These guidelines were developed jointly by the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA). This work represents an update to the

/pdf/clinical-practice-guidelines-for-antimicrobial-prophylaxis-1gq1adk8ux.pdf

Clinical practice guidelines for antimicrobial prophylaxis in surgery

Current medical imaging technologies allow visualization of tissue anatomy in the human body at resolutions ranging from 100 micrometers to 1 millimeter. These technologies are generally not sensitive enough to detect early-stage tissue abnormalities associated with diseases such as cancer and atherosclerosis, which require micrometer-scale resolution. Here, optical coherence tomography was adapted to allow high-speed visualization of tissue in a living animal with a catheter-endoscope 1 millimeter in diameter. This method, referred to as "optical biopsy," was used to obtain cross-sectional images of the rabbit gastrointestinal and respiratory tracts at 10-micrometer resolution.

In Vivo Endoscopic Optical Biopsy with Optical Coherence Tomography

Far from being simple degradative enzymes, proteases are now seen as key signalling molecules and desirable drug targets in several diseases. Turk discusses our success so far at targeting proteases and how these enzymes might be exploited therapeutically in the future. Until fairly recently, proteases were considered primarily to be protein-degrading enzymes. However, this view has dramatically changed and proteases are now seen as extremely important signalling molecules that are involved in numerous vital processes. Protease signalling pathways are strictly regulated, and the dysregulation of protease activity can lead to pathologies such as cardiovascular and inflammatory diseases, cancer, osteoporosis and neurological disorders. Several small-molecule drugs targeting proteases are already on the market and many more are in development. The status of human protease research and prospects for future protease-targeted drugs are reviewed here, with reference to some key examples where protease drugs have succeeded or failed.

Targeting proteases: successes, failures and future prospects.

/pdf/clinical-practice-guidelines-for-antimicrobial-prophylaxis-yxd0y9e4ks.pdf

Clinical practice guidelines for antimicrobial prophylaxis in surgery.

Carotenoids constitute a ubiquitous group of isoprenoid pigments. They are very efficient physical quenchers of singlet oxygen and scavengers of other reactive oxygen species. Carotenoids can also act as chemical quenchers undergoing irreversible oxygenation. The molecular mechanisms underlying these reactions are still not fully understood, especially in the context of the anti- and pro-oxidant activity of carotenoids, which, although not synthesized by humans and animals, are also present in their blood and tissues, contributing to a number of biochemical processes. The antioxidant potential of carotenoids is of particular significance to human health, due to the fact that losing antioxidant-reactive oxygen species balance results in “oxidative stress”, a critical factor of the pathogenic processes of various chronic disorders. Data coming from epidemiological studies and clinical trials strongly support the observation that adequate carotenoid supplementation may significantly reduce the risk of several disorders mediated by reactive oxygen species. Here, we would like to highlight the beneficial (protective) effects of dietary carotenoid intake in exemplary widespread modern civilization diseases, i.e., cancer, cardiovascular or photosensitivity disorders, in the context of carotenoids’ unique antioxidative properties.

https://www.mdpi.com/2072-6643/6/2/466/pdf

Potential role of carotenoids as antioxidants in human health and disease.

Laser micromanipulators deliver laser energy to difficult to access regions within the head and neck allowing surgeons to perform high precision microsurgical procedures. In this study, the laser spot sizes (as a function of power) produced by a two micromanipulators of different optical design were compared. A CO 2 laser and operating microscope (400 mm focal length) was coupled to either a reflective (Cassegrain-like) (Unimax 2000, Reliant Technologies, Inc., Foster City, CA) or refractive micromanipulator (Microslad 719, Sharplan Lasers Inc. Allendale, NJ). The laser spot size was determined by measuring the region of ablation following laser irradiation of dry tongue blades, exposed photopaper, and agar gel using optical micrometry. Laser power was varied from 0.5 to 20 W for pulse durations of 0.1 and 0.5 seconds. A logarithmic relationship between spot size (diameter) and laser power on wood and photopaper was observed for both devices. In agar samples a discontinuity in spot size was observed at 9 W due to the formation of a large ablation crater on the surface of the agar. For a given laser power, the micromanipulator with reflective optics demonstrated overall smaller spot sizes and lower incremental change in spots size with increasing power. These results suggest the reflective micromanipulator tested in this study produced a smaller spot size at all powers tested, and with increasing power the spot size increased more slowly than with the conventional refractive optical device tested.

Characterization of micromanipulators for CO2 laser surgery in head and neck: comparison of reflective and refractive optical systems

Objectives: To determine the feasibility and accuracy of the Niris Optical Coherence Tomography (OCT) system in imaging of the mucosal abnormalities of the head and neck. The Niris system is the first commercially available OCT device for applications outside ophthalmology.
Methods: We obtained OCT images of benign, premalignant and malignant lesions throughout the head and neck, using the Niris OCT imaging system (Imalux, Cleveland, OH). This imaging system has a tissue penetration depth of approximately 1-2mm, a scanning range of 2mm and a spatial depth resolution of approximately 10-20μm. Imaging was performed in the outpatient setting and in the operating room using a flexible probe.
Results: High-resolution cross-sectional images from the oral cavity, nasal cavity, ears and larynx showed distinct layers and structures such as mucosa layer, basal membrane and lamina propria, were clearly identified. In the pathology images disruption of the basal membrane was clearly shown. Device set-up took approximately 5 minutes and the image acquisition was rapid. The system can be operated by the person performing the exam.
Conclusions: The Niris system is non invasive and easy to incorporate into the operating room and the clinic. It requires minimal set-up and requires only one person to operate. The unique ability of the OCT offers high-resolution images showing the microanatomy of different sites. OCT imaging with the Niris device potentially offers an efficient, quick and reliable imaging modality in guiding surgical biopsies, intra-operative decision making, and therapeutic options for different otolaryngologic pathologies and premalignant disease.

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Optical coherence tomography using the Niris system in otolaryngology

A comparative analysis of treatment efficacy in intermediate-risk thyroid cancer

Introduction The notion that SEBMs can predict the effectiveness of chemopreventive agents against carcinogenesis in humans has motivated tremendous efforts to development of these compounds (1–3). Successful development of useful SEBMs in AIDS and cardiovascular disease seems to confirm the concept. Why should it not also be valid for chemoprevention of cancer (2)? Unfortunately, oncology has yet to replicate the success of the AIDS and cardiovascular communities in developing reliable SEBMs, but not for want of trying. Although chemopreventive agents have demonstrated some success in reducing the incidence of primary breast malignancies, reducing secondary head and neck cancer, and enhancing regression of cervical IEN, these achievements have been modest, accompanied by considerable toxicity, and, most relevantly, been developed without the aid of prospective end point marker assessment. Despite being long time proponents of this approach, even we have begun to ask “why?” Put another way, “Does the Emperor have no clothes?” Biomarkers have provided insight into the development of cancer and have been proposed to identify risk, target therapeutics, and identify responses to intervention. Whether biomarkers that identify putative risk for the development of cancer are likely to serve as SEBMs for the successful development of chemoprevention agents is the major focus and concern of this commentary. Despite intense efforts to identify and verify candidate SEBMs, no prehistologic biochemical or molecular intermediate marker to date has been validated as a SEBM in animals or humans for any cancer (for review, see Ref. 4), and even the data with histological SEBMs (e.g., IEN) leave a lot to be desired. Schatzken and Gail (5) have recently reviewed the topic and express concerns similar to the current commentary. They begin their review by pointing out the savings in time and money validated SEBMs offer, only later discussing the fairly torturous journeys required to discover and validate the SEBMs. Thus the groundwork necessary to arrive at SEBM studies that are smaller and less expensive than observing frank clinical disease is daunting and may not be cost effective at the present state of knowledge of pathways to malignancy. Although one can make the argument that the problem is ineffective agents rather than unreliable markers, in fact many compounds are effective in animal models, and successes in reducing IEN and cancer in humans have been shown. The lack of real progress in cancer chemoprevention despite the enormous efforts expended compels us to carefully reconsider the theoretical constructs and primary assumptions that underlie strategies for understanding cancer evolution and chemopreventive agent development. Using head and neck cancer as a case example, a number of factors will be shown to significantly hinder our ability to validate SEBMs to develop candidate chemopreventive agents using SEBMs.

Point/Counterpoint Point: Surrogate End Point Biomarkers Are Likely To Be Limited in Their Usefulness in the Development of Cancer Chemoprevention Agents against Sporadic Cancers 1

Publisher Summary Advances in otolaryngology, plastics and reconstruction surgery, ophthalmology, oral or maxillofacial surgery, and neurosurgery have resulted in improved treatment for skull-base tumors This chapter provides an overview of the diagnostic evaluation of a skull-base tumor patient, the anesthetic and intraoperative monitoring options available, the common pathologies encountered, the surgical approaches for tumors involving the cranial base, and the potential complications arising from skull-base surgery The evaluation of the patient with a cranial base lesion begins with a thorough history and physical examination Then, a complete head and neck examination, along with a neurological assessment, is performed Particular emphasis in the examination is placed on the region of tumor involvement Narcotic agents are favorable for skull-base surgery as they decrease the cerebral oxygen consumption rate, have fewer hypotensive side effects, avoid elevation of the intracranial pressure, and are reversible—allowing for rapid emergence from anesthesia Diuretics are often administered to shrink the brain during the intracranial portion of the surgery to enhance surgical exposure One of the most common complications in skull base surgery is a cerebrospinal fluid (CSF) leak The incidence of a CSF leak varies proportionally to the size of the dural defect created A CSF leak detected in the postoperative period occurs typically through the surgical wound, ear canal (otorrhea), or nose (rhinorrhea) Early identification and measures to correct this are important to minimize the risk of CSF contamination and the development of meningitis

William B. Armstrong

Papers

Characterization of micromanipulators for CO2 laser surgery in head and neck: comparison of reflective and refractive optical systems

Optical coherence tomography using the Niris system in otolaryngology

A comparative analysis of treatment efficacy in intermediate-risk thyroid cancer

Point/Counterpoint Point: Surrogate End Point Biomarkers Are Likely To Be Limited in Their Usefulness in the Development of Cancer Chemoprevention Agents against Sporadic Cancers 1

Skull Base Surgery