Preliminary results of a pilot study on the safety and efficacy of balloon dilatation of the Eustachian tube for nasopharyngeal cancer patients with chronic Eustachian tube dysfunction post irradiation.

OBJECTIVE: Eustachian tube dysfunction is a known complication following radiotherapy to the head and neck region. Unfortunately, treatment options are limited, with significant associated morbidity. Balloon Eustachian tube dilatation has been used successfully to treat Eustachian tube dysfunction; hence, this study aimed to determine the safety and efficacy of this method in treating Eustachian tube dysfunction in post-radiotherapy patients with nasopharyngeal carcinoma. METHOD: This interventional cohort pilot study on patients with Eustachian tube dysfunction compared those with nasopharyngeal carcinoma to patients without. Outcome assessment was based on tympanometry type and Eustachian Tube Dysfunction Questionnaire score. RESULTS: A total of 14 ears (12 patients) were tested. Only 14 per cent of the nasopharyngeal carcinoma cohort showed improvement, while 71 per cent of the non-nasopharyngeal carcinoma group were successfully treated. No significant adverse effect was reported in any patient during this study. CONCLUSION: Balloon Eustachian tube dilatation was not shown to be beneficial for post-radiotherapy Eustachian tube dysfunction in nasopharyngeal carcinoma patients in the preliminary stages of this pilot study.

Risk of needing completion thyroidectomy for low-risk papillary thyroid cancers treated by lobectomy.

Background: Low-risk differentiated thyroid cancers may, according to the American Thyroid Association (ATA) 2015 guidelines, be managed initially with lobectomy. However, definitive risk categorization requires pathological assessment of the specimen, resulting in completion thyroidectomy being recommended when discordance between preoperative and postoperative staging occurs. This study sought to establish the expected rate of completion thyroidectomy in patients with papillary thyroid cancer (PTC) treated by lobectomy. Methods: Patients with PTC treated over 5 years (2013-2017 inclusive) and meeting the ATA criteria for lobectomy were identified from the prospectively developed database of a high-volume, university department of endocrine surgery. Concordance between the ATA initial and final recommendation, and the putative rate of completion thyroidectomy were calculated. Multivariable analysis was used to assess preoperative factors as predictors of the need for total thyroidectomy. Results: Of 275 patients with PTC who met ATA preoperative criteria for lobectomy there was concordance between this and the final recommendation in 158 (57·5 per cent) and discordance in 117 (43·5 per cent). Most common reasons for discordance were: angioinvasion (30·8 per cent), local invasion (23·9 per cent) or both (20·5 per cent). Four patients (1·5 per cent) had permanent hypoparathyroidism. On multivariable analysis, age, sex, tumour size and family history did not independently predict the final treatment required. Conclusion: Although many patients may be treated adequately with lobectomy, just under half would require completion thyroidectomy. Further work is needed on preoperative risk stratification but, before this, total thyroidectomy remains the treatment of choice for low-risk 1-4-cm PTC in the hands of high-volume thyroid surgeons who can demonstrate low complication rates.

Cyanine fluorophores for cellular protection against ROS in stimulated macrophages and two-photon ROS detection.

We report the first example of a novel two-photon active, biocompatible, and macrophage cell-membrane permeable carbazole-based cyanine fluorophore for the detection of three biologically important ROS, namely, ˙OH, O2(-) and OCl(-) in solution. This versatile probe shows cellular protection not only in stimulated macrophages from phorbol-12-myristate-13-acetate-induced morphological changes but also lipopolysaccharide-induced cytotoxicity by quenching with the O2(-) and OCl(-) production, respectively. Such protection could be visualized by a distinct change in the fluorescence intensity of the probe.

Novel T-cell inhibiting peptides delay the onset of Type 1 diabetes in non-obese diabetic mice.

The aim of this study was to investigate the effectiveness of immunomodulatory peptides in preventing the spontaneous onset of Type 1 diabetes in NOD mice. Two such peptides, CP and C1, were injected intraperitoneally in NOD mice three times a week starting at two different time points, nine weeks and 11 weeks of age, and blood sugar levels monitored for the development of diabetes. CP was shown to be effective in delaying the onset of diabetes compared to control (P = 0.006). The timing of peptide administration was crucial since delay in treatment did not prevent the onset of diabetes (nine weeks versus 11 weeks of age). C1 was effective in delaying the onset of Type 1 diabetes with borderline significance when given at week 11 (P = 0.05). These findings confirm the efficacy of these peptides in the prevention and possible treatment for Type 1 diabetes and thereby create new opportunities for genetic manipulation.

Study of the mechanisms by which Sambucus williamsii HANCE extract exert protective effects against ovariectomy-induced osteoporosis in vivo.

UNLABELLED: The purpose of this study is to investigate the dose-dependent effects of SWH on bone properties and the mechanism involved in mediating the osteoprotective actions of SWH. The results indicated that SWH could improve bone properties by inhibiting the process of bone resorption and stimulating the process of bone formation. INTRODUCTION: Our previous study showed that Sambucus williamsii HANCE (SWH) improved trabecular bone mass and cortical bone strength in ovariectomized (OVX) rats. The purpose of this study is to investigate the dose-dependent effects of SWH on bone properties and the mechanism involved in mediating the osteoprotective actions of SWH. METHODS: Three-month-old C57BL/6J mice were fed a phytoestrogen-free diet and subjected to either ovariectomy or sham operation. OVX mice were treated with genistein (50 mg/kg), or a low (200 mg/kg), medium (500 mg/kg), or high (1,000 mg/kg) dose of SWH extract. RESULTS: SWH could dose-dependently decrease urinary Ca excretion and increase serum Ca level in OVX mice. It could increase tibial bone mineral density and exert beneficial effects on the microarchitecture of trabecular bone in the OVX mice. SWH suppressed the ovariectomy-induced expression of Cbfa1 mRNA and cathepsin K mRNA and enhanced the ratio of OPG/RANKL mRNA expression in the tibia. In vitro study showed that SWH dramatically reduced the number of TRAP-positive cells in RANKL-induced RAW 264.7 cells. CONCLUSIONS: The present study indicated that SWH could improve bone properties by inhibiting the process of bone resorption and stimulating the process of bone formation.

Computer-aided design and computer-aided manufacture (CAD/CAM) system for construction of spinal orthosis for patients with adolescent idiopathic scoliosis.

ABSTRACT Spinal orthoses are commonly prescribed to patients with moderate adolescent idiopathic scoliosis (AIS) for prevention of further curve deterioration. In conventional manufacturing method, plaster bandages are used to obtain the patient's body contour and then the plaster cast is rectified manually. With computer-aided design and computer-aided manufacture (CAD/CAM) system, a series of automated processes from body scanning to digital rectification and milling of the positive model can be performed in a fast and accurate fashion. The purpose of this manuscript is to introduce the application of CAD/CAM system to the construction of spinal orthosis for patients with AIS. Based on evidence within the literature, CAD/CAM method can achieve similar clinical outcomes but with higher efficiency than the conventional fabrication method. Therefore, CAD/CAM method should be considered a substitute to the conventional method in fabrication of spinal orthoses for patients with AIS.

Hearing screening for school children: comparison of low-cost, computer-based and conventional audiometry.

BACKGROUND: There is a need to develop affordable but effective audiometric screening equipment, particularly for use in low-income countries. With advances in computer technology, low-cost computer-based audiometer software has been developed. However, the efficacy of computer-based audiometers in hearing screening and diagnostic assessment requires investigation. The purpose of this study was to evaluate the accuracy of a low-cost, computer-based audiometric system in a school-based hearing screening programme. METHODS: Eighty children were screened using the computer-based audiometer and with a conventional pure tone screening audiometer. Overall refer rates, as well as frequency and age effects on the accuracy of the computer-based audiometer, were considered. RESULTS: There was a significant relationship between the low-cost, computer-based audiometer and a conventional pure tone audiometer when a 40 dBHL refer criterion was used in school hearing screening and when test results at 500 Hz were excluded from analysis. However, background noise effects and software limitations in the computer-based system had major adverse effects on screening performance. CONCLUSIONS: The study results and preliminary practical experience with the system suggest that, with further software and hardware improvements, a low-cost, computer-based system may well be feasible for routine school screening in developing countries.

Use of closed controlled subcutaneous drainage to manage chronic lower limb oedema in patients with advanced cancer.

Chronic lower limb oedema is common in patients with advanced cancer and can be difficult to manage. In this paper, we present two patients who had severe cancer-related chronic lower limb oedema which was refractory to conventional therapy. It was satisfactorily managed using closed controlled subcutaneous drainage without any skin infections or complications. We also review the prevalence, diagnosis, and management of cancer-related chronic oedema and lymphoedema.

Soy isoflavones and their bone protective effects.

Several observational studies have suggested that populations with a high dietary soy intake have a lower incidence of osteoporosis-related fractures when compared to Western populations. However, there has not been consistent data to show that soy isoflavones protect against or lessen bone loss. Studies in our laboratory showed that genistein, the major soy isoflavone, could stimulate osteoblastic functions as well as human breast cancer cell growth. These studies raised the concern of whether it would be safe for women who have a prior history of breast cancer to consume soy isoflavone for management of postmenopausal osteoporosis. As increasing the purity of genistein is known to increase its ability to induce human breast cancer cell growth, current effort in our laboratory is to determine if the in vivo bone protective effects will be affected by the complexity of the soy isoflavones extract in ovariectomized mice.

Localization of hRad9 in breast cancer.

BACKGROUND: hRad9 is a cell cycle checkpoint gene that is up-regulated in breast cancer. We have previously shown that the mRNA up-regulation correlated with tumor size and local recurrence. Immunohistochemical studies were made to better define the role of hRad9 in breast carcinogenesis. METHODS: Localisation of hRad9 protein were performed on paired tumor and normal breast tissues. Immunoblotting with and without dephosphorylation was used to define the protein isolated from breast cancer cells. RESULTS: Increased hRad9 protein was observed in breast cancer cells nucleus compared to non-tumor epithelium. This nuclear protein existed in hyperphosphorylated forms which may be those of the hRad9-hRad1-hHus1 complex. CONCLUSION: Finding of hyperphosphorylated forms of hRad9 in the nucleus of cancer cells is in keeping with its function in ameliorating DNA instability, whereby it inadvertently assists tumor growth.

A lipid extract of Perna canaliculus affects the expression of pro-inflammatory cytokines in a rat adjuvant-induced arthritis model.

As published initially in this same journal in 2000, the lipid extract of Perna canaliculus (New Zealand green-lipped mussel; Lyprinol) is known for its anti-inflammatory effects in animal models and in human controlled studies (arthritis; asthma). As a follow-up of its effects on pain in a rat model of adjuvant-induced arthritis (ALA), we studied its effects on the production of cytokines known to be associated with inflammation (IL-6, IL-1alpha TNF-alpha, IFN-gamma). Feeding with Lyprinol was associated with significantly decreased expression levels of TNF-alpha and IFN-gamma when compared to Naproxen (positive control) and, even more when compared with sham and extra-virgin olive oil (negative control). When compared to Naproxen, sham and extra-virgin olive oil, the levels of IL-6 and IL-1alpha were also marginally decreased in rats fed with Lyprinol. This study demonstrates that AIA rats fed with Lyprinol had decreased production ofcytokines associated with inflammation.

Molecular mechanisms of survival and apoptosis in RAW 264.7 macrophages under oxidative stress.

Organisms living in an aerobic environment are continuously exposed to reactive oxygen species (ROS). Apoptosis of cells can be induced by ROS and cells also develop negative feedback mechanisms to limit ROS induced cell death. In this study, RAW264.7 murine macrophage cells were treated with H(2)O(2) and cDNA microarray technique was used to produce gene expression profiles. We found that H(2)O(2) treatment caused up-regulation of stress, survival and apoptosis related genes, and down-regulation of growth and cell cycle promoting genes. Numerous genes of metabolism pathways showed special expression patterns under oxidative stress: glycolysis and lipid synthesis related genes were down-regulated whereas the genes of lipid catabolism and protein synthesis were up-regulated. We also identified several signaling molecules as ROS-responsive, including p53, Akt, NF-kappa B, ERK, JNK, p38, PKC and INF-gamma . They played important roles in the process of apoptosis or cell survival. Finally, an interactive pathway involved in cellular response to oxidative stress was proposed to provide some insight into the molecular events of apoptosis induced by ROS and the feedback mechanisms involved in cell survival.

Critical review on non-operative management of adolescent idiopathic scoliosis.

There are a number of different non-operative interventions which aim to control moderate adolescent idiopathic scoliosis (AIS) from progression. Clinicians may find difficulties in the selection of appropriate interventions for AIS. A comprehensive literature review was carried out to study all contemporary non-operative interventions, it was noted that rigid spinal orthoses apparently give more curve control; however, it would compromise the patient's quality of life via those inevitable factors--physical constraint, poor acceptance and psychological disturbance. There is a trend to develop more effective, acceptable and user-friendly interventions. Under such an aspiration, the theories and clinical evidence of different interventions should be developed along the clinical pathway of early intervention with reliable indicators/predictors, patient's active participation, dynamic control mechanism, holistic psychological and psychosocial considerations, and effective and long-lasting outcome.

[Current perspectives of orthogonal polarization spectral imaging in plastic surgery]. / Orthogonal Polarization Spectral Imaging und derzeitige Perspektiven in der Plastischen Chirurgie.

The technology of Orthogonal Polarization Spectral Imaging (OPSI), patented in the United States in 1999, has been heralded as an alternative to conventional intravital microscopy for several reasons, including ease of application and ability to perform continued observations. In the following examples, OPSI was applied to reconstructive plastic surgery. Two experimental and one clinical model are presented. Currently, the image quality does not allow a qualitative analysis of the microvasculature. The data analysis of images remains inconclusive. However, a technically modified version with improved image resolution and software could become a valuable experimental as well as clinical tool in the field of reconstructive plastic surgery in the future.

Recent advances in radiotherapy for head and neck cancers.

Advancements in surgery have made it possible to resect cancers that had previously been regarded as incurable. Similarly, new developments in radiation oncology have helped improve the outlook for patients with locally advanced or recurrent head and neck cancers. Among these advancements are refinements in altered fractionation, three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, stereotactic radiosurgery and fractionated stereotactic radiotherapy, neutron-beam radiotherapy, charged-particle radiotherapy, and intraoperative radiotherapy. These recent developments have allowed radiation oncologists to escalate the dose of radiation delivered to tumors while minimizing the dose delivered to surrounding normal tissue. Additionally, more continues to be learned about the optimum delivery of chemotherapy. This article provides an update on the status of these new developments in the treatment of head and neck cancers.

Ceruloplasmin promotes iron uptake rather than release in BT325 cells.

This study was initiated to investigate the mechanism of ceruloplasmin (CP)-mediated iron release from brain cells using BT325 cells (a glioblastoma cell line); however, negative results were obtained. The BT325 cells were preloaded with 1 microM 59Fe2+ in sucrose (pH 5.8) for 60 min, and then with CP (0-300 microg/ml) for 30 min at 37 degrees C. The addition of CP, either at low (25 microg/ml) or high (300 microg/ml) concentrations, did not lead to a significant change in iron release from iron-loaded BT325 cells. No significant difference in total iron of cells was found between all CP treated groups and the control (P>0.05). Although apotransferrin (apoTf) was shown to have a role in iron release from the cells, the effect of apoTf was not significantly affected by the addition of different concentrations of CP. When the cells were incubated with 1 microM 59Fe2+ in the presence of varying amounts of CP for 30 min at 37 degrees C, it was found that CP increased iron uptake. The total iron uptake by BT325 cells in CP treatment groups (25, 75, 150, 300 microg/ml) was significantly higher than that in the control (no CP addition) (all P<0.01). Furthermore, in contrast to our expectation, CP was shown to promote significantly iron uptake in not only iron-sufficient but also iron-deficient cells. These results showed that CP had a role in iron uptake rather than release in BT325 cells.

Effectiveness of audio-biofeedback in postural training for adolescent idiopathic scoliosis patients.

The possibility of using learned physiological responses in control of progressive adolescent idiopathic scoliosis (AIS) was investigated. Sixteen (16) AIS patients with progressing or high-risk curves (Cobb's angle between 25 degrees and 35 degrees at start and reducible by lateral bending) were fitted with a device with tone alarm for poor posture. In the first 18 months of application, 3 patients defaulted and 4 showed curve progression > 10 degrees (2 changed to rigid spinal orthoses and 2 underwent surgery). The curves for the other 9 patients were kept under control (within +/- 5 degrees of Cobb's angle) and 5 of them have reached skeletal maturity and terminated the application. The remaining 4 patients were still using the devices until skeletal maturity or curve progression. The curve control rate was 69%. A long-lasting active spinal control could be achieved through the patient's own spinal muscles. Nevertheless, before the postural training device could become a treatment modality, a long-term study for more AIS patients was necessary. This project is ongoing in the Duchess of Kent Children's Hospital, Sandy Bay, Hong Kong.

Potency preservation after three-dimensional conformal radiotherapy for prostate cancer: preliminary results.

We sought to assess potency preservation after three-dimensional conformal radiotherapy (3D-CRT) in prostate cancer patients eligible for radical prostatectomy, conventional radiotherapy, 3D-CRT, or transperineal prostate implantation. Patients with more advanced disease are commonly treated with hormonal therapy, which can cause impotence, and were consequently excluded from the analysis. Between December 1991 and June 1998, 198 prostate cancer patients were treated with 3D-CRT at the University of California, Davis Medical Center. Fifty-two of these patients had a pretreatment prostate-specific antigen (PSA) level of 10.0 ng/ml or less, a Gleason score of 6 or less, and a 1997 AJCC clinical stage T1bN0M0 to T2bN0M0. One patient was not evaluable. None of the 51 evaluable patients had diabetes mellitus. In 40 patients, the prostate gland only was irradiated to a total dose of 66 to 79.2 Gy by using daily 1.8-Gy fractions. In 11 patients, the prostate and seminal vesicles were treated to 44 to 55.8 Gy. Lymph nodes were not included in the clinical target volume. The median age was 68 years, and the median length of follow-up was 15 months. Potency in this study is defined as an erection sufficient for vaginal penetration. Kaplan-Meier analysis was used to describe potency as a function of time after 3D-CRT. Of the 51 evaluable patients, 35 (69%) were potent, 15 were impotent, and 1 was sexually inactive before 3D-CRT. Kaplan-Meier estimates of the potency preservation rates 1, 2, and 3 years after 3D-CRT are 100%, 83%, and 63%, respectively. On multivariate analysis, age, total radiation dose, and a history of transurethral resection of the prostate did not significantly affect potency preservation rates. Three (43%) of 7 patients who became impotent after 3D-CRT and used sildenafil were subsequently able to achieve erections sufficient for vaginal penetration. The preliminary results reported herein suggest that approximately two thirds of prostate cancer patients will retain their potency 3 years after 3D-CRT. Further follow-up is necessary to assess long-term potency after 3D-CRT. Sildenafil should be considered in patients who develop radiation-induced impotence.