bluuebunny/crossref_metadata_2025 huggingface dataset:
Recanalization Rates after Endovascular Coil Embolization in a Cohort of Matched Ruptured and Unruptured Cerebral Aneurysms
Authors: Tan I.Y.L. , Agid R.F. , Willinsky R.A.
Published: January 2017

The aim of this study was to retrospectively assess the recanalization rate, factors associated with and time taken for recanalization to occur in a matched ruptured and unruptured aneurysm population that were treated with endovascular coiling.

Ruptured and unruptured aneurysms treated between 2002 and 2007 were matched for aneurysm location, diameter and neck size. Recanalization rate, time to recanalize, re-treatment rate and clinical outcome were analysed.

Ninety-eight matched ruptured and unruptured aneurysms (49 aneurysms in each group) were studied. 46.8% of aneurysms in the ruptured group achieved complete obliteration on the initial post treatment angiogram versus 34.7% in the unruptured group. The ruptured group had a higher rate of recanalization (40.4% versus 20.4%). 25.5% of aneurysms had significant recanalization in the ruptured group versus 6.1% in the unruptured group (p=0.009). The retreatment rate was higher in the ruptured group (21.3% versus 6%). Ruptured aneurysms took a shorter time to recanalize with a mean time of 5.3±3.8 months versus 12.4±7.7months (p=0.003). Multivariate logistic regression analysis found neck size (p=0.0098), wide neck morphology (p=0.0174), aneurysm diameter (p< 0.0001) and ruptured aneurysms (p=0.0372) were significant predictors of recanalization. The majority of patients in both groups had a good outcome with GOS=5 (85.7% and 83.7%) but two deaths occurred in the ruptured group.

Ruptured and unruptured aneurysms showed significant differences in rate, degree and timing of recanalization, thus requiring different protocols for imaging follow-up post endovascular treatment. Earlier and more frequent imaging follow-up is recommended for ruptured aneurysms.
Outcomes Analysis of Ruptured Distal Anterior Cerebral Artery Aneurysms Treated by Endosaccular Embolization and Surgical Clipping
Authors: Suzuki S. , Kurata A. , Yamada M. , Iwamoto K. , Nakahara K. , Sato K. , Niki J. , Sasaki M. , Kitahara T. , Fujii K. , Kan S.
Published: January 2017

Although endovascular surgery is now widely used to treat intracranial aneurysms, no comparative studies of clipping versus endovascular surgery to address distal ACA aneurysms at the same institution are available. We compared the results of these treatment modalities to address distal ACA aneurysms at our institution.

We treated 68 patients with ruptured distal ACA aneurysms (endovascular surgery, n=13; clipping surgery, n=55). We performed a retrospective comparison of the treatment outcomes. To study the efficacy of endovascular surgery we classified all our cases into three types: type A were small-necked aneurysms, type B were wide-necked aneurysms on the parent artery, and type C were aneurysms in which the A3 portion of the ACA arose from the aneurysmal dome near the neck.

Intraoperative hemorrhage occurred in 7.7% of aneurysms treated by endovascular surgery and in 34.5% treated by clipping surgery. In 7.7% of the endovascularly-treated aneurysms we noted coil migration during embolization surgery; venous infarction due to cortical vein injury occurred in 7.3% of clipped aneurysms. Of the endovascularly-treated aneurysms, 7.7% manifested post-embolization hemorrhage; 23.1% manifested coil compaction. In clipping surgery, postoperative rerupture occurred in 1.8% of the aneurysms; one patient presented with postoperative acute epidural hematoma. Clip dislocation was noted in 1.8% of aneurysms. Angiography was indicative of post-treatment vasospasm in 7.7% of aneurysms treated endovascularly and in 50.9% of the clipped aneurysms.

The clinical outcome showed no significant difference between endovascular surgery and clipping surgery.
Transformation of a Cranial Fusiform Aneurysm into a Pseudotumoral-Like Mass Prior to Spontaneous Occlusion and Regression
Authors: Kalin-Hajdu E. , Guilbert F.
Published: January 2017

This report documents the evolution of a non-ruptured cranial fusiform aneurysm that underwent both spontaneous occlusion and regression. During this process, unique images of the aneurysm as a pseudotumoral-like mass were obtained. The pseudotumoral-like mass most likely reflected inflammation and secondary neovascularization within the aneurysm, supporting the theory that spontaneous aneurysmal healing involves an inflammatory process.
Simultaneous Combined Intravenous Recombinant Tissue Plasminogen Activator and Endovascular Therapy for Hyperacute Middle Cerebral Artery M1 Occlusion
Authors: Toyota S. , Sugiura S. , Iwaisako K.
Published: January 2017

We investigated the efficacy and safety of combined intravenous (IV) recombinant tissue plasminogen activator (rtPA) and simultaneous endovascular therapy (ET) for hyperacute middle cerebral artery (MCA) M1 occlusion.

Between October 2005 and April 2007, in the combined group, 22 patients eligible for IV rtPA, who were diagnosed as having MCA M1 occlusion, were treated with IV rtPA and simultaneous ET was initiated as soon as possible. The other patients were treated with IV rtPA alone (IV group A: n = 11). Between May 2007 and November 2008, all patients eligible for IV rtPA, who were diagnosed as having MCA M1 occlusion, underwent thrombolysis by IV rtPA alone (IV group B: n = 24).

The improvement of the National Institutes of Health Stroke Scale score at 24 hours was highest in the combined group (10 ± 4.1). In contrast, it was 5.1 ± 4.7 in the IV group A (P = 0.017) and 5.6 ± 5.6 in IV group B (P = 0.006). In the combined group, successful recanalization was observed in 18 of 22 patients with one symptomatic intracranial hemorrhage. The rate of mRS0–2 at three months was highest in the combined group, 36% in the IV group A and 33% in the IV group B (P = 0.008).

Simultaneous treatment with IV rtPA and ET improved the clinical outcome of MCA M1 occlusion without a significant increase of adverse effects in our study.
Stenting of the cervical internal carotid artery in acute stroke management: The Karolinska experience
Authors: Mpotsaris Anastasios , Kabbasch Christoph , Borggrefe Jan , Gontu Vamsi , Soderman Michael
Published: January 2017

Background

Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is a routine procedure. Yet, precise indications and clinical safety in this setting remains controversial. Present data for mechanical thrombectomy include few studies with acute stenting of tandem occlusions. We evaluated the feasibility, safety and clinical outcome of this endovascular treatment in a retrospective analysis of all consecutive cases at a comprehensive stroke centre.

Methods

This was a retrospective analysis of all consecutive patients with acute extracranial carotid artery occlusion including acute dissection or high-grade stenosis and concomitant intracranial large-vessel occlusion treated with emergency carotid stenting and intracranial mechanical thrombectomy between November 2007 and May 2015.

Results

A total of 63 patients with a median age of 67 years (range 33–84 years) were treated. Of these, 33 (52%) patients had concomitant intravenous thrombolysis with recombinant tissue-type plasminogen activator initially. Median admission National Institutes of Health Stroke Scale was 14 (range 1–29). Median time from stroke onset to recanalization was 408 minutes (range 165–1846 minutes). Procedure time was significantly shorter after intravenous thrombolysis (110 minutes [range 15–202 minutes] vs. 130 minutes [range 60–280 minutes]; p = 0.02). Three (5%) patients experienced post-procedural symptomatic intracerebral haemorrhage. In 55/63 (87%) patients, a score of ≥2b on the Thrombolysis in Cerebral Infarction scale could be achieved. Eight (13%) patients died, five (8%) during the acute phase. A total of 29/63 (46%) patients showed a favourable outcome (modified Rankin Scale score of 0–2) after three months.

Conclusions

Our single-centre retrospective analysis of emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy demonstrated high technical success, reasonable clinical outcomes and acceptable rates of symptomatic intracranial haemorrhage in carefully chosen patients which are triaged interdisciplinary based on clinical and computed tomography imaging criteria. This warrants further study in a randomised prospective trial.
Gamma Knife radiosurgery for the treatment of intracranial dural arteriovenous fistulas
Authors: Dmytriw Adam A , Schwartz Michael L , Cusimano Michael D , Mendes Pereira Vitor , Krings Timo , Tymianski Michael , Radovanovic Ivan , Agid Ronit
Published: January 2017

Background

Intracranial dural arteriovenous fistulae (DAVF) may present a treatment challenge. Endovascular embolization is in most cases the first line of treatment but does not always achieve cure. Gamma Knife (GK) radiosurgery represents an alternative treatment option, and the purpose of this study was to further evaluate its utility.

Methods

We reviewed all cases of DAVF treated between 2009 and 2016 at our institution with GK radiosurgery independently, or following failed/refused endovascular or surgical management. Patients’ clinical files, radiological images, catheter angiograms, and surgical DAVF disconnection reports were retrospectively reviewed.

Results

Sixteen DAVF (14 patients) treated by GK radiosurgery were identified. Eleven fistulae were aggressive and five were benign. Marginal doses ranged from 15 to 25 Gy. Target volumes ranged from 0.04 to 4.47 cm3. In all symptomatic patients, GK treatment resulted in symptom palliation. In 13/15 lesions, cure of symptoms (86.0%) was reported. One lesion was asymptomatic. Angiographic cure was achieved in eight cases (50%), small residual DAVF occurred in four, and four were unchanged. One patient developed headache that resolved at one year. No hemorrhage occurred during the follow-up period. There was no significant association between Borden type and cure rate. Prior failed endovascular treatment and small target volume were associated with lower rates of cure.

Conclusions

Stereotactic radiosurgery is viable treatment for DAVF. It is very effective in palliating symptoms as a de novo approach or adjunctive to endovascular therapy. In our experience it is only somewhat effective in achieving complete angiographic cure.
Bisphosphonate and Osteonecrosis of the Jaw: The Oral Surgeon's Perspective
Authors: Pompa G. , Bignozzi I. , Cristalli M.P. , Quaranta A. , Di Carlo S. , Annibali S.
Published: January 2017

Bisphosphonates (BPs) are an important class of drugs, useful in the treatment of some metabolic and oncologic skeletal diseases. BPs have shown a sure effectiveness in the treatment and in the palliative care of such pathologies; on the other hand, an avascular osteonecrosis of the jaws (B-ONJ = Bisphosphonate OsteoNecrosis of the Jaw) has recently been reported as an adverse effect not only of BP intravenous infusions, but also of their prolonged oral administration. B-ONJ normally follows a dental extraction or other surgical procedure in the oral cavity, but it also can develop spontaneously. In the latter case, some systemic risk factors, such as comorbidities and co-therapies or jaw anatomical conditions, can play a leading role in the onset of this pathologic condition. B-ONJ is an uncommon but potentially serious complication of BP therapy that can gravely affect the patient's quality of life, producing significant morbidity. To date, no therapies are completely effective and predictable in the treatment of B-ONJ, therefore prevention should be strongly promoted by sharing knowledge in the involved medical community.
Therapeutic Effects of Ethyl Pyruvate on Tumor Growth and Metastasis in a Severe Combined Immunodeficiency Mouse Orthotopic Implantation Model
Authors: Zhang J. , Zhu J-S. , Zhou Z. , Chen W-X. , Chen N-W.
Published: January 2017

Ethyl pyruvate (EP) has been shown to have significant anti-inflammatory activities. Here, we explore the therapeutic effects of EP administration on tumor growth and metastasis in orthotopic implantation human gastric cancer models in severe combined immunodeficiency (SCID) mice. After SCID mice were treated with EP, the tumor growth and liver metastasis from gastric cancer were investigated and its possible molecular mechanisms were further studied. As a result, it was found that EP could inhibit tumor growth and liver metastasis of gastric cancer, and reduce tumor lymphangiogenesis indicated by lymphatic microvessel density (LVD) in gastric cancer and metastatic liver tumor. Also, EP decreased the expression of high mobility group box-B1 (HMGB1), receptor for advanced glycation endproducts (RAGE), vascular endothelial growth factor (VEGF) and membrane type-1 matrix metalloprotease (MT1-MMP) in gastric cancer and metastatic liver tumor, but it exerted no effect on expression of nuclear factor-kappa B (NF-κB). Taken together, we suggest that the new application of EP could be a therapeutic option in the treatment of gastric cancer and metastatic liver tumor.
Analysis of Plasma Fibronectin Levels in Patients Affected by Oral Lichen Planus
Authors: Petruzzi M. , Campus G. , Paparusso F. , Lucchese A. , Lauritano D. , De Benedittis M. , Serpico R.
Published: January 2017

Previous studies have demonstrated that patients affected by Oral Lichen Plauns (OLP) show lower levels of salivary fibronectin when compared with normal controls. Similarly, tissutal fibronectin expression is lost in epidermal basal layer and papillary dermis of OLP patients. To date, no data exist on the potential role of Plasma Fibronectin(PFn) in OLP pathogenesis, diagnosis and treatment. The objectives of the present study are: a) to determine the PFn levels in OLP patients; b) to evaluate a possible association between OLP clinical form and PFn levels; and c) to determine the PFn levels in relation to OLP signs and symptoms treatment. Twenty consecutive patients affected by OLP were enrolled. All patients were treated for eight weeks with topical clobetasol 0.05%. OLP signs and symptoms were scored before and after treatment. PFn level was determined by a nephelometric system. OLP signs and symptoms significantly improved after treatment. The mean levels of PFn were 31.84mg/dL at the beginning and 26.76mg/dL at the end of the study. The difference was not statistically significant (p=0.60). PFn in OLP patients remains in normal value range. OLP clinical form does not influence the PFn levels. Amelioration of symptoms and signs of atrophic-erosive and reticular OLP are induced by clobetasol treatment and the PFn seems not to interfere in the healing processes induced by topical corticosteroid. In contrast to what is observed in traumatic or diabetic wound healing, levels of PFn do not promote OLP lesion healing. PFn is not to be considered as a marker of OLP disease activity and its role in OLP pathogenesis still remains unclear.
PBS-1086, a Rel Inhibitor of NF-κB, Ameliorates Collagen-Induced Arthritis in Mice
Authors: Impellizzeri D. , Mazzon E. , Di Paola R. , Galuppo M. , Bramanti P. , Zhang J. , Bobb K. , Monie D. , Meshulam J. , Sliskovic D.R. , Cuzzocrea S.
Published: January 2017

The family of nuclear factor-kappaB (NF-κB) transcription factors is intimately involved in the regulation of expression of numerous genes in the setting of the inflammatory response. Inflammation, cartilage degradation, cell proliferation, angiogenesis and pannus formation are hallmarks of the pathogenesis of both collagen-induced arthritis (CIA) in rodents and rheumatoid arthritis (RA) in humans. The aim of this study is to investigate the effect of PBS-1086, a ReI inhibitor of NF-κB, on the modulation of the inflammatory response in mice subjected to CIA in comparison to the effect of etanercept. CIA was induced in mice by an intradermal injection of bovine type II collagen (CII) emulsion and complete Freund's adjuvant (CFA) at the base of the tail. On day 21, a second injection of CII in CFA was administered. Mice developed erosive hind paw arthritis when immunised with CII in CFA. Macroscopic clinical evidence of CIA first appeared as peri-articular erythema and oedema in the hind paws. The incidence of CIA was 100% by day 28 in the CII challenged mice and the severity of CIA progressed over a 35-day period with a resorption of bone. The histopathology of CIA included erosion of the cartilage at the joint. Treatment with PBS-1086 starting at the onset of arthritis (day 21) ameliorated the clinical signs at days 21–35 and improved histological status in the joint and paw. In addition, it also reduced the neutrophil infiltration which is a key mediator of RA. In this study, we demonstrate that PBS-1086 exerts an anti-inflammatory effect during chronic inflammation and ameliorates the tissue damage associated with CIA. The anti-inflammatory activities of PBS-1086 are comparable to those of etanercept treatment.
Salivary Proteomic Signatures of Oral Squamous Cell Carcinoma
Authors: Russo L. Lo , Papale M. , Perrone D. , Ranieri E. , Rubini C. , Giannatempo G. , Santarelli A. , Colella G. , Muzio L. Lo
Published: January 2017

Delay in diagnosing oral squamous cell carcinoma (OSCC) can be still identified as a major cause of its high morbidity and mortality. To date, the early diagnosis for OSCC is mainly based on clinical oral examination and there is an urgent need for reliable markers; thus, advancements in molecular technologies has set the stage for investigating new markers, as well as new diagnostic matrices. The aim of the present study is to investigate the presence of proteomic signatures of OSCC in saliva and their use as potential biomarkers for early and non-invasive diagnosis. Saliva from 45 OSCC patients and 30 healthy controls was analysed by SELDI-TOF mass spectrometry and ProteinChip® technology. A supervised multivariate statistical analysis (Classification and Regression Tree - CART) was used to build models for discriminating between OSCC and controls, and between early (ES-OSCC) and late stage (LS-OSCC) cancers. The peptide with 8041 Da mass was 22-fold more expressed in OSCC, thus being a suitable potential biomarker. Classification and regression analysis allowed to build a model that was capable of correctly classifying all cancers and controls in an independent testing set, using the 8041 m/z peak as splitter. Eleven peaks were also differently expressed between ES-OSCCand LS-OSCC, but, basing on these differences, it was not possible to build an algorithm to predict tumour staging. These findings confirm that saliva proteome in OSCC patients is different from healthy controls and these variations might reflect different stages of disease progression and are worthy of further validation as diagnostic and prognostic biomarkers.
Intra-Articular Ultrasound-Guided Injection of Sinovial® Forte 1.6% in Patients Affected by Symptomatic Hip Osteoarthritis: Effectiveness and Safety in a Large Cohort of Patients
Authors: Migliore A. , Massafra U. , Bizzi E. , Giovannangeli F. , Tormenta S.
Published: January 2017

The aim of this prospective observational study is to assess the efficacy and safety profile of intraarticular Sinovial® Forte 1.6% administered under ultrasound-guidance in a large cohort of patients affected by symptomatic hip osteoarthritis (OA). Patients with symptomatic hip OA referred to our clinic in 2008–2010 received one 4 ml (2 vials) intra-articular injection of Sinovial® Forte 1.6% under ultrasound guidance. Patients were followed-up every 3 months for a total of 6 months and were offered an optional, additional injection at the 3-month follow-up visit if clinically justified. At each visit, pain scores [0–10 Visual Analogue Scale (pain VAS)], Lequesne index scores and NSAID intake were recorded. Adverse events (AEs) were recorded throughout the study. An effect size of 30% and 50% reduction in Lequesne index and Pain VAS scores was evaluated for each patient to ascertain the number of patients achieving partial remission of symptoms and functional impairment by the use of intra-articular hyaluronic acid in hip osteoarthritis. One hundred and fourteen patients completed the 6-month follow-up and received a total of 142 injections. A statistically significant reduction in Lequesne index scores, VAS pain scores and NSAID consumption was observed at all time-points ( p < 0.05). No systemic, severe or even moderate side effects were observed. Only 7 patients reported mild local reaction at the injection site, consisting of mild pain and localized warmth, which resolved spontaneously without any additional medication. This study provides evidence of the efficacy and tolerability of Sinovial® Forte 1.6% in the treatment of patients affected by symptomatic hip OA. Sinovial® Forte may also offer economical benefits, owing to the reduction in NSAID consumption associated with this treatment. The percentage of patients achieving the effect size of 30% and 50% reduction in Lequesne index and pain VAS scores encourages the use of intra-articular hyaluronic acid in patients with hip osteoarthritis.
Incidence and Intensivity of Postoperative Pain and Periapical Inflammation after Endodontic Treatment with Two Different Instrumentation Techniques
Authors: Gambarini G. , Al Sudani D. , Di Carlo S. , Pompa G. , Pacifici A. , Pacifici L. , Testarelli L.
Published: January 2017

Apical extrusion of infected debris to the periradicular tissues is considered one of the possible factors related to the occurrence of postoperative pain and inflammation. The goal of the present study is to evaluate and compare the incidence and intensity of postoperative pain using two different nickel-titanium instrumentation techniques: a rotary crown-down technique using TF instruments (SybronEndo, Orange, Ca, USA) and a reciprocating single-file technique using Reciproc instruments (VDW, Munich, Germany). Sixty patients requiring endodontic treatment on permanent premolar and molar teeth with non-vital pulps preoperatively were included in the study. The patients were divided into two groups of 30 patients each, trying to make the groups very similar, concerning the number of root canals, presence of initial pain and periapical lesions. The teeth in group 1 (n = 30) were treated with a crown-down technique using TF instruments whilst those in group 2 (n = 30) were treated with, a single-file technique using Reciproc 08 25. All canals were shaped, cleaned and obturated in a single-visit. The assessment of postoperative pain was carried out at 3 days by using a visual analogue scale. CAi-square tests and independent-sample t-tests to compare the incidence and intensity of postoperative pain of two groups were carried out. A statistically significant difference was found between the two techniques. When comparing patients who developed no pain, the TF instrumentation technique showed significantly better results ( chi-square = 4.059 P = 0.039). When evaluating patients experiencing severe pain the incidence of symptoms was significantly higher with the Reciproc technique ( chi-square = 7.246 P = 0.023). Since the incidence of preoperative pain, the type of tooth and the pulp and periodontal pathology were quite similar between the two tested groups, and all the other variables (operator, irrigation, and obturation) were identical, the difference in postoperative pain can be mainly related to the different instrumentation technique
Biocompatibility of Root Canal Filling Materials: Differences between Vitality and Functionality Tests
Authors: Testarelli L. , Nocca G. , Lupi A. , Pacifici L. , Pompa G. , Vozza I. , Gambarini G.
Published: January 2017

Biocompatibility of root canal filling materials is of great interest because they can come into permanent contact with the living periapical tissue, and induce mild or severe inflammatory responses. Usually biocompatibility tests only determine non-cytotoxic effects of dental materials, even if their functional interactions with cells also play a role in the host responses. The purpose of this study is to evaluate peripheral blood monocyte (PBM) vitality and functionality after contact with 5 different root canal filling materials: Thermafil (gutta-percha), Real Seal and Real Seal 1 (methacrylic resins), AureoSeal (MTA) and SuperSeal (EBA). Cellular vitality was determined by MTT test and cellular functionality by Chemiluminescence (CL) technique. Dishes of the materials were covered with cell culture medium (0.5 cm2/mL) and incubated for 24 h. The extracts were added to PBMs and the latter, after 2 h of incubation, were analysed by MTT and by Chemiluminescence (CL). All results are expressed as mean ± SEM. The group means were compared by analysis of variance. Results showed that SuperSeal and AuroSeal exhibited a moderate cytotoxic effect, while the toxicity induced by RealSeal, RealSeal 1 and Thermafil was lower. SuperSeal and AuroSeal induced a significant decrease of both oxidative burst and basal reactive oxygen species (ROS) production. RealSeal 1 caused a doubling of basal ROS production in respect to control. The results demonstrate that a low cytotoxic effect does not guarantee a total integrity of cellular functionality and more differences among biocompatibility of root canal materials can be detected when a functionality test is used.
Oral Focal Mucinosis of the Tongue: A Rare Clinical Case
Authors: Pacifici L. , Meleo D. , Pompa G. , Pacifici A. , Gambarini G. , Testarelli L.
Published: January 2017

Oral focal mucinosis (OFM) is a rare mucosal lesion of unknown etiopathogenesis. It is considered the oral counterpart of cutaneous focal mucinosis. From the anatomo-pathological point of view it is characterised by a focal degeneration of myxoid type of connective tissue. A literature survey revealed 50 reports of OFM cases worldwide. Here, we present an even more rare case with tongue involvement. Particular emphasis is placed on diagnostic-differential aspects of this kind of lesion, both from the clinical and the histopathological point of view, in respect to other manifestations of tongue mucosa.
Two Cases of Cercarial Dermatitis in An Italian Lake
Authors: Tammaro A. , Narcisi A. , Abruzzese C. , Cortesi G. , Persechino F. , Parisella F.R. , Caperchi C. , Persechino S.
Published: January 2017

Cercarial dermatitis (also named Swimmer's itch or Clam-digger's disease) was first described about 80 years ago, but today its impact is increasing and it is considered an emerging disease. This represents a hypersensitive or allergic reaction to Trichobilharzia spp, clinically characterized by initial erythema and cutaneous itching, followed by macular or papular eruptions, itching and occasionally diffuse erythema or urticaria. We report two cases of patients affected by a cercarial dermatitis after bathing in Lake Vico (Central Italy). We highlight these cases for the rarity of this dermatitis and its increasing prevalence, also in previously non-affected geographical areas, associated to a high level of social discomfort.
Aseptic Abscess: A Report of Two Cases
Authors: Isik M. , Çalgüneri M. , Doğan İ. , Yeşilkaya Y. , Shourbagi A.
Published: January 2017

An aseptic abscess (AA) is an auto-inflammatory disorder characterized by necrotic lymph nodes and internal organ abscesses, most frequently located in the spleen. Described herein are two cases of aseptic abscesses; one in a patient with Behçet's disease and the other in a patient with mesenteric panniculitis.
Soft-Tissue Healing and Impression Technique in Implant Dentistry: A Case Report
Authors: Varvara G. , Caputi S. , D'Arcangelo C. , Murmura G.
Published: January 2017

The present clinical report describes a technique for aesthetic restoration of single dental implants in the anterior area. One objective of implant therapy in anterior areas is the achievement of an aesthetic result, which is highly dependent on the condition of the peri-implant soft tissue. A 22-year-old woman presented with right maxillary lateral incisor agenesis. An implant was placed, and a transfer impression technique carried out. The model was used to construct the custom abutment, provisional crown, and metal substructure. The metal substructure was covered with a waxed collar with the same emergence profile as the provisional restoration. The abutment and the provisional crown were placed, and after soft-tissue healing, an impression was taken using the waxed metal framework as coping. This final impression also registered and transferred the architecture of the soft peri-implant tissues. This clinical report describes an impression technique that accurately duplicates the peri-implant tissue profile. The final prosthesis is therefore shaped according to the interim prosthesis, for ideal contour and soft-tissue position. This technical procedure requires minimal chair time and is cost effective, as fewer components are used during the treatment.
Primary school autonomy in the context of the expanding academies programme
Authors: Boyask Ruth
Published: January 2017

The transnational trend towards school autonomy has been enacted in England through the academies programme. The programme is poised to enter its third phase of expansion in light of government commitment to the conversion of all state-funded schools to academies. This article considers the moral implications of the expansion of the programme that aims to include all primary schools. It draws upon a study of schools in four local authorities to examine the extent to which autonomy and therefore academy conversion is desirable. In their relationships with local authorities, primary schools that have resisted conversion and primary schools that have already converted show ambivalence to the notion of autonomy which has been promoted by the government as motivation to convert. Indeed most of the primary schools in this study that have already converted are critical of the local authorities that are driven by business values. Given that expansion of the academies programme is likely to lead to more rather than less fragmentation in the education system, worsen student outcomes overall and see market values extended, it is concluded that the vision of autonomy for primary schools offered via the academies programme is both misleading and undesirable.
Minimum absolute lymphocyte counts during radiation are associated with a worse prognosis in patients with unresectable hepatocellular carcinoma
Authors: Zhao Qianqian , Xu Xiaoqing , Yue Jinbo , Zhu Kunli , Feng Rui , Jiang Shumei , Qi Zhonghua , Wang Renben
Published: January 2017

Background:

Peripheral blood lymphocytes play an important role in antitumour immunity. We examined the relationship between the minimum absolute lymphocyte counts (Min ALCs) during radiotherapy (RT) and clinical outcomes in patients with hepatocellular carcinoma (HCC).

Methods:

Data from a total of 69 HCC patients who had received RT were retrospectively analysed. Peripheral blood lymphocytes were measured before RT, weekly during RT and after RT. Regression and mixed-effect models were used to assess the relationships with and potential predictors of overall survival (OS). Receiver-operating characteristic (ROC) curve analysis was used to define optimal cut-off points of continuous variables for outcomes.

Results:

The median follow up was 30 months (range, 4–68 months). The median survival time (MST), 1-year OS rate and 2-year OS rate of the whole group were 25 months, 51% and 39%, respectively. The average circulating lymphocyte counts declined during RT (1493.19 versus 503.48 cells/µl, p < 0.001). A lower Min ALC was associated with worse OS ( p = 0.001), with a cut-off value of 450 cells/µl (sensitivity and specificity, 50% and 70.6%, respectively). The MSTs, 1-year OS rates and 2-year OS rates were 15 months versus 47 months, 27% versus 78% and 4% versus 71% for patients with relatively lower (⩽450 cells/µl) and higher Min ALCs (>450 cells/µl), respectively ( p < 0.001). After adjusting for potential confounders, multivariate Cox regression analysis demonstrated that Min ALC independently predicted patients’ OS (HR, 0.32; 95% CI, 0.15–0.69).

Conclusions:

Lower Min ALCs during RT may act as a worse prognostic factor for HCC after RT.
Endovascular thrombectomy with or without systemic thrombolysis?
Authors: Tsivgoulis Georgios , Katsanos Aristeidis H. , Mavridis Dimitris , Alexandrov Anne W. , Magoufis Georgios , Arthur Adam , Caso Valeria , Schellinger Peter D. , Alexandrov Andrei V.
Published: January 2017

Objectives:

Current recommendations advocate that pretreatment with intravenous thrombolysis (IVT) should first be offered to all eligible patients with emergent large vessel occlusion (ELVO) before an endovascular thrombectomy (ET) procedure. However, there are observational data that question the safety and efficacy of IVT pretreatment in patients with ELVO.

Methods:

We performed a meta-analysis of the included subgroups from ET randomized controlled trials (RCTs) to evaluate the comparative efficacy between direct ET without IVT pretreatment and bridging therapy (IVT and ET) in patients with ELVO.

Results:

We included a total of seven RCTs, including 1764 patients with ELVO (52.8% men). Patients receiving bridging therapy (IVT followed by ET) had lower rates ( p = 0.041) of 90-day death/severe dependency (modified Rankin Scale-score of 5–6; 19.0%, 95% CI: 14.1–25.1%) compared with patients receiving only ET (31.0%, 95% CI: 21.2–42.9%). Moreover, patients receiving IVT and ET had a nonsignificant ( p = 0.389) trend towards higher 90-day functional independence rates (51.4%, 95% CI: 42.5–60.1%) compared with patients undergoing only ET (41.7%, 95% CI: 24.1–61.7%). Finally, shift-analysis uncovered a nonsignificant trend towards functional improvement at 90 days for bridging therapy over ET (cOR = 1.28, 95% CI: 0.91–1.89; p = 0.155). It should be noted that patients included in the present meta-analysis were not randomized to receive IVT, and thus the two groups (bridging therapy versus ET monotherapy) may differ in terms of baseline characteristics and, in particular, in terms of onset to groin puncture time and thus the risk of confounding bias cannot be ruled out.

Conclusion:

Despite the limitations and the risk of confounding bias, our findings contradict the recent notion regarding potential equality between ET and bridging therapy in ELVO patients and suggest that IVT and ET are complementary therapies that should be pursued in a parallel and noncompeting fashion.
The BP Catastrophe and Sociological Practice Mitigating Community Impacts through Peer-Listener Training
Authors: Picou J. Steven
Published: January 2017

The catastrophic BP oil spill in the Gulf of Mexico has caused significant ecological and community damage. A series of complex economic, social, and mental-health impacts rapidly emerged as a significant source of distress for communities throughout the Northern Gulf Coast. As acute forms of social pathology, including suicides, became increasingly visible, we implemented a peer listener-training program in Louisiana, Mississippi, Alabama, and Florida. Based on a mitigation strategy developed in the aftermath of the Exxon Valdez spill in Alaska, we offered the program 26 times and trained over 600 peer listeners in 2010. As the impacts of the BP catastrophe persist, the peer listener program provides a sociological practice intervention available to Gulf Coast communities for reducing community and mental health problems.
Urban Ritual Events and Coping with Disaster Risk a Case Study of Lalitpur, Nepal
Authors: Bhandari Roshan Bhakta , Okada Norio , Knottnerus J. David
Published: January 2017

This study analyzes the role of ritual for enhancing the capacity of a community in Nepal to adapt to disaster risk. Personal accounts of 1934 earthquake survivors of Lalitpur City were recorded and analyzed to better understand the social dynamics that occurred during this event. This data was supplemented and expanded upon with more recent interviews, observations, and other forms of evidence concerning the experiences of modern-day residents in this community. We employ structural ritualization theory and its key concepts—salience, repetitiveness, homologousness, and resources—to investigate how ritualized symbolic practices contribute to the social capacity of a community to cope with disasters. Findings reveal that people engage in various ritualized activities before, during, and after disasters and these practices enhance their ability to cope with such situations and revive a normal social life. Finally, implications of this study and the need for further research are discussed.
Applied Sociology and Prisoner Reentry a Primer for More Successful Reintegration
Authors: Guy Roget
Published: January 2017

Prisoner reentry has assumed increased attention recently as hundreds of thousands of former inmates return to their communities through mandatory release, parole, or placement on probation: Most of the large influx of offenders is due to the enormous financial commitment of incarceration exacerbated by the strain of diminishing state revenues and decades of punitive sentencing policy. This potential mass transfer of people from institutional settings requires a concerted effort from those involved in applied sociology. While psychology has established a strong foothold in the field of correctional rehabilitation, sociology has retreated since the early 1970s following the publication of Robert Martinson's research on rehabilitation programs in prisons. Sociology began as an applied science of society. More than ever before, sociological practice must embrace and re-engage communities in facilitating reentry and reducing recidivism among those released or under community supervision. This article offers direction to those prepared to take an active role in prisoner reentry by delineating the unique position of applied sociology to reclaim a place in community corrections.
Latino Health Care in Southern Appalachia a Community-Engaged Examination
Authors: Lippard Cameron D. , Price Jammie
Published: January 2017

Between 2007 and 2009, we created a research-based community partnership to identify and assess the health care needs of Latino1 families in the Appalachian Mountains of North Carolina. This report presents the survey and focus group findings for 159 Latinos concerning their views of health care services and barriers to accessing resources. Only 20 percent of the sample reported health as a major concern in their daily lives; however, notable proportions accessed health care within the last year through free or reduced-fee clinics (36%), hospital emergency rooms (25%), and individual doctors (18%). Most (82%) reported cost of care as the most significant barrier to accessing health care along with language fluency and facing discrimination. Many suggested they waited to seek care until symptoms worsened; hence the high number of hospital visits. Most (82%) did not have any health insurance. However, based on the focus groups, respondents felt that once a serious disease afflicted them, only faith and family could help them, as accessing American health care was a luxury they could not afford.
Weakly Institutionalized Party Systems and Presidential Democracy: Evidence from Guatemala
Authors: Jones Mark P.
Published: January 2017

Today, all of Latin America's presidential republics are at least nominal democracies, with the region's past experience with frequent military coups an increasingly distant memory. As a result, over the past two decades, many scholars concerned with the health of Latin America's presidential democracies have shifted their focus from those factors which contribute to the consolidation or breakdown of presidential democracies to those which influence the manner in which these democracies operate. In particular, scholars have endeavored to better understand the manner in which constitutional and partisan institutions strengthen or weaken the functioning of a country's democratic system. As the linchpin of a democratic system, political parties have a profound impact on the quality of democracy in a nation. This article highlights the case of Guatemala, where a very weakly institutionalized political party system has had a negative impact on the functioning of the country's presidential democracy. After underscoring Guatemala's status as one of Latin America's least institutionalized party systems via a cross-national analysis of the region's presidential democracies, the article analyzes in detail the limited institutionalization of the Guatemalan party system from a variety of vantage points ranging from the level of temporal volatility in voting patterns within the electorate to the amount of party switching among legislators.
Dependency and health utilities in stroke: Data to inform cost-effectiveness analyses
Authors: Ali Myzoon , MacIsaac Rachael , Quinn Terence J , Bath Philip M , Veenstra David L , Xu Yaping , Brady Marian C , Patel Anita , Lees Kennedy R
Published: January 2017

Introduction

Health utilities (HU) assign preference weights to specific health states and are required for cost-effectiveness analyses. Existing HU for stroke inadequately reflect the spectrum of post-stroke disability. Using international stroke trial data, we calculated HU stratified by disability to improve precision in future cost-effectiveness analyses.

Materials and methods

We used European Quality of Life Score (EQ-5D-3L) data from the Virtual International Stroke Trials Archive (VISTA) to calculate HU, stratified by modified Rankin Scale scores (mRS) at 3 months. We applied published value sets to generate HU, and validated these using ordinary least squares regression, adjusting for age and baseline National Institutes of Health Stroke Scale (NIHSS) scores.

Results

We included 3858 patients with acute ischemic stroke in our analysis (mean age: 67.5 ± 12.5, baseline NIHSS: 12 ± 5). We derived HU using value sets from 13 countries and observed significant international variation in HU distributions (Wilcoxon signed-rank test p < 0.0001, compared with UK values). For mRS = 0, mean HU ranged from 0.88 to 0.95; for mRS = 5, mean HU ranged from −0.48 to 0.22. OLS regression generated comparable HU (for mRS = 0, HU ranged from 0.9 to 0.95; for mRS = 5, HU ranged from −0.33 to 0.15). Patients’ mRS scores at 3 months accounted for 65–71% of variation in the generated HU.

Conclusion

We have generated HU stratified by dependency level, using a common trial endpoint, and describing expected variability when applying diverse value sets to an international population. These will improve future cost-effectiveness analyses. However, care should be taken to select appropriate value sets.
Understanding the relationship between costs and the modified Rankin Scale: A systematic review, multidisciplinary consensus and recommendations for future studies
Authors: Wilson Alastair , Bath Philip MW , Berge Eivind , Cadilhac Dominique A , Cuche Matthieu , Ford Gary A , Macisaac Rachael , Quinn Terence J , Taylor Matthew , Walters Matthew , Wolff Claudia , Lees Kennedy R ,   for the ESO-VISTA Health Economics Working Group
Published: January 2017

Background and purpose

Cost-of-illness studies often describe a single aggregate cost of a disease state. This approach is less helpful for a condition with a spectrum of outcomes like stroke. The modified Rankin Scale is the most commonly used outcome measure for stroke. We sought to describe the existing evidence on the costs of stroke according to individual modified Rankin Scale categories. This may be useful in future cost effectiveness modelling studies of interventions where cost data have not been collected, but disability outcome is known.

Methods

Systematic review of the published literature, searching electronic databases between 2004 and 2015 using validated search filters. Results were screened to identify studies presenting costs by individual modified Rankin Scale categories.

Results

Of 17,782 unique identified articles, 13 matched all inclusion criteria. In only four of these studies were costs reported by modified Rankin Scale categories. Most studies included direct medical costs only. Societal costs were assessed in two studies. Overall, studies had a high methodological and reporting quality. The heterogeneity in costing methods used in the identified studies prevented meaningful comparison of the reported cost data. Despite this limitation, the costs consistently increased with greater severity (increasing modified Rankin Scale score).

Conclusions

Few cost studies of stroke include information based on stroke recovery measured by individual modified Rankin Scale categories and the existing data are limited. To reliably capture this information, future studies are needed that preferably apply standardised costing methods to promote greater potential for use in cost-effectiveness analyses whereby direct collection of patient-level resource use has not been possible.
Personalised medicine in asthma: from curative to preventive medicine
Authors: Guilleminault Laurent , Ouksel Hakima , Belleguic Chantal , Le Guen Yannick , Germaud Patrick , Desfleurs Emilie , Leroyer Christophe , Magnan Antoine
Published: January 2017

The concept of asthma has changed substantially in recent years. Asthma is now recognised as a heterogeneous entity that is complex to treat. The subdivision of asthma, provided by “cluster” analyses, has revealed various groups of asthma patients who share phenotypic features. These phenotypes underlie the need for personalised asthma therapy because, in contrast to the previous approach, treatment must be tailored to the individual patient. Determination of the patient's asthma phenotype is therefore essential but sometimes challenging, particularly in elderly patients with a multitude of comorbidities and a complex exposure history. This review first describes the various asthma phenotypes, some of which were defined empirically and others through cluster analysis, and then discusses personalisation of the patient's diagnosis and therapy, addressing in particular biological therapies and patient education. This personalised approach to curative medicine should make way in the coming years for personalised preventive and predictive medicine, focused on subjects at risk who are not yet ill, with the aim of preventing asthma before it occurs. The concept of personalised preventive medicine may seem a long way off, but is it really?
Pulmonary vascular and cardiac impairment in interstitial lung disease
Authors: Panagiotou Marios , Church Alistair C. , Johnson Martin K. , Peacock Andrew J.
Published: January 2017

Pulmonary vascular and cardiac impairment is increasingly appreciated as a major adverse factor in the natural history of interstitial lung disease. This clinically orientated review focuses on the current concepts in the pathogenesis, pathophysiology and implications of the detrimental sequence of increased pulmonary vascular resistance, pre-capillary pulmonary hypertension and right heart failure in interstitial lung disease, and provides guidance on its management.
Epoprostenol and pulmonary arterial hypertension: 20 years of clinical experience
Authors: Sitbon Olivier , Vonk Noordegraaf Anton
Published: January 2017

Epoprostenol was the first therapy to be approved for the treatment of pulmonary arterial hypertension (PAH). In the 20 years since the introduction of this prostacyclin analogue, the outlook for patients with PAH has improved, with survival rates now double those from the era before the development of disease-specific treatments. Today, there are a large amount of data on the clinical role of prostacyclin treatments and a body of evidence attesting the efficacy of epoprostenol in improving exercise capacity, key haemodynamic parameters and PAH symptoms, as well as in reducing mortality. The place of epoprostenol in the therapeutic management of PAH continues to evolve, with the development of new formulations and use in combination with other drug classes. In this review, we provide a historical perspective on the first 20 years of epoprostenol, a therapy that led to evidence-based study of PAH-specific treatments and the subsequent expansion of treatment options for PAH.