Πέμπτη 1 Αυγούστου 2019

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


MDPI
IJERPH, Vol. 16, Pages 2745: Vulnerable Populations Exposed to Lead-Contaminated Drinking Water within Houston Ship Channel CommunitiesIJERPH, Vol. 16, Pages 2745: Vulnerable Populations Exposed to Lead-Contaminated Drinking Water within Houston Ship Channel Communities International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16152745 Authors: Garett Sansom Leslie Cizmas Kathleen Aarvig Benika Dixon Katie R. Kirsch Anjali Katare Lindsay Sansom Recent events have drawn...
Αλέξανδρος Γ. Σφακιανάκης
6m
Viruses, Vol. 11, Pages 701: Metagenomic Next-Generation Sequencing Reveal Presence of a Novel...
Viruses, Vol. 11, Pages 701: Metagenomic Next-Generation Sequencing Reveal Presence of a Novel Ungulate Bocaparvovirus in AlpacasViruses, Vol. 11, Pages 701: Metagenomic Next-Generation Sequencing Reveal Presence of a Novel Ungulate Bocaparvovirus in Alpacas Viruses doi: 10.3390/v11080701 Authors: Kumar Chaudhary Lu Duff Heffel McKinney Bedenice Marthaler Viruses belonging to the genus Bocaparvovirus (BoV) are a genetically diverse group of DNA viruses known to cause respiratory, enteric, and neurological...
Αλέξανδρος Γ. Σφακιανάκης
38m
Vaccines, Vol. 7, Pages 77: Nanobodies that Neutralize HIV Vaccines, Vol. 7, Pages 77: Nanobodies...
Vaccines, Vol. 7, Pages 77: Nanobodies that Neutralize HIVVaccines, Vol. 7, Pages 77: Nanobodies that Neutralize HIV Vaccines doi: 10.3390/vaccines7030077 Authors: Weiss Verrips Nanobodies or VHH (variable domains of heavy-chain only antibodies) are derived from camelid species such as llamas and camels. Nanobodies isolated and selected through phage display can neutralize a broad range of human immunodeficiency virus type 1 (HIV-1) strains. Nanobodies fit into canyons on the HIV envelope that may...
Αλέξανδρος Γ. Σφακιανάκης
38m
Antibiotic and Pesticides Residues in Breast Milk
Toxics, Vol. 7, Pages 39: Assessment of Antibiotic and Pesticides Residues in Breast Milk of Syrian Refugee Lactating MothersNadia Smadi 1,†, Adla Jammoul 2,† and Nada El Darra 1,*1Faculty of Heath Sciences, Beirut Arab University, Tarik El Jedidah–Beirut, P.O.Box: 115020, Riad EL Solh, Beirut 1107 2809, Lebanon2Food Department, Lebanese Agricultural Research Institute, Fanar P.O. Box 2611, Beirut 1107 2809, Lebanon*Author to whom correspondence should be addressed.†These authors contributed equally.Toxics...
Αλέξανδρος Γ. Σφακιανάκης
42m
Social Sciences, Vol. 8, Pages 229: The Street-Wise University: The Amsterdam Knowledge Mile as an Intermediary...
Social Sciences, Vol. 8, Pages 229: The Street-Wise University: The Amsterdam Knowledge Mile as an Intermediary and Place-Making ConceptSocial Sciences, Vol. 8, Pages 229: The Street-Wise University: The Amsterdam Knowledge Mile as an Intermediary and Place-Making Concept Social Sciences doi: 10.3390/socsci8080229 Authors: van Winden Hagemans van Hemert Universities have become more engaged or entrepreneurial, forging deeper relations with society beyond the economic sphere. To foster, structure,...
Αλέξανδρος Γ. Σφακιανάκης
43m
Psych, Vol. 1, Pages 429-430: Expression of Concern: Lynn, R. Reflections on Sixty-Eight Years of Research...
Psych, Vol. 1, Pages 429-430: Expression of Concern: Lynn, R. Reflections on Sixty-Eight Years of Research on Race and Intelligence. Psych, 2019, 1, 123–131Psych, Vol. 1, Pages 429-430: Expression of Concern: Lynn, R. Reflections on Sixty-Eight Years of Research on Race and Intelligence. Psych, 2019, 1, 123–131 Psych doi: 10.3390/psych1010033 Authors: Psych Editorial Office The Editorial Office of Psych issues the following Expression of Concern about the published paper: Reflections on Sixty-Eight...
Αλέξανδρος Γ. Σφακιανάκης
44m
Microorganisms, Vol. 7, Pages 230: Contrast of Real-Time Fluorescent PCR Methods for Detection...
Microorganisms, Vol. 7, Pages 230: Contrast of Real-Time Fluorescent PCR Methods for Detection of Escherichia coli O157:H7 and of Introducing an Internal Amplification ControlMicroorganisms, Vol. 7, Pages 230: Contrast of Real-Time Fluorescent PCR Methods for Detection of Escherichia coli O157:H7 and of Introducing an Internal Amplification Control Microorganisms doi: 10.3390/microorganisms7080230 Authors: Zhao Xia Liu Various constituents in food specimens can inhibit the PCR assay and lead to false-negative...
Αλέξανδρος Γ. Σφακιανάκης
44m
Medicina, Vol. 55, Pages 423: Handheld Ultrasound and Focused Cardiovascular Echography: Use and...
Medicina, Vol. 55, Pages 423: Handheld Ultrasound and Focused Cardiovascular Echography: Use and InformationMedicina, Vol. 55, Pages 423: Handheld Ultrasound and Focused Cardiovascular Echography: Use and Information Medicina doi: 10.3390/medicina55080423 Authors: Savino Ambrosio The availability of miniaturized ultrasound machines has changed our approach to many cardiovascular diseases. Handheld ultrasound imaging can be performed at the bedside, it is easy to use, and the information provided,...
Αλέξανδρος Γ. Σφακιανάκης
45m
JCM, Vol. 8, Pages 1144: Shock Index Predicts Outcome in Patients with Suspected Sepsis or Community-Acquired...
JCM, Vol. 8, Pages 1144: Shock Index Predicts Outcome in Patients with Suspected Sepsis or Community-Acquired Pneumonia: A Systematic ReviewJCM, Vol. 8, Pages 1144: Shock Index Predicts Outcome in Patients with Suspected Sepsis or Community-Acquired Pneumonia: A Systematic Review Journal of Clinical Medicine doi: 10.3390/jcm8081144 Authors: Middleton Smith Bedford Neilly Myint Background: To improve outcomes for patients who present to hospital with suspected sepsis, it is necessary to accurately...
Αλέξανδρος Γ. Σφακιανάκης
45m
Humanities, Vol. 8, Pages 130: The Composite Nature of Andreas Humanities, Vol. 8, Pages 130:...
Humanities, Vol. 8, Pages 130: The Composite Nature of AndreasHumanities, Vol. 8, Pages 130: The Composite Nature of Andreas Humanities doi: 10.3390/h8030130 Authors: Maddock Scholars of the Old English poem Andreas have long debated its dating and authorship, as the poem shares affinities both with Beowulf and the signed poems of Cynewulf. Although this debate hinges on poetic style and other internal evidence, the stylistic uniformity of Andreas has not been suitably demonstrated. This paper investigates...
Αλέξανδρος Γ. Σφακιανάκης
46m
Children, Vol. 6, Pages 89: Emerging Topics in Cardiometabolic and Psychologic Sequelae, Pathogenesis,...
Children, Vol. 6, Pages 89: Emerging Topics in Cardiometabolic and Psychologic Sequelae, Pathogenesis, and Treatment of Polycystic Ovarian Syndrome: A ReviewChildren, Vol. 6, Pages 89: Emerging Topics in Cardiometabolic and Psychologic Sequelae, Pathogenesis, and Treatment of Polycystic Ovarian Syndrome: A Review Children doi: 10.3390/children6080089 Authors: Shah Polycystic ovarian syndrome (PCOS) is a common endocrine disorder, affecting 6–10% of reproductive age women and influences the reproductive,...
Αλέξανδρος Γ. Σφακιανάκης
46m
Cancers, Vol. 11, Pages 1091: Glioblastoma: State of the Art and Future Perspectives Cancers,...
Cancers, Vol. 11, Pages 1091: Glioblastoma: State of the Art and Future PerspectivesCancers, Vol. 11, Pages 1091: Glioblastoma: State of the Art and Future Perspectives Cancers doi: 10.3390/cancers11081091 Authors: Tabatabai Wakimoto This special issue is dedicated to glioblastoma and elucidates this disease from differentperspectives [...]CancersWed Jul 31, 2019 03:00Cancers, Vol. 11, Pages 1092: Combination of Whole-Brain Radiotherapy with Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors...
Αλέξανδρος Γ. Σφακιανάκης
47m
Impact of skeletal muscle mass volume on surgical site infection in free flap reconstruction for oral...
Impact of skeletal muscle mass volume on surgical site infection in free flap reconstruction for oral cancerTakaya Makiguchi MD, PhD  Takahiro Yamaguchi DDS  Hideharu Nakamura MD  Keisuke Suzuki DDS Norifumi Harimoto MD, PhD  Ken Shirabe MD, PhD  Satoshi Yokoo DMD, DMScFirst published: 22 July 2019 https://doi.org/10.1002/micr.30494Read the full textePDFPDFTOOLS SHAREAbstractBackgroundSarcopenia is a disease in which skeletal muscle mass (SMM) and function are progressively lost. Here, we investigate...
Αλέξανδρος Γ. Σφακιανάκης
48m
A method using the cephalic vein for superdrainage in breast reconstruction Hideki Tokumoto MD, PhD ...
A method using the cephalic vein for superdrainage in breast reconstructionHideki Tokumoto MD, PhD  Shinsuke Akita MD, PhD  Minami Arai MD  Yoshitaka Kubota MD, PhD Motone Kuriyama MD, PhD  Nobuyuki Mitsukawa MD, PhDFirst published: 22 July 2019 https://doi.org/10.1002/micr.30489Read the full textePDFPDFTOOLS SHAREAbstractBackgroundIn breast reconstruction, a superdrainage procedure using the superficial inferior epigastric vein has been described. The purpose of this study was to investigate whether...
Αλέξανδρος Γ. Σφακιανάκης
49m
Direct muscle neurotization with long acellular nerve allograft: A case report Sami H. Tuffaha MD ...
Direct muscle neurotization with long acellular nerve allograft: A case reportSami H. Tuffaha MD  Jesse D. Meaike MD  Steven L. Moran MDFirst published: 22 July 2019 https://doi.org/10.1002/micr.30498Read the full textePDFPDFTOOLS SHAREAbstractNerve repair and nerve transfer are the optimal approaches to restore function to denervated muscle. When the distal‐most portion of the nerve entering the muscle is compromised, these are not possible and direct muscle neurotization (DMN) is considered. We...
Αλέξανδρος Γ. Σφακιανάκης
49m
Allergy, Asthma , Immunology
Management of Asthma COPD OverlapPublication date: Available online 31 July 2019Source: Annals of Allergy, Asthma & ImmunologyAuthor(s): Diego Jose Maselli, Nicola Alexander HananiaDrug reaction with eosinophilia and systemic symptoms (DRESS) and cytomegalovirus colitisPublication date: Available online 31 July 2019Source: Annals of Allergy, Asthma & ImmunologyAuthor(s): Dr Matthew Krummenacher, Dr Tatjana Banovic, Dr Frank Kette, Dr William Smith, Dr Pravin HissariaCharacterization of Idiopathic...
Αλέξανδρος Γ. Σφακιανάκης
49m
CranioMaxillofacial Surgery
Simultaneous endoscopic endonasal sinus surgery and sinus augmentation with immediate implant placement: A retrospective clinical study of 23 patientsPublication date: August 2019Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 8Author(s): Levon Khachatryan, Grigor Khachatryan, Gagik Hakobyan, Anna KhachatryanAbstractObjectiveThe aim of this study was to evaluate the efficacy of simultaneous endoscopic endonasal sinus surgery and sinus augmentation with immediate implant placement.Patients...
Αλέξανδρος Γ. Σφακιανάκης
51m
Neuroradiology/Head and Neck Imaging Original ResearchArterial Spin-Labeling MRI Identifies Hypervascular...
Neuroradiology/Head and Neck ImagingOriginal ResearchArterial Spin-Labeling MRI Identifies Hypervascular MeningiomasVera Mayercik, et al. | American Journal of Roentgenology | Jul 30, 2019Ahead of PrintCardiopulmonary ImagingReviewA Radiologist's Guide to the Changing Treatment Paradigm of Advanced Non–Small Cell Lung Cancer: The ASCO 2018 Molecular Testing Guidelines and Targeted TherapiesLydia Chen, et al. | American Journal of Roentgenology | Jul 30, 2019Ahead of PrintNuclear Medicine and Molecular...
Αλέξανδρος Γ. Σφακιανάκης
51m
Systems approach reveals photosensitivity and PER2 level as determinants of clock‐modulator efficacyDae...
Systems approach reveals photosensitivity and PER2 level as determinants of clock‐modulator efficacyDae Wook Kim, Cheng Chang, Xian Chen, Angela C Doran, Francois Gaudreault, Travis Wager, George J DeMarco, Jae Kyoung Kime8838 | First Published: 08 July 2019 The study identifies the sources of the inter‐ and intraspecies variability in the modulation of circadian phase by CK1δ/ε inhibition: photosensitivity and PER2 abundance, and proposes a personalized chronotherapy to treat circadian disruption.
Αλέξανδρος Γ. Σφακιανάκης
52m
NeuroOncology
A review of eligibility for patients with central nervous system (CNS) metastases from non-small cell lung cancer (NSCLC) in immunotherapy clinical trialsCentral nervous system neuroblastoma metastases pseudoprogression following intraventricular anti-B7-H3 radioimmunotherapyA novel finding of an IDH2 mutation in an interesting adult Sonic Hedgehog mutated medulloblastomaPrognostic significance of VEGF receptors expression on the tumor cells in skull base chordomaAbstractBackgroundChordoma is a rare...
Αλέξανδρος Γ. Σφακιανάκης
54m
Griseofulvin versus Terbinafine for pediatric Tinea Capitis: when and for how long Jonathan Bar  Liat...
Griseofulvin versus Terbinafine for pediatric Tinea Capitis: when and for how longJonathan Bar  Liat Samuelov  Eli Sprecher  Jacob MashiahFirst published: 25 July 2019 https://doi.org/10.1111/myc.12970This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/myc.12970ePDFPDFTOOLS...
Αλέξανδρος Γ. Σφακιανάκης
55m
Identification of Cryptococcus Antigen in HIV‐positive Turkish Patients by Using the Dynamiker® Lateral...
Identification of Cryptococcus Antigen in HIV‐positive Turkish Patients by Using the Dynamiker® Lateral Flow AssayEvrim Karaman  Macit Ilkit  Ferit KuşçuFirst published: 25 July 2019 https://doi.org/10.1111/myc.12969This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/myc.12969ePDFPDFTOOLS...
Αλέξανδρος Γ. Σφακιανάκης
55m
Epidemiology and Management Burden of Invasive Fungal Infections after Autologous Hematopoietic Stem...
Epidemiology and Management Burden of Invasive Fungal Infections after Autologous Hematopoietic Stem Cell Transplantation: 10‐Year Experience at a European Pediatric Cancer CenterChristina Linke  Athanasios Tragiannidis  Martina Ahlmann  Birgit Fröhlich  Maria Wältermann  Birgit Burkhardt  Claudia Rossig  Andreas H. GrollFirst published: 23 July 2019 https://doi.org/10.1111/myc.12968This article has been accepted for publication and undergone full peer review but has not been through the copyediting,...
Αλέξανδρος Γ. Σφακιανάκης
55m
Phaeohyphomycosis caused by Phialophora americana with CARD9 mutation and 20‐year literature review...
Phaeohyphomycosis caused by Phialophora americana with CARD9 mutation and 20‐year literature review in ChinaChen Huang  Yi Zhang  Yinggai Song  Zhe Wan  Xiaowen Wang  Ruoyu LiFirst published: 04 July 2019 https://doi.org/10.1111/myc.12962Read the full textePDFPDFTOOLS SHARESummaryBackgroundPhaeohyphomycosis is a chronic cutaneous, subcutaneous or systemic mycotic infection caused by various dematiaceous fungi. The diverse clinical manifestations and poor prognosis of phaeohyphomycosis necessitate...
Αλέξανδρος Γ. Σφακιανάκης
56m
Microsurgery Early View Online Version of Record before inclusion in an issue BOOK REVIEWSJoint Denervation:...
MicrosurgeryEarly ViewOnline Version of Record before inclusion in an issueBOOK REVIEWSJoint Denervation: Anatomic Atlas of Surgical Technique, Dellon, A. Lee Springer; 1st ed. 2019 edition (March 4, 2019), 277 pages, Price $134.62Zenggan Chen MD, PhD, Feng Zhang MD, PhDVersion of Record online: 22 July 2019CLINICAL ARTICLESImpact of skeletal muscle mass volume on surgical site infection in free flap reconstruction for oral cancerTakaya Makiguchi MD, PhD, Takahiro Yamaguchi DDS, Hideharu Nakamura...
Αλέξανδρος Γ. Σφακιανάκης
56m
Chondro-Osseous Respiratory Epithelial Adenomatoid Hamartoma (COREAH): Case Report and Literature...
Chondro-Osseous Respiratory Epithelial Adenomatoid Hamartoma (COREAH): Case Report and Literature ReviewAndrew Daniel, Eugene Wong, Joyce Ho, and Narinder SinghWestmead Hospital, Westmead, NSW, AustraliaCorrespondence should be addressed to Andrew Daniel; andrew.rms.daniel@gmail.comReceived 25 February 2019; Revised 28 April 2019; Accepted 3 July 2019; Published 25 July 2019Academic Editor: Kamal MorshedCopyright © 2019 Andrew Daniel et al. This is an open access article distributed under the Creative...
Αλέξανδρος Γ. Σφακιανάκης
59m
Otolaryngology
Thyroglossal Duct Cyst Carcinoma in a Young Female: Case Report and Review of LiteratureThyroglossal duct remnants form during embryologic development and can develop into a thyroglossal duct cyst (TGDC). In rare cases, carcinoma is present within these cysts, most commonly papillary thyroid carcinoma. Diagnosis is difficult, but imaging and fine-needle aspiration (FNA) biopsies can help with the diagnosis. Given the rarity of TGDC carcinoma, treatment is not well agreed upon and can include the...
Αλέξανδρος Γ. Σφακιανάκης
59m
Adult-Type Rhabdomyoma of the Omohyoid Muscle Brian H. Cameron,1 Kyle Hannabass,2 Anuradha Kanungo,3 and Dinesh...
Adult-Type Rhabdomyoma of the Omohyoid MuscleBrian H. Cameron,1 Kyle Hannabass,2 Anuradha Kanungo,3 and Dinesh K.Chhetri21Keck School of Medicine of USC, Los Angeles, CA, USA2Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA3Department of Pathology, Olive View-UCLA Medical Center, Los Angeles, CA, USACorrespondence should be addressed to Dinesh K. Chhetri; dchhetri@mednet.ucla.eduReceived 4 March 2019; Revised 12 June...
Αλέξανδρος Γ. Σφακιανάκης
1h
Thyroglossal Duct Cyst Carcinoma in a Young Female: Case Report and Review of Literature Jenna Van...
Thyroglossal Duct Cyst Carcinoma in a Young Female: Case Report and Review of LiteratureJenna Van Beck and Sobia F. KhajaDepartment of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USACorrespondence should be addressed to Jenna Van Beck; vanb0092@umn.eduReceived 8 May 2019; Accepted 22 July 2019; Published 31 July 2019Academic Editor: Manish GuptaCopyright © 2019 Jenna Van Beck and Sobia F. Khaja. This is an open access article distributed under the Creative Commons...
Αλέξανδρος Γ. Σφακιανάκης
1h
Case Reports in Otolaryngology Volume 2019, Article ID 3725720, 5 pages https://doi.org/10.1155/2019/3725720...
Case Reports in OtolaryngologyVolume 2019, Article ID 3725720, 5 pageshttps://doi.org/10.1155/2019/3725720Case ReportA Case Report of Aggressive Chronic Rhinosinusitis with Nasal Polyps Mimicking Sinonasal MalignancyS. Velegrakis, N. Chatzakis, E. Prokopakis, M. Papadakis, E. Panagiotaki, M.Doulaptsi, and A. KaratzanisDepartment of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, GreeceCorrespondence should be addressed to A. Karatzanis; akaratzanis@yahoo.comReceived...
Αλέξανδρος Γ. Σφακιανάκης
1h
Lung Perfusion Scintigraphy in Eisenmenger Syndrome Due to Patent Ductus Arteriosus Eisenmenger syndrome...
Lung Perfusion Scintigraphy in Eisenmenger Syndrome Due to Patent Ductus ArteriosusEisenmenger syndrome refers to the elevation of pulmonary arterial pressure to the systemic level caused by an increased pulmonary vascular resistance with right-to-left shunt through an intracardiac or aortopulmonary communication. A 36-year-old woman with Eisenmenger syndrome due to patent ductus arteriosus underwent 99mTc-MAA lung perfusion scintigraphy to evaluate right-to-left shunt. Whole-body imaging visualized...
Αλέξανδρος Γ. Σφακιανάκης
1h
Otology & Neurotology
Preclinical Validation of a Novel Device Designed to Reduce Biofilms on Percutaneous Osseointegrated AbutmentsAim: To assess the efficacy of a prototype cleaning device in removing biofilm from skin-penetrating abutments. Background: Adverse skin reactions around percutaneous osseointegrated implants have been linked to poor hygiene and infection. A cleaning device made from open-cell polyfoam has been developed to facilitate manual cleaning of abutments by the patient. Methods: Serratia biofilm...
Αλέξανδρος Γ. Σφακιανάκης
1h
Case Reports in Otolaryngology
A Case Report of Aggressive Chronic Rhinosinusitis with Nasal Polyps Mimicking Sinonasal Malignancy, S. Velegrakis, N. Chatzakis, E. Prokopakis, M. Papadakis, E. Panagiotaki, M. Doulaptsi, and A. KaratzanisVolume 2019 (2019), Article ID 3725720, 5 pagesA Case of Focal Dermal Hypoplasia (Goltze Syndrome) Masquerading as Lingual Tonsillar Hypertrophy, Samuel T. Roberts, Greg Shein, and Ian JacobsonVolume 2019 (2019), Article ID 9536256, 3 pagesFloppy Closing Door Epiglottis Treated Successfully with...
Αλέξανδρος Γ. Σφακιανάκης
1h
Hunger-Activated AgRP Neurons Inhibit MPOA Neurons Controlling Parenting Morgane Boillot The Journal...
Hunger-Activated AgRP Neurons Inhibit MPOA Neurons Controlling ParentingMorgane BoillotThe Journal of Neuroscience, 31 July 2019, 39(31):6032-6034; doi:10.1523/JNEUROSCI.0589-19.2019http://www.jneurosci.org/content/39/31/6032Toward a Multimodal Framework of Brainstem Pain-Modulation Circuits in MigraineJulio A. YanesThe Journal of Neuroscience, 31 July 2019, 39(31):6035-6037; doi:10.1523/JNEUROSCI.0301-19.2019http://www.jneurosci.org/content/39/31/6035Research ArticlesCellular/MolecularInorganic...
Αλέξανδρος Γ. Σφακιανάκης
1h
From Hybrid to TransplantsPublished on Jul 31, 2019A Japanese researcher may soon be developing rat...
From Hybrid to TransplantsPublished on Jul 31, 2019A Japanese researcher may soon be developing rat and mouse embryos with human cells as part of a plan to eventually develop organs for transplants, according to Nature News. Read more >Skipping the DelaysPublished on Jul 31, 2019Kentucky law enforcement officials are testing a rapid DNA analyzer in sexual assault cases, CNBC reports. Read more >Avoid the PredatorsPublished on Jul 31, 2019Three medical writing organizations warn about the harm...
Αλέξανδρος Γ. Σφακιανάκης
1h
Development of a delayed-release nutrient for appetite control in adults with obesity and type 2 diabetes
Do we need race-specific resting metabolic rate prediction equations?James Reneau, Brittaney Obi, Andrea Moosreiner & Srividya KidambiNutrition & Diabetes 2019 9: 10.1038/s41387-019-0087-8Abstract | Full TextDevelopment of a delayed-release nutrient for appetite control in adults with obesity and type 2 diabetes and initial clinical testing in a single dose randomized controlled trialE. Beale, E. Lim, H. Yassine, C. Azen & C. ChristopherNutrition & Diabetes 2019 9: 10.1038/s41387-019-0088-7Abstract | Full...
Αλέξανδρος Γ. Σφακιανάκης
1h
Neoadjuvant BRAF‐targeted therapy in regionally advanced and oligometastatic melanoma Zeynep Eroglu ...
Neoadjuvant BRAF‐targeted therapy in regionally advanced and oligometastatic melanomaZeynep Eroglu  Jennifer Eatrides  Syeda Mahrukh Hussnain Naqvi  Youngchul Kim  Jeani Rich  Nalan Akgul Babacan  Andrew S Brohl  Joseph Markowitz  Amod Sarnaik  Jonathan Zager … See all authorsFirst published: 22 July 2019 https://doi.org/10.1111/pcmr.12813This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading...
Αλέξανδρος Γ. Σφακιανάκης
1h
Discoidin domain receptors: A promising target in melanoma Coralie Reger de Moura  Maxime Battistella ...
Discoidin domain receptors: A promising target in melanomaCoralie Reger de Moura  Maxime Battistella  Anjum Sohail  Anne Caudron  Jean Paul Feugeas  Marie‐Pierre Podgorniak  Cecile Pages  Sarra Mazouz Dorval  Oren Marco … See all authorsFirst published: 04 July 2019 https://doi.org/10.1111/pcmr.12809Coralie Reger de Moura and Maxime Battistella: co‐first authors.Rafael Fridman, Celeste Lebbé, Samia Mourah and Fanélie Jouenne contributed equally to this work: co‐last authors.Read the full textePDFPDFTOOLS...
Αλέξανδρος Γ. Σφακιανάκης
1h
Self-seeding circulating tumor cells promote the proliferation and metastasis of human osteosarcoma...
Self-seeding circulating tumor cells promote the proliferation and metastasis of human osteosarcoma by upregulating interleukin-8Tao Liu, Qiong Ma, Yinglong Zhang, Xin Wang, Kui Xu et al.Cell Death & Disease 2019 10: 10.1038/s41419-019-1795-7Abstract | Full TextGLI1 activation by non-classical pathway integrin αvβ3/ERK1/2 maintains stem cell-like phenotype of multicellular aggregates in gastric cancer peritoneal metastasisHui Dong, Hongchang Liu, Wen Zhou, Fan Zhang, Chuan Li et al.Cell Death...
Αλέξανδρος Γ. Σφακιανάκης
1h

Autosomal recessive hyper‐IgE syndrome successfully treated with hematopoietic stem cell transplantationJorge...
Autosomal recessive hyper‐IgE syndrome successfully treated with hematopoietic stem cell transplantationJorge Lopes MD, Diogo Teixeira MD, Cristina Sousa MD, Armando Baptista MD, Diana Moreira MD, Eduarda O. Ferreira MDVersion of Record online: 24 July 2019REVIEW ARTICLESThe infantile cutaneous microbiome: A reviewJennifer J. Schoch MD, Reesa L. Monir MD, Kerrie G. Satcher MD, Jessica Harris MD, Eric Triplett PhD, Josef Neu MDVersion of Record online: 23 July 2019ORIGINAL ARTICLESApple cider vinegar...
Αλέξανδρος Γ. Σφακιανάκης
1h
Improving Accuracy and Efficiency with Concurrent Use of Artificial Intelligence for Digital...
Improving Accuracy and Efficiency with Concurrent Use of Artificial Intelligence for Digital Breast Tomosynthesis Reading times were significantly reduced, and sensitivity, specificity, and recall rate improved in a nonclinical reader study when an artificial intelligence system was utilized concurrently with image interpretation for digital breast tomosynthesis.  Emily F. Conant, Alicia Y. Toledano... Jeffrey W. HoffmeisterUsing Time as a Measure of Impact for AI Systems: Implications in Breast...
Αλέξανδρος Γ. Σφακιανάκης
1h
Implementation and Validation of a Three-dimensional Cardiac Motion Estimation Network  ...
Implementation and Validation of a Three-dimensional Cardiac Motion Estimation Network A deep learning–based three-dimensional nonrigid body motion estimation technique based on cine MR images was implemented; the method was validated against five state-of-the-art nonrigid body registration methods by using several image and motion metrics.  Manuel A. Morales, David Izquierdo-Garcia... Ciprian Catana
Αλέξανδρος Γ. Σφακιανάκης
1h
Radiomics Model to Predict Early Progression of Nonmetastatic Nasopharyngeal Carcinoma after...
Radiomics Model to Predict Early Progression of Nonmetastatic Nasopharyngeal Carcinoma after Intensity Modulation Radiation Therapy: A Multicenter Study A machine-learning radiomic model based on pretreatment MRI findings has potential in the identification of patients with nonmetastatic nasopharyngeal carcinoma who are at risk for early disease progression after primary treatment.   Richard Du, Victor H. Lee... Varut Vardhanabhuti
Αλέξανδρος Γ. Σφακιανάκης
1h
Urinary Stone Detection on CT Images Using Deep Convolutional Neural Networks: Evaluation of...
Urinary Stone Detection on CT Images Using Deep Convolutional Neural Networks: Evaluation of Model Performance and Generalization A cascading convolutional neural network model, enriched with labeled CT images, detected the presence of urinary tract stones on unenhanced abdominopelvic CT scans with high accuracy.   Anushri Parakh, Hyunkwang Lee... Synho Do
Αλέξανδρος Γ. Σφακιανάκης
1h
Necrosis Rather Than Apoptosis is The Dominant form of Alveolar Epithelial Cell Death In Lipopolysaccharide-Induced...
Necrosis Rather Than Apoptosis is The Dominant form of Alveolar Epithelial Cell Death In Lipopolysaccharide-Induced Experimental Acute Respiratory Distress Syndrome ModelAlveolar epithelial cell (AEC) death, which is classified as apoptosis or necrosis, plays a critical role in the pathogenesis of acute respiratory distress syndrome (ARDS). In addition to apoptosis, some types of necrosis are known to be molecularly regulated, and both apoptosis and necrosis can be therapeutic targets for diseases....
Αλέξανδρος Γ. Σφακιανάκης
1h
  Magician's Corner: How to Start Learning about Deep Learning  Deep learning can be done with...
 Magician's Corner: How to Start Learning about Deep Learning Deep learning can be done with minimal hardware and software.  Bradley J. Erickson
Αλέξανδρος Γ. Σφακιανάκης
1h
Impact of Long Wavelength Ultraviolet A1 and Visible Light on Light‐Skinned Individuals Indermeet Kohli ...
Impact of Long Wavelength Ultraviolet A1 and Visible Light on Light‐Skinned IndividualsIndermeet Kohli  Raheel Zubair  Alexis B. Lyons  Amanda F. Nahhas  Taylor L. Braunberger  Mohsen Mokhtari  Eduardo Ruvolo  Henry W. Lim  Iltefat H. HamzaviFirst published: 25 July 2019 https://doi.org/10.1111/php.13143This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences...
Αλέξανδρος Γ. Σφακιανάκης
1h
Method for Measurements of Terrestrial Ultraviolet Radiation on Inclined Surfaces in Personal Dosimetry...
Method for Measurements of Terrestrial Ultraviolet Radiation on Inclined Surfaces in Personal Dosimetry Field Studies Elena Corradi, Katarzyna A Baczynska, Marco Morelii, Danilo Giulietti, Marina KhazovaVersion of Record online: 25 July 2019A hypothesis that UVR measured on a vertical plane in the north direction can be used in the UK as a proxy for diffuse radiation to derive three‐dimensional irradiance profile was tested against direct measurements and compared with models based on solar tracker...
Αλέξανδρος Γ. Σφακιανάκης
1h
 Predictive Laboratories, Preeclampsia Foundation Partner to ID Genetic Factors of ConditionPublished...
 Predictive Laboratories, Preeclampsia Foundation Partner to ID Genetic Factors of ConditionPublished on Jul 31, 2019 Finnish Exomes Yield New Trait, Disease Associations Involving Rare, Deleterious VariantsPublished on Jul 31, 2019 Natural Selection May Have Influenced Abundance of Neurons That Sense Certain OdorsPublished on Jul 31, 2019Featured in Depth Meridian Bioscience Dx Revenue Woes Likely to Continue Through 2020 Despite Promising Integration of GenePOCPublished on Jul 31, 2019 MIT Researchers...
Αλέξανδρος Γ. Σφακιανάκης
1h
Unusually complicated course of a common disease: challenges in managing pediatric HIV Publication date:...
Unusually complicated course of a common disease: challenges in managing pediatric HIVPublication date: Available online 15 July 2019Source: Medical Journal Armed Forces IndiaAuthor(s): Punam Bajracharya, Suprita Kalra, Gitanjali Jain, Amit SoodDoes pre-procedure ultrasound increase the success and safety of right internal jugular venous catheterization? An intervention studyPublication date: Available online 12 July 2019Source: Medical Journal Armed Forces IndiaAuthor(s): Vikrant Ghode, Naresh Dhawan,...
Αλέξανδρος Γ. Σφακιανάκης
1h
Guiding choices and opening doors: Mentoring revisited By Mike Taigman Mentorship comes full circle...
Guiding choices and opening doors: Mentoring revisitedBy Mike TaigmanMentorship comes full circle for EMS leader Mike Taigman, in collaborations in quality improvement and advancing EMS
Αλέξανδρος Γ. Σφακιανάκης
1h
Early Acid Suppression Therapy Exposure and Fracture in Young Children Laura Malchodi, Kari Wagner, Apryl Susi, Gregory Gorman, Elizabeth Hisle-Gorman...
Early Acid Suppression Therapy Exposure and Fracture in Young ChildrenLaura Malchodi, Kari Wagner, Apryl Susi, Gregory Gorman, Elizabeth Hisle-GormanPediatrics Jul 2019, 144 (1) e20182625; DOI: 10.1542/peds.2018-2625PPI use in infancy, alone or with H2RAs, is associated with fracture after 1 year of age. PDFAcellular Pertussis Vaccine Effectiveness Over TimeOusseny Zerbo, Joan Bartlett, Kristin Goddard, Bruce Fireman, Edwin Lewis, Nicola P.KleinPediatrics Jul 2019, 144 (1) e20183466; DOI: 10.1542/peds.2018-3466Compared...
Αλέξανδρος Γ. Σφακιανάκης
1h
Toppling the Ethical Balance — Health Care Refusal and the Trump Administration E. Sepper DOI: 10.1056/NEJMp1908839...
Toppling the Ethical Balance — Health Care Refusal and the Trump AdministrationE. SepperDOI: 10.1056/NEJMp1908839 | July 31, 2019Population and the Environment — Time for Another Contraception RevolutionD.J. AndersonN Engl J Med 2019;381:397-399Saving the Endangered Physician-Scientist — A Plan for Accelerating Medical BreakthroughsM.K. Jain and OthersN Engl J Med 2019;381:399-402Ghosts of Our Collective Subconscious — What Blackface in a Yearbook Photo Means for Medical EducationD.W. Paul, Jr.N...
Αλέξανδρος Γ. Σφακιανάκης
1h
Buried bumper syndrome (BBS) is one of the uncommon and late complications of percutaneous endoscopic gastrostomy (PEG) placement. It occurs when the internal bumper of the PEG tube erodes into the gastric wall and lodges itself between the gastric wall and skin.
Buried bumper syndrome: A complication of percutaneous endoscopic gastrostomyJiri Cyrany, Stanislav Rejchrt, [...], and Jan BuresAdditional article informationAbstractPercutaneous endoscopic gastrostomy (PEG) is a widely used method of nutrition delivery for patients with long-term insufficiency of oral intake. The PEG complication rate varies from 0.4% to 22.5% of cases, with minor complications being three times more frequent. Buried bumper syndrome (BBS) is a severe complication of this method,...
Αλέξανδρος Γ. Σφακιανάκης
1h
GASTROENTEROLOGY ENDOSCOPY: NOT JUST A PROCEDURAL FOCUS No abstract available An Intervention for Person-Centered...
GASTROENTEROLOGY ENDOSCOPY: NOT JUST A PROCEDURAL FOCUSNo abstract availableAn Intervention for Person-Centered Support in Irritable Bowel Syndrome: Development and Pilot StudyIrritable bowel syndrome is a common and often chronic functional bowel disorder that can cause severe disruption of daily functioning in those affected, with subsequent high healthcare utilization and work absenteeism. Nurses represent an underutilized group in the current management of irritable bowel syndrome. The aim of...
Αλέξανδρος Γ. Σφακιανάκης
1h
Health Physics
Measuring Workload With Paired DetectorsLinear accelerator workloads for each available photon energy are important quantities to know for radiation safety considerations, and presented is a technique to measure the workload using paired detectors. The signals from the two detectors can give sufficient information to separate the signal contributions from 6 and 18 MV photon fields and, combined with a signal-per-monitor-unit calibration factor, yields the number of monitor units delivered for each...
Αλέξανδρος Γ. Σφακιανάκης
1h
Techniques in Shoulder & Elbow Surgery
Treatment of Sagittal Split Olecranon Fractures Using Dorsal Plates Combined With Tension Band Wiring or Cerclage WiresWe evaluated the results of olecranon fractures with an intra-articular sagittal plane fracture treated by dorsal plates in combination with tension band wiring or cerclage wires. We included patients with comminuted olecranon fractures with sagittal split treated with combination fixation. Postoperative functional assessment, Mayo Elbow Performance Score (MEPS) and complications...
Αλέξανδρος Γ. Σφακιανάκης
1h
Primer on Precision Medicine for Complex Chronic Disorders Precision medicine promises patients with...
Primer on Precision Medicine for Complex Chronic DisordersPrecision medicine promises patients with complex disorders the right treatment for the right patient at the right dose at the right time with expectation of better health at a lower cost. The demand for precision medicine highlights the limitations of modern Western medicine. Modern Western medicine is a population-based, top-down approach that uses pathology to define disease. Precision medicine is a bottom-up approach that identifies predisease...
Αλέξανδρος Γ. Σφακιανάκης
1h
Clinical and Translational Gastroenterology
Primer on Precision Medicine for Complex Chronic DisordersPrecision medicine promises patients with complex disorders the right treatment for the right patient at the right dose at the right time with expectation of better health at a lower cost. The demand for precision medicine highlights the limitations of modern Western medicine. Modern Western medicine is a population-based, top-down approach that uses pathology to define disease. Precision medicine is a bottom-up approach that identifies predisease...
Αλέξανδρος Γ. Σφακιανάκης
1h

Technological Pedagogical and Content Knowledge Among Medical Educators: What Is Our Readiness to Teach...
Technological Pedagogical and Content Knowledge Among Medical Educators: What Is Our Readiness to Teach With Technology?Purpose: This study aimed to empirically assess medical educator knowledge of pedagogy and technology to inform the direction of medical school faculty development efforts. Method: The Technological Pedagogical and Content Knowledge framework (TPACK) survey is a validated instrument for understanding educators' knowledge of content (CK), pedagogy (PK) and technology (TK) in teaching....
Αλέξανδρος Γ. Σφακιανάκης
1h
Intraoperative Placement of Paravertebral Catheters to Manage Postoperative Pain in Opioid-Dependent...
Intraoperative Placement of Paravertebral Catheters to Manage Postoperative Pain in Opioid-Dependent Patients After Thoracolumbar Spine Fusion Surgery: A Case ReportWe introduce a regional technique that involves the intraoperative placement of bilateral paravertebral catheters under direct visualization. The patient had stage IV lung cancer and was on chronic oxycodone therapy. He presented with a T10 metastatic lesion, and underwent spinal decompression with T7–L1 fusion and T10 corpectomy. Before...
Αλέξανδρος Γ. Σφακιανάκης
1h
Heterogeneity of human pancreatic islet isolation around Europe: results of a survey study. Aim. Europe...
Heterogeneity of human pancreatic islet isolation around Europe: results of a survey study.Aim. Europe is currently the most active region in the field of pancreatic islet transplantation and many of the leading groups are actually achieving similar good outcomes. Further collaborative advances in the field require the standardization of islet cell product isolation processes and this work aimed to identify differences in the human pancreatic islet isolation processes within European countries. Methods....
Αλέξανδρος Γ. Σφακιανάκης
1h
Anaesthesia
Intraoperative Placement of Paravertebral Catheters to Manage Postoperative Pain in Opioid-Dependent Patients After Thoracolumbar Spine Fusion Surgery: A Case ReportWe introduce a regional technique that involves the intraoperative placement of bilateral paravertebral catheters under direct visualization. The patient had stage IV lung cancer and was on chronic oxycodone therapy. He presented with a T10 metastatic lesion, and underwent spinal decompression with T7–L1 fusion and T10 corpectomy. Before...
Αλέξανδρος Γ. Σφακιανάκης
1h
Academic Medicine
Recognizing and Eliminating Shame Culture in Health Professions EducationNo abstract availableApplying to Medical School as a DACA RecipientWhen I was 15 years old, I left home to enter a prep school in New Hampshire, and quickly went from being a top student at my inner-city public school to someone struggling to reach the middle of the class. My parents were convinced that my attending this school was an opportunity that would open doors to a world I could barely glimpse at home. But during those...
Αλέξανδρος Γ. Σφακιανάκης
2h
Menopause
Sexual pain in the menopausal patient: individualizing treatment still bestNo abstract availableUnderstanding the unmet sexual health needs of women with breast cancerNo abstract availableVaginal laser treatment—first, do no harmNo abstract availableSexual frequency and pain in a randomized clinical trial of vaginal estradiol tablets, moisturizer, and placebo in postmenopausal womenObjective: To evaluate the efficacy of two common interventions for bothersome postmenopausal vaginal symptoms on improving...
Αλέξανδρος Γ. Σφακιανάκης
2h
Clinical Orthopaedics and Related Research(R)
Editorial: What Do You Say When a Patient Says Thank You?No abstract availableEditor's Spotlight/Take 5: What Role Does Positive Psychology Play in Understanding Pain Intensity and Disability Among Patients with Hand and Upper-extremity Conditions?No abstract availableWhat Role Does Positive Psychology Play in Understanding Pain Intensity and Disability Among Patients with Hand and Upper Extremity Conditions?Background A large body of research shows that psychologic distress and ineffective coping...
Αλέξανδρος Γ. Σφακιανάκης
2h
pH-sensitive anti-CTLA4 antibodies: yes to efficacy, no to toxicity Amnon Altman & Kok-Fai Kong ...
pH-sensitive anti-CTLA4 antibodies: yes to efficacy, no to toxicityAmnon Altman & Kok-Fai Kong Cell Research 2019 29 :601 - 602; July 12, 2019; 10.1038/s41422-019-0198-8Abstract | Full TextMicrobiota guides insulin trafficking in beta cellsOzren Stojanović & Mirko Trajkovski Cell Research 2019 29 :603 - 604; July 02, 2019; 10.1038/s41422-019-0200-5Abstract | Full TextCrystallizing BubR1's kinase activityJazeel F. Limzerwala & Jan M. van Deursen Cell Research 2019 29 :605 - 606; June 28,...
Αλέξανδρος Γ. Σφακιανάκης
2h
Therapeutics
https://sfakianakisorl.blogspot.com/2019/07/american-journal-of-therapeutics.htmlAlexandros SfakianakisAnapafseos 5 . Agios NikolaosCrete.Greece.7210028410261826948891480alsfakia@gmail.com
Αλέξανδρος Γ. Σφακιανάκης
2h
"Use of Raman spectroscopy in the assessment of skin after CO2 ablative fractional laser surgery on...
"Use of Raman spectroscopy in the assessment of skin after CO2 ablative fractional laser surgery on acne scars"Ivan A. Bratchenko, Lyudmila A. Bratchenko, Dmitry N. Artemyev, Yulia A. KhristoforovaVersion of Record online: 25 July 2019LETTERS TO THE EDITORInfrared thermography and color Doppler: Two combined tools for assessing inflammation in hidradenitis suppurativaGianluca Nazzaro, Chiara Moltrasio, Angelo V. MarzanoVersion of Record online: 24 July 2019ORIGINAL ARTICLESConfocal laser scanning...
Αλέξανδρος Γ. Σφακιανάκης
2h
American Journal of Therapeutics
Deprescription of Antihypertensive Medication in Aging: A Debatable IssueRituximab to Treat Fibrosing Mediastinitis–Associated Recurrent HemoptysisVancomycin-Associated Erythema MultiformeTopical Administration of Amphotericin B as an Effective Adjuvant Treatment for a Deep Fungal Infection of Diabetic Foot InjuryPrevalence of Colorectal Neoplasms and Mortality in New Users of Low-Dose Aspirin With Lower Gastrointestinal BleedingBackground: Aspirin inhibits platelet function and may therefore accelerate...
Αλέξανδρος Γ. Σφακιανάκης
2h
FULL MOON > AUGUST - We have the Algonquin Indians and giant prehistoric fish to thank for August's Full Moon name. The Algonquin have made their home around the North American Great Lakes since after the last ice age. The ice age was a time of fantastical beasts - ferocious short-faced bears (about twice the size of today's grizzly) stalked elephant-sized woolly mammoths on the steppe. While the mammoths and bears have vanished, one prehistoric relic still remains hidden in the dark waters of the lakes.
August's full moon is called the Full Sturgeon Moon, after the primitive fish that used to be abundant in North America's lakes and rivers during the summer months. Having remained mostly unchanged since the earliest fossil records, sturgeons are ancient living fossils that can grow up until 3.5 meters long, or as long as two adult humans stacked on top of each other. Nowadays, however, it's almost impossible to see a sturgeon during the Full Sturgeon Moon. While they used to thrive, sturgeons are...
Αλέξανδρος Γ. Σφακιανάκης
2h
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
Injection laryngoplasty as adjunct treatment method for muscle tension dysphonia: Preliminary findings...Injection laryngoplasty as adjunct treatment method for muscle tension dysphonia: Preliminary findingsDaniel Novakovic FRACS, MBBS, MPH, BSc  Duong Duy Nguyen MD, PhD  Antonia Chacon BAppSc (SpPath) Hons, CPSP  Catherine Madill PhD, CPSPFirst published: 30 July 2019 https://doi.org/10.1002/lary.28205Editor's Note: This Manuscript was accepted for publication on July 9, 2019.Presented at the American...
Αλέξανδρος Γ. Σφακιανάκης
1d
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 forceThe above article was published online with an incorrect author name.Physeal separation in pediatric osteomyelitisAbstractIn 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...
Αλέξανδρος Γ. Σφακιανάκης
1d
Obesity Surgery
Timing of Gestation After Laparoscopic Sleeve Gastrectomy (LSG): Does it Influence Obstetrical and Neonatal Outcomes of Pregnancies?Ivor Lewis Oesophagectomy for a Distal Adenocarcinoma of the Oesophagus 10 Years After Roux-en-Y Gastric Bypass (RYGB)Correction to: Longitudinal Impacts of Gastric Bypass Surgery on Pharmacodynamics and Pharmacokinetics of StatinsIn the original article the authors failed to include the following footnote:Christine Ren FieldingCorrection to: Incidence and Risk Factors...
Αλέξανδρος Γ. Σφακιανάκης
1d
Pediatric Orthopaedics
Bone maturation of MRI residual developmental dysplasia of the hip with discrepancy between osseous and cartilaginous acetabular indexQuality of spontaneous amelioration of residual developmental dysplasia of the hip (DDH) is nowadays not possible to predict. Normal age-related values of the osseous acetabular index (OAI), cartilaginous acetabular index and labral acetabular index have been established on MRI. In this study, MRI of dysplastic hips has been evaluated, and further osseous acetabular...
Αλέξανδρος Γ. Σφακιανάκης
1d
Rheumatology
Editorial introductionsNo abstract availableImplications of juvenile idiopathic arthritis genetic risk variants for disease pathogenesis and classificationPurpose 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...
Αλέξανδρος Γ. Σφακιανάκης
1d
Anaesthesiology
Analgesic efficacy of ultrasound-guided interscalene block vs. supraclavicular block for ambulatory arthroscopic rotator cuff repair: A randomised noninferiority studyBACKGROUND 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),...
Αλέξανδρος Γ. Σφακιανάκης
1d
Cardiovascular Medicine
Percutaneous coronary interventions for stable ischemic heart disease in ItalyAims Although the benefits of percutaneous coronary interventions (PCIs) in patients with stable chronic ischemic heart disease (SIHD) are controversial, a large number of PCIs are currently performed in SIHD patients, frequently after coronary angiography (ad-hoc procedures), without the use of fractional flow reserve (FFR) to identify patients most likely to benefit from PCI. Methods Assessment of regional variations...
Αλέξανδρος Γ. Σφακιανάκης
1d
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
MDPIMolbank, Vol. 2019, Article M1075: N-Benzo[c][1,2,5]thiazol-4-yl-3-trifluoromethylbenzamideMolbank, Vol. 2019, Article M1075: N-Benzo[c][1,2,5]thiazol-4-yl-3-trifluoromethylbenzamide Molbank doi: 10.3390/M1075 Authors: Hamad H. Al Mamari Nasser Al Awaimri Yousuf Al Lawati The title compound, N-benzo[c][1,2,5]thiazol-4-yl-3-trifluoromethylbenzamide (1) was synthesized by reacting 3-trifluoromethylbenzoyl chloride (4) and 4-aminobenzo[c][1,2,5]thiadiazole (5). The compound was characterized by...
Αλέξανδρος Γ. Σφακιανάκης
2d

Advances in Neonatal Care
Why does Joy at Work Matter?No abstract availableNoteworthy Professional NewsNo abstract availableJoin Our 35th Anniversary Celebration in SaNANNah This Fall!No abstract availableZAP-VAP: A Quality Improvement Initiative to Decrease Ventilator-Associated Pneumonia in the Neonatal Intensive Care Unit, 2012-2016Background: Ventilator-associated pneumonia (VAP) is the second most frequent hospital-acquired infection in neonatal intensive care units (NICUs) and significantly affects neonatal morbidity...
Αλέξανδρος Γ. Σφακιανάκης
2d
Trauma and Acute Care Surgery
Selective aortic arch perfusion with fresh whole blood or HBOC-201 reverses hemorrhage-induced traumatic cardiac arrest in a lethal model of noncompressible torso hemorrhageBACKGROUND Hemorrhage-induced traumatic cardiac arrest (HiTCA) has a dismal survival rate. Previous studies demonstrated selective aortic arch perfusion (SAAP) with fresh whole blood (FWB) improved the rate of return of spontaneous circulation (ROSC) after HiTCA, compared with resuscitative endovascular balloon occlusion of the...
Αλέξανδρος Γ. Σφακιανάκης
2d
Advanced Emergency Nursing
AAENP and ACEP: Cultivating InterprofessionalismNo abstract availableThe Modified Valsalva Maneuver for Reversion of Stable Supraventricular Tachycardia: Lessons Learned From the REVERT TrialThe 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,...
Αλέξανδρος Γ. Σφακιανάκης
2d
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 seriesThe 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...
Αλέξανδρος Γ. Σφακιανάκης
2d
Endocrine
LncRNA MCM3AP-AS1 promotes proliferation and invasion through regulating miR-211-5p/SPARC axis in papillary thyroid cancerAbstractBackgroundLong non-coding RNAs (lncRNAs) are an emerging class of regulators in cancer. A lncRNA, MCM3AP-AS1, has been demonstrated as a versatile mediator in many cancers, except papillary thyroid cancer. The aim of this study is to investigate the role and mechanism of MCM3AP-AS1 in papillary thyroid cancer.MethodsQuantitative real-time PCR was used to assess the level...
Αλέξανδρος Γ. Σφακιανάκης
2d
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
MDPIVaccines, Vol. 7, Pages 75: Why New Vaccines for the Control of Ectoparasite Vectors Have Not Been Registered and Commercialized?Vaccines, Vol. 7, Pages 75: Why New Vaccines for the Control of Ectoparasite Vectors Have Not Been Registered and Commercialized? Vaccines doi: 10.3390/vaccines7030075 Authors: José de la Fuente Agustín Estrada-Peña The prevention and control of vector-borne diseases is a priority for improving global health. Despite recent advances in the characterization of ectoparasite-host-pathogen...Medicine...
Αλέξανδρος Γ. Σφακιανάκης
3d
Hypertension
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
3d
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...
Αλέξανδρος Γ. Σφακιανάκης
3d
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...
Αλέξανδρος Γ. Σφακιανάκης
3d
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...
Αλέξανδρος Γ. Σφακιανάκης
3d
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...
Αλέξανδρος Γ. Σφακιανάκης
3d
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...
Αλέξανδρος Γ. Σφακιανάκης
3d

Τετάρτη 31 Ιουλίου 2019

Otology & Neurotology

Preclinical Validation of a Novel Device Designed to Reduce Biofilms on Percutaneous Osseointegrated Abutments
Aim: To assess the efficacy of a prototype cleaning device in removing biofilm from skin-penetrating abutments. Background: Adverse skin reactions around percutaneous osseointegrated implants have been linked to poor hygiene and infection. A cleaning device made from open-cell polyfoam has been developed to facilitate manual cleaning of abutments by the patient. Methods: Serratia biofilm was grown on clean and sterile conical bone-anchored hearing system abutments including both pre-2007 (straight sided) and post-2007 (conical-sided) designs. Eighteen were photographed and then subjected to cleaning using a toothbrush or the cleaning device soaked in water or a proprietary mouthwash. Biofilm on a further group of 10 conical abutments was recorded using a scanning electron microscope before and after cleaning with the test device soaked in water. Quantitative analysis of the efficiency of the cleaning was made using image analysis. Results: Removal of biofilm using a dry or wet toothbrush was not as effective as cleaning with the device. In 10 cases subjected to image analysis, approximately 90% of the biofilm was removed from the top third of the abutments, 85% from the middle third, and 48% from the basal third. Conclusion: The cleaning device is effective in removing most biofilm from the test abutments and represents a significant improvement in comparison with traditional methods such as a toothbrush. Address correspondence and reprint requests to Rachel Sammons, Ph.D., School of Dentistry, University of Birmingham, 5, Mill Pool Way, Birmingham B5 7EG, UK; E-mail: r.l.sammons@bham.ac.uk This study was funded by Sapere Systems Ltd. UK. The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Histopathology of Inner Ear Malformations: Potential Pitfalls for Cochlear Implantation
Hypothesis: The presence of bony inner ear malformations may associate with a number of anatomical abnormalities affecting the middle ear structures. Those malformations may create pitfalls and complications for cochlear implantation. Background: Inner ear malformations associate with varying degrees of hearing loss, and frequently require cochlear implantation for hearing rehabilitation. Therefore, the abnormalities affecting the middle- and inner-ear structures may increase the risk of surgical complications. Methods: We examined 38 human temporal bones from donors with bony inner ear malformations. Using light microscopy, we analyzed the presence of abnormalities in the structures of the middle- and inner-ear. Results: Our collection comprises of 38 specimens with inner-ear malformations (cochlear aplasia, n = 3; cochlear hypoplasia, n = 30; incomplete partition, n = 3; isolated vestibular malformation, n = 2). The anatomy of the middle ear was abnormal in most temporal bones with cochlear aplasia, cochlear hypoplasia, and incomplete partition type I (40%–100%). Some of those abnormalities (hypoplastic or obliterated mastoid, 55.2%; aplastic or obliterated round window, 71.0%; aberrant course of the facial nerve, 36.8%) may hinder the access to the round window using the conventional facial recess approach for cochlear implantation. The cochlear nerve and associated bony structures (internal auditory canal and bony canal for cochlear nerve) were normal in 71.0% of all temporal bones with inner ear malformations. Conclusion: Each different type of malformation may create specific surgical challenges to surgeons. Comprehensive preoperative imaging is fundamental toward the surgical success of cochlear implants in patients with malformations. Alternatives to circumvent those middle- and inner-ear abnormalities and potential complications are further discussed. Address correspondence and reprint requests to Rafael da Costa Monsanto, M.D., Ph.D., Department of Otolaryngology, Head and Neck Surgery – University of Minnesota, Lions Research Building, Room 210 – 2001 6th St. SE, Minneapolis, MN 55455, U.S.A. E-mail: rafaelmonsanto@hotmail.com The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. R.d.C.M. received a scholarship from the "Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES)" (Finance Code 001). The research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the NIH (UG3NS107688), the International Hearing Foundation, the 5 M Lions International, the Starkey Foundation, and the "Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil. (CAPES). The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Osteonecrosis of the External Auditory Canal Associated With Oral Sorafenib Therapy: Sorafenib and Temporal Bone Osteonecrosis
Objective: To present the first case of osteonecrosis of the external auditory canal associated with sorafenib treatment. Patient: 58-year-old patient with right-sided otorrhea and otalgia was treated for otitis externa for 1 month without improvement. Otoscopic examination revealed a large defect in the inferior wall of the tympanic bone filled with skin debris and bony fragments. Previous medical history included treatment with sorafenib for metastatic renal cell cancer; he had never been exposed to radiotherapy. Computed tomography of the temporal bone showed a large right external auditory canal bony erosion with involvement of the tympanic bone and bony sequestra extending to the mastoid cells and temporomandibular joint. Histologic examination revealed necrotic bone and inflammatory changes with no signs of malignancy. A diagnosis of osteonecrosis of external auditory canal was made. Intervention: Right subtotal petrosectomy with obliteration of surgical cavity with abdominal fat was performed. Results: Final histological report revealed avascular necrosis of the bone with perivascular lymphocitic infiltration of the soft tissues. Diagnosis of medication-related external auditory canal osteonecrosis was confirmed. Conclusion: Medication-related osteonecrosis of the temporal bone is not a well-known entity among otolaryngologists and could therefore be misclassified as another diagnosis. In patients with othorrea and earache following sorafenib treatment, temporal bone osteonecrosis should be suspected. Address correspondence and reprint requests to Dr. Federica Canzano, M.D., University Hospital of Parma, Parma, Italy; E-mail: Federica.canzano@gmail.com The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Effect of Vestibular Exercises Associated With Repositioning Maneuvers in Patients With Benign Paroxysmal Positional Vertigo: A Randomized Controlled Clinical Trial
In addition to positional vertigo, it is quite common for patients with benign paroxysmal positional vertigo (BPPV) to present complaints associated with balance problems and a feeling of dizziness even after repositioning maneuvers. Objective: It was to evaluate the additional effects of vestibular rehabilitation exercises as a therapeutic resource in the treatment of BPPV, to improve symptoms and reduce recurrence. Study Design: This was an experimental, prospective, randomized, controlled study. Setting: Instituto Brasiliense de Otorrinolaringologia (IBORL) from August 2016 to September 2017. Patients: Thirty-two individuals, both men and women, over 18 years of age with BPPV. Intervention: They were randomly assigned to two groups: the control group (n = 15) performing only the maneuver technique as treatment and the experimental group (n = 17) performing the maneuvers and vestibular rehabilitation exercises. Patients underwent treatment and responded to the dizziness handicap inventory (DHI) and visual analog scale (VAS) questionnaires for comparison between groups. Participants were followed up for 6 months to observe recurrence of symptoms. Main Outcome Measures: To investigate the additional effects of vestibular exercises in the treatment of BPPV. Results: The experimental group had a lower level of dizziness in the posttreatment period (p < 0.05) and a lower incidence of recurrences (p = 0.038) than the control group. Conclusions: Vestibular exercises performed after repositioning treatments for BPPV increased the overall efficacy of treatment by improving symptoms with a lower rate of recurrence. Address correspondence and reprint requests to Fayez Bahmad, Jr, M.D., Ph.D., Setor Médico Hospitalar Norte Quadra 02, Bloco C, Ed. Dr. Crispim, Sala 515 - Asa Norte, Brasília - DF, 70710-149, Brazil; E-mail: fayezbjr@gmail.com There are no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Speech Perception Outcomes in Transcutaneous Versus Percutaneous Bone Conduction Stimulation in Individuals With Single-Sided Deafness
Objective(s): To investigate the differences in percutaneous versus passive transcutaneous bone-conduction stimulation in individuals with single-sided deafness. Study Design: Prospective, single-subject. Setting: Tertiary academic referral center. Patients: Adult bone-anchored implant listeners with single-sided deafness using a percutaneous implant system. Interventions: Experienced percutaneous bone anchored implant recipients were tested in the percutaneous and transcutaneous conditions using a BAHA 5 (Cochlear Corp., Cochlear Bone-Anchored Solutions, Mölnlycke, Sweden) sound processor on the patient's own abutment and on a softband. Main Outcome Measures: Phoneme recognition was assessed using Consonant-Nucleus-Consonant (CNC) words for soft (47 dB SPL) and average (62 dB SPL) speech inputs. Speech perception in noise performance was also assessed for soft (47 dB SPL) and average (62 dB SPL) speech inputs using sentences presented in multi-talker babble. Aided free-field thresholds were obtained in both conditions using warble tone stimuli. Results: Compared with percutaneous bone-conduction stimulation, transcutaneous stimulation demonstrated reduced effective gain for high frequency stimulation. Transcutaneous stimulation required higher signal to noise ratios to achieve comparable performance to the percutaneous condition. Phoneme recognition was poorer in transcutaneous versus percutaneous stimulation with the most significant impact observed for soft speech inputs. Conclusion: A significant performance gap in speech recognition is observed between percutaneous and transcutaneous bone-conduction stimulation in individuals with single-sided deafness at the same signal to noise ratios. Compared with percutaneous bone-conduction stimulation, transcutaneous stimulation demonstrated reduced effective gain, decreased phoneme recognition, word recognition, and performance in noise, with the most significant impact observed for soft speech inputs. Address correspondence and reprint requests to Hillary A. Snapp, Au.D., Ph.D., 1120 NW 14th Street, 5th Floor, Miami, FL 33136; E-mail: hsnapp@med.miami.edu This research was presented in part at the 6th International Congress on Bone Conduction Hearing and Related Technologies, May 2017, Nijmegen, The Netherlands. The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Outcomes of Primary Pediatric Stapedotomy
Objective: To review a single institution experience with pediatric stapedotomy for juvenile otosclerosis (JO), congenital stapes footplate fixation (CSFF), or tympanosclerosis. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Pediatric patients undergoing surgery for stapes fixation from 2001 to 2017. Main Outcome Measures: Hearing result based on preoperative, first postoperative, and final postoperative pure-tone average air-bone gap (PTA-ABG). Age, sex, diagnosis, procedure performed, prosthesis, and ossicular anomalies were considered. Results: A total of 59 children (4–16 years of age) underwent surgery for stapes fixation (67 ears), with an average postoperative audiogram out to 2.88 years. Final postoperative ABG for tympanosclerosis (30.4 dB ± 10.9 dB) showed some improvement but the outcome was significantly worse than in CSFF (21.0 dB ± 11.4 dB) (p = 0.020) and JO (22.8 dB ± 14.9 dB). Conclusion: Our data suggest, that in our clinic, surgery for stapes fixation is safe to perform in children. While we achieved desirable results for JO and CSFF, patients with tympanosclerosis showed a statistically worse hearing outcome. Tympanosclerosis deserves special consideration and may be better served with a malleovestibulopexy, total ossicular replacement prosthesis (TORP), or amplification in lieu of traditional stapes surgery. Address correspondence and reprint requests to Joshua Cody Page, M.D., Department of Otolaryngology–Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham #543, Little Rock, AR 72205; E-mail: jcpage@uams.edu Funding is not received for this work. The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Management of Traumatic Injury and Osseointegration Failure in Children With Percutaneous Bone Conduction Implants
Objective: This study examines the incidence and management of traumatic loss or osseointegration failure of percutaneous bone conduction implants in children. Study Design: Case series. Setting: Pediatric tertiary care institution. Patients: Children who underwent percutaneous osseointegrated implant placement from 1996 to 2016. Interventions: Clinical evaluation and revision surgery after implant loss. Main Outcome Measures: This study compares the characteristics of children who experienced traumatic loss of implant to those who did not to calculate odds ratios (ORs) describing the risk of injury and investigate device utilization after implant failure. Results: One hundred forty-seven children received percutaneous bone conduction devices; 129 were followed for at least 1 year. Trauma occurred in 19 of 129 cases (15%). Among children with traumatic injury, mean age at initial surgery was 5 years (SD = ±3.3), and 42% had a developmental delay. Among children without traumatic injury, mean age at initial surgery was 6.5 years (SD = ±4.4), and 28% had a developmental delay. Multivariate logistic regression found no significant differences in age, sex, or developmental delay associated with implant loss. In five of 19 traumatic cases (26%), the implant remained in situ due to either skull fracture or abutment loss. In the remaining 14 of 19 cases (74%), there was osseointegration failure with extrusion of the implant. Seventeen children underwent revision surgery utilizing previously placed "sleeper," or backup, osseointegrated implant, and 14 (82%) of these continued to use their device. Two patients with extruded implants did not undergo revision surgery. Conclusion: Traumatic injury or osseointegration failure leads to loss of percutaneous bone conduction implants in approximately 15% of children. Revision surgery is often successful. Address correspondence and reprint requests to Patricia L. Purcell, M.D., M.P.H., Department of Otolaryngology, Head & Neck Surgery, 555 University Avenue, 6th floor Burton Wing, Toronto, ON M5G1X8, Canada; E-mail: patricia.purcell@sickkids.ca Financial Disclosures: S.L.C., B.C.P., and K.A.G. hold sponsored research agreements with Cochlear Americas. B.C.P. and K.A.G. receive speaking fees from Cochlear Americas. S.L.C. receives speaking fees for Interacoustics. S.L.C. earns royalties from the book, Balance Disorders in the Pediatric Population. S.L.C. and B.C.P. are Patent Holders for Patents #: 7041-0: Systems and Methods for Balance Stabilization. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Physical and Emotional Burden of the Epley Maneuver in the Elderly
Objective: To analyze and compare experiences of anxiety and discomfort caused by the Epley maneuver and the willingness for a potential retreatment between younger (≤70 yr) and older (>70 yr) patients. Study Design: Prospective, observational cohort study. Setting: Tertiary referral center. Methods: Dutch adults, diagnosed with posterior canal benign paroxysmal positional vertigo, were included. Patients with dementia or subjected to an Epley maneuver ≤4 months before the hospital visit were excluded. Patients were asked about their experiences with the Epley maneuver directly after the maneuver, after 2 weeks and after 2 months. Differences in experiences between the age groups were tested with the Fisher's exact test and subgroup analyses were performed using multivariable logistic regression. Results: Out of 179 included patients, 115 (64%) were aged ≤70 and 134 (75%) were female. In both groups, 25% reported anxiety directly after the Epley maneuver. Two weeks later, 19 and 27%, respectively (p = 0.26) reported anxiety. In the young group, 30% expressed discomfort directly after treatment compared with 45% in the elderly (OR 1.98, 95% CI 1.05–3.75, p = 0.04). Two weeks later, this was 36 and 38%, respectively (p = 0.87). This decreased to 24 and 33%, respectively (p = 0.37), after 2 months. There was no significant difference in willingness for potential retreatment between both groups after 2 weeks (93 and 95%, respectively, p = 0.75) nor after 2 months (97 and 92%, respectively, p = 0.13). Conclusion: The Epley maneuver results in little anxiety and discomfort both in young and in elderly patients. Most patients show willingness for potential retreatment in case symptoms recur. Address correspondence and reprint requests to Britta D.P.J. Maas, M.D., Apeldoorn Dizziness Centre, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, the Netherlands; E-mail: b.maas@gelre.nl This work was supported solely from institutional and/or departmental sources from the Apeldoorn Dizziness Centre, Gelre Hospital, Apeldoorn. The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Meta-analysis of Delayed Facial Palsy Following Middle Ear Surgery
Objective: Delayed facial palsy has been reported following various types of otologic surgery. However, the exact characteristics of this disease have not been fully elucidated because of its low incidence. This study analyzed case series studies on delayed facial palsy to increase the sample size and outline credible disease characteristics. Data Sources: PubMed, Embase, and Cochrane Library databases were searched on October 10, 2018. Study Selection: Delayed facial palsy case series covered in English in which the intervention was typical tympanoplasty, mastoidectomy, stapedectomy, or cochlear implantation including a statement of sample size. Data Extraction: Evaluated according to the Joanna Briggs Institute Critical Appraisal Checklist for Case Series. Data Synthesis: Fourteen case series studies were included. Incidence rate, onset time, prognosis were evaluated with meta-analysis. Etiology and treatment were discussed with systematic review. Conclusions: The overall incidence rate of delayed facial palsy after middle ear surgery was 0.65%; however, it differed depending on the type of surgery. The mean onset time of facial palsy was 8.47 ± 3.98 days after surgery, and 95.3% of the patients completely recovered. The disease seems to have multiple etiologies. Facial palsy occurring 2 to 20 days after surgery is suggested to be considered delayed facial palsy. Address correspondence and reprint requests to Jinsei Jung, M.D., Ph.D., Department of Otorhinolaryngology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea; E-mail: jsjung@yuhs.ac The authors disclose no conflicts of interest. Supplemental digital content is available in the text. 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.jcraniofacialsurgery.com). Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

A Transcutaneous Active Middle Ear Implant (AMEI) in Children and Adolescents: Long-term, Multicenter Results
Objective: Evaluation of the long-term safety and performance of an active middle ear implant (AMEI) in the treatment of hearing loss in children and adolescents with a primary focus on improvement in speech discrimination. Study Design: Prospective, multicentric, single-subject repeated-measures design in which each subject serves as his or her own control. Subjects: Thirty-one pediatric subjects aged 5 to 17 years. Intervention: Implantation of an active middle ear implant. Methods: Improvement in word recognition scores, speech reception thresholds (SRT) in quiet and noise, in addition to air conduction, bone conduction, and sound field thresholds were evaluated in two age groups. Results: Residual hearing did not change over time and speech intelligibility significantly improved and remained stable after 36 months. Children aged 5 to 9 improved in WRS from 21.92 to 95.38% and in SRT in quiet and in noise respectively from 62.45 dB SPL (sound pressure level) and +1.14 dB SNR to 42.07 dB SPL and −4.45 dB SNR. Adolescents aged 10 to 17 improved in WRS from 12.78 to 84.71% and in SRT in quiet and in noise respectively from 63.96 dB SPL and +3.32 dB SNR to 35.31 dB SPL and −4.55 dB SNR. Conclusions: The AMEI, under investigation, is a safe treatment for children and adolescents, and significantly improved audiological performance that remains stable on the long-term scale (up to 36 mo postimplantation). In general, all adult-related issues and questions regarding safety and performance can also be applied to the pediatric population, as no apparent specific issues developed. Address correspondence and reprint requests to John-Martin Hempel, Priv.-Doz. Dr. med., Clinic and Policlinic for ENT Treatment, Ludwig-Maximilians-University (LMU) Clinic Grosshadern, Marchioninistr. 15, 81377 München, Germany; E-mail: John-Martin.Hempel@med.uni-muenchen.de MED-EL, Innsbruck, Austria, initiated, organized, and monitored this study and gave support for statistical analysis and manuscript preparation. There was no external financial funding for this project (National Institutes of Health [NIH], Wellcome Trust, Howard Hughes Medical Institute [HHMI], or others). None of the authors has any financial interest (consultancies, stock ownership, or other equity interests, patent licensing arrangements, or payments for conducting or publicizing a study) in the used and mentioned products or companies. The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Clinical and Translational Gastroenterology

Primer on Precision Medicine for Complex Chronic Disorders
imagePrecision medicine promises patients with complex disorders the right treatment for the right patient at the right dose at the right time with expectation of better health at a lower cost. The demand for precision medicine highlights the limitations of modern Western medicine. Modern Western medicine is a population-based, top-down approach that uses pathology to define disease. Precision medicine is a bottom-up approach that identifies predisease disorders using genetics, biomarkers, and modeling to prevent disease. This primer demonstrates the contrasting strengths and limitations of each paradigm and why precision medicine will eventually deliver on the promises.

Blunted Evoked Prouroguanylin Endocrine Secretion in Chronic Constipation
imageOBJECTIVES: Prouroguanylin (ProUGN) in the intestine is cleaved to form uroguanylin (UGN), which stimulates guanylate cyclase C (GUCY2C), inducing cyclic guanosine monophosphate signaling. Paracrine release regulates fluid secretion, contributing to bowel function, whereas endocrine secretion evoked by eating forms a gut-brain axis, controlling appetite. Whereas hormone insufficiency contributes to hyperphagia in obesity, its contribution to the pathophysiology of constipation syndromes remains unexplored. Here, we compared circulating ProUGN and UGN in healthy subjects and in patients with chronic idiopathic constipation (CIC) and patients with irritable bowel syndrome with constipation (IBS-C). METHODS: Circulating ProUGN and UGN levels were measured in 60 healthy subjects, 53 patients with CIC, and 54 patients with IBS-C. After an overnight fast, the participants ingested a standardized meal; blood samples were drawn at fasting and at 30, 60, and 90 minutes thereafter, and hormone levels were quantified by enzyme-linked immunosorbent assay. RESULTS: Fasting ProUGN levels were >30% lower in patients with CIC and those with IBS-C compared with healthy subjects regardless of age, sex, or disease state. After eating, ProUGN levels increased compared with fasting levels, although the rate of change was slower and maximum levels were lower in patients with CIC and those with IBS-C. Similarly, fasting UGN levels were lower in patients with CIC and those with IBS-C compared with healthy subjects. However, unlike ProUGN levels, UGN levels did not increase after eating. DISCUSSION: These observations support a novel pathophysiologic model in which CIC and IBS-C reflect a contribution of ProUGN insufficiency dysregulating intestinal fluid and electrolyte secretion. TRANSLATIONAL IMPACT: This study suggests that CIC and IBS-C can be treated by oral GUCY2C hormone replacement. Indeed, these observations provide a mechanistic framework for the clinical utility of oral GUCY2C ligands like plecanatide (Trulance) and linaclotide (Linzess) to treat CIC and IBS-C.

Immunologic Features of Patients With Advanced Hepatocellular Carcinoma Before and During Sorafenib or Anti-programmed Death-1/Programmed Death-L1 Treatment
imageINTRODUCTION: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. Today, a promising treatment strategy is focused on the enhancement of antitumor immune responses by immune checkpoint modification. However, as only 20% of patients with HCC are responders, identification of predictive factors is urgently required. Therefore, for the first time, the features of the intrahepatic and circulating immune system in patients with advanced-stage HCC, before and during the treatment, were analyzed. METHODS: We collected fresh HCC biopsies, along with adjacent tumor-free liver tissues and peripheral blood samples, from 21 patients with advanced HCC. Furthermore, we performed an extensive immunomonitoring of patients with HCC treated with sorafenib or programmed death (PD)-1/PD-L1 pathway blockade using multiparametric flow cytometry. RESULTS: We observed that regardless of the treatment, low baseline intratumoral CD4+/CD8+ T-cell ratio was associated with better overall survival (P = 0.0002). The baseline frequency of intratumoral PD-1high CD8+ T cells was significantly lower in patients responding to sorafenib treatment than in the nonresponders (P = 0.0117), and the frequency of circulating PD-1high T cells increased with tumor progression (P = 0.0329). By contrast, responders to PD-1/PD-L1 pathway blockade showed a trend of high baseline frequency of intratumoral PD-1high CD8+ T cells. Moreover, we observed a trend of LAG3 and TIM3 upregulation on circulating T cells in nonresponding patients to PD-1/PD-L1 pathway blockade. DISCUSSION: Immunosuppressive state, characterized by an enhanced intratumoral CD4+/CD8+ T-cell ratio, was associated with poor prognosis. Additionally, our results suggest that the frequency of intratumoral PD-1high CD8+ T cells may serve as a biomarker to identify which individuals will benefit from which treatment and support the use of combination strategies.

Clinicopathologic and Racial/Ethnic Differences of Colorectal Cancer Among Adolescents and Young Adults
imageOBJECTIVES: Despite overall reductions in colorectal cancer burden, incidence rates continue to rise among younger patients, and causes remain unknown. We examined differences in clinicopathologic and racial/ethnic characteristics within the adolescent and young adult (AYA) population diagnosed with colorectal cancer in the United States. METHODS: Using the National Cancer Institute's Surveillance, Epidemiology, and End Results program data, we identified individuals diagnosed with first primary colorectal cancer between ages 15 and 39 years from 2010 to 2015. Adjusted multivariable logistic regression models were used to quantify clinicopathologic and racial/ethnic differences across age at onset subgroups (15–19, 20–24, 25–29, 30–34, and 35–39 years). RESULTS: We identified 5,350 AYA patients diagnosed with colorectal cancer. Of note, 28.6% of AYA cases were diagnosed with right-sided tumors (cecum to transverse colon). The proportion of right-sided colorectal cancers differed significantly by age group at diagnosis (38.3% vs 27.3% of AYAs aged 15–19 vs 35–39 years, respectively; P trend = 0.01). Proportions of cases with mucinous adenocarcinoma and signet ring cell carcinoma histopathologic subtypes significantly increased with younger age at onset (P trends = 0.01 and 0.03, respectively). Differences in clinical stage were observed across AYA age groups, with stage II disease increasing with younger age (P trend = 0.01). The proportion of Hispanic AYAs was higher within younger patients, accounting for 21.0% of the AYA population aged 35–39 years up to 28.3% of 15–19-year-old individuals (P trend = 0.003). DISCUSSION: Within the AYA population, colorectal cancers differ by clinicopathologic and racial/ethnic characteristics. Further investigation of the clinical and biologic diversity of colorectal cancers that partially underlie age- and race-related differences in cancer susceptibility and outcomes is warranted.

Variable Features of Juvenile Polyposis Syndrome With Gastric Involvement Among Patients With a Large Genomic Deletion of BMPR1A
imageOBJECTIVES: Loss-of-function mutations of BMPR1A cause juvenile polyposis syndrome (JPS), but large genomic deletions in BMPR1A are rare, reported in few families only, and data regarding the associated phenotype are limited. METHODS: We investigated clinical features and genomic data of 7 extended seemingly unrelated families with a genomic deletion of the entire coding region of BMPR1A. We defined mutation size, mutation prevalence, and tumor pathogenesis using whole-genome sequencing, targeted genotyping, and haplotype analysis. RESULTS: Patients with JPS from 7 families of Bukharin Jewish ancestry carried a deletion of 429 kb, encompassing the BMPR1A coding sequence and 8 downstream genes. Haplotype analysis and testing controls identified this as a common founder mutation occurring in 1/124 individuals of Bukharin origin. Tumor testing did not demonstrate loss of heterozygosity. Among carriers, JPS was almost fully penetrant, but clinical features varied widely, ranging from mild to very severe, including pan-enteric polyps, gastritis, and colorectal, esophageal, and testicular cancer, and carriers with phenotypes, which would not have raised suspicion of JPS. DISCUSSION: The phenotype in this large cohort was extremely variable, although all carriers shared the same variant and the same genetic background. New observations include a preponderance of adenomatous rather than juvenile polyps, possible association with testicular cancer, and unexpected upper gastrointestinal involvement.

Transjugular Liver Biopsy: Safe Even in Patients With Severe Coagulopathies and Multiple Biopsies
imageOBJECTIVES: To investigate the safety profile and diagnostic efficacy of transjugular liver biopsy (TJLB), with a focus on patients with severe coagulopathies and with multiple biopsies. METHODS: Clinical, laboratory, and demographic information was collected on 1,321 TJLBs in 932 patients (mean age 43.5 ± 23.2 years) performed between January 2009 and May 2017 to determine the diagnostic success rate and incidence of both major and minor complications in the 3-day and 30-day period post-biopsies. These outcomes were also analyzed for severely coagulopathic patients and a subgroup of patients who underwent multiple biopsies. RESULTS: The overall success rate (diagnostic yield) of the TJLB procedure was 97.7% (1,291/1,321). Overall, the major and minor complication rates were 1.0% (13/1,321) and 9.5% (126/1,321), respectively. In patients with multiple biopsies, the overall complication rate was similar to the entire study cohort, which was 10.4% (57/550). Patients were also stratified according to the platelet counts of 0–50, 51–100, 101–200, 201–300 and >300 × 103 platelets/μL. The overall complication rates were 8.0% (10/124), 11.6% (36/310), 9.9% (54/547), 11.9% (28/235), and 14.3% (11/77), respectively, and these were not statistically significant from each other. Patients were also stratified by international normalized ratio into 0–1, 1.1–2, 2.1–3, and >3. The overall complication rates of these patients were 8.0% (19/237), 11.8% (113/954), 16.3% (7/43), and 0% (0/9), respectively, and were not statistically significant from each other. DISCUSSION: TJLB is a highly efficacious, well-tolerated and safe procedure. It can be safely performed multiple times in the same patient or in critically ill, severely coagulopathic patients with no significant increase in the rate of complication while maintaining an extremely favorable diagnostic yield.

Clinical Potential of Circulating Tumor Cells in Colorectal Cancer: A Prospective Study
imageOBJECTIVES: Circulating tumor cells (CTCs) in the blood have been used as diagnostic markers in patients with colorectal cancer (CRC). In this study, we evaluated a CTC detection system based on cell size to assess CTCs and their potential as early diagnostic and prognostic biomarkers for CRC. METHODS: From 2014 to 2015, 88 patients with newly diagnosed CRC, who were scheduled for surgery, and 31 healthy volunteers were enrolled and followed up in Pusan National University Hospital. CTCs were enriched using a centrifugal microfluidic system with a new fluid-assisted separation technique (FAST) and detected by cytomorphological evaluation using fluorescence microscopy. RESULTS: Two or more CTCs were detected using FAST in 74 patients and 3 healthy volunteers. The number of CTCs in the CRC group was significantly higher than that in the healthy volunteers (P < 0.001). When a receiver operating characteristic curve was created to differentiate patients with CRC from healthy volunteers, the sensitivity and specificity were almost optimized when the critical CTC value was 5/7.5 mL of blood. When this value was used, the sensitivity and specificity in differentiating patients with CRC from the healthy controls were 75% and 100%, respectively. In patients with CRC with ≥5 CTCs, vascular invasion was frequently identified (P = 0.035). All patients with stage IV were positive for CTCs. Patients with ≥5 CTCs showed a trend toward poor overall and progression-free survival. DISCUSSION: Our study demonstrated promising results with the use of FAST-based CTC detection for the early diagnosis and prognosis of CRC.

A Phase 2 Study of Galunisertib (TGF-β1 Receptor Type I Inhibitor) and Sorafenib in Patients With Advanced Hepatocellular Carcinoma
imageINTRODUCTION: Inhibition of tumor growth factor-β (TGF-β) receptor type I potentiated the activity of sorafenib in preclinical models of hepatocellular carcinoma (HCC). Galunisertib is a small-molecule selective inhibitor of TGF-β1 receptor type I, which demonstrated activity in a phase 2 trial as second-line HCC treatment. METHODS: The combination of galunisertib and sorafenib (400 mg BID) was tested in patients with advanced HCC and Child-Pugh A liver function without prior systemic therapy. Galunisertib dose was administered 80 or 150 mg b.i.d. orally for 14 days every 28 days in safety lead-in cohorts; in the expansion cohort, all patients received galunisertib 150 mg b.i.d. Objectives included time-to-tumor progression, changes in circulating alpha fetoprotein and TGF-β1, safety, overall survival (OS), response rate, and pharmacokinetics (PK). RESULTS: Patients (n = 47) were enrolled from 5 non-Asian countries; 3 and 44 patients received the 80 mg and 150 mg b.i.d. doses of galunisertib, respectively. The pharmacokinetics and safety profiles were consistent with monotherapy of each drug. For the 150 mg b.i.d. galunisertib cohort, the median time-to-tumor progression was 4.1 months; the median OS was 18.8 months. A partial response was seen in 2 patients, stable disease in 21, and progressive disease in 13. TGF-β1 responders (decrease of >20% from baseline) vs nonresponders had longer OS (22.8 vs 12.0 months, P = 0.038). DISCUSSION: The combination of galunisertib and sorafenib showed acceptable safety and a prolonged OS outcome.

Genetic Risk Score in Diabetes Associated With Chronic Pancreatitis Versus Type 2 Diabetes Mellitus
imageIntroduction: Diabetes mellitus (DM) is a complication of chronic pancreatitis (CP). Whether pancreatogenic diabetes associated with CP-DM represents a discrete pathophysiologic entity from type 2 DM (T2DM) remains uncertain. Addressing this question is needed for development of specific measures to manage CP-DM. We approached this question from a unique standpoint, hypothesizing that if CP-DM and T2DM are separate disorders, they should be genetically distinct. To test this hypothesis, we sought to determine whether a genetic risk score (GRS) based on validated single nucleotide polymorphisms for T2DM could distinguish between groups with CP-DM and T2DM. Methods: We used 60 T2DM single nucleotide polymorphisms to construct a weighted GRS in 1,613 subjects from the North American Pancreatitis Study 2 and 2,685 subjects from the Multi-Ethnic Study of Atherosclerosis, all of European origin. Results: The mean GRS was identical between 321 subjects with CP-DM and 423 subjects with T2DM (66.53 vs 66.42, P = 0.95), and the GRS of both diabetic groups was significantly higher than that of nondiabetic controls (n = 3,554, P < 0.0001). Exploratory analyses attempting to enrich the CP-DM group for pancreatogenic diabetes, such as eliminating diabetes diagnosed before CP, requiring pancreas-specific comorbidities, or removing those with a family history of diabetes, did not improve the ability of the GRS to distinguish between CP-DM and T2DM. Discussion: Recognizing that we lacked a gold standard to define CP-DM, our study suggests that CP-DM may be a subtype of T2DM, a notion that should be tested in future, large prospective studies.

A Low FODMAP Diet May Reduce Symptoms in Patients With Fecal Incontinence
imageINTRODUCTION: Fecal incontinence (FI) is a common complaint and is often associated with diarrhea and urgency. Foods high in fermentable oligo-, di-, and mono-saccharides and polyols (FODMAP) cause symptoms of diarrhea and urgency. Therefore, this study assesses the impact of a low FODMAP diet on the occurrence of FI due to loose stool. METHODS: This study is a retrospective chart review of patients with FI seen in the Michigan Bowel Control Program clinic between August 2012 and December 2017. Patients who had FI with loose stool without red flag signs and who were recommended a low FODMAP diet and underwent formal dietary instruction with a Michigan Medicine dietician were included. RESULTS: Sixty-five patients with FI who underwent formal dietary teaching were included in this study. Eighty-eight percent of the patients were white, and 87% were women with a mean age of 62 years (±14 years). Additionally, the chart review showed that 35% of the patients had FI daily, 21.5% had FI weekly, and 5% had FI monthly. About 64.6% of the patients (42) had reported a reduction in their FI symptoms with the low FODMAP diet. There was no demographic or clinical characteristic that predicted the response to a low FODMAP diet. DISCUSSION: In this case series, dietary manipulation with a low FODMAP diet was a useful tool to treat patients who suffer from FI due to loose stool. Further confirmatory, prospective randomized controlled trials are required to see the true efficacy of a low FODMAP diet in patients who suffer with FI.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480