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61.
Asgeir Store Jakola Geirmund Unsgård Kristin Smistad Myrmel Roar Kloster Sverre Helge Torp Ole Kristian Losvik Sigurd Lindal Ole Solheim 《Acta neurochirurgica》2013,155(12):2227-2235
Background
We recently demonstrated a survival benefit of early resection in unselected diffuse low-grade gliomas (LGG). However, heterogeneity within the LGG entity warrants investigation in a homogenous subgroup. Astrocytoma represents the largest subgroup of LGG, and is characterized by diffuse growth and inferior prognosis. We aimed to study the effects of early resection compared to biopsy and watchful waiting in this subgroup.Methods
Patient data was retrospectively reviewed in two neurosurgical departments with regional referral practice. In one hospital, initial diagnostic biopsies and watchful waiting was favored, while early resections guided with three-dimensional (3D) ultrasound were advocated in the other hospital. This created a natural experiment with patient management heavy influenced by residential address. In the hospitals’ histopathology databases, all adult patients diagnosed with supratentorial LGG from 1998 through 2009 were screened (n?=?169) and underwent blinded histopathological review. Histopathological review concluded with 117 patients with grade II astrocytomas that were included in the present study. The primary end-point was overall survival assessed by a regional comparison.Results
Early resections were performed in 51 (82 %) versus 12 (22 %) patients in the respective hospitals (p?<?0.001). The two patient populations were otherwise similar. Median survival was 9.7 years (95 % CI 7.5–11.9) if treated in the hospital favoring early resections compared to 5.6 years (95 % CI 3.5–7.6) if treated at the hospital favoring biopsy and watchful waiting (p?=?0.047). No difference in surgical-related neurological morbidity was seen (p?=?0.843).Conclusions
Early 3D ultrasound guided resections improve survival, apparently without increased morbidity, compared to biopsy and watchful waiting in patients with diffuse World Health Organization (WHO) grade II astrocytomas. 相似文献62.
Wagner M Bjerkvig R Wiig H Melero-Martin JM Lin RZ Klagsbrun M Dudley AC 《Angiogenesis》2012,15(3):481-495
Tumor-associated stroma is typified by a persistent, non-resolving inflammatory response that enhances tumor angiogenesis, growth and metastasis. Inflammation in tumors is instigated by heterotypic interactions between malignant tumor cells, vascular endothelium, fibroblasts, immune and inflammatory cells. We found that tumor-associated adipocytes also contribute to inflammation. We have analyzed peritumoral adipose tissue in a syngeneic mouse melanoma model. Compared to control adipose tissue, adipose tissue juxtaposed to implanted tumors exhibited reduced adipocyte size, extensive fibrosis, increased angiogenesis and a dense macrophage infiltrate. A mouse cytokine protein array revealed up-regulation of inflammatory mediators including IL-6, CXCL1, MCP-1, MIP-2 and TIMP-1 in peritumoral versus counterpart adipose tissues. CD11b(+) macrophages contributed strongly to the inflammatory activity. These macrophages were isolated from peritumoral adipose tissue and found to over-express ARG1, NOS2, CD301, CD163, MCP-1 and VEGF, which are indicative of both M1 and M2 polarization. Tumors implanted at a site distant from subcutaneous, anterior adipose tissue were strongly growth-delayed, had fewer blood vessels and were less populated by CD11b(+) macrophages. In contrast to normal adipose tissue, micro-dissected peritumoral adipose tissue explants launched numerous vascular sprouts when cultured in an ex vivo model. Thus, inflamed tumor-associated adipose tissue fuels the growth of malignant cells by acting as a proximate source for vascular endothelium and activated pro-inflammatory cells, in particular macrophages. 相似文献
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Justus Gille Gerhard Heinrichs Andreas Unger Helge Riepenhof Jan Herzog Benjamin Kienast Ralf Oheim 《International orthopaedics》2013,37(1):77-82
Purpose
We present a new technique of arthroscopic-assisted AC-hook plate fixation for acromioclavicular joint dislocation with all the advantages of minimally invasive surgery and the possibility to treat concomitant pathologies.Methods
Initially a glenohumeral arthroscopy is performed to address concomitant intra-articular injuries. Under subacromial visualisation the drill hole for the hook of the plate can be exactly positioned in the acromion. The hook plate is put in place under visual control.Results
The initial results (n = 3) are promising with good to excellent results in the Constant score [90.5 (range 82–100)] in all cases studied. The cross-body test was slightly positive in one case. The median follow-up time after the index procedure was seven months (range five to ten).Conclusions
In conclusion, arthroscopic-assisted reconstruction of acromioclavicular joint separation is feasible and may provide patients with all the benefits of AC-hook fixation with decreased risks related to open surgery. The described technique is recommended for all surgeons familiar with arthroscopic surgery. 相似文献66.
Helge H. Müller Udo Reulbach Juan Manuel Maler Johannes Kornhuber Wolfgang Sperling 《Journal of neural transmission (Vienna, Austria : 1996)》2013,120(10):1507-1510
In the present study, the effects of vagus nerve stimulation (VNS) on the resting motor threshold (rMT) of patients treated with repetitive transcranial magnetic stimulation were evaluated. Patients showed a significant decrease in the rMT during VNS-on stimulation. VNS was the only significant factor affecting rMT changes and did not appear to be a static variable. Further studies should focus on the effect of VNS on neural neurogenesis in depressive disorders, and the effects of other treatment options for major depressive disorder on the rMT should also be determined. 相似文献
67.
Jarle Eid Gerry Larsson Bjørn Helge Johnsen Jon Christian Laberg Paul T. Bartone Berit Carlstedt 《Nordic journal of psychiatry》2013,67(5):426-432
Background: Despite the widespread use of the Impact of Event Scale to measure post-traumatic stress symptoms, psychometric evaluations of the scale have revealed mixed findings. Aim: The aim of the present study is to provide new empirical evidence and examine the factor structure, reliability, and predictive validity of the Norwegian version of the IES-R. Methods: Posttraumatic stress symptoms were recorded in a student sample (n=312) 3 weeks after the Southeast Asian tsunami disaster in December 2004. Confirmatory factor analyses of the IES-R behavior items using structural equation modeling (SEM) were performed on four models from existing research. Results: The original three-factor model of intrusion, avoidance and hyperarousal symptoms exhibited the best goodness-of-fit indices when defined as oblique. The IES-R also revealed satisfactory reliability. Symptom levels of intrusion and avoidance were moderate, while hyperarousal scores were low, with a significant gender difference. Conclusion: Taken together, the IES-R revealed good psychometric properties in this nonclinical student sample and could be a useful instrument to assess and follow-up on PTSD symptoms after a certain identified trauma. 相似文献
68.
Cecilie Javo John A. Rønning Bjørn Helge Handegård Floyd W. Rudmin 《Nordic journal of psychiatry》2013,67(2):178-187
In a 7-year follow-up birth cohort from the general population in the Sami core area in Finnmark, Arctic Norway, we examined mothers’ and teachers’ reports of social competence and emotional/behavioral problems among 71 indigenous Sami and 77 Norwegian 11–12-year-olds. The instruments used were the Child Behavior Checklist (CBCL) for parents and the Teacher Report Form (TRF). No ethnic differences were found on competence scales. Total Problems reported by Sami and Norwegian mothers were low in comparison with the overall mean found in multicultural meta-studies. Sami mothers reported lower Total Problems and Attention Problems than did Norwegian mothers. There were no ethnic differences on the TRF measures. Consistent with other international studies, mothers and teachers rated girls higher than boys on social competence and boys higher than girls on Externalizing and Attention Problems. Gender differences were larger on the TRF than on the CBCL. The very low problem ratings made by the Sami mothers indicate that there is a need for specific clinical cut-off points to distinguish between clinically referred and non-referred children in this indigenous Arctic population. 相似文献
69.
Helene A. Nissen-Lie Jon Trygve Monsen Michael Helge Rønnestad 《Psychotherapy research》2013,23(6):627-646
Abstract The present study investigated whether and how various therapists' (N=68) self-reported characteristics relating to their therapeutic work predicted patients' (N = 335) early ratings of the working alliance in a naturalistic psychotherapy study. Results from multilevel modeling demonstrated that certain self-reports accounted well for the therapist effect in the early alliance. The effect of therapists' experiences of difficulties in practice was particularly strong: a negative influence of difficulties termed negative personal reaction (NPR) and a surprising positive influence of another factor, professional self-doubt (PSD), were found. The latter was interpreted as reflecting an attitude of therapist humbleness and sensitivity, which seems to facilitate alliance development. A negative impact of self-reported skills in using one's own and the patients' emotional reactions in the therapeutic relationship (advanced relational skills) was found when controlling for a warm interpersonal style. The negative effect of advanced relational skills depended on the level of NPR difficulties. The findings suggest that therapists should be cautious in using this kind of relational skill unless they experience relating to patients in a warm manner and report low levels of NPR in their practice. 相似文献
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