Transpetrosal approach: an anatomical study of temporal bone

Resection of the petrous temporal bone to various degrees provides different levels of access to lesions of the posterior fossa. However, regarding the numerous variations, precise distances of petrosal bone are not still clearly described. This may lead to serious complications during transpetrosal surgeries. Our objective was to evaluate different distances of temporal bone landmarks in order to assess their variations and the possible correlations between them. This anatomical study was performed on 60 temporal bones from 60 human cadavers in the years 2006 and 2007. All the bones contained an adequate portion of the petrous apex and attached fossa dura. Twelve landmarks were defined and 27 different distances were measured for each temporal bone using two-point caliper. Less variation was observed in the superoinferior diameter of horizontal carotid canal with the less coefficient of variation (CV) of 9.29; whereas, the most variation was detected in the inferior (axial) plane of posterior semicircular canal to superior plane of jugular bulb (CV = 57.65). There was a significant correlation between vertical intratemporal diameter of carotid in pyramidal direction, and superior–inferior diameter of horizontal carotid canal (r _Pearson = 0.500, P < 0.001). Other significant correlations were also found between other distances. The variations of different distances and landmarks were evaluated and many significant correlations were demonstrated between them which could potentially aid ENT specialists and neurosurgeons in order to approach anatomical landmarks and cranial fossas more safely during otologic and neurotologic surgeries. It could also help the design of middle ear prosthesis.     

Bidirectionally adjustable TIPS reduction by parallel stent and stent-graft deployment

Excessive shunting through transjugular intrahepatic portosystemic shunts (TIPS) can cause life-threatening hepatic encephalopathy and insufficiency. Intentional reduction of flow may be effective but difficult to control. The present report describes refinements of the parallel stent/stent-graft technique of flow reduction that is adjustable in either direction. Six patients underwent TIPS reduction with varying stent positioning and a variety of commercial products. Flow was adjusted by iterative balloon dilatation of the stent and stent-graft, resulting in a mean gradient increase of 8 mm Hg. All cases were technically successful, but 1-year survival was seen in only the patient who underwent liver transplantation.     

Oral immunization with recombinant Lactococcus lactis NZ9000 expressing human papillomavirus type 16 E7 antigen and evaluation of its immune effects in female C57BL/6 mice

The ORFs of both native and codon-optimized E7 genes were successfully fused to SPusp45 signal peptide and expressed by a nisin-controlled gene expression system in the NZ9000 strains of Lactococcus lactis. Recombinant strains were confirmed by Western blot analysis. To measure immune responses against the E7 antigen, specific-pathogen-free C57BL/6 mice were inoculated with L lactis harboring pNZ8123-rE7 by oral gavage. Then, specific antibodies and cytokines were measured by enzyme-linked immunosorbent assay and enzyme-linked immunospot assay, respectively. Oral administration of L lactis strains expressing rE7 elicited the highest levels of E7-specific antibody and greatest numbers of E7-specific CD4⁺ T helper and CD8⁺ T cell precursors. Our outcomes indicated that the HPV-16 E7 specific IL-2- and IFN-γ-secreting T cells in antigen-stimulated splenocytes and intestinal mucosal lymphocytes were significantly higher than the control groups. Our data also demonstrated that mice vaccinated with recombinant L lactis were able to generate potent protective effects against challenge with the E7-expressing tumor cell line (TC-1). Moreover, L lactis containing pNZ8123-HPV16-optiE7 showed strong therapeutic antitumor effects against established tumors in vivo. These findings demonstrate that recombinant L lactis induce both humoral and cellular immune responses in mice and are therefore recommended for therapeutic treatments in humans after oral administration.     

Patient-Specific Numerical Analysis of Coronary Flow in Children With Intramural Anomalous Aortic Origin of Coronary Arteries

A summary of the steps conducted for patient-specific computational analysis of AACOA in the current investigation included model reconstruction from cardiac magnetic resonance imaging (CMR) data, mesh generation with local refinements on the ostial region and left main coronary artery (LMCA) bifurcation, assigning multiscale boundary conditions, and postprocessing of resulting hemodynamics to visualize and quantify changes in coronary artery velocity and indices of wall shear stress (WSS). Six AAOCA patients (3 left, 3 right) status post unroofing (median = 13.5 years) underwent CMR. Timing of post-MRI ranged from 3 months-6 years (mean 2.9 years). Computational fluid dynamics (CFD) models were created from pre (n = 2) and postunroofing (n = 6) CMR data. Mesh generation was performed and locally refined until it was properly representative of the geometry. Parameters of the boundary conditions were determined so that physiologic pressure and flow waveforms were achieved. Results showed that: (1) time averaged wall shear stress (TAWSS) was higher preoperatively due to more skewed velocity profiles along the length of the angulated anomalous arteries, (2) unroofing may normalize WSS, and (3) changes in AO led to significant alterations in the local flow patterns and hemodynamics. These findings suggest that acute AO creates abnormal coronary flow patterns and hemodynamics that could leave patients more susceptible to the early onset and progression of atherosclerosis and ultimately may help explain myocardial morbidity associated with intramural AAOCA. Future studies with a larger cohort will allow for a correlation analysis between hemodynamic indices and patient outcomes to predict the patients’ future risk for ischemia or morbidity.

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Factors that influence cancer patients' anxiety following a medical consultation: impact of a communication skills training programme for physicians.

BACKGROUND: No study has yet assessed the impact of physicians' skills acquisition after a communication skills training programme on the evolution of patients' anxiety following a medical consultation. This study aimed to compare the impact, on patients' anxiety, of a basic communication skills training programme (BT) and the same programme consolidated by consolidation workshops (CW), and to investigate physicians' communication variables associated with patients' anxiety. PATIENTS AND METHODS: Physicians, after attending the BT, were randomly assigned to CW or to a waiting list. The control group was not a non-intervention group. Consultations with a cancer patient were recorded. Patients' anxiety was assessed with the State Trait Anxiety Inventory before and after a consultation. Communication skills were analysed according to the Cancer Research Campaign Workshop Evaluation Manual. RESULTS: No statistically significant change over time and between groups was observed. Mixed-effects modelling showed that a decrease in patients' anxiety was linked with screening questions (P = 0.045), physicians' satisfaction about support given (P = 0.004) and with patients' distress (P < 0.001). An increase in anxiety was linked with breaking bad news (P = 0.050) and with supportive skills (P = 0.013). No impact of the training programme was observed. CONCLUSIONS: This study shows the influence of some communication skills on the evolution of patients' anxiety. Physicians should be aware of these influences.     

Factors limiting and favoring communication and information in oncology

The authors discuss actual concepts about the transmission of information to the patient and his family in oncology. After the discussion of problems related to the emission and reception of information, they introduce the useful strategies designed in order to achieve an optimal transmission of information, and to improve doctor-patient communication.