The Predictive Value of Peripheral Immune Cell Counts for the Presence of Brain Metastases in Stage IV Non-Small-Cell Lung Cancer (NSCLC).

Background High neutrophil-lymphocyte ratio (NLR) is associated with poor survival in lung cancer. This study evaluates whether NLR is associated with baseline brain metastasis in stage IV non-small cell lung cancer (NSCLC). Methods Medical records of stage IV NSCLC patients treated at King Hussein Cancer Center (Amman-Jordan) between 2006 and 2016 were reviewed. Patients with baseline brain imaging and complete blood count (CBC) were included. Receiver operating characteristic (ROC) curve was used to identify the optimal cutoff value for the association between NLR and baseline brain metastasis. Association between age, gender, location of the primary tumor, histology, and NLR was assessed using univariate and multivariate logistic regression analyses. Results A total of 722 stage IV NSCLC patients who had baseline brain imaging were included. Median age was 59 years. Baseline brain metastasis was present in 280 patients (39.3%). Nine patients had inconclusive findings about brain metastasis. The ROC curve value of 4.3 was the best fitting cutoff value for NLR association with baseline brain metastasis. NLR ≥ 4.3 was present in 340 patients (48%). The multivariate analyses showed that high baseline NLR (≥ 4.3) was significantly associated with higher odds of baseline brain metastasis (odds ratio [OR]: 1.6, 95% confidence interval [CI]: 1.2-2.2; p = 0.0042). Adenocarcinoma histology was also associated with baseline brain metastasis (OR: 0.4, 95% CI: 0.25-0.6; p = 0.001). Conclusion High NLR is associated with baseline brain metastasis in advanced-stage NSCLC. In the era of immunotherapy and targeted therapies, whether high NLR predicts response of brain metastasis to treatment is unknown.

Ectopic maxillary tooth as a cause of recurrent maxillary sinusitis: a case report and review of the literature.

This article presents a rare case report of an ectopic third molar tooth located in the medial wall of maxillary sinus in a young male manifesting as recurrent sinusitis along with upper jaw pain and postnasal discharge diagnosed with an ectopic tooth and bilateral dentigerous cysts. This article aims to discuss this rare presentation of an ectopic tooth as a cause of recurrent maxillary sinusitis and the endonasal endoscopic management of the case.

Tandem vaginoscopy with colonoscopy: a diagnostic technique for the assessment of colovaginal fistula.

AIM: Colovaginal fistula (CVF) has a negative impact on quality of life. Identifying the fistula track is a critical step in its management. In a subset of patients, localizing the fistula preoperatively can be difficult. The purpose of this report is to describe the technique and results of tandem vaginoscopy with colonoscopy (TVC). METHOD: A retrospective analysis was conducted of all patients referred to a tertiary centre with symptoms suggestive of CVF but no prior successful localization of a fistula. TVC was performed by one colorectal surgeon in the endoscopy suite under intravenous sedation. RESULTS: Between 2003 and 2013, 18 patients (median age 58 years) underwent TVC. CVF was ruled out in three patients. In the remaining 15 patients, TVC documented the fistula in 13. In eight cases a wire was passed through the fistulous track from the vagina to the colon, in three the track was large enough to be traversed with the endoscope and in two a fistulous opening was noted on the vaginal side but passage of a wire to localize the opening on the colonic side was not possible due to extensive scarring. No TVC-related complications were recorded. The sensitivity, specificity, positive predictive value and negative predictive value for TVC in detecting CVF were 86.7%, 100%, 100% and 60%, respectively. CONCLUSION: TVC is a useful technique that can localize the fistulous track in most patients with CVF.

Brief Report: Implementing a Mediterranean Diet Intervention into a RCT: Lessons Learned from a Non-Mediterranean Based Country.

OBJECTIVE: To examine the participant experiences regarding perceived barriers and facilitators which impact on consuming the Mediterranean diet in the East of England. DESIGN: Qualitative methodology with focus groups. SETTING: A healthy, middle-aged population situated in the East of England. INTERVENTION: An 8-week Mediterranean dietary intervention trial. PARTICIPANTS: Eleven participants (including three co-habiting partners) in three focus groups, ranging between 50-65 yrs with a mean age of 54.3 yrs (±4.0) RESULTS: Thematic analysis from the focus groups revealed that participants considered that the MD intervention had introduced a better quality of food, widening the food-horizon and allowed them to re-define cultural eating habits. They also reported several physical benefits from adapting to this diet and found the experience as positive. Whilst claiming that the MD was an enjoyable and pleasurable, the participants did express difficulty adapting to the eating pattern, finding difficulty in purchasing food items, an increase in food costs and found work, stress and time pressures undermining adherence. CONCLUSION: The participants' experiences suggested that the MD was an encouraging dietary change with a middle aged non-Mediterranean based population group. Future MD interventions should tailor interventions and support participants closely, particularly with the necessary planning, organisation and purchasing involved with implementing this diet in non-Mediterranean countries. Secondly, researchers should also challenge any erroneous assumptions regarding the consumption of Mediterranean food, which may hinder implementation.

A single dose of prophylactic antibiotic may be sufficient to prevent postprocedural infection in upper endosonography guided fiducial marker placement.

AIM: Prophylactic antibiotic after endosonographic ultrasound (EUS) guided fiducial marker placement is common practice to prevent infection. Duration of using prophylaxis antibiotic is unknown. The aim of this paper was to assess whether one time intraprocedural administration of a prophylactic antibiotic is sufficient to prevent infection after EUS guided fiducial marker placement. METHODS: Retrospective study was performed included all adult patients who underwent EUS guided fiducial markers over 18 month period. Procedure related infection was defined as any infection not directly attributable to any other cause within 30 days of the procedure. The patients followed up with the Gastroenterology clinic in one week and with Radiation Oncology clinic weekly after undergoing EUS guided fiducial marker placement. RESULTS: A total of 35 upper EUS-guided fiducial markers were placed during 20 procedures on 18 patients. The average age of patients was 59 years. There were 10 females and 8 males.. All patients received one dose of cephalosporin, amoxicillin, clindamycin or levoflocaxin. The fiducial markers were deployed in different organs. None of the patients developed any infections due to the procedure. CONCLUSION: This study suggests that one dose of intravenous antibiotic administered intraprocedurally is sufficient to prevent infection related to upper EUS guided fiducial marker placement.

High cycling cadence reduces carbohydrate oxidation at given low intensity metabolic rate.

Cycling cadence (RPM)-related differences in blood lactate concentration (BLC) increase with increasing exercise intensity, whilst corresponding divergences in oxygen uptake ([Formula: see text]O2) and carbon dioxide production ([Formula: see text]CO2) decrease. Aim of the present study was to test whether a higher RPM reduces the fraction (%) of the [Formula: see text]O2 used for carbohydrate oxidation (relCHO) at a given BLC. Eight males (23.9 ± 1.6 yrs; 177 ± 3 cm; 70.3 ± 3.4 kg) performed incremental load tests at 50 and 100 RPM. BLC, [Formula: see text]O2 and [Formula: see text]CO2 were measured. At respiratory exchange ratios (RER) < 1, relCHO were calculated and the constant determining 50 % relCHO (kCHO) was approximated as a function of the BLC. At submaximal workload [Formula: see text]O2, [Formula: see text]CO2, and relCHO were lower (all p < 0.002; η(2) > 0.209) at 50 than at 100 RPM. No differences were observed in [Formula: see text]O2peak (3.96 ± 0.22 vs. 4.00 ± 0.25 l · min (-1)) and RERpeak (1.18 ± 0.02 vs. 1.15 ± 0.02). BLC was lower (p < 0.001; η(2) = 0.680) at 50 than at 100 RPM irrespective of cycling intensity. At 50 RPM, kCHO (4.2 ± 1.4 (mmol · l (-1))(3)) was lower (p = 0.043; η(2) = 0.466) than at 100 RPM (5.9 ± 1.9 (mmol · l (-1))(3)). This difference in kCHO reflects a reduced CHO oxidation at a given BLC at 100 than at 50 RPM. At a low exercise intensity, a higher cycling cadence can substantially reduce the reliance on CHO at a given metabolic rate and/or BLC.

Effect of fluoroscopy utilization monitoring on fluoroscopy times during ERCP.

AIM: The aim of the present study was to find whether informing endoscopists that their FT is being tracked would result in decreasing their overall fluoroscopy utilization as measured by FT. METHODS: We reviewed the medical charts of patients underwent ERCP from April 2011 to May 2012. On December 15, 2011, the endoscopists were informed about their mean FT during ERCP, were encouraged to decrease FT and were informed their FT would be monitored. We compared the mean FT of the endoscopists individually and as a group before and after December 15, 2011. RESULTS: The study included 293 patients and 3 endoscopists. Before informing the endoscopists that their FT was being tracked, utilization of fluoroscopy was significantly variable among endoscopists. The mean FT for all endoscopists was 9.04 minutes and for each endoscopist was 6.06, 11.43, and 7.67 minutes, respectively (P<0.02). After informing the endoscopists that their FT will be followed, there was a trend toward a decrease in FT among the group (9.04 vs. 7.4 minutes, P=0.06). However, the changes in FT among endoscopists individually were variable. The FT for first, second and third endoscopists changed from 6.06 min to 3.39 min, p<0.02, 11,43 min to 8.8 min, P=0.14 and 7.67 to 11.47 minutes, P=0.06, respectively. CONCLUSION: Fluoroscopic utilization during ERCP among endoscopists is variable. Endoscopists' knowledge that their FT during ERCP is being tracked leads to variable results among endoscopists. Nonetheless, overall it leads to a trend in reducing fluoroscopy utilization.

Case report: preservation of teeth involved with an odontogenic cyst.

BACKGROUND: Odontogenic cysts are often encountered in the paediatric and adolescent population, dentigerous cyst being the most common. The current report aims to raise the awareness of paediatric dentists about the management of this condition. CASE REPORT: The current report presents a case of a healthy 14 year-old boy with an odontogenic cyst involving two displaced mandibular premolars. TREATMENT: The cyst was enucleated surgically and the two premolars were preserved. The diagnosis was a dentigerous cyst. FOLLOW-UP: At 4, 12 and 20 months there was substantial bone healing and non-assisted eruption of the premolars. CONCLUSION: A less invasive approach when treating odontogenic cysts in children and adolescents is recommended when possible to preserve the permanent teeth involved.

Sirolimus-induced intractable chronic diarrhea: a case report.

Sirolimus is a macrolide that is extensively used in transplant clinics. The most common side effects of sirolimus are hypertriglyceridemia, hypercholesterolemia, hypertension, rash, and well-tolerated diarrhea. Herein I have reported a case of intractable, disabling, chronic diarrhea secondary to sirolimus in a renal transplant recipient. The sirolimus dose had been recently increased from 2 mg to 5 mg 1 month before the patient began to complain of severe diarrhea. In addition to the case presentation, the literature is reviewed as well as possible mechanisms of sirolimus-induced diarrhea are discussed. In conclusion, clinicians should consider sirolimus as a potential etiology for severe chronic diarrhea among patients who are treated with sirolimus.

Mechanically versus electro-magnetically braked cycle ergometer: performance and energy cost of the Wingate Anaerobic Test.

Performance and metabolic profiles of the Wingate Anaerobic Test (WAnT) were compared between a mechanically resisted (ME) and an electro-magnetically braked (EE) cycle ergometer. Fifteen healthy subjects (24.0+/-3.5 years, 180.5+/-6.1 cm, 75.4+/-11.9 kg) performed a WAnT on ME, and EE 3 days apart. Performance was measured as peak power (PP), minimum power (MP), mean power (AP), time to PP (TTPP), fatigue rate (FR), and maximum cadence (RPM(MAX)). Lactic (W (LAC)) and alactic (W (PCR)) anaerobic energy were calculated from net lactate appearance and the fast component of post-exercise oxygen uptake. Aerobic metabolism (W (AER)) was calculated from oxygen uptake during the WAnT. Total energy cost (W (TOT)) was calculated as the sum of W (LAC), W (PCR), and W (AER). There was no difference between ME and EE in PP (873+/-159 vs. 931+/-193 W) or AP (633+/-89 vs. 630+/-89 W). In the EE condition TTPP (2.3+/-0.7 vs. 4.3+/-0.7 s) was longer (P<0.001), MP (464+/-78 vs. 388+/-57 W) was lower (P<0.001), FR (15.2+/-5.2 vs. 20.5+/-6.8%) was higher (P<0.005), and RPM(MAX) (168+/-18 vs. 128+/-15 rpm) was slower (P<0.001). There was no difference in W (TOT) (1,331+/-182 vs. 1,373+/-120 J kg(-1)), W (AER) (292+/-76 vs. 309+/-72 J kg(-1)), W (PCR) (495+/-153 vs. 515+/-111 J kg(-1)) or W (LAC) (545+/-132 vs. 549+/-141 J kg(-1)) between ME and EE devices. The EE produces distinctly different performance measures but valid metabolic WAnT results that may be used to evaluate anaerobic fitness.