OtorhinolaryngologySfakianakis: Ιουλίου 2017

Δευτέρα, 31 Ιουλίου 2017

The lymphocyte cytokinesis block micronucleus test in human populations occupationally exposed to vinyl chloride: a systematic review and meta-analysis

Publication date: Available online 31 July 2017
Source:Mutation Research/Reviews in Mutation Research
Author(s): Claudia Bolognesi, Marco Bruzzone, Marcello Ceppi, Micheline Kirsch-Volders
Vinyl chloride (VC) is widely used in industry in the production of polyvinyl chloride (PVC), which is used to manufacture a large variety of materials. VC was classified as a known (Group 1) human carcinogen by IARC on the basis of increased risk for liver angiosarcoma and hepatocellular cancer, and the carcinogenicity of VC was shown to be mediated by a genotoxic mechanism. Following inhalation, the compound is rapidly absorbed and metabolized in the liver to the electrophilic metabolites chloroethylene-oxide and chloroacetaldehyde, which form DNA adducts that can be processed into point mutations in cancer-related genes detected in humans and rats exposed to VC. A number of genotoxicity biomarkers were applied in workers exposed to VC to detect early biological responses associated with the carcinogenesis process. The present systematic review analyzed the published studies in which the cytokinesis-block micronucleus assay in peripheral lymphocytes (L-CBMN) was applied in VC-exposed subjects. Thirteen out of fifteen retrieved studies performed in China showed increased MN frequencies (FR 1.92-3.98) associated with increased cumulative exposure or employment time. Twofold and more than threefold increases were detected in PVC-exposed workers exposed to a mean of 50ppm of VC in the former Yugoslavia and in South India, respectively. The meta-analysis of MN frequency from six eligible studies confirmed this tendency (pooled MR 2.32 − 95% CI 1.64-3.27). The benchmark dose lower limit for 10% excess risk (BMDL 10) calculated from three studies resulted in an estimated exposure limit of 0.03-0.07mg/m³. Overall the results of this review showed the need for further studies, especially because PVC products from China may contain high levels of uncoupled VCM that could represent a source of exposure to workers and consumers. Moreover, the results underline the importance of re-evaluating the recommended exposure limits using new biomonitoring methods in addition to MN.

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Phylogenetic diversity and functional characterization of the Manila clam microbiota: a culture-based approach

Abstract

According to the hologenome theory, the microbiota contributes to the fitness of the holobiont having an important role in its adaptation, survival, development, health, and evolution. Environmental stress also affects the microbiota and its capability to assist the holobiont in coping with stress factors. Here, we analyzed the diversity of cultivable bacteria associated with Manila clam tissues (mantle, gills, hemolymph) in two non-contaminated sites (Portugal and France) and one metal-contaminated site (Portugal). A total of 240 isolates were obtained. Representative isolates (n = 198) of the overall diversity were identified by 16S rDNA sequencing and subjected to functional characterization. Isolates affiliated with Proteobacteria, Actinobacteria, Firmicutes, and Bacteroidetes. Proteobacteria (mostly Pseudoalteromonadaceae and Vibrionaceae) were dominant in non-contaminated sites while Actinobacteria (mostly Microbacteriaceae) dominated in the metal-contaminated site. The main factor affecting the microbiota composition was contamination. No significant differences were observed between clam tissues and geographic regions. Several isolates tested positive for antibacterial activity, biofilm formation, protease, and siderophore production. The results show that the Manila clam harbors a diverse microbiota that may contribute to clam protection and overall fitness, as well as to its adaptation to stressful environments. In addition, the Manila clam microbiota is revealed as a promising source of novel probiotics with potential application in aquaculture.

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Outcome of patients with lung adenocarcinoma with transformation to small-cell lung cancer following tyrosine kinase inhibitors treatment: A Systematic Review and Pooled Analysis

Publication date: Available online 31 July 2017
Source:Cancer Treatment Reviews
Author(s): Elisa Roca, Cristina Gurizzan, Vito Amoroso, William Vermi, Vittorio Ferrari, Alfredo Berruti
BackgroundLung adenocarcinoma can transform to small-cell lung cancer (SCLC) when resistance to tyrosine kinase inhibitors (TKIs) develops. This phenomenon has repeatedly been described in several case reports and small patient series. The characteristics and treatment outcomes of this population, however, have not been comprehensively reported.MethodsWe performed a systematic review of the published literature to obtain explorative information on the clinical and pathological features and prognosis of the reported cases.ResultsTwenty-five eligible publications were identified, contributing to 39 patients. The median time from initial diagnosis of lung adenocarcinoma to the transformation to SCLC (ttSCLC) was 19 months (range 1-61 months). The median survival after SCLC diagnosis was 6 months. Female gender was significantly associated with longer ttSCLC at the multivariable analysis. Smoking status seemed to be associated with worse prognosis after the diagnosis of SCLC.ConclusionIn this series of published cases, the transformation to a SCLC phenotype after an initial diagnosis of lung adenocarcinoma following TKI therapy appeared to be a late phenomenon. The prognosis after SCLC diagnosis is poor and current treatment strategies derived from primary SCLC seem to be largely inefficacious. New therapies are needed in the management of transformed SCLC.

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Immunotherapy in ovarian, endometrial and cervical cancer: state of the art and future perspectives

Publication date: Available online 31 July 2017
Source:Cancer Treatment Reviews
Author(s): Jole Ventriglia, Immacolata Paciolla, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Rosa Tambaro, Daniela Califano, Simona Losito, Giosuè Scognamiglio, Sergio Venanzio Setola, Laura Arenare, Sandro Pignata, Chiara Della Pepa
The tumors of the female genital tract represent a leading cause of morbidity and mortality among women worldwide. Substantial progresses have been made in ovarian cancer, with the increasing knowledge about BRCA mutated tumors and the recent development of PARP inhibitors, and in cervical cancer, thanks to extensive screening and widespread of vaccination against Human Papilloma Virus. Nevertheless many needs remain unmet, advanced stage diseases are still incurable and cervical and endometrial carcinoma, as well as platinum-resistant ovarian carcinoma, can certainly be classifiable among the cancers with poor sensitivity to conventional chemotherapy. Immunotherapy, including a number of approaches, checkpoint inhibitors, adoptive cellular transfer, vaccines, has experienced a remarkable growth in the last few years and it is already an available option in melanoma, lung and renal malignancies. We reviewed the main findings about the immune microenvironment in ovarian, endometrial and cervical cancer with a special focus on the clinical data, the therapeutic implications and the most promising novel agents.

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Re: Comparison of different hypotensive anaesthesia techniques in orthognathic surgery with regard to intraoperative blood loss, quality of the surgical field, and postoperative nausea and vomiting

In regard to our low incidence of postoperative nausea and vomiting (PONV) after bimaxillary osteotomies, minimizing the use of inhalational agents and narcotic pain medication are the two main focuses in our clinical practice, as inhalational agents and narcotics are associated with an increased incidence of PONV.

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Characterizing the skull base in craniofacial microsomia using principal component analysis

The aim of this study was to compare the anatomical differences in the skull base between the affected and non-affected side in patients with craniofacial microsomia (CFM), and to compare the affected and non-affected sides with measurements from a normal population. Three-dimensional computed tomography scans of 13 patients with unilateral CFM and 19 normal patients (age range 7–12 years) were marked manually with reliable homologous landmarks. Principal component analysis (PCA), as part of a point distribution model (PDM), was used to analyse the variability within the normal and preoperative CFM patient groups.

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Hypotensive anaesthesia techniques in orthognathic surgery

We read with interest the article by Lin et al., "Comparison of different hypotensive anaesthesia techniques in orthognathic surgery with regard to intraoperative blood loss, quality of the surgical field, and postoperative nausea and vomiting".1 It provoked a lot of discussion and an audit of our practice. The low incidence of postoperative nausea and vomiting (PONV) was particularly notable. In a group of similar cases of similar age and sex ratio, the incidence of PONV requiring intervention in the post anaesthesia care unit (PACU) was 35%, comparable to the sevoflurane group in the study.

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Efficacy and tolerability of a double-conjugated retinoid cream vs 1.0% retinol cream or 0.025% tretinoin cream in subjects with mild to severe photoaging

Summary

Background

Topical retinoids are used to treat the visible signs of photoaging. While efficacious, they are irritating.

Objective

Evaluate the effectiveness and tolerability of a double-conjugate retinoid cream (AlphaRet Overnight Cream; AHA-Ret) in improving visible signs of photoaging vs 1.0% retinol or 0.025% tretinoin.

Methods

A 12-week, split-face, randomized trial was conducted in 48 female subjects, aged 30-65 years with mild to severe photodamage. AHA-Ret was applied to one side of the face and either retinol (n=24) or tretinoin (n=24) to the other side (PM). Expert blinded evaluation of images and Nova measurements occurred at 4, 8, and 12 weeks. Tolerability was assessed throughout the study.

Results

Forty-seven subjects completed the study. AHA-Ret demonstrated significant reductions in average severity from baseline: Fine Lines/Wrinkles (P<.001; all time points); Erythema (P=.004, P<.0001; 8 and 12 weeks, respectively); Dyschromia (P<.0001; all time points); Skin Tone (P<.0001; all time points), and Pore Size (P=.035, P<.0001; 8 and 12 weeks, respectively). AHA-Ret induced less Erythema vs retinol at 8 (P=.008) and 12 (P<.02) weeks. AHA-Ret was noninferior to prescription tretinoin in all categories at 4 and 8 weeks, and for Fine Lines/Wrinkles, Erythema, Dyschromia, and Skin Tone at 12 weeks. Improvements in Hydration occurred at every time point with AHA-Ret only (P<.04, P<.03, P<.01). Less irritation was reported with AHA-Ret vs retinol or tretinoin.

Conclusions

Treatment with a double-conjugate retinoid cream demonstrated early reductions in photodamage and improvements in Hydration. AHA-Ret induced less Erythema vs retinol and was more tolerable vs retinol and tretinoin.

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Conceptualisation, development and validation of T-QoL© (Teenagers’ Quality of Life): a patient-focused measure to assess quality of life of adolescents with skin diseases

Abstract

Aim

To develop and validate a dermatology-specific quality of life (QoL) instrument for adolescents with skin diseases.

Methods

Qualitative semi-structured interviews were conducted with adolescents with skin disease to gain in-depth understanding of how skin diseases affect their QoL. A prototype instrument based on the themes identified from content analysis of interviews was tested in several stages, using Classical Test Theory (CTT) and Item Response Theory (IRT) models to develop this new tool and conduct its psychometric evaluation.

Results

Thirty-three QoL issues were identified from semi-structured interviews with 50 adolescents. A questionnaire based on items derived from content analysis of interviews was subjected to Rasch analysis: factor analysis identified three domains, therefore not supporting the validity of T-QoL as a unidimensional measure. Psychometric evaluation of the final 18-item questionnaire was carried out in a cohort of 203 adolescents. Convergent validity was demonstrated by significant correlation with Skindex-Teen and CDLQI or DLQI. The T-QoL showed excellent internal consistency reliability: Cronbach's α=0.89 for total scale score and 0.85, 0.60, and 0.74 respectively for domains 1, 2 and 3. Test-retest reliability was high in stable subjects. T-QoL showed sensitivity to change in two sub-groups of patients who indicated change in their self-assessed disease severity.

Conclusion

Built on rich qualitative data from patients, the T-QoL is a simple and valid tool to quantify the impact of skin disease on adolescents' QoL; it could be used as an outcome measure in both clinical practice and clinical research.

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The protective effect of platelet released growth factors and bone augmentation (Bio-Oss®) on ethanol impaired osteoblasts

Publication date: Available online 31 July 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Tolga Taha Sönmez, Andreas Bayer, Tillman Cremer, Jennifer Vanessa Phi Hock, Bernd Lethaus, Nisreen Kweider, Christoph Jan Wruck, Wolf Drescher, Holger Jahr, Sebastian Lippross, Thomas Pufe, Mersedeh Tohidnezhad
BackgroundChronic alcohol consumption is a known limiting factor for bone healing. One promising strategy to improve bone augmentation techniques with Bio-Oss^® in oral and maxillofacial surgery might be the supportive application of platelet-concentrated biomaterials as platelet-released growth factor (PRGF). To address this matter, we performed an in vitro study investigating the protective effects of PRGF and Bio-Oss^® in ethanol (EtOH) treated osteoblasts.MethodsThe SAOS-2 osteosarcoma cell line, with and without EtOH pretreatment was used. The cell viability, proliferation and alkali phosphatase activity (ALP) after application of 0%, 5% and 10% PRGF and Bio-Oss^® were assessed.ResultsThe application of PRGF and Bio-Oss^® in EtOH impaired osteoblasts showed a significant beneficial influence increasing the viability of the osteoblasts in cell culture. The synergistic effect of Bio-Oss^® and 5% PRGF on the proliferation of osteoblasts was also demonstrated. Bio-Oss^® only in combination with PRGF increases the alkaline phosphatase (ALP) activity in EtOH pretreated cells.ConclusionsThese results indicate that the simultaneous application of PRGF and Bio-Oss^® inhibits EtOH induced bone healing impairment. Furthermore, in the cells, PRGF induced a protective mechanism which might promote bone regeneration.

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Expression of C-X-C motif chemokine receptors 4 and 7 in salivary gland neoplasms

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Ekarat Phattarataratip, Kittipong Dhanuthai
ObjectivesChemokine receptors have been shown to overexpress in several cancer types. Binding of chemokines to their cognate chemokine receptors on tumor cells can promote tumor growth, angiogenesis and metastasis. The purposes of this study was to examine the expression of chemokine receptors, CXCR4 and CXCR7, in salivary gland neoplasms and its association with pathologic characteristics.DesignSixty-two cases of salivary gland neoplasms, including 25 mucoepidermoid carcinomas (MEC), 18 adenoid cystic carcinomas (ACC), 14 pleomorphic adenomas (PA) and 5 polymorphous low-grade adenocarcinoma (PLGA) were investigated for CXCR4 and CXCR7 expression immunohistochemically. The immunoreactivity was categorized as low expression or high expression group, based on whether the positive staining was below or higher than 50% of the neoplastic cells, respectively.ResultsThe majority of MECs, ACCs and PLGAs showed high CXCR4 and CXCR7 expression, whereas most PAs showed high CXCR4 but low CXCR7 expression. The levels of CXCR4 and CXCR7 expression were significantly correlated. In MECs, the expression of both chemokine receptors was localized to squamous cells, intermediate cells and glandular epithelial cells, whereas mucous cells and clear cells were negative. In ACCs and PAs, their immunoreactivity was more intense in ductal cells than myoepithelial cells. Most neoplastic myoepithelial cells in PAs did not express CXCR7, while those in ACCs showed strong CXCR7 expression. The increased CXCR4 expression was significantly associated with advanced pathologic grade of MECs (P=0.03).ConclusionOverexpression of CXCR4 and CXCR7 is common in the 4 salivary gland neoplasms investigated. CXCR4 may play a role in the progression of MECs.

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Expression of C-X-C motif chemokine receptors 4 and 7 in salivary gland neoplasms

68 Ga-DOTATATE PET/CT in recurrent medullary thyroid carcinoma: a lesion-by-lesion comparison with 111 In-octreotide SPECT/CT and conventional imaging

Abstract

Purpose

The aim of this study was to prospectively compare the detection rate of ⁶⁸Ga-DOTATATE PET-CT with ¹¹¹In-octreotide SPECT-CT and conventional imaging (CI) in medullary thyroid carcinoma (MTC) patients with increased calcitonin (Ctn) levels but negative CI after thyroidectomy.

Methods

Fifteen patients with raised Ctn levels and/or CI evidence of recurrence underwent ⁶⁸Ga-DOTATATE PET-CT, ¹¹¹In-octreotide SPECT-CT and CI. Histopathology, CI and biochemical/clinical/imaging follow-up were used as the reference standard. PET/CT, SPECT/CT and CI were compared in a lesion-based and organ-based analysis.

Results

PET/CT evidenced recurrence in 14 of 15 patients. There were 13 true positive (TP), 1 true negative (TN), 1 false positive (FP) and no false negative (FN) cases, resulting in a sensitivity and accuracy of 100% and 93%. SPECT/CT was positive in 6 of 15 cases. There were 6 TP, 2 TN, 7 FN and no FP cases, resulting in a sensitivity of 46% and accuracy of 53%. CI procedures detected tumor lesions in 14 of 15 patients. There were 13 TP, 1TN, 1 FP and no FN cases with a sensitivity of 100% and accuracy of 93%.

A significantly higher number of lesions was detected by PET/CT (112 lesions, p = 0.005) and CI (109 lesions, p = 0.005) in comparison to SPECT/CT (16 lesions). There was no significant difference between PET/CT and CI for the total number of detected lesions (p = 0.734). PET/CT detected more lesions than SPECT/CT regardless of the organ. PET/CT detected more bone lesions but missed some neck nodal metastases evidenced by CI. The number of lesions per region demonstrated by PET/CT and CI were similar in the other sites.

Conclusion

⁶⁸Ga-DOTATATE PET/CT is superior to ¹¹¹In-octreotide SPECT/CT for the detection of recurrent MTC demonstrating a significantly higher number of lesions. ⁶⁸Ga-DOTATATE PET/CT showed a superior detection rate compared to CI in demonstrating bone metastases.

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Imaging children suffering from lymphoma: an evaluation of different 18 F-FDG PET/MRI protocols compared to whole-body DW-MRI

Abstract

Objectives

The objectives of this study were to evaluate and compare the diagnostic potential of different PET/MRI reading protocols, entailing non-enhanced / contrast-enhanced and diffusion-weighted ¹⁸F–FDG PET/MR imaging and whole-body diffusion-weighted MRI for lesion detection and determination of the tumor stage in pediatric lymphoma patients.

Methods

A total of 28 ¹⁸F–FDG PET/MRI datasets were included for analysis of four different reading protocols: (1) PET/MRI utilizing sole unenhanced T2w and T1w imaging, (2) PET/MRI utilizing additional contrast enhanced sequences, (3) PET/MR imaging utilizing unenhanced, contrast enhanced and DW imaging or (4) WB-DW-MRI. Statistical analyses were performed on a per-patient and a per-lesion basis. Follow-up and prior examinations as well as histopathology served as reference standards.

Results

PET/MRI correctly identified all 17 examinations with active lymphoma disease, while WB-DW-MRI correctly identified 15/17 examinations. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 96%, 96.5%, 97%, 95%, and 96% for PET/MRI₁; 97%, 96.5%, 97%, 96.5%, and 97% for PET/MRI₂; 97%, 96.5%, 97%, 96.5%, and 97% for PET/MRI₃ and 77%, 96%, 96%, 78.5% and 86% for MRI-DWI.

Conclusion

¹⁸F–FDG PET/MRI is superior to WB-DW-MRI in staging pediatric lymphoma patients. Neither application of contrast media nor DWI leads to a noticeable improvement of the diagnostic accuracy of PET/MRI. Thus, unenhanced PET/MRI may play a crucial role for the diagnostic work-up of pediatric lymphoma patients in the future.

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Development of standardized image interpretation for 68Ga-PSMA PET/CT to detect prostate cancer recurrent lesions

Abstract

Methods

After primary treatment, biochemical relapse (BCR) occurs in a substantial number of patients with prostate cancer (PCa). PET/CT imaging with prostate-specific membrane antigen based tracers (68Ga-PSMA) has shown promising results for BCR patients. However, a standardized image interpretation methodology has yet to be properly agreed. The aim of this study, which was promoted and funded by European Association of Nuclear Medicine (EANM), is to define standardized image interpretation criteria for 68Ga-PSMA PET/CT to detect recurrent PCa lesions in patients treated with primary curative intent therapy (radical prostatectomy or radiotherapy) who presented a biochemical recurrence. In the first phase inter-rater agreement between seven readers from seven international centers was calculated on the reading of 68Ga-PSMA PET/CT images of 49 patients with BCR. Each reader evaluated findings in five different sites of recurrence (local, loco-regional lymph nodes, distant lymph nodes, bone, and other). In the second phase the re-analysis was limited to cases with poor, slight, fair, or moderate agreement [Krippendorff's (K) alpha<0.61]. Finally, on the basis of the consensus readings, we sought to define a list of revised consensus criteria for 68Ga-PSMA PET/CT interpretation.

Results

Between-reader agreement for the presence of anomalous findings in any of the five sites was only moderate (K's alpha: 0.47). The agreement improved and became substantial when readers had to judge whether the anomalous findings were suggestive for a pathologic, uncertain, or non-pathologic image (K's alpha: 0.64). K's alpha calculations for each of the five sites of recurrence were also performed and evaluated. First Delphi round was thus conducted. A more detailed definition of the criteria was proposed by the project coordinator, which was then discussed and finally agreed by the seven readers. After the second Delphi round only four cases of disagreement still remained. These were evaluated for a final round, allowing a final agreement table to be written.

Conclusion

We hope that by developing these consensus guidelines on the interpretation of 68Ga-PSMA PET/CT, clinicians reporting these studies will be able to provide more consistent clinical reports and that within clinical trials, abnormality classifications will be harmonized, allowing more robust assessment of its diagnostic performance.

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Reply to: Predicting the outcome of peptide receptor radionuclide therapy in neuroendocrine tumors: the importance of dual-tracer imaging

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Patterns of failure after radical prostatectomy in prostate cancer – implications for radiation therapy planning after 68 Ga-PSMA-PET imaging

Abstract

Background

Salvage radiotherapy (SRT) after radical prostatectomy (RPE) and lymphadenectomy (LAE) is the appropriate radiotherapy option for patients with persistent/ recurrent prostate cancer (PC). ⁶⁸Ga-PSMA-PET imaging has been shown to accurately detect PC lesions in a primary setting as well as for local recurrence or for lymph node (LN) metastases.

Objective

In this study we evaluated the patterns of recurrence after RPE in patients with PC, putting a highlight on the differentiation between sites that would have been covered by a standard radiation therapy (RT) field in consensus after the RTOG consensus and others that would have not.

Methods and materials

Thirty-one out of 83 patients (37%) with high-risk PC were the subject of our study. Information from ⁶⁸Ga-PSMA-PET imaging was used to individualize treatment plans to include suspicious lesions as well as possibly boost sites with tracer uptake in LN or the prostate bed. For evaluation, ⁶⁸Ga-PSMA-PET-positive LN were contoured in a patient dataset with a standard lymph drainage (RTOG consensus on CTV definition of pelvic lymph nodes) radiation field depicting color-coded nodes that would have been infield or outfield of that standard lymph drainage field and thereby visualizing typical patterns of failure of a "blind" radiation therapy after RPE and LAE.

Results

Compared to negative conventional imaging (CT/MRI), lesions suspicious for PC were detected in 27/31 cases (87.1%) by ⁶⁸Ga-PSMA-PET imaging, which resulted in changes to the radiation concept. There were 16/31 patients (51.6%) that received a simultaneous integrated boost (SIB) to a subarea of the prostate bed (in only three cases this dose escalation would have been planned without the additional knowledge of ⁶⁸Ga-PSMA-PET imaging) and 18/31 (58.1%) to uncommon (namely presacral, paravesical, pararectal, preacetabular and obturatoric) LN sites. Furthermore, 14 patients (45.2%) had a changed TNM staging result by means of ⁶⁸Ga-PSMA-PET imaging.

Conclusion

Compared to conventional CT or MRI staging, ⁶⁸Ga-PSMA-PET imaging detects more PC lesions and, thus, significantly influences radiation planning in recurrent prostate cancer patients enabling individually tailored treatment.

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Monitoring early response to chemoradiotherapy with 18 F-FMISO dynamic PET in head and neck cancer

Abstract

Purpose

There is growing recognition that biologic features of the tumor microenvironment affect the response to cancer therapies and the outcome of cancer patients. In head and neck cancer (HNC) one such feature is hypoxia. We investigated the utility of ¹⁸F-fluoromisonidazole (FMISO) dynamic positron emission tomography (dPET) for monitoring the early microenvironmental response to chemoradiotherapy in HNC.

Experimental design

Seventy-two HNC patients underwent FMISO dPET scans in a customized immobilization mask (0–30 min dynamic acquisition, followed by 10 min static acquisitions starting at ∼95 min and ∼160 min post-injection) at baseline and early into treatment where patients have already received one cycle of chemotherapy and anywhere from five to ten fractions of 2 Gy per fraction radiation therapy. Voxelwise pharmacokinetic modeling was conducted using an irreversible one-plasma two-tissue compartment model to calculate surrogate biomarkers of tumor hypoxia (k ₃ and Tumor-to-Blood Ratio (TBR)), perfusion (K ₁ ) and FMISO distribution volume (DV). Additionally, Tumor-to-Muscle Ratios (TMR) were derived by visual inspection by an experienced nuclear medicine physician, with TMR > 1.2 defining hypoxia.

Results

One hundred and thirty-five lesions in total were analyzed. TBR, k ₃ and DV decreased on early response scans, while no significant change was observed for K ₁ . The k ₃ -TBR correlation decreased substantially from baseline scans (Pearson's r = 0.72 and 0.76 for mean intratumor and pooled voxelwise values, respectively) to early response scans (Pearson's r = 0.39 and 0.40, respectively). Both concordant and discordant examples of changes in intratumor k ₃ and TBR were identified; the latter partially mediated by the change in DV. In 13 normoxic patients according to visual analysis (all having lesions with TMR = 1.2), subvolumes were identified where k ₃ indicated the presence of hypoxia.

Conclusion

Pharmacokinetic modeling of FMISO dynamic PET reveals a more detailed characterization of the tumor microenvironment and assessment of response to chemoradiotherapy in HNC patients than a single static image does. In a clinical trial where absence of hypoxia in primary tumor and lymph nodes would lead to de-escalation of therapy, the observed disagreement between visual analysis and pharmacokinetic modeling results would have affected patient management in <20% cases. While simple static PET imaging is easily implemented for clinical trials, the clinical applicability of pharmacokinetic modeling remains to be investigated.

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Practical recommendations for radium-223 treatment of metastatic castration-resistant prostate cancer

Abstract

Purpose

Radium Ra 223 dichloride (radium-223, Xofigo®) is the first targeted alpha therapy for patients with castration-resistant prostate cancer and symptomatic bone metastases. Radium-223 provides a new treatment option for this setting, but also necessitates a new treatment management approach. We provide straightforward and practical recommendations for European nuclear medicine centres to optimize radium-223 service provision.

Methods

An independent research consultancy agency observed radium-223 procedures and conducted interviews with all key staff members involved in radium-223 treatment delivery in 11 nuclear medicine centres across six countries (Germany, Italy, the Netherlands, Spain, Switzerland and the UK) experienced in administering radium-223. The findings were collated and discussed at a meeting of experts from these centres, during which key consensus recommendations were defined.

Results

The recommendations cover centre organization and preparation; patient referral; radium-223 ordering, preparation and disposal; radium-223 treatment delivery/administration; and patient experience. Guidance includes structured coordination and communication within centres and multidisciplinary teams, focusing on sharing best practice to provide high-quality, patient-centred care throughout the treatment pathway.

Conclusions

These expert recommendations are intended to complement existing management guidelines. Sharing best practice and experience will help nuclear medicine centres to optimize radium-223 service provision and improve patient care.

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SPECT/CT and PET/CT molecular imaging in medullary thyroid carcinoma. Are we running in the right direction?

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The role of 18 F-FDG PET/CT in the detection of osteosarcoma recurrence

Abstract

Aim

The aim of this study was to investigate the diagnostic accuracy of ¹⁸F-FDG-PET/CT in osteosarcoma patients suspicious for disease recurrence after adequate surgical therapy.

Methods

Inclusion criteria were: a) adequate surgical treatment for proven osteosarcoma and documented complete remission after therapy; b) ¹⁸F-FDG-PET/CT performed during follow-up for clinical/diagnostic suspicion of relapse; c) new surgical treatment with excision of the suspected lesions; d) histological validation of ¹⁸F-FDG-PET/CT findings. Thirty-seven patients matching all inclusion criteria were retrospectively enrolled (20 men and 17 female). Primary surgical treatment consists of resection (31 cases) or amputation (six cases). ¹⁸F-FDG-PET/CT performance was assessed with a per-patient and per-site evaluation of sensitivity, specificity, accuracy, positive predicting value (PPV), and negative predicting value (NPV). The sites of relapse were classified as local, lung, lymphnodes (LNs), and distant (other skeletal segments and/or distant soft tissue). The disease-free survival (DFS) and the overall survival (OS) after 18F-FDG PET/CT were evaluated.

Results

¹⁸F-FDG-PET/CT was positive in 89.2% (33/37) of patients. Local uptake only was observed in 35.1% patients (13/37); lung uptake only in 18.9% (7/37); distant uptake only in 2.7% (1/37) case; multiple sites of uptake in 32.4% (12/37). Histology resulted positive in 92% (34/37) of patients. A total of 51 pathologic lesions were evaluated (22 local relapse, 11 lung metastasis, 10 metastatic LNs, eight distant metastatic lesions). On a per-patient analysis ¹⁸F-FDG-PET/CT showed a sensitivity, specificity, accuracy, PPV, and NPV of 91%, 75%, 89%, 97%, 50%. On a per-site analysis the performance for local relapse was 96%, 100%, 97%, 100%, 93%, while for lung relapse detection was 80%, 100%, 92%, 100%, 88%. The mean follow-up after ¹⁸F-FDG-PET/CT was 21.5 months. At the last follow-up, 19% (7/37) of patients were death with disease, 38% (14/37) were alive with disease, and 43% (16/37) had no evidence of disease. Overall survival was 90% and 75% at 24 and 60 months, respectively.

Conclusion

¹⁸F-FDG-PET/CT showed valuable results for detecting recurrence(s) in osteosarcoma patients with suspicious of relapse after treatment, particularly in the detection of local relapse and lung metastasis.

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Early PET imaging with [68]Ga-PSMA-11 increases the detection rate of local recurrence in prostate cancer patients with biochemical recurrence

Abstract

Purpose

PET/CT using ⁶⁸Ga-labelled prostate-specific membrane antigen PSMA-11 (HBEDD-CC) has emerged as a promising imaging method in the diagnostic evaluation of prostate cancer (PC) patients with biochemical recurrence. However, assessment of local recurrence (LR) may be limited by intense physiologic tracer accumulation in the urinary bladder on whole-body scans, normally conducted 60 min post-tracer injection (p.i.). It could be shown on early dynamic imaging studies that ⁶⁸Ga-PSMA-11 uptake in PC lesions occurs earlier than tracer accumulation in the urinary bladder. This study aims to investigate whether early static PET acquisition increases detection rate of local recurrence on ⁶⁸Ga-PSMA-11 PET/CT in comparison to PET imaging 60 min p.i..

Methods

203 consecutive PC patients with biochemical failure referred to ⁶⁸Ga-PSMA-11 PET/CT were analysed retrospectively (median prostate specific antigen (PSA) value: 1.44 ng/ml). In addition to whole-body PET/CT scans 60 min p.i., early static imaging of the pelvis was performed, starting at a median time of 283 s p.i. (range: 243–491 s). Assessment was based on visual analysis and calculation of maximum standardized uptake value (SUV_max) of pathologic lesions present in the pelvic area found on early PET imaging and on 60 min-PET scans.

Results

26 patients (12.8%) were judged positive for LR on PET scans 60 min p.i. (median SUV_max: 10.8; range: 4.7–40.9), whereas 50 patients (24.6%) revealed a lesion suggestive of LR on early PET imaging (median SUV_max: 5.9; range: 2.9–17.6), resulting in a significant rise in detection rate (p < 0.001). Equivocal findings on PET scans 60 min p.i. decreased significantly with the help of early imaging (15.8% vs. 4.5% of patients; p < 0.001). Tracer activity in the urinary bladder with a median SUV_max of 8.2 was present in 63 patients on early PET scans (31.0%). However, acquisition starting time of early PET scans differed significantly in the patient groups with and without urinary bladder activity (median starting time of 321 vs. 275 s p.i.; range: 281–491 vs. 243–311 s p.i.; p < 0.001). Median SUV_max value of lesions suggestive of LR on early images was significantly higher in comparison to gluteal muscle, inguinal vessels and seminal vesicle/anastomosis (median SUV_max: 5.9 vs. 1.9, 4.0 and 2.4, respectively).

Conclusions

Performance of early imaging in ⁶⁸Ga-PSMA-11 PET/CT in addition to whole-body scans 60 min p.i. increases the detection rate of local recurrence in PC patients with biochemical recurrence. Acquisition of early PET images should be started as early as 5 min p.i. in order to avoid disturbing tracer activity in the urinary bladder occuring at a later time point.

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Players of ‘hypoxia orchestra’ – what is the role of FMISO?

http://ift.tt/2f3hBIw

PET and PET/CT with radiolabeled choline in prostate cancer: a critical reappraisal of 20 years of clinical studies

Abstract

We here aim to provide a comprehensive and critical review of the literature concerning the clinical applications of positron emission tomography/computed tomography (PET/CT) with radiolabeled choline in patients with prostate cancer (PCa). We will initially briefly summarize the historical context that brought to the synthesis of [¹¹C]choline, which occurred exactly 20 years ago. We have arbitrarily grouped the clinical studies in three different periods, according to the year in which they were published and according to their relation with their applications in urology, radiotherapy and oncology. Studies at initial staging and, more extensively, studies in patients with biochemical failure, as well as factors predicting positive PET/CT will be reviewed. The capability of PET/CT with radiolabeled choline to provide prognostic information on PCa-specific survival will also be examined. The last sections will be devoted to the use of radiolabeled choline for monitoring the response to androgen deprivation therapy, radiotherapy, and chemotherapy. The accuracy and the limits of the technique will be discussed according to the information available from standard validation processes, including biopsy or histology. The clinical impact of the technique will be discussed on the basis of changes induced in the management of patients and in the evaluation of the response to therapy. Current indications to PET/CT, as officially endorsed by guidelines, or as routinely performed in the clinical practice will be illustrated. Emphasis will be made on methodological factors that might have influenced the results of the studies or their interpretation. Finally, we will briefly highlight the potential role of positron emission tomography/magnetic resonance and of new radiotracers for PCa imaging.

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A new perspective for nuclear medicine: expanding the indications for PSMA targeted imaging and therapy

http://ift.tt/2hj7osq

Selective removal of carious lesion with Er:YAG laser followed by dentin biomodification with chitosan

Abstract

The aim of this study was to evaluate the effect of Er:YAG laser for selective removal of carious lesion, followed by biomodification with chitosan gel where the subsurface microhardness, chemical composition, and morphological changes of the residual caries-affected dentin were examined. Artificial dentinal lesions were created by pH-cycling method (14 days) in 104 bovine specimens (5 × 5 mm). Specimens were randomly divided according to the carious removal method: bur (low-speed handpiece) or Er:YAG laser (250 mJ/4 Hz). Specimens were treated with 35% phosphoric acid and were subdivided into two groups according to dentin biomodification: without chitosan (control) and 2.5% chitosan. Forty specimens were restored with an adhesive system and composite resin. Subsurface microhardness tests were performed in sound dentin, caries-affected dentin, residual caries-affected dentin, and after the restoration. The other 64 specimens were subjected to SEM-EDS atomic analysis. Data were statistically analyzed (p < 0.05). After the Er:YAG laser excavation, the microhardness value of residual caries-affected dentin was higher (p < 0.05) than bur-treated dentin. A significant decrease in the amount of Ca, P, and Ca/P ratio was found after the removal of carious lesions with Er:YAG laser (p < 0.05). The biomodification with chitosan did not influence the microhardness and atomic percentage of Ca, P, and Ca/P ratio of residual caries-affected dentin (p > 0.05). SEM analysis showed morphological changes on residual caries-affected dentin (p > 0.05). The selective removal of carious dentin with Er:YAG laser increased microhardness of residual caries-affected dentin, changing its surface morphology and chemical composition. The biomodification with chitosan did not influence the structural and chemical composition of residual caries-affected dentin.

http://ift.tt/2vc54sY

Selective removal of carious lesion with Er:YAG laser followed by dentin biomodification with chitosan

Abstract

http://ift.tt/2vc54sY

Factor Structure of the Intolerance of Uncertainty Scale for Children

Publication date: Available online 31 July 2017
Source:Journal of Anxiety Disorders
Author(s): Danielle Cornacchio, Amanda L. Sanchez, Stefany Coxe, Amy Roy, Donna B. Pincus, Kendra L. Read, Robert M. Holaway, Philip C. Kendall, Jonathan S. Comer
Intolerance of uncertainty (IU), a dispositional negative orientation toward uncertainty and its consequences, has been studied in adults, but research has only recently examined IU in youth. Despite some advances, little is known about the factor structure of measures of IU in youth. The present study used confirmatory factor analysis to examine the structure of IU as measured by the Intolerance of Uncertainty Scale for Children (IUSC; Comer et al., 2009) in a sample of youth (N=368) 9-18 years of age (Mage=12.47) with and without anxiety disorders and their mothers. Findings demonstrated multiple acceptable factor structures: a correlated factors 2-factor structure and a bifactor model where a general factor underlies all items. While the bifactor model provides better fit and reliability to the data, multivariate analyses indicated that the 2-factor structure distinguishes apprehensive anxiety regarding future events (prospective IU) from present-focused inhibition of behavior due to uncertainty and negative reactions to the presence of uncertainty (inhibitory IU); a total IU score predicted all anxiety domains for self- and parent-reports except for parent-report harm avoidance. Findings are discussed in terms of consistency of IU across adult and youth samples, and how results can inform treatment efforts and etiologic models of IU and anxiety.

http://ift.tt/2vdptxw

Effect of mechanical loading on the metabolic activity of cells in the temporomandibular joint: a systematic review

Abstract

Objectives

The purpose of this systematic review was to elucidate how different modalities and intensities of mechanical loading affect the metabolic activity of cells within the fibro-cartilage of the temporomandibular joint (TMJ).

Materials and methods

A systematic review was conducted according to PRISMA guidelines using PubMed, Embase, and Web of Science databases. The articles were selected following a priori formulated inclusion criteria (viz., in vivo and in vitro studies, mechanical loading experiments on TMJ, and the response of the TMJ).

A total of 254 records were identified. After removal of duplicates, 234 records were screened by assessing eligibility criteria for inclusion. Forty-nine articles were selected for full-text assessment. Of those, 23 were excluded because they presented high risk of bias or were reviews. Twenty-six experimental studies were included in this systematic review: 15 in vivo studies and 11 in vitro ones.

Conclusion

The studies showed that dynamic mechanical loading is an important stimulus for mandibular growth and for the homeostasis of TMJ cartilage. When this loading is applied at a low intensity, it prevents breakdown of inflamed cartilage. Yet, frequent overloading at excessive levels induces accelerated cell death and an increased cartilage degradation.

Clinical Significance

Knowledge about the way temporomandibular joint (TMJ) fibrocartilage responds to different types and intensities of mechanical loading is important to improve existing treatment protocols of degenerative joint disease of the TMJ, and also to better understand the regenerative pathway of this particular type of cartilage.

http://ift.tt/2tYEFyQ

MAIT cells in infectious diseases

Marion Salou | Katarzyna Franciszkiewicz | Olivier Lantz

http://ift.tt/2f35gUM

Vaccines targeting helper T cells for cancer immunotherapy

Marit Melssen | Craig L Slingluff

http://ift.tt/2hiKgu1

Towards an evidence based approach for the development of adjuvanted vaccines

Derek T O’Hagan | Leonard R Friedland | Emmanuel Hanon | Arnaud M Didierlaurent

http://ift.tt/2f39Vpy

Tuberculosis vaccines — perspectives from the NIH/NIAID Mycobacteria vaccine testing program

Angelo A Izzo

http://ift.tt/2hiK6CV

TNF-receptor superfamily agonists as molecular adjuvants for cancer vaccines

Timothy NJ Bullock

http://ift.tt/2f39Ou8

Four pathways of CD1 antigen presentation to T cells

D Branch Moody | Rachel N Cotton

http://ift.tt/2hivPGo

MAIT cells in infectious diseases

Marion Salou | Katarzyna Franciszkiewicz | Olivier Lantz

http://ift.tt/2f35gUM

Vaccines targeting helper T cells for cancer immunotherapy

Marit Melssen | Craig L Slingluff

http://ift.tt/2hiKgu1

Towards an evidence based approach for the development of adjuvanted vaccines

Derek T O'Hagan | Leonard R Friedland | Emmanuel Hanon | Arnaud M Didierlaurent

http://ift.tt/2f39Vpy

Tuberculosis vaccines — perspectives from the NIH/NIAID Mycobacteria vaccine testing program

Angelo A Izzo

http://ift.tt/2hiK6CV

TNF-receptor superfamily agonists as molecular adjuvants for cancer vaccines

Timothy NJ Bullock

http://ift.tt/2f39Ou8

Four pathways of CD1 antigen presentation to T cells

D Branch Moody | Rachel N Cotton

http://ift.tt/2hivPGo

Dural metastasis of nasopharyngeal carcinoma: A case report

Publication date: Available online 16 June 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Mohd Irman Shah Ibrahim, Aishah Harizah Abdullah Alwi, Amran Mohamad, Norhafiza Mat Lazim
Nasopharyngeal carcinoma (NPC) with dural metastasis is extremely rare, mostly asymptomatic, leaving it to be highly at risk of being overlooked. We report a case of a woman with dural metastasis of NPC almost 1year post concurrent chemoradiotherapy (CCRT) that was detected following a trivial trauma to her head. Owing to its rare occurence, it presents a great challenge for clinicians to make a prompt diagnosis because delayed in the treatment may lead to a fatal outcome.

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Dural metastasis of nasopharyngeal carcinoma: A case report

Effect of glycerol test on audiovestibular tests in patients with Meniere’s disease

Publication date: Available online 9 May 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Enass S. Mohamed, Eman A. Said, Nashwa A. Mahmoud
This stud to explore the effect of glycerol on audiovestibular tests in patients with Meniere's disease (MD) and to reflect different pathologic states of endolymphatic hydrops (EH) in the inner ear and compare the results of glycerol on these results.SubjectsThirty patients and 15 normal volunteers.MethodsEach subject of this study underwent pure tone audiometry testing, evoked vestibular evoked myogenic potential (VEMP) and Vidionystagmography (VNG) before G1 and 2h after glycerol G2 administration (1.3g/kg).ResultsAffected ears were 32 and unaffected ears were 28. The affected ears had higher hearing and SRT thresholds when compared to the unaffected ears and control group. VEMPs of the affected ears were normal in six ears (18.75%), absent in four ears (12.5%) and augmented amplitude in 22 (68.75%), their VNG results showed peripheral vestibular disorder. After oral administration of glycerol, the previous test battery was repeated and it's result on PTA showed that 53.13% (17/32) of affected ears had positive glycerol test mainly in stage II and III. Ten of the 32 affected ears (31.26%) showed improvement of VEMPs after glycerol administration. Also, two (7.8%) of the unaffected ears showed positive glycerol. Latency of the VEMP had no significant changes after glycerol administration and there was no statistical correlation between the results of G-PTA and G-VEMP. There was statistical significant improvement of the slow peak velocity of caloric test in patient's affected ears and insignificant improvement in control group and in unaffected ears after glycerol administration.

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Editorial Board

Publication date: March 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences, Volume 18, Issue 1

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Effect of glycerol test on audiovestibular tests in patients with Meniere’s disease

Comparative study between selective nerve blocks and the intravenous opioids in mastoid surgery

Publication date: Available online 17 June 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Santosh Kumar Swain, Chandrasekhar Pradhan, Sidharth Mohanty, Mahesh Chandra Sahu
ObjectiveThis double-blind randomized trial was conducted to compare the efficacy of selective nerve blocks over intravenous use of morphine during mastoid surgery.Materials and methodsA total of 50 patients between the ages 25 to 45years were divided into two groups as per the anaesthetic techniques used; nerve block group (N) and intravenous morphine group (M). After induction of general anaesthesia and before surgical incision: Group N patients (nerve block group) were given Great Auricular Nerve (GAN) and Auriculo-Temporal Nerve (ATN) block with 0.25% bupivacaine. Group M patients (morphine group) received 0.1mg/kg morphine. In the post anaesthesia care unit (PACU), Visual Analogue Scale (VAS) was used to assess post operative pain, Ramsay Sedation Scale (RSS) for sedation and post operative nausea and vomiting (PONV) impact scale score.ResultsVAS scores and requirement of rescue analgesics in the PACU was significantly less in the N Group for first 3h. The group N patients had a less frequent incidence of vomiting requiring intervention and were ready to be discharged from hospital after 3h of surgery.ConclusionCombination of GAN and ATN block with general anaesthesia is an uncomplicated, effective and well tolerated method for the safe conduct of mastoid surgery.

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Editorial Board

Publication date: March 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences, Volume 18, Issue 1

http://ift.tt/2hiVAq6

Comparative study between selective nerve blocks and the intravenous opioids in mastoid surgery

Bio-inspired hybrid scaffold of zinc oxide-functionalized multi-wall carbon nanotubes reinforced polyurethane nanofibers for bone tissue engineering

Publication date: 5 November 2017
Source:Materials & Design, Volume 133
Author(s): Bishnu Kumar Shrestha, Sita Shrestha, Arjun Prasad Tiwari, Jeong-In Kim, Sung Won Ko, Han-Joo Kim, Chan Hee Park, Cheol Sang Kim
In this study, we prepared nanotopographical polyurethane (PU)-based bioactive scaffolds that incorporated uniformly dispersed functionalized multi-wall carbon nanotubes (fMWCNTs) and zinc oxide (ZnO) nanoparticles (NPs) using an electrospinning technique. We found that well dispersed fMWCNTs along with ZnO NPs reinforced PU fibers demonstrated significant improvement in mechanical strength, hydrophilicity, thermal stability, electrical conductivity, degradability, biomineralization, and biocompatibility. Inspired by the exciting nature of biopolymeric composite (PU/ZnO-fMWCNTs) membranes, these hybrid scaffolds offer extensive interest to tissue engineering as a potential biomedical application. The specific bioactive properties and cell-biomaterial interaction of electrospun scaffold containing 0.2wt% ZnO with 0.4wt% fMWCNTs were found to demonstrate anti-bacterial activity and cytocompatibility. Furthermore, the highly charged density, large surface-to-volume ratio, and more functional groups in fMWCNTs integrated on the scaffolds promote osteogenic differentiation of pre-osteoblast (MC3T3-E1) cells. Therefore, the novel as-prepared multifunctional electrospun fibrous scaffold could suggest new avenues for exploration as promising osteoproductive and osteoinductive biomaterials that offer great benefit to bone tissue engineering.

Graphical abstract

http://ift.tt/2tSZzLF

Tailoring modulus and hardness of in-situ formed β-Ti in bulk metallic glass composites by precipitation of isothermal ω-Ti

Publication date: 5 November 2017
Source:Materials & Design, Volume 133
Author(s): L. Zhang, S. Chen, H.M. Fu, H. Li, Z.W. Zhu, H.W. Zhang, Z.K. Li, A.M. Wang, H.F. Zhang
It is challenging to tailor the mechanical properties of in-situ formed β phases in Ti/Zr-based bulk metallic glass composites (β-type BMGCs) without changing the morphologies of the β phases. Recently, BMGCs containing metastable β-Ti/Zr phases (metastable β-type BMGCs) exhibit an exothermic reaction below the glass transition temperature (sub-Tg) of the glassy matrices during heating, however, the corresponding structural origin remains unclear. In this work, the precipitation of ω phase inside β phase was revealed to account for the sub-Tg exothermic event of the metastable Ti45.7Zr33Cu5.8Co3Be12.5 BMGC. The sub-Tg annealing of metastable β-type BMGCs causes the precipitation of nanometer-sized isothermal ω phase, which leads to a large increase in the modulus and hardness of the crystalline phase. This finding provides a novel route to tailor the modulus and hardness of the crystalline phases in BMGCs without changing their morphologies, including volume fractions, sizes, and distributions. On this basis, the influence of the modulus and hardness of the crystalline phase on mechanical properties of BMGCs was exclusively investigated. Our experimental results together with finite-element simulations proved that lower modulus and hardness of the crystalline phase benefit a larger plasticity of BMGCs.

Graphical abstract

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Dural metastasis of nasopharyngeal carcinoma: A case report

Effect of glycerol test on audiovestibular tests in patients with Meniere’s disease

Publication date: Available online 9 May 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Enass S. Mohamed, Eman A. Said, Nashwa A. Mahmoud
This stud to explore the effect of glycerol on audiovestibular tests in patients with Meniere’s disease (MD) and to reflect different pathologic states of endolymphatic hydrops (EH) in the inner ear and compare the results of glycerol on these results.SubjectsThirty patients and 15 normal volunteers.MethodsEach subject of this study underwent pure tone audiometry testing, evoked vestibular evoked myogenic potential (VEMP) and Vidionystagmography (VNG) before G1 and 2h after glycerol G2 administration (1.3g/kg).ResultsAffected ears were 32 and unaffected ears were 28. The affected ears had higher hearing and SRT thresholds when compared to the unaffected ears and control group. VEMPs of the affected ears were normal in six ears (18.75%), absent in four ears (12.5%) and augmented amplitude in 22 (68.75%), their VNG results showed peripheral vestibular disorder. After oral administration of glycerol, the previous test battery was repeated and it’s result on PTA showed that 53.13% (17/32) of affected ears had positive glycerol test mainly in stage II and III. Ten of the 32 affected ears (31.26%) showed improvement of VEMPs after glycerol administration. Also, two (7.8%) of the unaffected ears showed positive glycerol. Latency of the VEMP had no significant changes after glycerol administration and there was no statistical correlation between the results of G-PTA and G-VEMP. There was statistical significant improvement of the slow peak velocity of caloric test in patient’s affected ears and insignificant improvement in control group and in unaffected ears after glycerol administration.

http://ift.tt/2f2xe37

Editorial Board

Publication date: March 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences, Volume 18, Issue 1

http://ift.tt/2hiVAq6

Comparative study between selective nerve blocks and the intravenous opioids in mastoid surgery

The Impact of the Cosurgeon Model on Bilateral Autologous Breast Reconstruction

J reconstr Microsurg
DOI: 10.1055/s-0037-1604106

Background Microsurgical breast reconstructions (MBRs) are time and labor intensive procedures. To circumvent these barriers, plastic surgeons have started working together as cosurgeons (CSs). This study aims to evaluate the impact of the CS model (CSM) specifically on bilateral MBR. The hypothesis is that CS procedures reduce operative time and surgical complications. Study Design This was a single institutional retrospective cohort study, which included all consecutive patients who underwent bilateral MBR from 2014 to 2016. Patients were grouped into single surgeon (SS) or CSs based on the number of the attending plastic surgeons present. Demographic and clinical characteristics including age, body mass index, smoking, American Society of Anesthesiologist class, radiation, and the timing of the reconstruction were assessed. Univariate and multivariate analyses were performed for outcomes including operative time and postoperative complications. Results Of the 136 patients included in the study, 41% had breast reconstruction performed by CSs, whereas 59% had a SS. Sociodemographic features were evenly distributed with the exception of a greater number of delayed reconstructions in the SS group (33 vs. 13%; p <0.01). Pedicle TRAMS (transverse rectus abdominis musculocutaneous flaps) were performed in 5 versus 0% of SS versus CS cases, respectively. Rates of major (4 vs. 16%) and minor (11 vs. 24%) complications were significantly lower in CS procedures. Multivariate analyses demonstrated CS operations required significantly shorter operative time by 73 minutes (p <0.001), and trended toward a reduced postoperative complication rate (p = 0.07). Conclusion The CSM is associated with improved operative efficiency for bilateral MBR. Further evaluation of the CSM may prove useful in other surgical disciplines with time and labor intense procedures.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2uPBqsm

The Impact of the Cosurgeon Model on Bilateral Autologous Breast Reconstruction

J reconstr Microsurg
DOI: 10.1055/s-0037-1604106

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2uPBqsm

Action observation in the modification of postural sway and gait: Theory and use in rehabilitation

Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Mitesh Patel
The discovery of cortical neurons responsive to both the observation of another individual's movement and one's own physical movement has spurred scientists into utilising this interplay for rehabilitation. The idea that humans can quickly transfer motor programmes or refine existing motor strategies through observation has only recently gained interest in the context of gait rehabilitation but may offer significant promise as an adjunctive therapy to routine balance training. This review is the first dedicated to action observation in postural control or gait in healthy individuals and patients. The traditional use of action observation in rehabilitation is that the observer has to carefully watch pre-recorded or physically performed actions and thereafter imitate them. Using this approach, previous studies have shown improved gait after action observation in stroke, Parkinson's disease and knee or hip replacement patients. In healthy subjects, action observation reduced postural sway from externally induced balance perturbations. Despite this initial evidence, future studies should establish whether patients are instructed to observe the same movement to be trained (i.e., replicate the observed action(s)) or observe a motor error in order to produce postural countermeasures. The best mode of motor transfer from action observation is yet to be fully explored, and may involve observing live motor acts rather than viewing video clips. Given the ease with which action observation training can be applied in the home, it offers a promising, safe and economical approach as an adjunctive therapy to routine balance training.

http://ift.tt/2w0gZHV

The effects of ankle braces and taping on lower extremity running kinematics and energy expenditure in healthy, non-injured adults

Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Kaori Tamura, Kara N. Radzak, Rachele E. Vogelpohl, Bethany A. Wisthoff, Yukiya Oba, Ronald K. Hetzler, Christopher D. Stickley
Ankle braces and taping are commonly used to prevent ankle sprains and allow return to play following injury, however, it is unclear how passive restriction of joint motion may effect running gait kinematics and energy expenditure during exercise. The purpose of this study was to determine the effect of different types of ankle supports on lower extremity kinematics and energy expenditure during continuous running. Thirteen healthy physically active adults ran at self-selected speed on the treadmill for 30min in four different ankle support conditions: semi-rigid hinged brace, lace-up brace, tape and control. Three-dimensional lower extremity kinematics and energy expenditure were recorded every five minutes. The semi-rigid hinged brace was most effective in restricting frontal plane ankle motion. The lace-up brace and tape restricted sagittal plane ankle motion, while semi-rigid hinged bracing allowed for normal sagittal plane ankle kinematics. Kinematic changes from all three ankle supports were generally persistent through 25–30min of exercise. Only tape influenced knee kinematics, limiting flexion velocity and flexion-extension excursion. Small but significant increased in energy expenditure was found in tape and semi-rigid hinged brace conditions; however, the increases were not to any practically significant level (<0.5kcal/min).

http://ift.tt/2uPGmxp

Effects of interventions on normalizing step width during self-paced dual-belt treadmill walking with virtual reality, a randomised controlled trial

Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): I.L.B. Oude Lansink, L. van Kouwenhove, P.U. Dijkstra, K. Postema, J.M. Hijmans
BackgroundStep width is increased during dual-belt treadmill walking, in self-paced mode with virtual reality. Generally a familiarization period is thought to be necessary to normalize step width.AimThe aim of this randomised study was to analyze the effects of two interventions on step width, to reduce the familiarization period.MethodsWe used the GRAIL (Gait Real-time Analysis Interactive Lab), a dual-belt treadmill with virtual reality in the self-paced mode. Thirty healthy young adults were randomly allocated to three groups and asked to walk at their preferred speed for 5min. In the first session, the control-group received no intervention, the 'walk-on-the-line'-group was instructed to walk on a line, projected on the between-belt gap of the treadmill and the feedback-group received feedback about their current step width and were asked to reduce it. Interventions started after 1min and lasted 1min. During the second session, 7–10days later, no interventions were given.FindingsLinear mixed modeling showed that interventions did not have an effect on step width after the intervention period in session 1. Initial step width (second 30s) of session 1 was larger than initial step width of session 2. Step width normalized after 2min and variation in step width stabilized after 1min.InterpretationInterventions do not reduce step width after intervention period. A 2-min familiarization period is sufficient to normalize and stabilize step width, in healthy young adults, regardless of interventions. A standardized intervention to normalize step width is not necessary.

http://ift.tt/2w04eg8

Effect of hearing aids on static balance function in elderly with hearing loss

Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Hossein Negahban, Mahtab Bavarsad Cheshmeh ali, Gholamhossein Nassadj
While a few studies have investigated the relationship between hearing acuity and postural control, little is known about the effect of hearing aids on postural stability in elderly with hearing loss. The aim was to compare static balance function between elderly with hearing loss who used hearing aids and those who did not use. The subjects asked to stand with (A) open eyes on rigid surface (force platform), (B) closed eyes on rigid surface, (C) open eyes on a foam pad, and (D) closed eyes on a foam pad. Subjects in the aided group (n=22) were tested with their hearing aids turned on and hearing aids turned off in each experimental condition. Subjects in the unaided group (n=25) were tested under the same experimental conditions as the aided group. Indicators for postural stability were center of pressure (COP) parameters including; mean velocity, standard deviation (SD) velocity in anteroposterior (AP) and mediolateral (ML) directions, and sway area (95% confidence ellipse). The results showed that within open eyes–foam surface condition, there was greater SD velocity in the off-aided than the on-aided and the unaided than the on-aided (p<0.0001 for SD velocity in AP and ML). Also, no significant differences were found between the off-aided and unaided group (p=0.56 and p=0.77 for SD velocity in AP and ML, respectively). Hearing aids improve static balance function by reducing the SD velocity. Clinical implications may include improving hearing inputs in order to increase postural stability in older adults with hearing loss.

http://ift.tt/2uPBTuq

The Impact of the Cosurgeon Model on Bilateral Autologous Breast Reconstruction

J reconstr Microsurg
DOI: 10.1055/s-0037-1604106

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2uPBqsm

Action observation in the modification of postural sway and gait: Theory and use in rehabilitation

Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Mitesh Patel
The discovery of cortical neurons responsive to both the observation of another individual’s movement and one’s own physical movement has spurred scientists into utilising this interplay for rehabilitation. The idea that humans can quickly transfer motor programmes or refine existing motor strategies through observation has only recently gained interest in the context of gait rehabilitation but may offer significant promise as an adjunctive therapy to routine balance training. This review is the first dedicated to action observation in postural control or gait in healthy individuals and patients. The traditional use of action observation in rehabilitation is that the observer has to carefully watch pre-recorded or physically performed actions and thereafter imitate them. Using this approach, previous studies have shown improved gait after action observation in stroke, Parkinson’s disease and knee or hip replacement patients. In healthy subjects, action observation reduced postural sway from externally induced balance perturbations. Despite this initial evidence, future studies should establish whether patients are instructed to observe the same movement to be trained (i.e., replicate the observed action(s)) or observe a motor error in order to produce postural countermeasures. The best mode of motor transfer from action observation is yet to be fully explored, and may involve observing live motor acts rather than viewing video clips. Given the ease with which action observation training can be applied in the home, it offers a promising, safe and economical approach as an adjunctive therapy to routine balance training.

http://ift.tt/2w0gZHV

The effects of ankle braces and taping on lower extremity running kinematics and energy expenditure in healthy, non-injured adults

Effects of interventions on normalizing step width during self-paced dual-belt treadmill walking with virtual reality, a randomised controlled trial

Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): I.L.B. Oude Lansink, L. van Kouwenhove, P.U. Dijkstra, K. Postema, J.M. Hijmans
BackgroundStep width is increased during dual-belt treadmill walking, in self-paced mode with virtual reality. Generally a familiarization period is thought to be necessary to normalize step width.AimThe aim of this randomised study was to analyze the effects of two interventions on step width, to reduce the familiarization period.MethodsWe used the GRAIL (Gait Real-time Analysis Interactive Lab), a dual-belt treadmill with virtual reality in the self-paced mode. Thirty healthy young adults were randomly allocated to three groups and asked to walk at their preferred speed for 5min. In the first session, the control-group received no intervention, the ‘walk-on-the-line’-group was instructed to walk on a line, projected on the between-belt gap of the treadmill and the feedback-group received feedback about their current step width and were asked to reduce it. Interventions started after 1min and lasted 1min. During the second session, 7–10days later, no interventions were given.FindingsLinear mixed modeling showed that interventions did not have an effect on step width after the intervention period in session 1. Initial step width (second 30s) of session 1 was larger than initial step width of session 2. Step width normalized after 2min and variation in step width stabilized after 1min.InterpretationInterventions do not reduce step width after intervention period. A 2-min familiarization period is sufficient to normalize and stabilize step width, in healthy young adults, regardless of interventions. A standardized intervention to normalize step width is not necessary.

http://ift.tt/2w04eg8

Effect of hearing aids on static balance function in elderly with hearing loss

Stable Coronary Syndromes: The Case for Consolidating the Nomenclature of Stable Ischemic Heart Disease.

Author: Berry, Colin MD, PhD

Page: 437-439

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Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: SPRINT (Systolic Blood Pressure Intervention Trial).

Author: Soliman, Elsayed Z. MD, MSc, MS; Ambrosius, Walter T. PhD; Cushman, William C. MD; Zhang, Zhu-ming MD, MPH; Bates, Jeffrey T. MD; Neyra, Javier A. MD, MSCS; Carson, Thaddeus Y. MD; Tamariz, Leonardo MD, MPH; Ghazi, Lama MD; Cho, Monique E. MD; Shapiro, Brian P. MD; He, Jiang MD, PhD; Fine, Lawrence J. MD, DrPH; Lewis, Cora E. MD, MSPH; For the SPRINT Research Study Group

Page: 440-450

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Intensive Blood Pressure Lowering and Regression of Left Ventricular Hypertrophy.

Author: Verdecchia, Paolo MD; Angeli, Fabio MD; Reboldi, Gianpaolo MD, PhD, MSc

Page: 451-453

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Associations Between Adding a Radial Artery Graft to Single and Bilateral Internal Thoracic Artery Grafts and Outcomes: Insights From the Arterial Revascularization Trial.

Author: Taggart, David P. MD, PhD; Altman, Douglas G. DSc; Flather, Marcus MD; Gerry, Stephen MSc; Gray, Alastair PhD; Lees, Belinda BSc, PhD; Benedetto, Umberto MD, PhD; On Behalf of the ART (Arterial Revascularization Trial) Investigators

Page: 454-463

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Human Plasma Thioredoxin-80 Increases With Age and in ApoE-/- Mice Induces Inflammation, Angiogenesis, and Atherosclerosis.

Author: Couchie, Dominique PhD; Vaisman, Boris PhD; Abderrazak, Amna PhD; Mahmood, Dler Faieeq Darweesh PhD; Hamza, Magda M. PhD; Canesi, Fanny; Diderot, Vimala; El Hadri, Khadija PhD; Negre-Salvayre, Anne PhD; Le Page, Aurelie PhD; Fulop, Tamas MD, PhD; Remaley, Alan T. MD, PhD; Rouis, Mustapha PhD

Page: 464-475

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Functional Characterization of the GUCY1A3 Coronary Artery Disease Risk Locus.

Author: Kessler, Thorsten MD *; Wobst, Jana MS *; Wolf, Bernhard MD; Eckhold, Juliane BS; Vilne, Baiba PhD; Hollstein, Ronja MS; von Ameln, Simon PhD; Dang, Tan An MS; Sager, Hendrik B. MD; Moritz Rumpf, Philipp MD; Aherrahrou, Redouane PhD; Kastrati, Adnan MD; Bjorkegren, Johan L.M. MD, PhD; Erdmann, Jeanette PhD; Lusis, Aldons J. PhD; Civelek, Mete PhD; Kaiser, Frank J. PhD; Schunkert, Heribert MD

Page: 476-489

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Should We Perform Catheter Ablation for Asymptomatic Atrial Fibrillation?.

Author: Kalman, Jonathan M. MBBS, PhD; Sanders, Prashanthan MBBS, PhD; Rosso, Raphael MD; Calkins, Hugh MD

Page: 490-499

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Soda Taxes Take Off Across the Country.

Author: Kuehn, Bridget M.

Page: 500-501

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Chest Pain in an 18-Year-Old Man.

Author: Abdelghany, Mahmoud MD; Chaudhary, Arbind MD; Liu, Kan MD, PhD

Page: 502-504

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Letter by Shi et al Regarding Article, "Body Mass Index and Mortality Among Adults Undergoing Cardiac Surgery: A Nationwide Study With a Systematic Review and Meta-Analysis".

Author: Shi, Yu MD; Yu, Hai MD; Yang, Xiao-Yun MD

Page: 505-506

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Letter by Banack et al Regarding Article, "Body Mass Index and Mortality Among Adults Undergoing Cardiac Surgery: A Nationwide Study With a Systematic Review and Meta-Analysis".

Author: Banack, Hailey R. PhD; Stovitz, Steven D. MD, MS; Kaufman, Jay S. PhD

Page: 507-508

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Letter by Butcher et al Regarding Article, "Body Mass Index and Mortality Among Adults Undergoing Cardiac Surgery: A Nationwide Study With a Systematic Review and Meta-Analysis".

Author: Butcher, Anna BMed, MBBS, PhD; Klein, Andrew MBBS; Richards, Toby MBBS, MD

Page: 509

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Response by Mariscalco and Murphy to Letters Regarding Article, "Body Mass Index and Mortality Among Adults Undergoing Cardiac Surgery: A Nationwide Study With a Systematic Review and Meta-Analysis".

Author: Mariscalco, Giovanni MD, PhD; Murphy, Gavin J. MD

Page: 510-511

http://ift.tt/2tT3nfN

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.

Author: Shen, Win-Kuang MD, FACC, FAHA, FHRS, Chair +; Sheldon, Robert S. MD, PhD, FHRS, Vice Chair; Benditt, David G. MD, FACC, FHRS *++; Cohen, Mitchell I. MD, FACC, FHRS ++; Forman, Daniel E. MD, FACC, FAHA ++; Goldberger, Zachary D. MD, MS, FACC, FAHA, FHRS ++; Grubb, Blair P. MD, FACC [S]; Hamdan, Mohamed H. MD, MBA, FACC, FHRS *++; Krahn, Andrew D. MD, FHRS *[S]; Link, Mark S. MD, FACC ++; Olshansky, Brian MD, FACC, FAHA, FHRS *++; Raj, Satish R. MD, MSc, FACC, FHRS *[S]; Sandhu, Roopinder Kaur MD, MPH ++; Sorajja, Dan MD ++; Sun, Benjamin C. MD, MPP, FACEP %7c%7c; Yancy, Clyde W. MD, MSc, FACC, FAHA ++,[P]

Page: e25-e59

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2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.

Page: e60-e122

http://ift.tt/2ueb6o6

Pacing as a Treatment for Reflex-Mediated (Vasovagal, Situational, or Carotid Sinus Hypersensitivity) Syncope: A Systematic Review for the 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.

Author: Varosy, Paul D. MD, FACC, FAHA, FHRS, Chair; Chen, Lin Y. MD, MS, FACC, FAHA, FHRS *; Miller, Amy L. MD, PhD *; Noseworthy, Peter A. MD *; Slotwiner, David J. MD, FACC, FHRS *; Thiruganasambandamoorthy, Venkatesh MBBS *

Page: e123-e135

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Correction to: Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: SPRINT (Systolic Blood Pressure Intervention Trial).

Author:

Page: e136

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Effect of mechanical loading on the metabolic activity of cells in the temporomandibular joint: a systematic review

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http://ift.tt/2tYEFyQ

A comparative intracellular proteomic profiling of Pseudomonas aeruginosa strain ASP-53 grown on pyrene or glucose as sole source of carbon and identification of some key enzymes of pyrene biodegradation pathway

Publication date: Available online 31 July 2017
Source:Journal of Proteomics
Author(s): Ashis K. Mukherjee, Pabitra Bhagowati, Bhim Bahadur Biswa, Abhishek Chanda, Bhargab Kalita
Pseudomonas aeruginosa strain ASP-53, isolated from a petroleum oil-contaminated soil sample, was found to be an efficient degrader of pyrene. PCR amplification of selected hydrocarbon catabolic genes (alkB gene, which encodes for monooxygenase, and the C12O, C23O, and PAH-RHDα genes encoding for the dioxygenase enzyme) from the genomic DNA of P. aeruginosa strain ASP-53 suggested its hydrocarbon degradation potential. The GC–MS analysis demonstrated 30.1% pyrene degradation by P. aeruginosa strain ASP-53 after 144h of incubation at pH6.5, 37°C. Expressions of 115 and 196 intracellular proteins were unambiguously identified and quantitated by shotgun proteomics analysis when the isolate was grown in medium containing pyrene and glucose, respectively. The pyrene-induced uniquely expressed and up-regulated proteins in P. aeruginosa strain ASP-53 in addition to substrate (pyrene) metabolism are also likely to be associated with different cellular functions for example-related to protein folding (molecular chaperone), stress response, metabolism of carbohydrate, proteins and amino acids, and fatty acids; transport of metabolites, energy generation such as ATP synthesis, electron transport and nitrate assimilation, and other oxidation-reduction reactions. Proteomic analyses identified some important enzymes involved in pyrene degradation by P. aeruginosa ASP-53 which shows that this bacterium follows the salicylate pathway of pyrene degradation.SignificanceThis study is the first report on proteomic analysis of pyrene biodegradation pathway by Pseudomonas aeruginosa, isolated from a petroleum-oil contaminated soil sample. The pathway displays partial similarity with deduced pyrene degradation mechanisms of Mycobacterium vanbaalenii PYR-1. The GC–MS analysis as well as PCR amplification of hydrocarbon catabolic genes substantiated the potency of the bacterium under study to effectively degrade high molecular weight, toxic PAH such as pyrene for its filed scale bioremediation experiments. The proteomics approach (LC-MS/MS analysis) identified the differentially regulated intracellular proteins of the isolate P. aeruginosa ASP-53 when grown in pyrene medium. This study identified some important pyrene biodegradation enzymes in Pseudomonas aeruginosa ASP-53 and highlights that the bacterium follows salicylate pathway for pyrene degradation.

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Synovial sarcoma showing loss of a green signal in SS18 fluorescence in situ hybridization: a clinicopathological and molecular study of 12 cases

Abstract

The phenomenon of losing a green signal in synovial sarcoma (SS) using the SS18 break-apart probe by fluorescence in situ hybridization (FISH) has been poorly described. In this study, 12 SS with missing a green signal were identified. This series included 7 males and 5 females, aged 17 to 69 years (median, 38.5 years). The tumors involved the extremities (50%), mediastinum (16.7%), hypopharynx (8.3%), neck (8.3%), thyroid (8.3%), and retroperitoneum (8.3%). The tumors were classified as monophasic SS (58.3%) and poorly differentiated SS (41.7%). An anaplastic SS showing features of pleomorphic sarcoma was observed. Immunostaining for TLE1, BCL2, CD99, epithelial membrane antigen, cytokeratin (AE1/AE3), cytokeratin 7, S-100 protein, and CD34 was consistent with typical SS. In FISH, all the tumors showed the pattern of 1 to 3 fused signal(s) with 1 to 3 red signal(s), without corresponding a green signal. The fusion transcripts included SS18-SSX1 (8/10, 80%) and SS18-SSX2 (2/10, 20%) fusions. Median and 5-year overall survival were 19.1 months and 43.6%, respectively. In conclusion, we reported a series of SS losing a green signal in the SS18 FISH assay. We propose that this variant FISH pattern should be interpreted as a peculiar unbalanced rearrangement of the SS18 gene and subsequent SS18-SSX fusion test should be recommended. The cases in this study seem to show some unusual clinicopathological features, including unusual locations, higher proportions of poorly differentiated SS, and aggressive clinical course. However, whether this variant FISH pattern is associated with peculiar clinicopathologic features awaits larger series.

http://ift.tt/2wfqTo9

ΒΟΗΘΗΜΑΤΑ ΑΚΟΗΣ ΑΚΟΥΣΤΙΚΑ ΒΑΡΗΚΟΙΑΣ ΕΝΙΣΧΥΤΕΣ ΑΚΟΗΣ ΑΤΟΚΕΣ ΔΟΣΕΙΣ

ΒΟΗΘΗΜΑΤΑ ΑΚΟΗΣ ΑΚΟΥΣΤΙΚΑ ΒΑΡΗΚΟΙΑΣ ΕΝΙΣΧΥΤΕΣ ΑΚΟΗΣ ΑΤΟΚΕΣ ΔΟΣΕΙΣ

! # Ola via Alexandros G.Sfakianakis on Inoreader

Δευτέρα, 31 Ιουλίου 2017

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