Evaluation of sentinel lymph nodes in vulvar, endometrial and cervical cancers

Sentinel lymph node(SLN) biopsies are a sensitive tool in evaluating lymph nodes for multiple cancers, and in some diseases they decrease morbidity in both the short- and long-term. SLN detection in gynecologic malignancies has been studied extensively over the past decade. We review the current literature on SLN dissection in vulvar, endometrial and cervical cancers. Large, well-designed trials in each of the three types of cancer have demonstrated high sensitivity and low false-negative rates when SLN biopsy is performed in the correct patients and with an appropriate technical approach. In all of these cases the addition of ultrastaging to conventional pathology yields increased detection of micrometastatic disease. Biopsy of the sentinel nodes is feasible and safe in early vulvar malignancies, with multiple studies describing low recurrence rates in those women who have with negative SLNs. There does not appear to be a survival benefit to lymphadenectomy over SLN biopsy and quality of life is improved in women undergoing SLN biopsy. Optimal treatment strategies for women with positive nodal biopsies, particularly in cases with micrometastatic disease, remain unclear. Multiple large studies investigating the utility of SLN biopsy in endometrial malignancy have found that sentinel nodal status is a reliable predictor of metastases in women with low-risk disease. Prospective studies are ongoing and suggest sentinel nodal detection may soon become widely accepted as an alternative standard of care for select cases of endometrial cancer. In cervical cancer, SLN biopsy is accurate for diagnosing metastatic disease in early stage tumors(≤ 2 cm diameter or stage ≤ IB2) where the risk of metastasis is low. It is unknown if women who undergo SLN biopsy alone will have different survival outcomes than women who undergo complete lymphadenectomy in these cases. In a specific population of women with vulvar cancer, SLN dissection is an effective and safe alternative to complete dissection. It can be offered as an alternative management strategy in these women. In women who do undergo SLN biopsy, it is associated with improved quality of life. Promising evidence supporting the utility of SLN dissection in endometrial and cervical cancer continues to emerge, and it may soon become a reasonable option for select patients. However, continued research and refinement of appropriate patient selection and long-term follow-up are necessary.

Therapeutic Effects of Myriocin in Experimental Alcohol-Related Neurobehavioral Dysfunction and Frontal Lobe White Matter Biochemical Pathology

Background & Objective: Chronic excessive alcohol consumption causes white matter degeneration with myelin loss and impaired neuronal conductivity. Subsequent rarefaction of myelin accounts for the sustained deficits in cognition, learning, and memory. Correspondingly, chronic heavy or repeated binge alcohol exposures in humans and experimental models alter myelin lipid composition leading to build-up of ceramides which can be neurotoxic and broadly inhibitory to brain functions. Methods: This study examined the effects of chronic + binge alcohol exposures (8 weeks) and intervention with myriocin, a ceramide inhibitor, on neurobehavioral functions (Open Field, Novel Object Recognition, and Morris Water Maze tests) and frontal lobe white matter myelin lipid biochemical pathology in an adult Long-Evans rat model. Results: The ethanol-exposed group had significant deficits in executive functions with increased indices of anxiety and impairments in spatial learning acquisition. Myriocin partially remediated these effects of ethanol while not impacting behavior in the control group. Ethanol-fed rats had significantly smaller brains with broadly reduced expression of sulfatides and reduced expression of two of the three sphingomyelins detected in frontal white matter. Myriocin partially resolved these effects corresponding with improvements in neurobehavioral function. Conclusion: Therapeutic strategies that support cerebral white matter myelin expression of sulfatide and sphingomyelin may help remediate cognitive-behavioral dysfunction following chronic heavy alcohol consumption in humans.

Role of human papillomavirus in oropharyngeal squamous cell carcinoma: A review

Human papillomavirus(HPV) has been implicated in the pathogenesis of a subset of oropharyngeal squamous cell carcinoma. As a result, traditional paradigms in relation to the management of head and neck squamous cell carcinoma have been changing. Research into HPVrelated oropharyngeal squamous cell carcinoma is rapidly expanding, however many molecular pathological and clinical aspects of the role of HPV remain uncertain and are the subject of ongoing investigation. A detailed search of the literature pertaining to HPV-related oropharyngeal squamous cell carcinoma was performed and information on the topic was gathered. In this article, we present an extensive review of the current literature on the role of HPV in oropharyngeal squamous cell carcinoma, particularly in relation to epidemiology, risk factors, carcinogenesis, biomarkers and clinicalimplications. HPV has been established as a causative agent in oropharyngeal squamous cell carcinoma and biologically active HPV can act as a prognosticator with better overall survival than HPV-negative tumours. A distinct group of younger patients with limited tobacco and alcohol exposure have emerged as characteristic of this HPV-related subset of squamous cell carcinoma of the head and neck. However, the exact molecular mechanisms of carcinogenesis are not completely understood and further studies are needed to assist development of optimal prevention and treatment modalities.

Additional responsibility for physicians caring for cardiac patients: Insight from a case series

Resuscitation measures performed at the scene of the event have the ultimate impact on the outcome of a cardiac arrest. We analysed six case histories of those sudden cardiac arrest patients who were revived in the field and were subsequently admitted to the intensive care unit during a six-month period. All were known cardiac patients and were under the care of healthcare providers. Four of those were discharged home from the hospital and did not suffer any residual damage where as one died of multi-organ failure and the other was declared brain dead. The outcome was good in patients who received early intervention in the form of basic life support. The family members of non-survivors witnessed the cardiac arrest at home but were not familiar with the concept or procedures of basic life support. We propose that physicians who care for cardiac patients should undertake the task of increasing family member awareness and knowledge in the techniques of basic life support.

Early pregnancy maternal cardiovascular profiling in the prediction of hypertensive disease in pregnancy

Prediction of hypertensive disease in pregnancy remains challenging. Risk factor based screening utilizing history, physical characteristics, uterine artery Doppler and serum markers have been used with varying success. As hypertension in pregnancy appears to be associated with changes in the maternal vasculature, we have investigated the utility of maternal arterial elasticity measurement, prior to 20 weeks gestation, in the prediction of hypertensive disease in pregnancy. A HDI/Pulsewave CR2000 Research Cardiovascular Profiling System was used to obtain radial artery pulse pressure waveforms from 623 Caucasian women at the time of their first antenatal visit. Outcome data were available in 610 cases and these comprised the study group. The results showed that women who subsequently developed gestational hypertension (n = 20) had higher baseline systolic, diastolic and pulse pressure values (though within the normal range) but similar arterial elasticity to those patients who did not develop hypertension. Women who later developed pre-eclampsia (n = 23) had, in addition, reduced large artery elasticity and increased systemic vascular resistance compared with women who did not develop hypertension. The measurement of maternal radial artery elasticity in early pregnancy may provide an additional refinement in screening for hypertensive disease, particularly pre-eclampsia, in pregnancy.

Developmental Dysplasia of the Hip: Management of Graf IIa Dysplastic Hip

Developmental Dysplasia of the Hip (DDH) describes a wide range of anatomic abnormalities of the growing hips which might result in permanent abnormal gait. Therefore, early detection and management is crucial to improve the outcome and minimise the risk of osteoarthritis in later life. Hip ultrasound is used to evaluate DDH based on Graf classification. Graf score is a widely used ultrasound grading score to evaluate DDH in infants. There is conflicting evidence regarding the management of the developmentally immature Graf type IIa hip. Some physicians adopt watchful waiting for natural maturation of hips while other early treatment. This article will provide an evidence-based review on the management modalities of the Graf type IIa hip.

婴儿腹痛和喂养困难间的相关性

目的:研究婴儿腹痛和喂养困难之间的关系,及两者对患儿父母的抚养能力的影响。方法:共收集出生6-8个月的婴儿病例(及其母亲)43例。根据改良Wessel婴儿腹痛诊断三项标准,将所有病例分成患儿组(n=19)和对照组(n=24)。分别在实验室和儿科放射检查室,两次评价患儿病情。观察指标:婴儿口部运动熟练度的临床评估,喂养时母婴间的相互行为。

双重用药治疗停服阿片药物后出现的神经行为反应的疗效

A partially randomised, controlled trial was performed to test the hypothesis that opiate exposed infants treated with diluted tincture of opium (DTO) and phenobarbital would have better neurobehavioral scores than infants treated with DTO alone. Compared with those treated with DTO alone (n = 15), infants treated with DTO and phenobarbital (n = 17)were more interactive, had smoother movements, were easier to handle, and less stressed. Dual treatment results in improved neurobehavioral organisation during the first three weeks of life, which may indicate a more rapid recovery from opiate withdrawal.

头颅超声检查结果正常的极低出生体重儿的不良神经发育结局:流行病学和先导性研究

Objective. Severe abnormalities of the head ultrasound (HUS)-are important predictors of cerebral palsy (CP) and mental retardation, and a normal HUS usually ensures the absence of major impairments. With the increasing survival of extremely low birth weight (ELBW) infants (birth weight < 1000 g), the prognostic significance of a normal HUS may differ. This study examined the prevalence of and risk factors for CP and impaired mental development among ELBW infants with a normal HUS. Methods. Study infants were ELBW infants who were cared for in Neonatal Research Network centers in the years 1995-1999, had a normal early and late HUS, survived to discharge, and returned for follow-up assessments at 18 to 22 months’corrected age. The outcomes of interest were a score < 70 on the Bayley Scales of Infant Development-II Mental Developmental Index (MDI) and CP. Risk factors included maternal demographics; infant characteristics; and interventions or morbidities related to the lung, infection, and nutrition. Logistic regression was used to estimate odds ratios (ORs) and 95%confidence intervals (CIs). A time-oriented approach was used to select variables for inclusion in logistic models. Results. Of 1749 infants with a normal early and late HUS (performed at a mean age of 6 and 47 days, respectively), 1473 (84%) returned for follow-up assessment. Infants had a birth weight of 792 ±134 g (mean ±SD) and gestational age of 26 ±2 weeks. Rates of CP and MDI < 70 were 9.4%and 25.3%, respectively, and 29.2%of infants had either CP or MDI < 70. In multivariate analyses, factors associated with CP were male gender (OR: 1.8; 95%CI: 1.2-2.6),multiple birth, (OR: 1.6; 95%CI: 1.1-2.5), decreasing birth weight (OR: 1.3 for each 100-g decrease; 95%CI: 1.1-1.5), pneumothorax (OR: 2.3; 95%CI: 1.2-4.4), and days of conventional ventilation (OR: 1.2 for each additional 10 days; 95%CI: 1.1-1.3). With the exception of pneumothorax, these same factors were associated with MDI < 70, in addition to less maternal education (OR: 1.4; 95%CI: 1.0-1.9) and Medicaid or lack of coverage for maternal insurance (OR: 1.7; 95%CI: 1.2-2.4). Conclusions. Nearly 30%of ELBW infants with a normal HUS had either CP or a low MDI. Risk factors that are associated with this high rate of adverse outcomes include pneumothorax, prolonged exposure to mechanical ventilation, and educational and economic disadvantage. Improvements in pulmonary care to reduce duration of ventilation and avoid air leaks might improve neurodevelopmental outcome for ELBW infants.

Assessment of Bronchodilator Response in Children with Asthma Exacerbation Using the Respiratory Resistance Values

Sixty-four pediatric patients with asthma exacerbation were studied. The children were subjected to respiratory resistance evaluation using the Airflow Perturbation Device (APD) and spirometry evaluation. They were then administered albuterol and 15 minutes later the APD and spirometry evaluations were repeated. Eleven of the children could not perform spirometry. The APD results demonstrated that respiratory resistance of the patients decreased by about 20%, indicating that the APD could detect the expected response to bronchodilator. However, no similar conclusion could be made with the spirometry parameters (FVC, FEV1, FEV1/FVC, and FEF25% - 75%) performed on the same patients. The differences on the spirometry parameters did not change significantly before and after bronchodilator administration. Furthermore, these differences were negligibly increased or decreased for some with no consistency between the FVC, FEV1, FEV1/FVC, and FEF25% - 75%. Even though all the children were clinically improved after albuterol administration and discharged home, this could not be demonstrated by spirometry data. This study validates previous reports that spirometry is not a reliable pulmonary diagnostic tool for young children, as spirometry is highly effort-dependent and requires a substantial degree of patient cooperation. APD on the other hand is a reliable, simple, effortless diagnostic tool that can be utilized in evaluation and management of children with asthma symptoms and exacerbation.

Impacts of assisted reproductive technology on perinatal outcomes and offspring health

Assisted reproductive technology(ART)has evolved rapidly over the last 40 years,offering hope to individuals and couples struggling with infertility.As technology continues to evolve,simulating a realistic female reproductive system environment has become a common goal for all types of ARTs,thereby reducing the impact of the artificial microenvironment on perinatal and offspring health.In this review,we provide a brief history of the development of each major ART and discuss the impact of ART on perinatal and offspring health.We also explore how the negative consequences of ART may be overcome and how its benefits can be maximized.

A New Mutation Identified by Whole Exome Sequencing in a Cornelia de Lange Syndrome Newborn

To the Editor：Cornelia de Lange syndrome （CdLS,OMIM # 122470）,also called Brachmann-de Lange syndrome,is a serious genetic disease with unknown exact incidence.The estimated prevalence varies with a reported 1：10,000 individuals in the United States and 1：50,000 in Denmark.It may be underestimated because ofunderdiagnosis of mild phenotype.CdLS patients have a distinguishing facial appearance,namely synophrys joining at the midline and with an arched appearance of the eyebrows,thick,and long eyelashes,extending down to the bridge of the nose,long prominent philtrum with down-turned lip comers short and flattened nose,hirsute forehead,and cutis marmorata.Besides,prenatal/postpartum growth retardation,cognitive impairment,psychomotor delay,and behavioral problems such as repetitive and self-injurious behaviors are also remarkable in CdLS patients.