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PURPOSE: Although intracranial meningiomas are the most common primary brain tumor in adults, treatment options are few and have traditionally been limited to surgical resection and radiotherapy. Additional targeted therapies and biomarkers are needed, especially as complete surgical resection is frequently not feasible in many patients. METHODS: Non-pathologic brain tissue from 3 patients undergoing routine autopsies and tumor specimens from 16 patients requiring surgical resection for meningioma were collected. EMP2 protein expression was evaluated by immunohistochemistry and western blot analysis. EMP2 mRNA expression was also investigated using surgical specimens and validated by analysis of several independent NCBI GEO databases. RESULTS: EMP2 mRNA expression levels were found to be higher in meningioma relative to non-pathologic meninges (P = 0.0013) and brain (P = 0.0011). Concordantly, strong EMP2 protein expression was demonstrated in 100% of meningioma specimens from all 16 patients, with no observable protein expression in normal brain tissue samples from 3 subjects (P < 0.001). EMP2 expression was confirmed by western blot analysis in five samples, with EMP2 protein intensity positively correlating with histologic staining score (R2 = 0.780; P = 0.047). No association was found between EMP2 mRNA or protein levels and WHO grade or markers of proliferation. However, EMP2 expression was positively associated with an angiomatous pattern on histologic evaluation (P = 0.0597), VEGF-A mRNA expression (P < 0.001), and clinical markers of tumor vascularity such as operative blood loss (P = 0.037). CONCLUSIONS: EMP2 is not found in normal brain tissue, yet has shown consistently high mRNA and protein expression in meningiomas, and may serve as a useful molecular marker for these tumors.
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Regulação Neoplásica da Expressão Gênica , Glicoproteínas de Membrana/metabolismo , Neoplasias Meníngeas/metabolismo , Neoplasias Meníngeas/patologia , Meningioma/metabolismo , Meningioma/patologia , Neovascularização Patológica/metabolismo , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Feminino , Humanos , Masculino , Glicoproteínas de Membrana/genética , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/genética , Meningioma/complicações , Meningioma/genética , Pessoa de Meia-Idade , Neovascularização Patológica/complicações , Neovascularização Patológica/genética , RNA Mensageiro/metabolismoRESUMO
Extracranial carotid artery aneurysms (ECAAs) are rare in comparison to the total number of peripheral artery aneurysms. Although there are multiple treatment modalities, no clear guidelines exist for the optimal management of ECAA. We describe a case of a 59-year-old female with an incidental finding of a 2.6 cm right internal carotid artery (ICA) aneurysm on computed tomography (CT) that was eventually excised via transcervical approach followed by end-to-end anastomosis with great saphenous vein (GSV) graft. To our knowledge, this case demonstrates a novel multidisciplinary approach to an ECAA near the skull base involving head and neck surgery (HNS), vascular surgery (VS), and neuro-interventional radiology (NIR).
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An escape room is a team-based activity that requires players to solve a series of puzzles to complete a story and "break out" of a room. It has recently gained traction in medical education for its ability to interactively and effectively present learning objectives. This was a prospective educational study that describes the successful application of a nephrology themed escape room for first- and second-year medical students. Compared to pre-escape room participation, the 52 students demonstrated a statistically significant improvement in self-reported knowledge for renal physiology (p < 0.01), pharmacology (p < 0.01), pathology (p < 0.01), and relevant clinical practice guidelines (p < 0.01). A majority of the students also claimed that the escape room was "more effective" than traditional lectures (80.8%) and textbooks (73.1%) and "equally effective" as third-party board preparation resources (69.2%) and their institution's problem-based learning curriculum (51.9%). The escape room also facilitated a high-level peer-to-peer collaboration with 82.7% and 76.9% of students reporting that they worked with someone in their year and outside of their year for at least half of the game, respectively. Ninety-five percent of the first-years and 84.6% of the second-years believed that the escape room was effective at preparing them for their respective exams, and an overwhelming majority (90.4%) described the escape room as "very enjoyable." Overall, this nephrology themed escape room was an engaging and well received educational modality and may be an effective supplemental study resource for medical students. Further studies are needed to assess knowledge acquisition. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01917-6.
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Objective: To determine the effect of smoking history on the risk of developing obstructive eustachian tube dysfunction (OETD). Study Design: Cross-sectional review. Setting: National database. Methods: Data from the National Health and Nutrition Examination Survey (1999 to present) was analyzed. OETD was defined as middle ear pressure less than -100 decapascals (daPa). Nonsmokers, current smokers, with tympanometry data were analyzed. Patients under the age of 18, with myringotomy tubes, or with a sinus problem/earache/cold in the past 24 hours were excluded. The relative risks (RRs) for developing OETD were calculated for nonsmokers versus smokers and those with greater versus less than 10, 20, and 30 pack years (py). Results: A total of 9472 patients met inclusion criteria (54.1% female, 75.9% non-Hispanic, mean age 43, 20.3% smokers). The RR of having OETD for smokers versus nonsmokers was 1.75 [95% confidence interval, CI: 1.45-2.11]. The RR of having OETD for patients with a 10+ py was 1.97 [95% CI 1.57-2.47], 20+ py was 2.29 [95% CI 1.76-2.95], and 30 py or greater was 2.08 [95% CI 1.49-2.90]. Conclusion: In this study, smoking roughly doubled the risk of developing OETD, as represented by a single measurement of negative middle ear pressure less than -100 daPa. The definition of OETD used in this study was limited, as it did not include symptomology, and more work is needed to examine additional covariates. However, these results may guide future research to better counsel and screen patients for OETD.
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INTRODUCTION: This is the first systematic review and meta-analysis to investigate the effectiveness of the nasal airflow-inducing maneuver (NAIM) in olfactory rehabilitation for total laryngectomy (TL) patients. METHODS: We conducted a systematic literature search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria required that patients must have undergone a TL with subsequent NAIM training for at least 2 weeks and olfactory evaluation. The impact of NAIM on olfactory outcomes compared to that at baseline was measured. Olfactory measures included the Sniffin' Sticks Test, Smell Disk Test, Scandinavian Odor Identification Test, and Quick Odor Detection Test. The primary outcome measures were the proportion of patients with normosmia at baseline and after intervention. RESULTS: Seven studies from 2000 to 2023 comprising a total of 290 TL patients met the inclusion criteria. The meta-analysis revealed that prior to intervention, the pooled proportion of patients with normosmia was 0.16 (95% confidence interval [CI]: 0.09â0.27, p = 0.01). After intervention, the same proportion increased to 0.55 (95% CI: 0.45â0.68, p = 0.001). Among the included patients, 88.3% were initially anosmic or hyposmic, which was reduced to 48.9% after NAIM practice, with 51.1% achieving normosmia. The percent improvement was not found to be significantly associated with the timing of intervention post-TL (p = 0.18). CONCLUSIONS: NAIM increased the proportion of patients who achieved normosmia in TL patients. NAIM stands out as a safe, easily teachable maneuver with promising results. Further efforts are warranted to provide specific recommendations and guidelines for the use of NAIM in clinical practice.
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The One Health concept focuses on the interconnections between human health, animal health, and the environment, stressing the need for interdisciplinary collaborations to address complex issues such as the health challenges posed by climate change and global pandemics. One Health is a central part of the curriculum of veterinary schools, however, it is rarely incorporated into medical school education. Nationally, there are limited examples of formal One Health education and training for medical students. To incorporate One Health into its curriculum, John A. Burns School of Medicine developed a Dean's Certificate of Distinction in One Health that consists of a One Health foundational course, a clinical One Health elective course, participation in the One Health Interest Group, engagement in One Health educational and outreach activities, and a One Health research or curriculum development project. To the authors' knowledge, this is the first One Health certificate program developed and implemented in any Association of American Medical Colleges accredited medical school. Although introducing similar programs into medical curricula will continue to be challenging, we hope it will serve as a framework for other academic institutions.
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Currículo , Educação Médica , Saúde Única , Humanos , Currículo/tendências , Currículo/normas , Educação Médica/métodosRESUMO
BACKGROUND: ClariFix for posterior nasal nerve ablation has been approved for use since 2017, and this is the first study attempting to synthesize and assess the efficacy of this new device on the management of chronic rhinitis. OBJECTIVE: The primary objective of this meta-analysis is to assess the efficacy of ClariFix in the symptomatic management of patients with chronic rhinitis. The main outcome measure is the mean difference in the reflective total nasal symptom score (rTNSS). METHODS: A systematic search of Pubmed/Medline, Web of Science, and EBSCOhost was conducted from inception to May 2022. Peer-reviewed clinical trials reporting postcryotherapy rTNSS at both 1- and 3-month intervals for patients with chronic rhinitis were included. A random-effects model was utilized for meta-analysis. Study heterogeneity, bias, and overall quality were all assessed. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The primary outcome measures included mean differences in rTNSS from baseline to both 1- and 3-month postoperative time points. Secondary measures included other questionnaires including the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). RESULTS: There were 5 studies that met the criteria (247 individuals). The pooled rTNSS mean difference from baseline to 1 and 3 months postoperatively was found to be -3.48 points (95% CI: -3.73 to -3.23, I2 = 0.13). and -3.50 (95% CI: -3.71 to -3.29, I2 = 0.00), respectively. The mean difference from baseline to 3 months postoperatively regarding the RQLQ was found to be -1.53 (95% CI: -1.74 to -1.31, I2 = 0.00). The most common adverse effects included facial or surgical site pain (40.4%), followed by headache (18.2%), oral numbness (11.1%), and sinusitis (4.0%). CONCLUSIONS: The findings of this systematic review suggest that cryoablation with Clarifix is an effective treatment modality for chronic rhinitis. However, higher-quality randomized controlled trials will need to be performed to affirm the findings of this study.
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Criocirurgia , Rinite , Sinusite , Humanos , Rinite/cirurgia , Rinite/tratamento farmacológico , Qualidade de Vida , Sinusite/cirurgia , Sinusite/tratamento farmacológico , NarizRESUMO
Study design: Retrospective cohort study. Introduction: Malpractice claims analysis is performed by several specialties to improve quality of patient care and to identify areas where physicians can improve their practice to mitigate the incidence of committing malpractice. The Food and Drug Administration has flagged over 80,000 injuries caused by spinal cord stimulator (SCS), making them the 3rd most flagged medical device. This study analyzed malpractice claims due to SCS by querying two legal databases widely used in medicolegal research. Methods: Westlaw Edge and VerdictSearch were queried for malpractice cases filed between the years 2000 and 2022 using the keywords "spinal cord stimulator." Case inclusion criteria was defined as a plaintiff's basis of litigation resting on a claim of medical malpractice due to SCS. Additional data collected included date of case hearing, plaintiff sex and age, defendant specialty, verdict ruling, location of the filed claim, payment or settlement amount, and sustained injuries. Result: Of the 1773 reviewed cases, 45 cases were included and categorized as battery or implantable pulse generator malfunction (35.56 %), lead complications (28.89 %), surgical complications (20.00 %), and miscellaneous (15.56 %). Four (8.89 %) cases resulted in settlement, 11 (24.44 %) in a plaintiff verdict, and 30 (68.00 %) resulted in a defendant verdict. Claims filed due to infection related to SCS were more likely to result in a defendant verdict (p = .047), whereas claims filed due to neurological deficit were more likely to result in a plaintiff verdict (p = .020). The average settlement amount for the 4 cases is $1,975,309.61. Conclusion: Our findings suggest obtaining adequate neuroimaging preoperatively with MRIs, disclosing neurological risks specifically paralysis on informed consent, and evaluating radiography intraoperative and postoperatively with anterior-posterior (AP) and lateral x-ray films to ensure proper SCS placement are practices that may mitigate malpractice due to SCS. Battery defects and lead complications were the most common grounds for SCS-related malpractice claims.
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Surgical margin status is one of the strongest prognosticators in predicting patient outcomes in head and neck cancer, yet head and neck surgeons continue to face challenges in the accurate detection of these margins with the current standard of care. Novel intraoperative imaging modalities have demonstrated great promise for potentially increasing the accuracy and efficiency in surgical margin delineation. In this current study, we collated and analyzed various intraoperative imaging modalities utilized in head and neck cancer to evaluate their use in discriminating malignant from healthy tissues. The authors conducted a systematic database search through PubMed/Medline, Web of Science, and EBSCOhost (CINAHL). Study screening and data extraction were performed and verified by the authors, and more studies were added through handsearching. Here, intraoperative imaging modalities are described, including optical coherence tomography, narrow band imaging, autofluorescence, and fluorescent-tagged probe techniques. Available sensitivities and specificities in delineating cancerous from healthy tissues ranged from 83.0% to 100.0% and 79.2% to 100.0%, respectively, across the different imaging modalities. Many of these initial studies are in small sample sizes, with methodological differences that preclude more extensive quantitative comparison. Thus, there is impetus for future larger studies examining and comparing the efficacy of these intraoperative imaging technologies.
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BACKGROUND: Antiangiogenic therapy with bevacizumab has failed to provide substantial gains in overall survival. Epithelial membrane protein 2 (EMP2) is a cell surface protein that has been previously shown to be expressed in glioblastoma, correlate with poor survival, and regulate neoangiogenesis in cell lines. Thus, the relationship between bevacizumab and EMP2 was investigated. METHODS: Tumor samples were obtained from 12 patients with newly diagnosed glioblastoma at 2 time points: (1) during the initial surgery and (2) during a subsequent surgery following disease recurrence post-bevacizumab treatment. Clinical characteristics and survival data from these patients were collected, and tumor samples were stained for EMP2 expression. The IVY Glioblastoma Atlas Project database was used to evaluate EMP2 expression levels in 270 samples by differing histological areas of the tumor. RESULTS: Patients with high EMP2 staining at initial diagnosis had decreased progression-free and overall survival after bevacizumab (median progression-free survival 4.6 months vs 5.9 months; log-rank P = .076 and overall survival 7.7 months vs 14.4 months; log-rank P = .011). There was increased EMP2 staining in samples obtained after bevacizumab treatment in both unpaired (mean H-score 2.31 vs 1.76; P = .006) and paired analyses (mean difference 0.571; P = .019). This expression increase correlated with length of bevacizumab therapy (R 2 = 0.449; Pearson P = .024). CONCLUSIONS: Bevacizumab treatment increased EMP2 protein expression. This increase in EMP2 correlated with reduced mean survival time post-bevacizumab therapy. We hypothesize a role of EMP2 in clinical bevacizumab resistance and as a potential antiangiogenic therapeutic target in glioblastoma.