Preamble and Transition to ACC/AHA Guidelines to Reduce Cardiovascular Risk S50

The goals of the American College of Cardiology (ACC) and the American Heart Association (AHA) are to prevent cardiovascular diseases (CVD); improve the management of people who have these diseases through professional education and research; and develop guidelines, standards, and policies that promote optimal patient care and cardiovascular health. Toward these objectives, the ACC and AHA have collaborated with the National Heart, Lung, and Blood Institute (NHLBI) and stakeholder and professional organizations to develop …

/pdf/2013-acc-aha-guideline-on-the-assessment-of-cardiovascular-1t8hg65cmz.pdf

2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk

Jeffrey L. Anderson, MD, FACC, FAHA, Chair 

Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect 

Nancy M. Albert, PhD, RN, FAHA

Biykem Bozkurt, MD, PhD, FACC, FAHA

Ralph G. Brindis, MD, MPH, MACC

Lesley H. Curtis, PhD, FAHA

David DeMets, PhD[¶¶][1]

Lee A. Fleisher, MD, FACC, FAHA

Samuel

/pdf/2014-acc-aha-guideline-on-perioperative-cardiovascular-3firuin78y.pdf

2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: A report of the American college of cardiology/American heart association task force on practice guidelines

Signalling through the ERBB/HER receptors is intricately involved in human cancer and already serves as a target for several cancer drugs. Because of its inherent complexity, it is useful to envision ERBB signalling as a bow-tie-configured, evolvable network, which shares modularity, redundancy and control circuits with robust biological and engineered systems. Because network fragility is an inevitable trade-off of robustness, systems-level understanding is expected to generate therapeutic opportunities to intercept aberrant network activation.

EGF–ERBB signalling: towards the systems level

The text consists of two sections, one for those studying or practicing diagnostic radiology, nuclear medicine and radiation oncology; the other for those engaged in the study or clinical practice of radiation oncology--a new chapter, on radiologic terrorism, is specifically for those in the radiation sciences who would manage exposed individuals in the event of a terrorist event. The 17 chapters in Section I represent a general introduction to radiation biology and a complete, self-contained course especially for residents in diagnostic radiology and nuclear medicine that follows the Syllabus in Radiation Biology of the RSNA. The 11 chapters in Section II address more in-depth topics in radiation oncology, such as cancer biology, retreatment after radiotherapy, chemotherapeutic agents and hyperthermia.

Radiobiology for the Radiologist

von Hippel-Lindau disease

Hypothesis Increasing numbers of cadaveric temporal bone (CTB) dissection translates to improved scores on a timed microdissection of a CTB. Background Recent literature regarding resident education has focused on virtual learning. However, advocates for virtual temporal bone drilling admit that there is not yet a substitute for drilling a CTB. Methods Retrospective review of resident performance on a standardized instrument during a timed microdissection of CTBs. Resident performance on the graded dissection was compared with the number of CTBs drilled during the year. Graded performance was also compared with the total number of CTBs dissected over 4 years of residency. Faculty assessed intraoperative skill of the senior residents. These rankings were compared with the number of CTBs drilled. Comparisons were made using Pearson's and Spearman's correlations. Results Comparison of test scores from the most recent resident year to the number of CTBs drilled during the corresponding year correlated well (r = 0.41, p = 0.002). The correlation between the score during the highest year of training and the cumulative number of CTB drilled during residency was even stronger (r = 0.604, p = 0.005). Faculty rankings correlated well comparing general surgical skills with TB surgical skills (r = 0.655, p = 0.008). Comparing faculty rankings of TB surgical skill with the number of CTB drilled during the final year of residency yielded a negative correlation (r = -0.8) but was not significant (p = 0.1). Conclusion Greater exposure to CTB dissection correlates with improved scoring on a standardized instrument. Residents who struggle with temporal bone surgery tend to use CTB dissection more than those who are more facile.

Resident participation in cadaveric temporal bone dissection correlates with improved performance on a standardized skill assessment instrument.

Enhanced spiral ganglion neuron (SGN) survival and regeneration of peripheral axons following deafness will likely enhance the efficacy of cochlear implants. Overexpression of Bcl-2 prevents SGN death but inhibits neurite growth. Here we assessed the consequences of Bcl-2 targeted to either the mitochondria (GFP-Bcl-2-Maob) or the endoplasmic reticulum (ER, GFP-Bcl-2-Cb5) on cultured SGN survival and neurite growth. Transfection of wild-type GFP-Bcl-2, GFP-Bcl-2-Cb5, or GFP-Bcl-2-Maob increased SGN survival, with GFP-Bcl-2-Cb5 providing the most robust response. Paradoxically, expression of GFP-Bcl-2-Maob results in SGN death in the presence of neurotrophin-3 (NT-3) and brain-derived neurotrophic factor (BDNF), neurotrophins that independently promote SGN survival via Trk receptors. This loss of SGNs is associated with cleavage of caspase 3 and appears to be specific for neurotrophin signaling, insofar as coexpression of constitutively active mitogen-activated kinase kinase (MEKDeltaEE) or phosphatidyl inositol-3 kinase (P110), but not other prosurvival stimuli (e.g., membrane depolarization), also results in the loss of SGNs expressing GFP-Bcl-2-Maob. MEKDeltaEE and P110 promote SGN survival, whereas P110 promotes neurite growth to a greater extent than NT-3 or MEKDeltaEE. However, wild-type GFP-Bcl-2, GFP-Bcl-2-Cb5, and GFP-Bcl-2-Maob inhibit neurite growth even in the presence of neurotrophins, MEKDeltaEE, or P110. Historically, Bcl-2 has been thought to act primarily at the mitochondria to prevent neuronal apoptosis. Nevertheless, our data show that Bcl-2 targeted to the ER is more effective at rescuing SGNs in the absence of trophic factors. Additionally, Bcl-2 targeted to the mitochondria results in SGN death in the presence of neurotrophins. (c) 2010 Wiley-Liss, Inc.

Interaction of neurotrophin signaling with Bcl-2 localized to the mitochondria and endoplasmic reticulum on spiral ganglion neuron survival and neurite growth.

Objectives/hypothesis Carcinomas of the temporal bone are rare, and appropriate treatment, staging, and survival data are limited. This study evaluates clinical characteristics and survival rates for patients with temporal bone carcinoma treated with resection at a single tertiary-care institution, with a focus on the outcomes of patients with locally advanced disease including skull base and/or dural invasion. Study design Retrospective chart review. Methods Demographic, tumor-specific, and survival data were collected for patients with primary carcinomas of the external auditory canal with involvement of the temporal bone from 2003 to 2015. All patients were staged according to the modified Pittsburgh system. Kaplan-Meier and logistic regression analysis were used to calculate factor-specific survival outcomes. Results Sixty-seven patients met inclusion criteria; 85% were male. There were 43 squamous cell carcinomas (64%) and 24 basal cell carcinomas (BCCs) (36%). Tumor stage was 24 (36%) T2, 12 (18%) T3, and 31 (46%) T4 tumors; 53% had recurrent disease. Surgical management included 49 lateral temporal bone resections and 18 subtotal temporal bone resections. Kaplan-Meier analyses revealed more favorable 5-year survival rates associated with BCC histology (P = .01), lateral temporal bone resection compared to subtotal temporal bone resection (P Conclusions Factors predictive of more favorable survival include lack of immunocompromise, BCC histology, absence of perineural/lymphovascular invasion, and disease extent amenable to lateral temporal bone resection. Dural invasion is not an absolute contraindication to surgery, with a subset of patients surviving >5 years. Level of evidence 3 Laryngoscope, 130:E11-E20, 2020.

Temporal bone carcinoma: Treatment patterns and survival

Microtopographical features generated by photopolymerization recruit RhoA/ROCK through TRPV1 to direct cell and neurite growth

Objectives/Hypothesis: To determine the efficacy of prophylactic famciclovir to significantly reduce the percentage of patients experiencing postoperative delayed facial paresis.



Study Design: Prospective evaluation of facial nerve grade for two groups (treated and untreated) with famciclovir before and after surgery. All procedures were conducted by the same group of experienced neurotologists.



Methods: In a tertiary neurotologic private practice, the percentage of 1,023 patients with delayed facial paresis after undergoing microsurgical removal of unilateral acoustic tumor with no preoperative treatment was compared to the percentage of 530 patients with preoperative famciclovir treatment. Patients were prescribed famciclovir 500 mg BID for 3 days before surgery and 5 days postoperative. The House-Brackmann Facial Nerve Grade was assessed prospectively at preoperative, immediate postoperative, and discharge from the hospital in both groups.



Results: Twenty-five percent of the no famciclovir group experienced delayed facial palsy compared to 20% in the famciclovir group, a statistically significant difference (P < .04). The famciclovir group undergoing translabyrinthine craniotomy showed a significantly greater decrease in percentage of patients with delayed facial palsy than those undergoing middle fossa craniotomies (P < .003).



Conclusions: Famciclovir administered preoperatively and after craniotomies resulted in a smaller percentage of patients developing delayed facial weakness. We are continuing the routine use of famciclovir in perioperative acoustic tumor management and recommend that others do so.

Marlan R. Hansen

Papers

Resident participation in cadaveric temporal bone dissection correlates with improved performance on a standardized skill assessment instrument.

Interaction of neurotrophin signaling with Bcl-2 localized to the mitochondria and endoplasmic reticulum on spiral ganglion neuron survival and neurite growth.

Temporal bone carcinoma: Treatment patterns and survival

Microtopographical features generated by photopolymerization recruit RhoA/ROCK through TRPV1 to direct cell and neurite growth

The effect of famciclovir on delayed facial paralysis after acoustic tumor resection.