugammadex. We cannot exclude that further differences have not been found due to interpatients variability in assessing diaphragm contractility by ultrasonography. TRIAL REGISTRATION EudraCT Identifier: 2013-004787-62, Clinicaltrials.gov Identifier: NCT02698969. Correspondence to Iacopo Cappellini, Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy E-mail: jacopocappellini © 2019 European Society of Anaesthesiology
Neuraxial labour analgesia is associated with a reduced risk of maternal depression at 2 years after childbirth: A multicentre, prospective, longitudinal study
BACKGROUND Severe labour pain is an important risk factor of postpartum depression, and early depression is associated with an increased risk of long-term depression; whereas the use of epidural analgesia during labour decreases the risk of postpartum depression. OBJECTIVE To investigate whether neuraxial labour analgesia was associated with a decreased risk of 2-year depression. DESIGN This was a multicentre, prospective, longitudinal study. SETTING The study was performed in Peking University First Hospital, Beijing Obstetrics and Gynecology Hospital and Haidian Maternal and Child Health Hospital in Beijing, China, between 1 August 2014 and 25 April 2017. PATIENTS Five hundred ninety-nine nulliparous women with single-term cephalic pregnancy preparing for vaginal delivery were enrolled. MAIN OUTCOME MEASURE Depressive symptoms were screened with the Edinburgh Postnatal Depression Scale at delivery-room admission, 6-week postpartum and 2 years after childbirth. A score of 10 or higher was used as the threshold of depression. The primary endpoint was the presence of depression at 2 years after childbirth. The association between the use of neuraxial labour analgesia and the development of 2-year depression was analysed with a multivariable logistic regression model. RESULTS Five hundred and eight parturients completed 2-year follow-up. Of these, 368 (72.4%) received neuraxial analgesia during labour and 140 (27.6%) did not. The percentage with 2-year depression was lower in those with neuraxial labour analgesia than in those without (7.3 [27/368] vs. 13.6% [19/140]; P = 0.029). After correction for confounding factors, the use of neuraxial analgesia during labour was associated with a significantly decreased risk of 2-year depression (odds ratio 0.455, 95% confidence interval 0.230 to 0.898; P = 0.023). CONCLUSION For nulliparous women with single-term cephalic pregnancy planning for vaginal delivery, the use of neuraxial analgesia during labour was associated with a reduced risk of maternal depression at 2 years after childbirth. TRIAL REGISTRATION wangdongxin Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Website (www.ejanaesthesiology.com). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 © 2019 European Society of Anaesthesiology
Guidewire-assisted vs. direct radial arterial cannulation in neonates and infants: A randomised controlled trial
BACKGROUND Cannulation of the radial artery is challenging to perform in neonates and infants because of the small vessel size. OBJECTIVE To compare guidewire-assisted with direct radial artery cannulation in neonates and infants. DESIGN A randomised controlled study. SETTING A tertiary university hospital from 7 August 2017 to 4 July 2018. PATIENTS Ninety neonates and infants who required radial artery cannulation during general anaesthesia. INTERVENTIONS All patients were allocated randomly into the guidewire group (guidewire-assisted cannulation, n=45) or control group (direct cannulation, n=45). Radial artery cannulation was performed under general anaesthesia. The contralateral radial artery was used if the arterial cannulation was not successful within two attempts. After the second failure in the contralateral radial artery, the case was considered a failure. MAIN OUTCOME MEASURES The primary outcome was the first-attempt success rate of radial artery cannulation. The secondary outcomes included the overall success rate, overall procedure time, number of attempts and use of the contralateral radial artery for radial artery cannulation. RESULTS The guidewire group showed a higher first-attempt success rate [76 vs. 56%; P = 0.046; odds ratio (OR) 2.47, 95% confidence interval (CI) of odds 1.01 to 6.08] and overall success rate (96 vs. 76%; P = 0.007; OR 6.96; 95% CI 1.44 to 33.52) than the control group. The overall procedure time was not significantly different between the guidewire group (median [IQR] 36 [28.0 to 70.5] s) and control group (98 [23.5 to 465.0] s; P = 0.400). There was no difference in the median number of attempts between the two groups (P = 0.454). However, use of the contralateral radial artery was significantly lower in the guidewire group (17.8%) than in the control group (40%; P = 0.020; OR 0.324, 95% CI 0.12 to 0.86). Kaplan–Meier analysis of the overall procedure time to successful radial artery cannulation showed that the overall success rate was significantly higher in the guidewire group than in the control group (P = 0.019). CONCLUSION For radial artery cannulation in neonates and infants, guidewire-assisted radial artery cannulation showed superiority over the direct technique in terms of first-attempt success rate and overall success rate without delaying the procedure time. TRIAL REGISTRATION Clinicaltrials.gov (identifier: NCT03217019). Correspondence to Prof Jin-Tae Kim, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakno, Jongnogu, Seoul 03080, Republic of Korea Tel: +82 2 2072 3295; fax: +82 2 745 5587; e-mail: jintae73 © 2019 European Society of Anaesthesiology
Does programmed intermittent epidural bolus improve childbirth conditions of nulliparous women compared with patient-controlled epidural analgesia?: A multicentre, prospective, controlled, randomised, triple-blind study
BACKGROUND Epidural analgesia may change the mechanics of childbirth. These changes are related to the concentration of the local anaesthetic used epidurally but probably also to its mode of delivery into the epidural space. OBJECTIVE To determine whether the administration of programmed intermittent epidural boluses (PIEB) improves the mechanics of second-stage labour compared with patient-controlled epidural analgesia (PCEA) with a background infusion. DESIGN Prospective, controlled, randomised, triple-blind study. SETTING Multicentre study including four level III maternity units, January 2014 until June 2016. PATIENTS A total of 298 nulliparous patients in spontaneous labour were randomised to a PIEB or PCEA group. INTERVENTION After epidural initiation with 15 ml of 0.1% levobupivacaine containing 10 μg of sufentanil, patients received either an hourly bolus of 8 ml (PIEB) or a continuous rate infusion of 8 ml h−1 (PCEA): the drug mixture used was levobupivacaine 0.1% and sufentanil 0.36 μg ml−1. MAIN OUTCOME MEASURES The primary outcome was a composite endpoint of objective labour events: a posterior occiput position in the second stage, an occiput position at birth, waiting time at full cervical dilatation before active maternal pushing more than 3 h, maternal active pushing duration more than 40 min, and foetal heart rate alterations. Vaginal instrumental delivery rates, analgesia and motor blockade scores were also recorded. RESULTS From the 298 patients randomised, data from 249 (124 PIEB, 125 PCEA) were analysed. No difference was found in the primary outcome: 48.0% (PIEB) and 45.5% (PCEA) of patients, P = 0.70. In addition, no difference was observed between the groups for each of the individual events of the composite endpoint, nor in the instrumental vaginal delivery rate, nor in the degree of motor blockade. Despite an equivalent volume of medication in the groups, a significantly higher analgesia score at full dilatation was observed in the PIEB group, odds-ratio = 1.9 (95% confidence interval, 1.0 to 3.5), P = 0.04. CONCLUSION The mechanics of the second stage did not differ whether PIEB or PCEA was used. Analgesic conditions appeared to be superior with PIEB, especially at full dilation. TRIAL REGISTRATION Clinical trial number: NCT01856166. Correspondence to Estelle Morau, CHU Arnaud de Villeneuve, 34295 Montpellier Cedex 5, France E-mail: estelle.morau © 2019 European Society of Anaesthesiology
Comparison of a simplified nasal continuous positive airways pressure device with nasal cannula in obese patients undergoing colonoscopy during deep sedation: A randomised clinical trial
BACKGROUND Continuous positive airways pressure (CPAP) with a CPAP machine and mask has been shown to be more effective at minimising hypoxaemia than other devices under deep sedation. However, the efficacy of a new and simple CPAP device for spontaneously breathing obese patients during colonoscopy is unknown. OBJECTIVE We hypothesised that oxygenation and ventilation in obese patients under deep sedation during colonoscopy using CPAP via a new nasal mask (SuperNO2VA) would be better than routine care with oxygen supplementation via a nasal cannula. DESIGN Randomised study. SETTING Single-centre, June 2017 to October 2017. PATIENTS A total of 174 patients were enrolled and randomly assigned to Mask group or Control group. Thirty-eight patients were excluded and data from 136 patients underwent final analysis. INTERVENTION Patients in the Mask group were provided with nasal CPAP (10 cmH2O) at an oxygen flow rate of 15 l min−1. In the Control group, patients were given oxygen via a nasal cannula at a flow rate of 5 l min−1. MAIN OUTCOME MEASURES The primary outcome was elapsed time from anaesthesia induction to the first airway intervention. RESULTS The elapsed time from anaesthesia induction to the first airway intervention was 19 ± 10 min in the Mask group (n=63) vs. 10 ± 12 min in the Control group (n=73, P < 0.001). In all, 87.5% (56/64) of patients achieved the target CPAP value. More patients in the Control group (63%) received airway intervention than in the Mask group (22%) (P < 0.001). Hypoxaemia (pulse oximeter oxygen saturation, SpO2 < 90%) occurred more frequently in the Control group (22%) than in the Mask group (5%) (P = 0.004). Minute ventilationPostinduction/minute ventilationBaseline and minute ventilationProcedure-end/minute ventilationBaseline was lower in the Control group than in the Mask group (P = 0.007 and 0.001, respectively). CONCLUSION Application of a nasal mask at a target CPAP of 10 cmH2O improves ventilation and decreases the frequency and severity of hypoxaemia. TRIAL REGISTRATION NCT03139448, registered at ClinicalTrials.gov. Correspondence to Koffi Kla, MD, Department of Anaesthesiology, Vanderbilt University Medical Centre, 1301 Medical Centre Drive, 4648 TVC, Nashville, TN 37232-5614, USA Tel: +1 615 343 9419; e-mail: koffi.m.kla © 2019 European Society of Anaesthesiology
Functional MRI: basic principles and emerging clinical applications for anaesthesiology and the neurological sciences
No abstract available
Validation of 3-minute diagnostic interview for CAM-defined Delirium to detect postoperative delirium in the recovery room: A prospective diagnostic study
BACKGROUND Recent guidelines on postoperative delirium (POD) recommend POD screening in all patients, using a validated tool, starting in the recovery room. An operationalisation of the Confusion Assessment Method (CAM) criteria, the 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM), has been developed for use in general medical units. OBJECTIVES The aim of this study was to evaluate 3D-CAM performance in an adult patient population to detect POD in the recovery room. DESIGN A prospective diagnostic study. SETTING Recovery room of a tertiary care university hospital in Berlin, Germany, in 2017. PATIENTS Patients at least 18 years of age undergoing elective surgery. MAIN OUTCOME MEASURES Patients were subjected to evaluation by blinded investigators using the 3D-CAM and the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5, reference standard). Sensitivity, specificity and positive predictive value (PPV) and negative predictive value (NPV) were analysed for 3D-CAM, in addition to test–retest and inter-rater reliability analyses. RESULTS Sixteen out of 176 patients (9.1%) developed POD. The 3D-CAM demonstrated strong test performance (specificity 0.88, sensitivity 1.0, area under the curve 0.94, PPV 0.44 and NPV 1.0), with a test–retest reliability of 90% (n = 10) and inter-rater reliability of 80% (n = 10). CONCLUSION In this diagnostic study, 3D-CAM showed strong performance for detection of POD in the recovery room. Due to the low training requirements, fast application and high sensitivity, it might be particularly appropriate for clinical staff with limited experience in the assessment of POD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02992717 Correspondence to Claudia D. Spies, MD, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin D-13353, Germany Tel: +49 30 450 551102/+49 30 450 531012; e-mail: claudia.spies Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Website (www.ejanaesthesiology.com). © 2019 European Society of Anaesthesiology
Comparison of low and high positive end-expiratory pressure during low tidal volume ventilation in robotic gynaecological surgical patients using electrical impedance tomography: A randomised controlled trial
BACKGROUND The appropriate level of positive end-expiratory pressure (PEEP) during intra-operative mechanical ventilation remains unclear. OBJECTIVE The aim of this study was to investigate the effects of different levels of PEEP with low tidal volume (low-VT) ventilation in a steep Trendelenburg position (30°) and pneumoperitoneum on oxygenation, respiratory mechanics and ventilation distribution using electrical impedance tomography. DESIGN A randomised controlled trial. SETTING Single university secondary care centre, conducted from January 2017 to December 2017. PATIENTS Forty female patients, aged 20 to 60 years, and of American Society of Anesthesiologists’ (ASA) physical status 1 or 2, undergoing elective robotic gynaecological surgery were included. INTERVENTION Forty patients were allocated randomly to a PEEP4 (PEEP 4 cmH2O) group or a PEEP8 (PEEP 8 cmH2O) group. MAIN OUTCOME MEASURES The primary outcomes were respiratory mechanics. The secondary outcomes included changes in ventilation distribution across the ventral and dorsal regions of interest and postoperative pulmonary complications (PPCs) using a modified clinical pulmonary infection score. RESULTS There was no difference in PaO2 at any time point. The peak inspiratory pressure (PIP) and mean airway pressure (Paw) of the PEEP4 group were lower than those of the PEEP8 group (P < 0.001). The oxygenation factor in the PEEP4 group was higher than that in the PEEP8 group during mechanical ventilation at all times. There was no difference in the fractional distribution of end-expiratory ventilation according to region of interest between the two groups. CONCLUSION Both 4 and 8 cmH2O of PEEP with low-VT ventilation can be used for robotic gynaecological surgery that requires a steep Trendelenburg position and pneumoperitoneum. However, 8 cmH2O of PEEP had no benefit over 4 cmH2O of PEEP with respect to oxygenation and improvement of dorsal regional ventilation. TRIAL REGISTRATION The trial was registered at the Clinical Trial Registry of Korea (KCT0002255). baikhj © 2019 European Society of Anaesthesiology

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Anaesthesiology

Advanced Emergency Nursing

AAENP and ACEP: Cultivating Interprofessionalism
No abstract available
The Modified Valsalva Maneuver for Reversion of Stable Supraventricular Tachycardia: Lessons Learned From the REVERT Trial
imageThe REVERT trial was a randomized multicenter trial that investigated the efficacy of using a modified Valsalva maneuver for the reversion of stable supraventricular tachycardia back to a sinus rhythm. Although no improvement in discharge to home from the emergency department (ED) or ED length of stay was observed, the REVERT trial demonstrated that the modified Valsalva maneuver was superior to the standard Valsalva maneuver. The modified Valsalva maneuver should be considered first-line treatment for patients who present with a stable supraventricular tachycardia. A case presentation illustrates the methodology for utilizing the modified Valsalva maneuver to treat supraventricular tachycardia in a hemodynamically stable patient who presents to the ED.
Mallet Finger
imageThis article provides an overview of issues associated with traumatic injury to the distal finger that results in extensor tendon disruption or bony avulsion at the base of the distal phalanx. Commonly referred to as mallet finger, drop finger, or baseball finger, terminal extensor tendon injuries are a common presentation to the emergency department. Providers need to be advised of evidence-based management of these extensor tendon injuries in order to prevent decreased function and permanent deformity. Current evidence supports nonoperative interventions, but injuries need to be addressed in a timely manner in order to avoid poor outcomes.
Orolingual Angioedema After Tissue Plasminogen Activator Administration in Patients Taking Angiotensin-Converting Enzyme Inhibitors
imageOrolingual angioedema is a rare adverse effect (1%–5%) of tissue plasminogen activator (tPA) that can lead to significant morbidity in patients with acute ischemic stroke. It is thought that increased levels of bradykinin and histamine resulting from tPA administration can result in angioedema. Angiotensin-converting enzyme (ACE) inhibitors can also lead to increased levels of bradykinin and appear to be a risk factor for tPA-associated angioedema. A literature review was conducted to examine previous cases of orolingual angioedema associated with tPA administration in patients also taking ACE inhibitors to better understand the relationship between ACE inhibitors and tPA-induced angioedema. Over a 20-year period, 27 patients who experienced angioedema with tPA while on ACE inhibitor therapy were identified. In this patient population, the onset of angioedema symptoms appeared as soon as 15 min after the tPA bolus and as late as 2 hr after the tPA infusion. Most patients required a combination of supportive medications such as corticosteroids (81.5%), antihistamines (74%), and epinephrine (18.5%) for the management of angioedema. Severe presentations of orolingual angioedema resulted in intubation for airway protection (26%). Symptom resolution ranged from shortly after the administration of supportive medications to 72 hr after symptom onset. Orolingual angioedema after tPA administration has the potential to cause significant morbidity, indicating patients should be monitored closely for a few hours after administration for the development of airway compromise. ACE inhibitors should not be the preferred antihypertensive agents for patients who require blood pressure lowering prior to tPA administration.
Orolingual Angioedema After Tissue Plasminogen Activator Administration in Patients Taking Angiotensin-Converting Enzyme Inhibitors
imageNo abstract available
An Atypical Case of Abdominal Pain in a Toddler: A Diagnostic Challenge
imageAbdominal pain in the pediatric patient presents a unique diagnostic challenge for emergency department (ED) providers due to the wide range of possible etiologies and sequelae. The list of differential diagnoses is extensive and includes the spectrum of conditions that range from benign and self-limiting to those that are potentially life-threatening. This article describes a case of a young toddler with an acute appendicitis complicated by perforation and abscess formation. Although acute appendicitis is uncommon in infants and younger children, it does occur and, as this case illustrates, is often misdiagnosed, which leads to delayed treatment and a higher incidence of complications. This article includes a discussion of the challenges faced by ED providers in the clinical-decision making process when caring for a pediatric patient with abdominal pain due to an acute appendicitis. This discussion includes the age-associated epidemiology, pathophysiology, clinical presentation, and evidence-based recommendations for diagnosis and treatment.
Kawasaki Disease in Infancy
imageKawasaki disease (KD) is an acute vasculitis that primarily affects young children and, if untreated, is associated with development of coronary artery aneurysms in approximately 25% of those affected. Infants, especially those younger than 6 months, often have atypical (incomplete) presentations of KD and are most at risk for development of aneurysms. Identification of KD requires a careful and thorough history and physical examination because multiple other conditions cause similar findings. Providers in acute care settings need to have a high degree of suspicion for KD so that those affected may receive appropriate and timely treatment.
Dental Pain Relief in the Age of ALTO
imageThe opioid public health crisis necessitates that health care providers seek alternatives to opioid pain control. For patients presenting with dental pain, a dental nerve block provides effective, long-lasting pain relief without the use of opioid pain medications. This article presents the techniques required to safely and effectively administer 3 types of dental nerve blocks, allowing the emergency nurse practitioner to provide effective pain control to patients with dental pain.
Dental Pain Relief in the Age of ALTO
imageNo abstract available
Advanced Practice Provider Burnout in a Large Urban Medical Center
imageBurnout is characterized by 3 facets: the presence of emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment. It arises when stress becomes so severe relative to a person’s own resources that he or she loses motivation to perform, and it is associated with many negative outcomes. Emergency medicine (EM) physicians ranked highest in a study of burnout rates among physician subspecialties. However, there is an overall lack of robust research examining the work-related psychological states in advanced practice providers (APPs). Because the utilization of APPs in emergency departments (EDs) is steadily increasing, we aimed to describe burnout in this understudied group. A sample of APPs employed in a large urban academic hospital was surveyed using 3 well-established questionnaires measuring burnout, resilience, and mindfulness. Responses were compared with a normative group of health care workers (HCWs). The respondents reported a significantly greater sense of personal accomplishment than other HCWs. This was greater with a perceived control over their work environment and if they self-identified as being nonjudgmental. The sense of accomplishment was less in the respondents of older age and for those with children. This group also reported an increased sense of depersonalization. Mindfulness traits of acting with awareness and having trust in their instincts were identified as potential protective factors against depersonalization. Although the respondents were not more emotionally exhausted than other HCWs, being more emotionally “reactive” did predict greater emotional exhaustion. This is an important finding for APPs working in affect-laden work environments such as EDs. These findings suggest that increasing control over the work environment, fostering trust of instincts, and reducing emotional reactiveness are prudent interventional targets for EM-APP leaders to prevent and reduce burnout in the workforce.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Advanced Emergency Nursing

Cancer Research and Clinical Oncology

Correction to: Neoadjuvant chemoradiotherapy delivered with helical tomotherapy under daily image guidance for rectal cancer patients: efficacy and safety in a large, multi-institutional series
The article “Neoadjuvant chemoradiotherapy delivered with helical tomotherapy under daily image guidance for rectal cancer patients: efficacy and safety in a large, multi-institutional series”
Low number of intrafollicular T cells may predict favourable response to rituximab-based immuno-chemotherapy in advanced follicular lymphoma: a secondary analysis of a randomized clinical trial

Abstract

Background

First-line rituximab therapy together with chemotherapy is the standard care for patients with advanced follicular B-cell lymphoma, as rituximab together with chemotherapy prolongs progression-free and overall survival (Herold et al. 2007; Marcus et al. 2005). However, as not all patient subgroups benefit from combined immuno-chemotherapy, we asked whether the microenvironment may predict benefit from rituximab-based therapy.

Design

To address this question, we performed a retrospective immunohistochemical analysis on pathological specimens of 18 patients recruited into a randomized clinical trial, where patients with advanced follicular lymphoma were randomized into either chemotherapy or immuno-chemotherapy with rituximab (Herold et al. 2007).

Results

We show here that rituximab exerts beneficial effects, especially in the subgroup of follicular lymphoma patients with low intrafollicular CD3, CD5, CD8, and ZAP70 and high CD56 and CD68 expression.

Conclusion

Rituximab may overcome immune-dormancy in follicular lymphoma in cases with lower intrafollicular T-cell numbers and higher CD56 and CD68 cell counts. As this was a retrospective analysis on a small subgroup of patients, these data need to be corroborated in larger clinical trials.

A prognostic score system with lymph node ratio in stage IIIA-N2 NSCLC patients after surgery and adjuvant chemotherapy

Abstract

Purpose

The survival of patients with IIIA-N2 non-small cell lung cancer after surgery followed by adjuvant chemotherapy is heterogeneous. The aim of this study is to form a prognostic system and a heat map method to visualize the overall survival rates in those patients.

Methods

Univariate and multivariate Cox hazards regression models and the associated Wald Chi square coefficient were used to form the prognostic score system. Recursive partitioning analysis was used to determine the cutoff values of lymph node ratio and prognostic score in SEER cohort and validated in FDUSCC cohort. Meanwhile, a heat map method was used to visualize the overall survival probabilities of 3, 5 and 10 years for individual patient of both cohorts.

Results

Lymph node ratio (with cutoff of 0.36) significantly correlates with overall survival of these patients. In addition, in patients with the same level of N2 disease, lymph node ratio still significantly affects survival. Also, after the multivariate analysis in SEER cohort, six factors were independent prognostic factors including age, sex, type of surgery, size, lymph node ratio and differentiation. A prognostic sore system with these factors (with cutoff of 12) was validated as a predictor for overall survival in FDUSCC cohort.

Conclusions

This prognostic score system including lymph node ratio can predict the survival rates of IIIA-N2 patient after surgery and post-operative chemotherapy. Lymph node ratio could be a useful supplementation in TNM stage classification for IIIA-N2 patients. The heat map method can visualize the predicted overall survival of an individual patient.

Genetic profiling as a clinical tool in advanced parathyroid carcinoma

Abstract

Context

Parathyroid carcinoma (PC) is a rare endocrine malignancy with no approved systemic therapies for unresectable locally invasive or distant metastatic disease. Understanding the molecular changes in advanced PC can provide better understanding of this disease and potentially help directing targeted therapy.

Objective

To evaluate tumor-specific genetic changes using next-generation sequencing (NGS) panels.

Design

All patients with advanced PC were tested for hot-spot panels using NGS panels including a 50-gene panel, a 409-gene panel if the standard 50-gene panel (Ion Torrent, Life Technology) was negative or a FoundationOne panel.

Setting

The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Patients or other participants

11 patients with advanced PC were selected to undergo molecular testing.

Main outcome measure(s)

Genetic profiles of advanced PC.

Results

Among the 11 patients, 4 patients had the 50-gene panel only, 6 had 409-gene panel after a negative 50-gene panel and 1 had FoundationOne. One patient who had 50-gene panel only also had his metastatic site (esophagus) of his tumor tested with FoundationOne. The most common mutations identified were in the PI3 K (PIK3CA, TSC1 and ATM) (4/11 patients) and TP53 (3/11) pathways. Genes not previously reported to be mutated in PC included: SDHA, TERT promoter and DICER1. Actionable mutations were found in 54% (6/11) of the patients.

Conclusions

Mutational profiling using NGS panels in advanced PC has yielded important potentially targetable genetic alterations. Larger studies are needed to identify commonly mutated genes in advanced PC patients. Development of novel therapies targeting these cellular pathways should be considered.

Effect of age on the effectiveness of the first-line standard of care treatment in patients with metastatic colorectal cancer: systematic review of observational studies

Abstract

Purpose

Most metastatic colorectal cancer (mCRC) patients are elderly. This systematic review identifies and describes observational studies evaluating the influence of age on first-line treatment effectiveness in real-world practice.

Methods

Medline and EMBASE were searched up to May 2016. The included studies were those that investigated first-line treatment of mCRC and reported age groups and overall survival (OS), progression-free survival (PFS) or overall response rate (ORR) were included. Studies published before 2008 were excluded. Study quality was assessed using the Newcastle–Ottawa Scale. Data were evaluated by age group (< 70 vs. ≥ 70 years; 65–75 vs. ≥ 75 years) and outcome. A pooled survival median was calculated for patients (cutoff = 70 years).

Results

In total, 11 articles with 11,063 patients were included. Four studies using a cutoff of 70 years of age reported OS and PFS, and two studies reported ORRs. In terms of OS, all studies showed a higher OS for those < 70 years of age than for those ≥ 70 years of age. PFS did not find differences by age. For ORRs, one study favoured the younger group, while the second study did not differ by age. Based on three studies, the pooled medians for  < 70 years of age and ≥ 70 years of age were the same for PFS (10.2) and were 27.0 and 22.9 for OS, respectively. All included studies were of high or acceptable quality.

Conclusions

The results suggest that age has no effect on PFS. For ORR, the results were inconsistent between studies. Younger patients in general had better OS, which might be partly explained by more aggressive treatment. This treatment seemed not to be guided by performance status or number of metastatic sites.

Targeting cathepsin K diminishes prostate cancer establishment and growth in murine bone

Abstract

Background

The processes of prostate cancer (PCa) invasion and metastasis are facilitated by proteolytic cascade involving multiple proteases, such as matrix metalloproteinases, serine proteases and cysteine proteases including cathepsin K (CatK). CatK is predominantly secreted by osteoclasts and specifically degrades collagen I leading to bone destruction. PCa and breast cancer preferentially metastasize to the bone. Importantly, CatK expression level is greater in PCa bone metastatic sites compared to primary tumor and normal prostate tissues. However, the underlying mechanism of CatK during PCa metastases into the bone remains to be elucidated. We investigated the functional role of CatK during the PCa establishment and growth process in the murine bone.

Methods

CatK mRNA expression was validated by RT-PCR, protein expression by immunoblotting in PCa LNCaP, C4-2B, and PC3 cells as well as in PCa tissues. Its protein production was measured using ELISA assay. The effect of both knockdowns via siRNA and CatK inhibitor was compared in regard to PCa cell invasion. We further studied the dose-dependent CatK inhibitor effect on conditioned media-induced bone resorption. In setting up an animal model, C4-2B cells were injected into the tibiae of SCID mice. The animals treated with either vehicle or CatK inhibitor for 8 weeks at the time of tumor cell injection (tumor establishment model; protocol I) or 4 weeks after tumor cell injection (tumor progression model; protocol II) were applied to histological and histomorphometric analyses.

Results

We confirmed CatK expression in PCa LNCaP, C4-2B, and PC3 cells as well as in PCa tissues. Furthermore, we observed the inhibitory effects of a selective CatK inhibitor on PCa cell invasion. The CatK inhibitor dose-dependently inhibited PCa-conditioned media-induced bone resorption. Upon injection of C4-2B cells into the tibiae of SCID mice, the selective CatK inhibitor significantly prevented the tumor establishment in protocol I, and reduced the tumor growth in bone in protocol II. It also decreased serum PSA levels in both animal models. The inhibitory effects of the CatK inhibitor were enhanced in combination with zoledronic acid (ZA).

Conclusion

The selective CatK inhibitor may prevent the establishment and progression of PCa in bone, thus making it a novel therapeutic approach for advanced PCa.

Aberrant expression of Sec61α in esophageal cancers

Abstract

Introduction

The heterotrimeric Sec61α translocon complex is topological located in the membrane of the endoplasmic reticulum (ER) and allows protein transport and calcium across the membrane. Recently, aberrant expression of Sec proteins was linked to carcinogenesis and prognosis of patients.

Materials and methods

Here, we analysed the role of Sec61α in esophageal cancer, and we analysed Sec61α staining on a tissue microarray containing more than 600 esophageal cancer specimens by immunohistochemistry.

Results

Sec61α staining was always strong in benign esophagus, but was only found in 5% of interpretable esophageal adenocarcinomas (EACs) and 14.5% of squamous cell carcinomas (ESCCs). Reduced Sec61α staining was not strongly linked to tumor phenotype in both subgroups of esophageal cancers and was unrelated to clinical outcome of patients (EACs: p = 0.8051 and ESCCs: p = 0.2751).

Conclusions

Thus, Sec61α measurement has not an additional prognostic benefit for the patients.

Association of glutathione- S -transferase p1 gene promoter methylation and the incidence of prostate cancer: a systematic review and meta-analysis

Abstract

Objective

Some studies have shown that the methylation status of the GSTP1 gene promoter is related to the incidence of prostate cancer, but this finding is still controversial. The aim of this study was to evaluate the association between glutathione-S-transferase p1 (GSTP1) promoter methylation and the incidence of prostate cancer.

Methods

The Medline, Embase, Web of Science, and Cochrane CENTRAL databases were searched from their inception to February 22, 2019. According to the inclusion criteria, studies of the association between the methylation status of the GSTP1 gene promoter and prostate cancer were included. The difference in the incidence of GSTP1 promoter methylation in tissues, blood, or urine between patients with prostate cancer and those without prostate cancer were compared, and the results were expressed as the odds ratio (OR) and 95% confidence interval (CI). The pooled OR of each study was estimated using a fixed-effects model or a random-effects model to generate forest plots.

Results

Ultimately, 15 studies (1540 samples) were included. The estimated effect from our meta-analysis showed that the incidence of GSTP1 promoter methylation was higher in patients with prostate cancer than in those without prostate cancer (OR 18.58, 95% CI 9.60–35.95, P = 0.000). GSTP1 promoter methylation was highly correlated with the incidence of prostate cancer.

Conclusions

Methylation of the GSTP1 promoter may increase the risk of prostate cancer. This study may provide a strategic direction for prostate cancer research. Pending validation of these findings, the methylation of the GSTP1 promoter may be a potential biomarker to diagnose prostate cancer.

RRx-001 protects normal tissues but not tumors via Nrf2 induction and Bcl-2 inhibition

Abstract

Background

RRx-001, a minimally toxic next-generation checkpoint inhibitor that targets myeloid suppressor cells in the tumor microenvironment, has also been shown to protect normal tissues from the cytotoxic effects of chemotherapy and radiation. The following experiments were carried out to determine whether the cytoprotective functions of RRx-001 in normal cells were operative in tumor cells.

Design

The effects of RRx-001 on normal cells, and ovarian cancer A2780 and UWB1 cells were evaluated with a colony-forming assay. Western blot densitometry was used to measure Nrf2 nuclear translocation in Caco2 cells after exposure to RRx-001. Following incubation with RRx-001, levels of the antioxidant, NQO1, were determined in Caco2 cells by measuring absorbance over 300 min at 440 nm. RRx-001-mediated cytotoxicity in HCT-116 colorectal cancer cells was evaluated with an MTT assay. In addition, the effect of RRx-001 incubation on the protein expression of Nrf2, PARP, cleaved PARP, procaspases 3, 8, and 9, Bcl-2, and Bax in HCT-116 colorectal cells was determined by western blot analysis.

Results

RRx-001 is demonstrated to induce Nrf2 in normal tissues, mediating protection, and to downregulate the Nrf2-controlled antiapoptotic target gene, B-cell lymphoma 2 (Bcl-2) in tumors, mediating cytotoxicity.

Conclusion

Through Nrf2 induction in normal cells and inhibition of Bcl-2 in tumor cells, RRx-001 selectively protects normal cells against lethality in normal cells, but induces apoptosis in tumor cells.

Human papillomavirus and lung cancer: an overview and a meta-analysis

Abstract

Purpose

This review is devoted to assessing the prevalence of human papillomavirus (HPV) in lung cancer (LC) in the world. HPV is recognized as the etiological factor of cervical cancer, however, there is widespread evidence that this virus is detected not only in gynecological carcinomas, but also in tumors of other organs, in particular the upper respiratory tract and digestive tract.

Materials and methods

A search was conducted to a depth of 29 years in the PubMed, Web of Science, Scopus, databases. The review includes 95 articles.

Results

Of all the analyzed studies (9195 patients), 12 works showed a complete absence of HPV in the biological material in patients with LC. The absence of a virus among lung cancer patients has been established for Canada, the Netherlands and Singapore. The highest average percent of occurrence of this virus is shown for such countries as: Brazil, Korea, Greece and Taiwan (more than 40%). But the highest percentage of HPV occurrence by region is observed in Latin America (33.5%), followed by the Asian countries (31%), in European countries the frequency is 18%. Interestingly, the highest occurrence of high oncogenic types (16 and 18) is observed in Asia (40.3%), then in Latin America (33.6%), Europe (25.6%) and North America (15.4%). Low-oncogenic types (6 and 11) are also predominantly observed in Asia (39.9%), while in Europe and North America 30% and 12.8%, respectively. A meta-analysis of the prevalence of HPV was conducted using Comprehensive Meta-Analysis 3.0. Program, which included 26 studies, the results of which revealed: the prevalence of HPV infection in tumor lung tissue was compared with normal lung tissue OR (95% CI) = 5.38 (3.21–9.00) p < 0.0001, significance was also found for Chinese studies OR = 6.3, 95% CI 3.42–11.53, p < 0.0001, I2 = 71.8% and for nine studies in Europe OR = 6.3, 95% CI 1.8–22.18, p = 0.004, I2 = 51.0%. However, given the fact that the frequency of occurrence of HPV in lung tumor tissue varies greatly, a question may arise about the real role of HPV in LC carcinogenesis, which makes further research relevant and promising.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Cancer Research and Clinical Oncology

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,



MDPI
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08:26


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08:24


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08:23


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08:18


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07:35

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07:35

Extent of maxillary sinus surgery and its effect on instrument access, irrigation penetration, and…
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07:34

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07:34

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07:32


PAPASH, PsAPASH and PASS autoinflammatory syndromes: phenotypic heterogeneity, common biological signature…
PAPASH, PsAPASH and PASS autoinflammatory syndromes: phenotypic heterogeneity, common biological signature and response to immunosuppressive regimensJ. Gottlieb M. Madrange C. Gardair E. Sbidian A. Frazier P. Wolkenstein G. Hickman P. Schneider C. Baudry P. Claudepierre P. Bertheau P. Richette A. Smahi H. BachelezFirst published: 13 April 2019 https://doi.org/10.1111/bjd.18003

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:26

British Journal of Dermatology Early View Online Version of Record before inclusion in an issue …
British Journal of DermatologyEarly ViewOnline Version of Record before inclusion in an issueResearch LettersPAPASH, PsAPASH and PASS autoinflammatory syndromes: phenotypic heterogeneity, common biological signature and response to immunosuppressive regimensJ. Gottlieb, M. Madrange, C. Gardair, E. Sbidian, A. Frazier, P. Wolkenstein, G. Hickman, P. Schneider, C. Baudry, P. Claudepierre, P. Bertheau, P. Richette, A. Smahi, H. BachelezVersion of Record online: 25 July 2019 Open AccessClinical TrialsSustained…

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:26

Angiogenesis
A new prognostic model for survival in second line for metastatic renal cell carcinoma: development and external validationAbstractBackgroundIn patients with metastatic renal cell carcinoma (mRCC), the oncologic benefit of second-line treatment for high volume tumors or presence of more than five risk factors remain to be defined. Our aim was to develop and externally validate a new model most likely to correctly predict overall survival (OS) categories in second line.MethodmRCC patients treated…

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:22

The role of poor oral health in surgical site infection following elective spinal surgery AbstractStudy…
The role of poor oral health in surgical site infection following elective spinal surgeryAbstractStudy designCross-sectional study.ObjectivesTo describe oral health and hygiene as a risk factor for surgical site infection (SSI).MethodsThis cross-sectional study was conducted on patients over 18 years of age who were candidates for elective spinal surgery. The exclusion criteria were immunodeficiency, history of cancer, history of previous infection at the surgical site, cutaneous diseases and long-term…

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:13

The role of poor oral health in surgical site infection following elective spinal surgery AbstractStudy…
The role of poor oral health in surgical site infection following elective spinal surgeryAbstractStudy designCross-sectional study.ObjectivesTo describe oral health and hygiene as a risk factor for surgical site infection (SSI).MethodsThis cross-sectional study was conducted on patients over 18 years of age who were candidates for elective spinal surgery. The exclusion criteria were immunodeficiency, history of cancer, history of previous infection at the surgical site, cutaneous diseases and long-term…

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:11

Surgical strategy in extensive proximal brachial plexus palsies AbstractPurpose To describe and assess…
Surgical strategy in extensive proximal brachial plexus palsiesAbstractPurposeTo describe and assess an overall surgical strategy addressing extensive proximal brachial plexus injuries (BPI).MethodsForty-five consecutive patients’ charts with C5–C6–C7 and C5–C6–C7–C8 BPI were reviewed. Primary procedures were nerve transfers to restore elbow function and grafts to restore shoulder function when a cervical root was available; when nerve surgery was not possible or had failed, tendon transfers were…

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:11

Musculoskeletal Surgery
Minimally invasive plate osteosynthesis (MIPO) in AO/OTA type B displaced clavicle fracturesAbstractIntroductionOpen reduction and plate fixation is known to reduce chances of malunion and symptomatic nonunion in displaced middle-third clavicle fractures. However, this treatment modality is also associated with several complications, such as hardware irritation, numbness around the surgical scar, infection, nonunion and implant failure. The minimally invasive plate osteosynthesis (MIPO) technique…

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:10

Effects of testosterone on circadian rhythmicity in olds
miceAbstractSerum testosterone concentration decreases with age in humans and rodents. Accordingly, old male mice show changes in locomotor activity rhythms: a lengthened free-running period and decreased activity levels among others. To investigate whether testosterone replacement improves the age-related decline in circadian rhythmicity, we examined the effects of testosterone on the circadian rhythms of wheel running activity in old male mice. Intact male C57BL/6J mice (18–22 months old) were…

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:07

Factors inhibiting intestinal calcium absorption: hormones and luminal factors that prevent excessive…
Factors inhibiting intestinal calcium absorption: hormones and luminal factors that prevent excessive calcium uptakeAbstractBesides the two canonical calciotropic hormones, namely parathyroid hormone and 1,25-dihydroxyvitamin D [1,25(OH)2D3], there are several other endocrine and paracrine factors, such as prolactin, estrogen, and insulin-like growth factor that have been known to directly stimulate intestinal calcium absorption. Generally, to maintain an optimal plasma calcium level, these positive…

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:07

Intermittent hyperbaric oxygen exposure mobilizing peroxiredoxin 6 to prevent oxygen toxicity Abstract…
Intermittent hyperbaric oxygen exposure mobilizing peroxiredoxin 6 to prevent oxygen toxicityAbstractIntermittent hyperbaric oxygen exposure (IE-HBO) can protect the body against oxygen toxicity, but the underlying mechanisms are not very clear. Peroxiredoxin 6 (Prdx6) is a special endogenous antioxidative protein. We explored if the protective effects of IE-HBO are related to Prdx6. Mice were exposed to 280 kPa O2 for 60 min, followed by 30-min exposure to 20% O2/N2 mixture with equal pressure,…

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:06

Thyroxin and calcitonin secretion into thyroid venous blood is regulated by pharyngeal mechanical stimulation
in anesthetized ratsAbstractThe effects of the pharyngeal non-noxious mechanical stimulation on the secretion of immunoreactive thyroxin (iT4), immunoreactive calcitonin (iCT), and immunoreactive parathyroid hormone (iPTH) into thyroid venous blood were examined in anesthetized rats. Secretion rates of iT4, iCT, and iPTH were calculated from their concentration in thyroid venous plasma and the plasma flow rate. A mechanical stimulation was delivered to the pharynx by a rubber balloon placed on the…

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:06


Assessment of the molluscicidal impact of extracted chlorophyllin on some biochemical parameters in…
Assessment of the molluscicidal impact of extracted chlorophyllin on some biochemical parameters in the nervous tissue and histological changes in Biomphalaria alexandrina and Lymnaea natalensis snailsAbstractBiomphalaria alexandrina and Lymnaea natalensis snails are the intermediate hosts of schistosomiasis and fasciolosis. The aim of the present study is to evaluate the molluscicidal activity of chlorophyll extract as a photodynamic substance against these snails and how it affected its tissues…

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:05

Physiological Sciences
Thyroxin and calcitonin secretion into thyroid venous blood is regulated by pharyngeal mechanical stimulation in anesthetized ratsAbstractThe effects of the pharyngeal non-noxious mechanical stimulation on the secretion of immunoreactive thyroxin (iT4), immunoreactive calcitonin (iCT), and immunoreactive parathyroid hormone (iPTH) into thyroid venous blood were examined in anesthetized rats. Secretion rates of iT4, iCT, and iPTH were calculated from their concentration in thyroid venous plasma and…

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:04

Cardiology
Electrical Storm: Current Evidence, Clinical Implications, and Future PerspectivesAbstractPurpose of ReviewElectrical storm (ES) is a life-threatening medical emergency of repetitive episodes of sustained ventricular arrhythmias within a short period. Its occurrence is associated with poor short- and long-term survival, even in patients with implantable cardioverter defibrillators (ICD). Management of ES is challenging and mainly based on retrospective studies. This article reviews the existing literature…

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:03

Gastroenterology
Recurrence of hepatocellular carcinoma at the porta-hepatis following liver transplantation diagnosed on EUS-FNAAbstractHepatocellular carcinoma (HCC) is a potentially fatal complication of chronic liver disease. Liver transplantation is now the preferred treatment due to good outcomes. We present a unique case of recurrence of HCC at the porta hepatis four years after orthotopic liver transplantation diagnosed via endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Our report also highlights…

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:02


Cutaneotrichosporon (Trichosporon) debeurmannianum associated with a subcutaneous mycotic cyst successfully…
Cutaneotrichosporon (Trichosporon) debeurmannianum associated with a subcutaneous mycotic cyst successfully treated with voriconazole M. L. Noy A. Abdolrasouli A. M. Borman M. Fraser N. Francis L. S. P. Moore E. E. MerikaFirst published: 22 July 2019 https://doi.org/10.1111/ced.14037

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:00


Concomitant GNA11 and SF3B1 mutations in two cases of melanoma associated with blue naevus , M. Danset …
Concomitant GNA11 and SF3B1 mutations in two cases of melanoma associated with blue naevus, M. Danset S. Milley O. Harou D. Vasseur M. Amini‐Adle L. Thomas S. Dalle B. Balme J. LopezFirst published: 23 July 2019 https://doi.org/10.1111/ced.14036

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

07:00

Small papular pseudolymphoma induced by a patch test for gold, T. Kiyohara, H Tanimura, K. Makimura, S….
Small papular pseudolymphoma induced by a patch test for gold, T. Kiyohara, H Tanimura, K. Makimura, S. Shimada, S. Ohnishi, M. Miyamoto, T. Shijimaya, N. Ma, H. OkamotoFirst Published: 27 July 2019Small papular pseudolymphoma (SPP)1 is characterized by multiple angiomatous papules, mainly on the acral sites of the hands and feet in children. It was first reported as acral pseudolymphomatous angiokeratoma of children (APACHE). The disorder may be recognized as a pseudolymphoma rather than a vascular…

sfakianakis19.blogspot.com?w=16&cs=3039609074&v=3

Medicine by Alexandros G. Sfakianakis

06:59

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,


Update on treatment options for blast-induced hearing loss Purpose of review The incidence of blast…

Update on treatment options for blast-induced hearing loss Purpose of review The incidence of blast injuries has increased, and the ear is the highest risk organ. Ear injury induced by blast exposure is important in both military and civilian conditions. The permanent hearing loss caused by blast exposure is associated with a decline in the quality of life. In this review, I describe recent therapeutic strategies for each of the ear pathologies caused by blast exposure. Recent findings For tympanic…

Αλέξανδρος Γ. Σφακιανάκης

2m

Triglycerides and endothelial function: molecular biology to clinical perspective Purpose of review…
Triglycerides and endothelial function: molecular biology to clinical perspectivePurpose of review Recently, a high level of triglycerides has attracted much attention as an important residual risk factor of cardiovascular events. We will review and show the mechanisms underlying the association of endothelial dysfunction with hypertriglyceridemia and present clinical evidence for a relationship between endothelial function and triglycerides. Recent findings Clinical studies have shown that hypertriglyceridemia…

Αλέξανδρος Γ. Σφακιανάκης

2m

Neuropsychology as a Method of Diagnosis and Treatment of Internet Addiction Objective: Nowadays, the…
Neuropsychology as a Method of Diagnosis and Treatment of Internet AddictionObjective: Nowadays, the widespread use of the internet has resulted in the creation of the phenomenon of addiction to the internet. Internet addiction constitutes a new kind of mental disorder that is caused by the excessive use of the internet to a point that it interferes with daily life. In our research, we detected and recorded the electrophysiological brain characteristics of addicted users. Materials and Methods: Our…

Αλέξανδρος Γ. Σφακιανάκης

3m



Combination of laser microdissection, 2D-DIGE and MALDI-TOF MS to identify protein biomarkers to predict…
Combination of laser microdissection, 2D-DIGE and MALDI-TOF MS to identify protein biomarkers to predict colorectal cancer spread Chandra Kirana, Lifeng Peng, Rose Miller, John P. Keating, Corinne Glenn, Hongjun Shi, T. William Jordan, Guy J. Maddern & Richard S. Stubbs Clinical Proteomicsvolume 16, Article number: 3 (2019) | Download CitationAbstractBiomarkers are urgently required to support current histological staging to provide additional accuracy in stratifying colorectal cancer (CRC)…

Αλέξανδρος Γ. Σφακιανάκης

6m



Plasma lipoproteome in Alzheimer’s disease: a proof-of-concept study Danni Li, Fangying Huang, Yingchun…
Plasma lipoproteome in Alzheimer’s disease: a proof-of-concept study Danni Li, Fangying Huang, Yingchun Zhao, Peter W. Villata, Timothy J. Griffin, Lin Zhang, Ling Li & Fang Yu Clinical Proteomicsvolume 15, Article number: 31 (2018) | Download CitationAbstractBackgroundAlthough total plasma lipoproteome consists of proteins that have shown promises as biomarkers that can identify Alzheimer’s disease (AD), effect sizes are modest. The objective of this study is to provide initial proof-of-concept…

Αλέξανδρος Γ. Σφακιανάκης

7m



Validation of a novel model for the early detection of hepatocellular carcinoma Philip M. Hemken, Lori…
Validation of a novel model for the early detection of hepatocellular carcinoma Philip M. Hemken, Lori J. Sokoll, Xiaoqing Yang, Jianliang Dai, Debra Elliott, Susan H. Gawel, Michael Lucht, Ziding Feng, Jorge A. Marrero, Sudhir Srivastava, Daniel W. Chan & Gerard J. Davis Clinical Proteomicsvolume 16, Article number: 2 (2019) | Download CitationAbstractBackgroundThe biomarkers alpha-fetoprotein (AFP) and protein induced by vitamin K absence/antagonist-II (PIVKA-II) may be useful for detecting…

Αλέξανδρος Γ. Σφακιανάκης

8m

Journal of the European Academy of Dermatology and Venereology Volume 33, Issue 8 Pages: 1439-1617,…
Journal of the European Academy of Dermatology and Venereology Volume 33, Issue 8 Pages: 1439-1617, e275-e309 August 2019Issue InformationIssue InformationPages: 1439-1444 | First Published: 25 July 2019COMMENTARIESNot everything is as it seems: commentary on ‘Stereophotogrammetric three‐dimensional photography is an accurate and precise planimetric method for the clinical visualization and quantification of human papilloma virus‐induced skin lesions’M. Skerlev, S. Ljubojević Hadžavdić, M. Sirotković‐SkerlevPages:…

Αλέξανδρος Γ. Σφακιανάκης

10m

Investigating the Effect of Cochlear Synaptopathy on Envelope Following Responses Using a Model of the…
Investigating the Effect of Cochlear Synaptopathy on Envelope Following Responses Using a Model of the Auditory NerveAbstractThe healthy auditory system enables communication in challenging situations with high levels of background noise. Yet, despite normal sensitivity to pure tones, many listeners complain about having difficulties in such situations. Recent animal studies demonstrated that noise overexposure that produces temporary threshold shifts can cause the loss of auditory nerve (AN) fiber…

Αλέξανδρος Γ. Σφακιανάκης

12m

High-throughput lipidomic profiling of high-density lipoprotein from egg yolk (EYHDL): comparison…
High-throughput lipidomic profiling of high-density lipoprotein from egg yolk (EYHDL): comparison based on UPLC-MS/MS and GC–MSAbstractHigh-density lipoproteins from egg yolk (EYHDL), also called lipovitellenin, is the second largest constituent of egg yolk (EY), and possesses important functional properties in lipid metabolism for its high content of phospholipids. To better understand its lipid profile, a lipidomic analysis based on ultrahigh-performance liquid chromatography tandem mass spectrometry…

Αλέξανδρος Γ. Σφακιανάκης

13m

Acetabular and femoral reconstruction in total hip replacement for adult hip dysplasia: A technical…
Acetabular and femoral reconstruction in total hip replacement for adult hip dysplasia: A technical guide for surgeons in our environmentOlukemi Lawani, Michael Okunola, Imoniche Adeoye-Sunday, Charles AyekoloyeNigerian Journal of Orthopaedics and Trauma 2019 18(1):1-3Hip dysplasia is abnormal development of the hip joint resulting in joint incongruity and characterised by a shallow acetabulum, inadequate femoral head coverage and femoral and acetabular version abnormalities. Childhood hip dysplasia…

Αλέξανδρος Γ. Σφακιανάκης

13m

The pathology of solid organ xenotransplantation Purpose of review The use of genetically modified pigs…
The pathology of solid organ xenotransplantationPurpose of review The use of genetically modified pigs has resulted in prolonged xenograft organ survival, overcoming the initial barriers that lead to hyperacute rejection and immediate loss of the graft. The purpose of the present review is to revisit the xenogeneic response and the pathologic changes in the xenograft organ in the context of recent publications of large animal studies that highlight existing challenges. Recent findings Transgenic…

Αλέξανδρος Γ. Σφακιανάκης

14m

Living with cancer and multimorbidity: the role of primary care Purpose of review As more people live…
Living with cancer and multimorbidity: the role of primary carePurpose of review As more people live longer with cancer, the number of patients with cancer and multiple other chronic conditions (multimorbidity) has increased. The presence of multimorbidity impacts on all stages of cancer care, from prevention and early detection through to end of life care, but research into cancer and multimorbidity is in its infancy. This review explores the impact of multimorbidity on adults living with (and beyond)…

Αλέξανδρος Γ. Σφακιανάκης

14m

Parvimico materdei gen. et sp. nov.: A new platyrrhine from the Early Miocene of the Amazon Basin, Peru1…
Parvimico materdei gen. et sp. nov.: A new platyrrhine from the Early Miocene of the Amazon Basin, Peru1Publication date: September 2019Source: Journal of Human Evolution, Volume 134Author(s): Richard F. Kay, Lauren A. Gonzales, Wout Salenbien, Jean-Noël Martinez, Siobhán B. Cooke, Luis Angel Valdivia, Catherine Rigsby, Paul A. BakerAbstractThree field seasons of exploration along the Río Alto Madre de Dios in Peruvian Amazonia have yielded a fauna of micromammals from a new locality AMD-45, at ∼12.8°S….

Αλέξανδρος Γ. Σφακιανάκης

15m

Functional and Cardiovascular Measurements in Patients With Peripheral Artery Disease: COMPARISON BETWEEN…
Functional and Cardiovascular Measurements in Patients With Peripheral Artery Disease: COMPARISON BETWEEN MEN AND WOMENPurpose: To compare functional and cardiovascular variables of men and women with peripheral artery disease (PAD). Methods: This observational, cross-sectional study included 67 women and 144 men (age 66 ± 9 and 67 ± 10 yr, respectively) with PAD. Patients were submitted to a clinical evaluation, 6-min walk test (6MWT) and cardiovascular evaluation, including blood pressure, arterial…

Αλέξανδρος Γ. Σφακιανάκης

17m

Real-world virological efficacy and safety of daclatasvir/asunaprevir/beclabuvir in patients with chronic…
Real-world virological efficacy and safety of daclatasvir/asunaprevir/beclabuvir in patients with chronic hepatitis C virus genotype 1 infection in JapanAbstractBackgroundThe virological efficacy and safety of the direct-acting antiviral (DAA) regimen consisting of daclatasvir, asunaprevir, and beclabuvir (DCV/ASV/BCV) for patients chronically infected with hepatitis C virus (HCV) genotype 1 have not been previously evaluated in Japanese real-world settings.MethodsIn a Japanese nationwide multicenter…

Αλέξανδρος Γ. Σφακιανάκης

18m

The efficacy of vonoprazan and proton-pump inhibitors for maintenance treatment of gastroesophageal reflux disease
Systematic review with network meta-analysis: indirect comparison of …AbstractBackgroundLong-term maintenance treatment of gastroesophageal reflux disease (GERD) is important to prevent relapse. Proton-pump inhibitors (PPIs) are used for both treatment and maintenance therapy of GERD. Recently, a potassium-competitive acid blocker vonoprazan was launched in Japan. We evaluated the comparative efficacy of vonoprazan and other PPIs for GERD maintenance.MethodsA systematic literature search was performed…

Αλέξανδρος Γ. Σφακιανάκης

18m

A Helicobacter pylor i screening and treatment program to eliminate gastric cancer among junior high school students
in Saga Prefecture: a preliminary reportAbstractBackgroundTo present the strategies and preliminary findings of the first 3 years after implementing a Helicobacter pylori screening and eradication program to prevent gastric cancer in Saga Prefecture.MethodsA screening and treatment program to eradicate H. pylori from third-grade junior high students was started in Saga Prefecture in 2016, using local governmental grants. Screening was with urinary anti-H. pylori antibody tests, followed by H. pylori stool…

Αλέξανδρος Γ. Σφακιανάκης

20m

Imatinib Induced Complete Remission of Psoriasis in a Patient with Chronic Myeloid Leukemia Clinical…
Imatinib Induced Complete Remission of Psoriasis in a Patient with Chronic Myeloid LeukemiaClinical Characteristics and Treatment Outcome of Hypocellular Acute Myeloid Leukemia Based on WHO ClassificationAbstractThe hypocellular acute leukemia is very rare atypical leukemia with frequency of 5–7% among patients with acute leukemias. It mainly occurs in older patients and usually has a myeloid phenotype. It is still unclear whether the outcome of hypocellular acute myeloid leukemia is less favorable…

Αλέξανδρος Γ. Σφακιανάκης

21m

The Innovator of Electrosurgery Hemostasis has been a major risk in the surgical field, causing Halsted…
The Innovator of ElectrosurgeryHemostasis has been a major risk in the surgical field, causing Halsted to preach for the need for better control of bleeding to improve the morbidity and mortality many surgeons faced at the time. This problem, while combated by suturing methods for many, remained an issue in the neurosurgical field. Dr. Cushing sought out the help of William Bovie, leading to the creation of electrosurgery. This invention changed the way surgery could be performed and remains to be…

Αλέξανδρος Γ. Σφακιανάκης

22m

Incidence of Pneumothorax Experienced After Orthognathic Surgery The purpose of this study is to…
Incidence of Pneumothorax Experienced After Orthognathic SurgeryThe purpose of this study is to evaluate the frequency of pneumothorax following orthognathic surgery and describe its clinical presentation. A retrospective analysis of a hospital database was carried out on consecutive patients with normal presurgical clinical assessment, laboratory findings, and chest X-ray who underwent orthognathic surgery from January 2007 to September 2018 in the Department of Oral and Craniomaxillofacial Surgery,…

Αλέξανδρος Γ. Σφακιανάκης

22m



Major Structural Airway Pathologies of Patient Complaining Nasal Obstruction Analysis of Frequency,…
Major Structural Airway Pathologies of Patient Complaining Nasal Obstruction Analysis of Frequency, Preoperative Complaints, and Benefit From SurgeryKankaya, Yuksel MD; Ozer, Kadri MDJournal of Craniofacial Surgery: July 26, 2019 – Volume Publish Ahead of Print – Issue – pdoi: 10.1097/SCS.0000000000005790

Αλέξανδρος Γ. Σφακιανάκης

23m

Endonasal Endoscopic Management of Pterigopalatine Fossa Hydatid Cyst Hydatid cyst (echinococcosis)…
Endonasal Endoscopic Management of Pterigopalatine Fossa Hydatid CystHydatid cyst (echinococcosis) is an infectious disease caused mainly by Echinococcus granulosus, a parasite transmitted by dogs and encountered 1st in the liver and then in the lungs. Involvement in the head and neck region is uncommon, and pterygopalatine fossa disease resulting from hydatid cyst is extremely rare, with only 4 reported patients. In this report, the authors present a patient with exophthalmus caused by a primary…

Αλέξανδρος Γ. Σφακιανάκης

23m

Algorithm for selection of balance assessment tools in post-stroke patients The aim of the study was…
Algorithm for selection of balance assessment tools in post-stroke patientsThe aim of the study was to design an algorithm of selecting the balance assessment tool in patients after stroke, which could be used in a subacute rehabilitation setting. A retrospective study was carried out to analyse results of standardized balance measurements in three groups of stroke patients classified by Functional Ambulation Category (FAC) (FAC 1 or 2, non-functional ambulation; FAC 3 or 4, ambulatory dependent;…

Αλέξανδρος Γ. Σφακιανάκης

25m

Functional improvement after severe brain injury with disorder of consciousness paralleling treatment…
Functional improvement after severe brain injury with disorder of consciousness paralleling treatment for comorbid obstructive sleep apnoea: a case reportSurvivors of brain injury who have disorders of consciousness often have chronic functional deficits and disability. Obstructive sleep apnoea, a sleep-related breathing disorder, is a medical comorbid condition common among persons with brain injury and is injurious to health. Research on obstructive sleep apnoea treatment among brain-injured patients–particularly…

Αλέξανδρος Γ. Σφακιανάκης

25m

Unique MicroRNAs Signature of Lymphocyte of Yang and Yin Syndromes in Acute Ischemic Stroke Patients…
Unique MicroRNAs Signature of Lymphocyte of Yang and Yin Syndromes in Acute Ischemic Stroke PatientsAbstractObjectiveTo identify the differentially expressed microRNAs (miRNAs) profiles of yang and yin syndromes in patients with acute ischemic stroke, and to provide the molecular basis of the classification of these two syndrome types in acute ischemic stroke patients.MethodsA microarray assay was performed to assess the expression pattern of miRNAs in the lymphocyte of acute ischemic stroke patients….

Αλέξανδρος Γ. Σφακιανάκης

26m

Wandering spiders recover more slowly than web-building spiders after fire Abstract Fire is a natural…
Wandering spiders recover more slowly than web-building spiders after fireAbstractFire is a natural feature of many ecosystems, with some vegetation types highly adapted to fire. However, very little is known about the effect of fire on spiders, especially as fires have become more frequent owing to human activity. We determine whether different spider functional guilds (web builders vs. wanderers) respond differently to fires in the sclerophyllous fynbos. We determine also the effect of rockiness…

Αλέξανδρος Γ. Σφακιανάκης

33m



Thoracolumbar junction orientation: its impact on thoracic kyphosis and sagittal alignment in both asymptomatic…
Thoracolumbar junction orientation: its impact on thoracic kyphosis and sagittal alignment in both asymptomatic volunteers and symptomatic patientsAbstractPurposeThe thoracolumbar junction (TLJ) has not been explored in regard to its contribution to global sagittal alignment. This study aims to define novel sagittal parameters of the TLJ and to assess their roles within global sagittal alignment.MethodsIncluded for cross-sectional, retrospective analysis were asymptomatic volunteers and symptomatic…

Αλέξανδρος Γ. Σφακιανάκης

33m

Neanderthal Population Dynamics Clarified With New Sequence Data Jun 26, 2019 | staff reporter Save…
Neanderthal Population Dynamics Clarified With New Sequence DataJun 26, 2019 | staff reporterSave for laterNEW YORK – A team from Germany and Belgium has sequenced two new Neanderthal genomes to untangle the ancient history of the ancient hominins.As they reported online today in Science Advances, investigators at the Max Planck Institute for Evolutionary Anthropology and elsewhere sequenced nuclear DNA from two Neanderthals whose remains were dated to about 120,000 years ago. The Neanderthals —…

Αλέξανδρος Γ. Σφακιανάκης

36m



Brain Evolution by Design Read the sample chapter: Insect Brains: Minute Structures Controlling Complex…
Brain Evolution by Design Read the sample chapter: Insect Brains: Minute Structures Controlling Complex Behaviors

Αλέξανδρος Γ. Σφακιανάκης

37m

Fathers’ and Mothers’ Early Mind-Mindedness Predicts Social Competence and Behavior Problems in Childhood…
Fathers’ and Mothers’ Early Mind-Mindedness Predicts Social Competence and Behavior Problems in ChildhoodAbstractParental mind-mindedness, the parent’s propensity to treat the child as an intentional agent, has repeatedly shown to promote children’s development of social understanding and secure attachment. Less is known about whether the impact of maternal and paternal mind-mindedness extends to children’s social and behavior problems. We investigated the combined effect of mothers’ and fathers’…

Αλέξανδρος Γ. Σφακιανάκης

38m

Planar Lens–Based Ultra-Wideband Dielectric Rod Waveguide Antenna for Tunable THz and Sub-THz Photomixer…
Planar Lens–Based Ultra-Wideband Dielectric Rod Waveguide Antenna for Tunable THz and Sub-THz Photomixer SourcesAbstractIn this manuscript, the use of dielectric rod waveguide antenna (DRW) with an embedded planar lens is proposed as a highly directional alternative to an electrically large hyper-hemispheric silicon lens for emission at millimeter and sub-millimeter wave frequencies. DRW antennas radiate properly if only the fundamental mode is excited to the structure. Since photomixer-based terahertz…

Αλέξανδρος Γ. Σφακιανάκης

38m

Association between invasively measured aortic pulse pressure and orthostatic hypotension in patients…
Association between invasively measured aortic pulse pressure and orthostatic hypotension in patients undergoing invasive coronary angiographyObjective: Underlying pathophysiology of orthostatic hypotension has been poorly understood. We hypothesized that aortic pulse pressure (APP) reflecting aortic stiffness may be involved in the development of orthostatic hypotension. Methods: A total of 200 patients (age 64.3 ± 10.9 years, 62.5% men) who underwent invasive coronary angiography (ICA) were prospectively…

Αλέξανδρος Γ. Σφακιανάκης

39m

‘Reader, I married him/her’: Ali Smith, Ovid, and queer translation , Holly Ranger This essay frames…
‘Reader, I married him/her’: Ali Smith, Ovid, and queer translation , Holly RangerThis essay frames Ali Smith’s novel Girl meets boy (2007) as a ‘queer translation’ of Ovid, Metamorphoses 9.666-797. I argue that Smith’s presentation of a contemporary genderqueer Iphis and Ianthe not only fictionalizes the critical argument proposed by Judith Butler’s Gender Trouble, but uses Gender Trouble as a queer translation manifesto. Reading Girl meets boy through this Butlerian lens, which foregrounds multiplicity…

Αλέξανδρος Γ. Σφακιανάκης

42m

One man and his dog: Umberto D Poverty is bad for the health of older people, as for others. It may…
One man and his dog: Umberto D Poverty is bad for the health of older people, as for others. It may be particularly bad for mental health and, while obviously not the only factor, changes in poverty rates have been strongly associated with the rising suicide rates in the United States (and falling global rates worldwide) in recent years [1, 2]. Loss of dignity is among the most harmful characteristics of poverty. Owning a pet may be good for the mental health of, and protective against loneliness…

Αλέξανδρος Γ. Σφακιανάκης

43m

A recent essay by poet laureate Tracy K. Smith contends that, through the 1990s, American poetry was…
A recent essay by poet laureate Tracy K. Smith contends that, through the 1990s, American poetry was gripped by a “firm admonition to avoid composing political poems,” but with the shock of 9/11 and the ensuing war in Iraq, “something shifted in the nation’s psyche” that sparked a renewed flowering of socially engaged political poetry. Three new critical monographs remind us, however, that, at least when it comes to war, poets have always been political. In their respective volumes, Tim Dayton, Rachel…

Αλέξανδρος Γ. Σφακιανάκης

44m

The call of the North Sanna Raninen Early English keyboard music revitalized Andrew Woolley A…
The call of the North Sanna Raninen Early English keyboard music revitalized Andrew Woolley A festival of Franciscans Michael Talbot Early modern elegies Katherine Butler Hildegard’s extraordinary life Marianne Richert Pfau Florentine patricians, art, music and culture around 1600 Valerio Morucci A harpsichordist’s handbook Thérèse de Goede

Αλέξανδρος Γ. Σφακιανάκης

45m

The Aura of Opera Reproduced: Fantasies and Traps in the Age of the Cinecast ,. João Pedro Cachopo
The Aura of Opera Reproduced: Fantasies and Traps in the Age of the Cinecast ,. João Pedro Cachopo

Αλέξανδρος Γ. Σφακιανάκης

45m

GuLF DREAM: A Model to Estimate Dermal Exposure Among Oil Spill Response and Clean-up Workers, Melanie…
GuLF DREAM: A Model to Estimate Dermal Exposure Among Oil Spill Response and Clean-up Workers, Melanie Gorman Ng; John W Cherrie; Anne Sleeuwenhoek; Mark Stenzel ; Richard K Kwok … Derivation of Time-Activity Data Using Wearable Cameras and Measures of Personal Inhalation Exposure among Workers at an Informal Electronic-Waste Recovery Site in Ghana Zoey Laskaris; Chad Milando; Stuart Batterman; Bhramar Mukherjee; Niladri Basu …

Αλέξανδρος Γ. Σφακιανάκης

46m

Is It Time to Reconsider the Group A Streptococcal Rheumatogenic Concept?
The Limitations of the Rheumatogenic Concept for Group A Streptococcus: Systematic Review and Genetic AnalysisGabrielle de Crombrugghe; Noemie Baroux; Anne Botteaux ; Nicole J Moreland; Deborah A Williamson …Wide genetic distribution of group A streptococcus emm types was associated with acute rheumatic fever. Rheumatogenic motifs were infrequent. Microbiology studies on rheumatic fever pathogenesis should also examine previously called nonrheumatogenic emm types. Vaccine development should aim…

Αλέξανδρος Γ. Σφακιανάκης

48m

Songs of Silver Speech: “CareMusLy”: Song Writing in the Treatment of Psychosis Andrea Volpini Songwriting…
Songs of Silver Speech: “CareMusLy”: Song Writing in the Treatment of Psychosis Andrea VolpiniSongwriting is commonly utilized in the clinical treatment of psychiatric patients suffering from a wide variety of psychoses. CareMusLy (CML) is a psychodynamic, systematically applied intervention combining music and lyrics to counteract and redefine the problems created by the psychotic dimension. The process starts from a free collective vocal improvisation, during which the music therapist transcribes…

Αλέξανδρος Γ. Σφακιανάκης

49m

New chromosomal lineages within Microvirga andBradyrhizobium genera nodulate Lupinus angustifolius growing…
New chromosomal lineages within Microvirga andBradyrhizobium genera nodulate Lupinus angustifolius growing on different Tunisian soils M Rejili; A Msaddak; I Filali; M A Benabderrahim; M Mars …

Αλέξανδρος Γ. Σφακιανάκης

50m

Polyneuropathy in Critically Ill Mechanically Ventilated Children: Experience From a Tertiary Care Hospital…
Polyneuropathy in Critically Ill Mechanically Ventilated Children: Experience From a Tertiary Care Hospital in North IndiaObjectives: To determine the prevalence of critical illness polyneuropathy and its risk factors in critically ill children mechanically ventilated for 7 days or more. Design: Observational cohort study. Setting: PICU of a tertiary care hospital from North India. Patients: Children 1–15 years old admitted in PICU from June 2016 to September 2017, mechanically ventilated for 7 days…

Αλέξανδρος Γ. Σφακιανάκης

50m

The relationship between guarding, pain, and emotion Introduction: Pain-related behavior in people with…
The relationship between guarding, pain, and emotionIntroduction: Pain-related behavior in people with chronic pain is often overlooked in a focus on increasing the amount of activity, yet it may limit activity and maintain pain and disability. Targeting it in treatment requires better understanding of the role of beliefs, emotion, and pain in pain behavior. Objectives: This study aimed to clarify the interrelationships between guarding, pain, anxiety, and confidence in movement in people with chronic…

Αλέξανδρος Γ. Σφακιανάκης

51m

Cochlear Implant Outcomes in Large Vestibular Aqueduct Syndrome—Should We Provide Cochlear Implants…
Cochlear Implant Outcomes in Large Vestibular Aqueduct Syndrome—Should We Provide Cochlear Implants Earlier?Objective: Examine postoperative speech perception outcomes in a large vestibular aqueduct syndrome (LVAS) patients at a major cochlear implantation center. Study Design: Retrospective analysis of the Sydney Cochlear Implant Centre (SCIC) database and medical records from January 1994 to December 2015 was performed. Setting: Tertiary referral center. Patients: Patients with a diagnosis of LVAS…

Αλέξανδρος Γ. Σφακιανάκης

52m

Evidence of Prostate-Specific Membrane Antigen Expression in Hepatocellular Carcinoma Using 68Ga-PSMA…
Evidence of Prostate-Specific Membrane Antigen Expression in Hepatocellular Carcinoma Using 68Ga-PSMA PET/CTIntroduction Prostate specific membrane antigen (PSMA) expression has been demonstrated in tumor neovasculature of many solid tumors, including hepatocellular carcinoma (HCC). The purpose of this study is to evaluate PSMA expression in patients with HCC. Materials and Methods Nineteen HCC patients who underwent 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) as part of restaging…

Αλέξανδρος Γ. Σφακιανάκης

53m

Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Patient Evaluation, Anatomy, and…
Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Patient Evaluation, Anatomy, and Technique for Successful Treatment Prostatic artery embolization is emerging as an effective and safe treatment of symptomatic benign prostatic hyperplasia. Andrew C. Picel, Tung-Chin Hsieh…Ari J. Isaacson

Αλέξανδρος Γ. Σφακιανάκης

56m



Contrast-enhanced US in Local Ablative Therapy and Secondary Surveillance for Hepatocellular…
Contrast-enhanced US in Local Ablative Therapy and Secondary Surveillance for Hepatocellular Carcinoma The role of contrast-enhanced US in ablative therapy for hepatocellular carcinoma includes patient selection, treatment planning, intraprocedural guidance, and immediate postprocedural assessment; the authors also describe their use of this modality for secondary surveillance. Sanjay Bansal, Jonathan Gui…Stephanie R. Wilson Invited Commentary on "Contrast-enhanced US in Local Ablative Therapy…

Αλέξανδρος Γ. Σφακιανάκης

57m

The Voices of Nîmes: Women, Sex, and Marriage in Reformation Languedoc, Tom Hamilton The Perraults:…
The Voices of Nîmes: Women, Sex, and Marriage in Reformation Languedoc, Tom Hamilton The Perraults: A Family of Letters in Early Modern France , Julie D Campbell National Gallery Catalogues: The Eighteenth Century French Paintings, Emma Barker

Αλέξανδρος Γ. Σφακιανάκης

57m

Théophile Gautier, Œuvres complètes, Romans, contes et nouvelles, iv: Le Capitaine Fracasse. Édition…
Théophile Gautier, Œuvres complètes, Romans, contes et nouvelles, iv: Le Capitaine Fracasse. Édition critique par Sarah Mombert Michael Tilby La Vraie Vie de Vinteuil. Par Jérôme Bastianelli Jennifer Rushworth Penser l’après Louis XIV: histoire, mémoire, représentation (1715–2015). Sous la direction de Sven Externbrink et Charles-Édouard Levillain Michael Sonenscher Le Double: littérature, arts, cinéma: nouvelles approches. Sous la direction de Erica Durante et Amaury Dehoux Jules O’Dwyer

Αλέξανδρος Γ. Σφακιανάκης

58m

David Alan Johnson, Diploma Mill: The Rise and Fall of Dr. John Buchanan and the Eclectic Medical College…
David Alan Johnson, Diploma Mill: The Rise and Fall of Dr. John Buchanan and the Eclectic Medical College of Pennsylvania Lynn E Miller Medical Surveillance and Medical Confidentiality in an Age of Transition: The Debate over Cancer Registration in West Germany Larry Frohman

Αλέξανδρος Γ. Σφακιανάκης

58m

Love and Money in the Informal Empire: The British in Argentina, 1830–1930, Deborah Cohen
Love and Money in the Informal Empire: The British in Argentina, 1830–1930, Deborah Cohen

Αλέξανδρος Γ. Σφακιανάκης

58m

Prescriptions on Demand: The Growth of Direct-to-Consumer Telemedicine Companies Tara Jain, BA; Richard…
Prescriptions on Demand: The Growth of Direct-to-Consumer Telemedicine CompaniesTara Jain, BA; Richard J. Lu, MBA; Ateev Mehrotra, MD, MPHJAMA DIAGNOSTIC TEST INTERPRETATIONInterpretation of Vitamin B12 Status After a Roux-en-Y Gastric BypassSameer B. Murali; MD MSHSEarn CME credit

Αλέξανδρος Γ. Σφακιανάκης

1h



OncologyEducation is proud to present our Best of ASCO Toronto 2019 Presentations. These videos incorporate…
OncologyEducation is proud to present our Best of ASCO Toronto 2019 Presentations.These videos incorporate perspectives from our faculty of experts.Please enjoy and share with your colleagues.To view the videos, click the images below:

Αλέξανδρος Γ. Σφακιανάκης

1h

The Longitudinal Association between Social Support on HIV Medication Adherence and Healthcare Utilization…
The Longitudinal Association between Social Support on HIV Medication Adherence and Healthcare Utilization in the Women’s Interagency HIV StudyAbstractSocial support is associated with HIV-related health outcomes. However, few studies have explored this longitudinally. We assessed psychometric properties of the Medical Outcomes Study’s Social Support Survey among women in the Women’s Interagency HIV Study, and explored the longitudinal effects of social support on HIV medication adherence (HIV-positive…

Αλέξανδρος Γ. Σφακιανάκης

1h



Virtual Reality to Improve the Experience of the Mohs Patient—A Prospective Interventional Study BACKGROUND…
Virtual Reality to Improve the Experience of the Mohs Patient—A Prospective Interventional StudyBACKGROUND Nonmelanoma skin cancer is the most common cancer in the United States with significant quality of life impact. OBJECTIVE To assess the utility of a highly immersive virtual reality (VR) experience in the context of outpatient skin cancer surgery as a means to minimize patient-reported feelings of anxiety or pain. The authors also sought to assess the effects on patient-reported overall satisfaction….

Αλέξανδρος Γ. Σφακιανάκης

1h



Robotic cholecystectomy for acute cholecystitis: Three case reports Introduction: Nowadays laparoscopic…
Robotic cholecystectomy for acute cholecystitis: Three case reportsIntroduction: Nowadays laparoscopic cholecystectomy is considered as criterion standard for surgical treatment of acute calculous cholecystitis. During the last few years, there has been growing interest about the robotic approach. Several authors have reported the superiority of robotic cholecystectomy, associated with a lower percentage of conversion especially in patients with intraoperative diagnosis of acute or gangrenous cholecystitis….

Αλέξανδρος Γ. Σφακιανάκης

1h



Thyroid cartilage loci and hyoid bone analysis using a video fluoroscopic swallowing study (VFSS) …
Thyroid cartilage loci and hyoid bone analysis using a video fluoroscopic swallowing study (VFSS)Introduction: Hyoid bone movement can be useful for diagnosing oropharyngeal dysphagia. In most clinical settings, the movement can be evaluated by a video fluoroscopic swallowing study (VFSS) that induces radiation exposure. In contrast with the hyoid bone, the thyroid cartilage is easily seen through the anterior neck surface. We hypothesized that the movement of thyroid cartilage correlates with hyoid…

Αλέξανδρος Γ. Σφακιανάκης

1h



E-cadherin expression is associated with susceptibility and clinicopathological characteristics of…
E-cadherin expression is associated with susceptibility and clinicopathological characteristics of thyroid cancer: A PRISMA-compliant meta-analysisBackground: Recently, many studies have been carried out to investigate the clinicopathological significance of E-cadherin expression in thyroid cancer. However, the results remained inconsistent. In the present study, we performed a meta-analysis to evaluate the associations of E-cadherin expression with susceptibility and clinicopathological characteristics…

Αλέξανδρος Γ. Σφακιανάκης

1h



A Unique Partnership to Bolster Public Health Practice No abstract available Factors Associated With…
A Unique Partnership to Bolster Public Health PracticeNo abstract availableFactors Associated With Continuous Improvement by Local Boards of HealthBackground: The continuous improvement function, 1 of the 6 public health governance functions, can be usefully applied in the context of local boards of health (LBoHs) operations to target self-improvements. Purpose: The purpose of this study was to determine the engagement level of LBoHs in continuous improvement efforts and to identify factors associated…

Αλέξανδρος Γ. Σφακιανάκης

1h

Lactic Acidosis and The Role of Sodium Bicarbonate: A Narrative Opinion Lactic acidosis occurs commonly…
Lactic Acidosis and The Role of Sodium Bicarbonate: A Narrative OpinionLactic acidosis occurs commonly and can be a marker of significant physiologic derangements. However what an elevated lactate level and acidemia connotes and what should be done about it is subject to inconsistent interpretations. This review examines the varied etiologies of lactic acidosis, the physiologic consequences, and the known effects of its treatment with sodium bicarbonate. Lactic acidosis is often assumed to be a marker…

Αλέξανδρος Γ. Σφακιανάκης

1h

Stem Cell Therapy and Hydrogen Sulfide: Conventional or Nonconventional Mechanisms of Action? Purpose:…
Stem Cell Therapy and Hydrogen Sulfide: Conventional or Nonconventional Mechanisms of Action?Purpose: Hydrogen sulfide (H2S) has many beneficial biological properties, including the ability to promote vasodilation. It has been shown to be released from stem cells and increased by hypoxia. Therefore, H2S may be an important paracrine factor in stem cell mediated intestinal protection. We hypothesized that hydrogen sulfide created through conventional pathways would be a critical component of stem…

Αλέξανδρος Γ. Σφακιανάκης

1h

Pediatric Respiratory Illness Measurement System (PRIMES) Scores and Outcomes Rita Mangione-Smith,…
Pediatric Respiratory Illness Measurement System (PRIMES) Scores and OutcomesRita Mangione-Smith, Chuan Zhou, Derek J. Williams, David P. Johnson, Chén C. Kenyon, Amy Tyler, Ricardo Quinonez, Joyee Vachani, Julie McGalliard, Joel S. Tieder, Tamara D. Simon, Karen M. Wilson and for the Pediatric Research in Inpatient Settings (PRIS) NetworkSpecial ArticleA Framework for Evaluation of the Higher-Risk Infant After a Brief Resolved Unexplained EventJ. Lawrence Merritt II, Ricardo A. Quinonez, Joshua…

Αλέξανδρος Γ. Σφακιανάκης

1h

Antimicrobial Activity of Biosynthesized Silver Nanoparticles Decorated Silica Nanoparticles Abstract…
Antimicrobial Activity of Biosynthesized Silver Nanoparticles Decorated Silica NanoparticlesAbstractThe production of cheap and effective compound for medicinal application is a major challenge for scientific community. So, several biological materials have been explored for the possible application in material synthesis which are useful in biomedical uses. Here, biomolecules from green tea leaves were functionalized on the surface of silicon dioxide nanoparticles (GSiO2 NPs). Next, the decoration…

Αλέξανδρος Γ. Σφακιανάκης

1h

The Effect of Maternity Leave Expansions on Fertility Intentions: Evidence from Switzerland Abstract…
The Effect of Maternity Leave Expansions on Fertility Intentions: Evidence from SwitzerlandAbstractWe study the effect of the expansion of the mandatory paid maternity leave, implemented in Switzerland in 2005, on individuals’ fertility intentions. Earlier literature found evidence of fertility increases induced by maternity leave expansions from other countries of a relatively large magnitude of 1 year. The expansion that we consider was smaller, from 8 unpaid weeks to 14 mandatory paid weeks, and…

Αλέξανδρος Γ. Σφακιανάκης

1h



Sabu Thomas, Yves Grohens, Nandakumar Kalarikkal, Oluwatobi Samuel Oluwafemi, Praveen K. M. (Eds): Nanotechnology-Driven…
Sabu Thomas, Yves Grohens, Nandakumar Kalarikkal, Oluwatobi Samuel Oluwafemi, Praveen K. M. (Eds): Nanotechnology-Driven Engineered Materials—New InsightsRecent Trends in Solid-Phase Extraction for Environmental, Food and Biological Sample PreparationSomenath Mitra, Pradyot Patnaik and Barbara B. Kebbekus: Environmental Chemical Analysis, 2nd EdnCongress, Conferences, and WorkshopsAdvances in Cellulose-Based Sorbents for Extraction of Pollutants in Environmental SamplesAbstractThe effective extraction…

Αλέξανδρος Γ. Σφακιανάκης

1h

Targeted RNA-sequencing identifies FBXW4 instead of MGEA5 as fusion partner of TGFBR3 in pleomorphic…
Targeted RNA-sequencing identifies FBXW4 instead of MGEA5 as fusion partner of TGFBR3 in pleomorphic hyalinizing angiectatic tumorAbstractPleomorphic hyalinizing angiectatic tumor (PHAT) is a rare mesenchymal tumor of intermediate malignancy. PHAT, and the related hemosiderotic fibrolipomatous tumor, show a recurrent t(1;10)(p22;q24). Fluorescence in situ hybridization (FISH) and BAC (bacterial artificial chromosome) clones have previously identified TGFBR3 and MGEA5 as fusion partners. However,…

Αλέξανδρος Γ. Σφακιανάκης

1h

“Early Elective” rather than “Emergency” Laparoscopic Transcystic Exploration can prevent bile duct…
“Early Elective” rather than “Emergency” Laparoscopic Transcystic Exploration can prevent bile duct exploration/ERCP in half of patientsSclerosing Angiomatoid Nodular Transformation of the Spleen (SANT) with IgG4 Plasma Cells InfiltrationCorrection to: The Association of Body Mass Index with Postoperative Outcomes After Elective Paraesophageal Hernia RepairIn this paper, the first author’s name was incorrectly tagged.Pure Laparoscopic Living Donor Right Hepatectomy Using Real-Time Indocyanine Green…

Αλέξανδρος Γ. Σφακιανάκης

1h



Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
IJERPH, Vol. 16, Pages 2673: Whitefly Control Strategies against Tomato Leaf Curl New Delhi Virus…IJERPH, Vol. 16, Pages 2673: Whitefly Control Strategies against Tomato Leaf Curl New Delhi Virus in Greenhouse ZucchiniIJERPH, Vol. 16, Pages 2673: Whitefly Control Strategies against Tomato Leaf Curl New Delhi Virus in Greenhouse Zucchini International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16152673 Authors: Estefanía Rodríguez Mª Mar Téllez Dirk Janssen (1) Background:…

Αλέξανδρος Γ. Σφακιανάκης

23h



Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
Morphology of the Middle Ear Ossicles in the Rodent Perimys (Neoepiblemidae) and a Comprehensive Anatomical…Morphology of the Middle Ear Ossicles in the Rodent Perimys (Neoepiblemidae) and a Comprehensive Anatomical and Morphometric Study of the Phylogenetic Transformations of these Structures in CaviomorphsAbstractThe extinct clade of caviomorph rodents Neoepiblemidae includes forms that lived in South America from the early Miocene to Pliocene. Among them is Perimys. The exceptional preservation…

Αλέξανδρος Γ. Σφακιανάκης

1d



Trauma
Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum, and Proximal Femur: A Randomized Controlled TrialObjective: To assess the safety and efficacy of tranexamic acid (TXA) use in fractures of the pelvic ring, acetabulum, and proximal femur. Design: Prospective, randomized controlled trial. Setting: Single Level 1 trauma center. Patients: Forty-seven patients were randomized to the study group, and 46 patients comprised the control group. Intervention:…

Αλέξανδρος Γ. Σφακιανάκης

1d



Plastic and Reconstructive Surgery
Pediatric/Craniofacial Article: Focus of Live Facebook #PRSJournalClub Q&ASurvival Following Self-inflicted Gunshots to the FaceSpecial Topic Article with an Expert DiscussionThe Use of Emotional Artificial Intelligence in Plastic SurgeryCosmetic Article Featured in the PressAppreciation of Postpartum Changes of the Rectus Muscles in Primary and Re-Do AbdominoplastyHead and Neck Article Featured in a Plastic Surgery Hot Topic VideoFacial Transplantation for an Irreparable Central and Lower Face…

Αλέξανδρος Γ. Σφακιανάκης

1d

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,