The Treatment of Medically Intractable Trigeminal Autonomic Cephalalgia With Supraorbital/Supratrochlear Stimulation: A Retrospective Case Series

Introduction: This is a retrospective case series of five patients with intractable trigeminal autonomic cephalalgia (TAC) who were implanted with a supraorbital/supratrochlear neuromodulation system. Objectives: The aim of this Institutional Review Board–approved study was to investigate the percentage of pain relief, treatment response, pain level, work status, medication intake, implantation technique, lead placement, programming information, and device use. Results: Trial stimulation led to implantation of all five patients. All patients reported improvement in their functional status in regard to activities of daily living. The device was revised in two patients due to skin erosion. It was later reimplanted in both patients due to worsening of symptoms, again with good pain relief. The device was explanted in two other patients because of the need to perform a magnetic resonance imaging or implant an automatic implantable cardioverter defibrillator. The follow‐up of the patients ranged between 18 months and 36 months, with a mean of 25.2 months. There was no change in work status. Following the implant, the Visual Analog Scale score was reduced to a mean of 1.6 from an initial mean score of 8.9. Three patients were completely weaned off opioid medications, while two patients continued to take opioid at a lower dosage. All patients experienced a decrease of the adjuvant neuropathic drugs. Conclusion: Supraorbital/supratrochlear nerve stimulation appears to be a promising modality for the treatment of patients with intractable TAC.     

Age determination of adult individuals by three-dimensional modelling of canines

Accurate age determination is fundamental in both forensic medicine and anthropology. Many methods that relate dental characteristics to adult age have been proposed, but there is still no simple and reliable method that does not damage the study material. The aim of this work was to propose a relevant and practical technique for determining age in adults that could be used in both living and deceased individuals. The sample was composed of 210 CT scans from individuals aged from 15 to 85 years old, with four healthy canines present in the mouth. The 840 canines were modelled using Mimics® 10.01 software. The pulp volume/total volume ratio ×100 was determined for each tooth. Seven mathematical models, corresponding to all possible real situations, were determined by the weighted least squares method and ranked in order of relative performance. The adequacy of the seven models to the data was very high with the regressions proposed (0.915?<?R ² _adjusted?<?0.964). Ranked in order of performance, the maxillary model was the most powerful of the seven models for age determination, followed by the 4 canines model, the 13 model and the 23 model.     

Midterm Outcomes of Revisional Surgery for Gastric Pouch and Gastrojejunal Anastomotic Enlargement in Patients with Weight Regain After Gastric Bypass for Morbid Obesity

Reoperative surgery for the morbidly obese has become increasingly common due to postoperative weight regain. There are limited studies evaluating the effectiveness of revisional surgery. This study evaluates the weight loss outcomes of revisional surgery over a 2-year period at our University Hospital, USA. Of the 412 patients who underwent laparoscopic bariatric surgery between June 2009 and June 2011, we identified 25 patients who had Roux-en-Y gastric bypass (RYGB) originally, who underwent laparoscopic revisional surgery for weight regain. Preoperative and postoperative data were reviewed. Statistical analysis was performed using paired t test. This study includes 0 male and 25 female patients with an average age of 42 (range min to max: 28–58), mean original body mass index (BMI) of 54.6 kg/m² (r?=?37.3–80.7), average lowest BMI achieved of 32.2 (r?=?20.1–50.9), and average BMI at the time of revision of 41.0 kg/m² (r?=?29.5–60.7, standard deviation (SD)?=?8.5). All laparoscopic revisions consisted of resizing the gastric pouch by resection and recreating the gastrojejunostomy. Average hospital length of stay was 1.28 days (r?=?1–4). Perioperative morbidity was 8 %; one patient developed a trocar site hernia which required repair, and another suffered postoperative bleeding requiring transfusion. There was no mortality. Postoperative BMI averages at 3, 6, 9, 12, and 24 months were 35.0 (SD?=?7.15), 34.7 (SD?=?4.26), 36.2 (SD?=?7.63), 33.0 (SD?=?6.58), and 44.2 (SD?=?12.87), respectively. Statistically significant weight loss was achieved at 3 [t (10)?=?6.74, p?<?0.05], 6 [t (7)?=?4.69, p?<?0.05], 9 [t (9)?=?2.94, p?<?0.05], and 12 [t (6)?=?3.78, p?<?0.05] months. However, there was no statistically significant weight loss at 24 months postoperatively [t (4)?=??0.16, p?>?0.05]. Laparoscopic revisional bariatric surgery can be performed with significant weight loss up to 1 year postoperatively. However, additional studies are required to evaluate longer-term success.     

Adjustments in the force–frequency relationship during passive and exercise‐induced hyperthermia

Introduction: We examined the extent to which fatiguing cycling exercise in the heat influences contractile function in modulating the force–frequency relationship. Methods: Before (∽37.0°C) and after (∽38.5°C) exercise (ExH) and passive (PaH) hyperthermia, an 8‐s train of stimulation at 10, 20, 50, and 100 Hz (2 s per frequency) and a potentiated twitch were evoked on the relaxed knee extensors using percutaneous stimulation. Results: ExH and PaH produced a decrease in the 20:50 Hz force ratio, indicative of low‐frequency fatigue (P < 0.01). This adjustment was more pronounced after ExH than PaH (P < 0.01). A rightward displacement in the force–frequency relationship occurred after ExH and PaH (P < 0.05) and was exacerbated by ExH (P < 0.05). Peak twitch force also decreased after ExH (P < 0.05). Conclusions: ExH reduces force summation due to development of skeletal muscle fatigue, exacerbating the shift in force–frequency to the right relative to PaH. Muscle Nerve 50 : 822–829, 2014     

Efficacy of a dyadic intervention to improve communication between patients with cancer and their caregivers: A randomized pilot trial

ObjectiveCancer-related communication is critical for patients’ and caregivers’ adaptation to illness. This randomized pilot study was conducted to test the feasibility, acceptability, and efficacy of a specific dyadic intervention to improve communication.MethodsA four weekly-session intervention was developed to reinforce cancer-related patient-caregiver communication. Patients receiving treatment for any diagnosed cancer, and their caregivers, were recruited from two oncology clinics in Belgium. Sixty-four patient-caregiver dyads were assigned randomly to intervention and waitlist groups. Cancer-related dyadic communication, dyadic coping and emotional distress were assessed at baseline and post-intervention.ResultsThe intervention attrition rate was 6 %. Linear mixed models were performed on 60 dyads. Significant two-way group × time interaction indicated improvement in participants’ cancer-related dyadic communication frequency (β = ?1.30; SE = 0.31; p = .004), self-efficacy (β = ?10.03; SE = 3.90; p = .011) and dyadic coping (β = ?5.93; SE = 2.73; p = .046) after the intervention.ConclusionThese results indicate that the brief dyadic communication intervention is feasible and acceptable, and show preliminary evidence of efficacy.Practice implicationsEncouraging patients and caregivers to discuss personal cancer-related concerns may improve their ability to cope with the illness together.     

Référentiel d’enseignement de la transfusion sanguine aux étudiants techniciens de laboratoire de biologie médicale

Purpose of the studyThe new French law about clinical laboratory medicine, the requirements of the ISO/CEI 15189 standard, the numerous abilities expected from the medical laboratory technologists and their involvement in blood bank management has led the working group “Recherche et démarche qualité” of the French Society of Blood Transfusion to initiate an inventory of blood transfusion teaching syllabus for medical laboratory technology students and to propose transfusion medicine teaching guidelines.Material and methodsSeven worksheets have been established for that purpose including red blood cell antigen typing and antibody screening, blood sampling in immunohaematology, automation, clinical practices, blood products, blood delivery and haemovigilance.ResultsThese guidelines aim at contributing to the harmonization of transfusion medicine teaching and at providing objective elements to the medical laboratory managers regarding the practical and theoretical skills of theirs collaborators.     

Determination of breast cancer prognosis after neoadjuvant chemotherapy: comparison of Residual Cancer Burden (RCB) and Neo-Bioscore

Background To compare RCB (Residual Cancer Burden) and Neo-Bioscore in terms of prognostic performance and see if adding pathological variables improve these scores.Methods We analysed 750 female patients with invasive breast cancer (BC) treated with neoadjuvant chemotherapy (NAC) at Institut Curie between 2002 and 2012. Scores were compared in global population and by BC subtype using Akaike information criterion (AIC), C-Index (concordance index), calibration curves and after adding lymphovascular invasion (LVI) and pre-/post-NAC TILs levels.Results RCB and Neo-Bioscore were significantly associated to disease-free and overall survival in global population and for triple-negative BC. RCB had the lowest AICs in every BC subtype, corresponding to a better prognostic performance. In global population, C-Index values were poor for RCB (0.66; CI [0.61–0.71]) and fair for Neo-Bioscore (0.70; CI [0.65–0.75]). Scores were well calibrated in global population, but RCB yielded better prognostic performances in each BC subtype. Concordance between the two scores was poor. Adding LVI and TILs improved the performance of both scores.Conclusions Although RCB and Neo-Bioscore had similar prognostic performances, RCB showed better performance in BC subtypes, especially in luminal and TNBC. By generating fewer prognostic categories, RCB enables an easier use in everyday clinical practice.Subject terms: Breast cancer, Breast cancer, Chemotherapy     

Influence of Fermentation and Drying Materials on the Contamination of Cocoa Beans by Ochratoxin A

Ochratoxin A (OTA) is a mycotoxin produced mainly by species of Aspergillus and Penicillium. Contamination of food with OTA is a major consumer health hazard. In Côte d’Ivoire, preventing OTA contamination has been the subject of extensive study. The current study was conducted to evaluate the influence of fermentation and drying materials on the OTA content in cocoa. For each test, 7000 intact cocoa pods were collected, split open to remove the beans, fermented using 1 of 3 different materials, sun-dried on 1 of 3 different platform types and stored for 30 days. A total of 22 samples were collected at each stage of post-harvesting operations. The OTA content in the extracted samples was then quantified by high-performance liquid chromatography. OTA was detected in beans at all stages of post-harvesting operations at varying levels: pod-opening (0.025 ± 0.02 mg/kg), fermentation (0.275 ± 0.2 mg/kg), drying (0.569 ± 0.015 mg/kg), and storage (0.558 ± 0.04 mg/kg). No significant relationships between the detected OTA level and the materials used in the fermentation and drying of cocoa were observed.