scholarly journals Core deficits and quality of survival after childhood medulloblastoma: a review

2016 ◽  
Vol 4 (2) ◽  
pp. 82-97 ◽  
Author(s):  
Mathilde Chevignard ◽  
Hugo Câmara-Costa ◽  
François Doz ◽  
Georges Dellatolas
Keyword(s):  
Environmental Factors ◽  
Family Background ◽  
Perioperative Complications ◽  
Community Integration ◽  
Central Nervous System Tumor ◽  
Molecular Subgroup ◽  
Cerebellar Damage ◽  
Childhood Medulloblastoma

Abstract Background. Medulloblastoma is the most common malignant central nervous system tumor in children. Treatment most often includes surgical resection, craniospinal irradiation, and adjuvant chemotherapy. Although survival has improved dramatically, the tumor and its treatments have devastating long-term side effects that negatively impact quality of survival (QoS). The objective was to review the literature on QoS following childhood medulloblastoma. Methods. This narrative review is based on a Medline database search and examination of the reference lists of papers selected. Results. Frequent problems after medulloblastoma treatment include medical complications, such as long-term neurological and sensory (hearing loss) impairments; endocrine deficits, including growth problems; and secondary tumors. Neurocognitive impairment is repeatedly reported, with decreasing cognitive performances over time. Although all cognitive domains may be affected, low processing speed, attention difficulties, and working memory difficulties are described as the core cognitive deficits resulting from both cerebellar damage and the negative effect of radiation on white matter development. Long-term psychosocial limitations include low academic achievement, unemployment, and poor community integration with social isolation. Important negative prognostic factors include young age at diagnosis, conventional craniospinal radiotherapy, presence of postoperative cerebellar mutism, and perioperative complications. The influence of environmental factors, such as family background and interventions, remains understudied. Conclusion. Future studies should focus on the respective impact of radiation, cerebellar damage, genomic and molecular subgroup parameters, and environmental factors on cognitive and psychosocial outcomes. Long-term (probably lifelong) follow-up into adulthood is required in order to monitor development and implement timely, suitable, multi-disciplinary rehabilitation interventions and special education or support when necessary.

scholarly journals Effect of Seed Ageing in Biochemical and Molecular Changes in Oilseeds: A Review

2020 ◽  
Author(s):  
Induja Sudhakaran
Keyword(s):  
Environmental Factors ◽  
Molecular Changes ◽  
Seed Deterioration ◽  
Physiological Phenomenon ◽  
Seed Ageing

Seed deterioration is the loss of quality, viability and vigour either due to ageing or effect of adverse environmental factors. The process of deterioration is an irresistible physiological phenomenon. The seeds which are stored under suitable conditions may sometime undergo a series of changes which can ultimately result in the deterioration of the quality of the seed. Hence a thorough study should be done in these deteriorative changes so that proper measures can be adopted to control the variations. Therefore in this article the changes within cellular, biochemical and metabolic aspects of long term stored oilseeds are discussed.

scholarly journals Perioperative Complications of Congenital Diaphragmatic Hernia Repair

2018 ◽  
Vol 28 (02) ◽  
pp. 141-147 ◽  
Author(s):  
Jorge Correia-Pinto ◽  
Catarina Barroso
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Recurrence Rate ◽  
Diaphragmatic Hernia ◽  
Perioperative Complications ◽  
Surgical Morbidity ◽  
Randomized Controlled Studies ◽  
Thoracoscopic Repair ◽  
Carbon Dioxide Co2

AbstractAlthough improvements have been made, the management of congenital diaphragmatic hernia (CDH) remains a major challenge for perinatologists and neonatal surgeons. Many aspects of the disease remain unknown and, being a rare entity, evidence-based data are hard to find. Surgical morbidity is considerable and affects long-term quality of life. Perioperative complications have been reviewed focusing on thoracoscopic repair. Intraoperative acidosis was more severe during thoracoscopy when compared with open surgery (OS), though it is possible that later neurodevelopment was not affected. Even so, strategies have been outlined to reduce acidosis, such as decreasing carbon dioxide (CO2) insufflation after reduction of the herniated viscera into the abdomen is complete. The risk of pleural complications decreased after introduction of gentle ventilation techniques and minimally invasive surgery (MIS); thus, the use of a prophylactic intraoperative thoracic tube is not routinely required. Recurrence rate was higher in large CDH and following MIS repair. Technical demands play an important role, therefore, in avoiding complications; every step of the OS technique must be strictly accomplished. In large defects, the use of prosthetic patch might reduce recurrence rate, even by MIS repair, once again only if technical demands are overcome with meticulous rules of suturing. Thoracoscopy significantly reduced the incidence of bowel obstruction and recovery time and improved cosmesis. The best approach of CDH is yet to be found, and it goes far beyond the management of perioperative complications. Meanwhile randomized controlled studies, namely on the outcome of thoracoscopic repair, are required to inform further practice.

Successful reduction of clinical relevant neovascularization with a modified crossectomy combined with a barrier technique after 10-year follow-up

2012 ◽  
Vol 27 (8) ◽  
pp. 404-408 ◽  
Author(s):  
S Schnyder ◽  
S Gabler ◽  
T O Meier ◽  
C Thalhammer ◽  
F Magnetti ◽  
...  
Keyword(s):  
Varicose Veins ◽  
Perioperative Complications ◽  
Duplex Ultrasound ◽  
Duplex Sonography ◽  
Long Term Results ◽  
Life Questionnaire ◽  
Successful Reduction

Objective The aim of this retrospective study was to assess the long-term results of stripping the insufficient great saphenous vein (GSV) with stump coagulation, closure of the cribriform fascia and some additional measures, which will be described in detail. Methods Patients treated from 1998 to 1999 for varicose veins had been invited in 2009 for follow-up colour-coded duplex sonography and had been asked to answer a quality-of-life questionnaire. In 2009, the examinations for the study were conducted at a clinic of angiology by an independent and experienced sonographer. Results From a total of 165 patients, 91 (136 limbs) had been willing to participate in the study. Duplex ultrasound after a mean follow-up of 10.7 years revealed only clinically non-relevant (Ø < 0.3 cm) neovascularizations in 1.5% of all treated legs. No clinical relevant varicosities from the groin had developed. Conclusion The crossectomy combined with stump coagulation and suture of the fossa ovalis, completed with some additional measures, is a successful method to reduce neovascularization and recurrent varicosities, even for redo-crossectomies, without increasing the risk of perioperative complications.

scholarly journals Novel evidence depicting adverse long-term outcomes linked to tonsillectomy: a spotlight on overtreatment

2019 ◽  
Vol 16 (1) ◽  
pp. 111-118
Author(s):  
Nikhil Nair Hariharan ◽  
Kashyap Patel
Keyword(s):  
Quality Of Life ◽  
Perioperative Complications ◽  
Adverse Outcomes ◽  
Evidence Based ◽  
Long Term Outcomes ◽  
Prophylactic Measure ◽  
Obstructive Sleep ◽  
Increased Risk

Tonsillectomies (TEs) are the first line of treatment when patients present with recurrent tonsillitis, peritonsillar abscesses or obstructive sleep apnea. Though TEs have modest efficacy, they remain a common pediatric surgery in Canada. TEs are now viewed as a prophylactic measure used to prevent tonsil-related diseases. Simultaneously, there is a lack of evidence-based decision-making when recommending TEs, leading to overtreatment. Novel findings indicate that pediatric TE patients have an increased risk of complications and poor long-term outcomes including respiratory, infectious, and allergic disorders. A need for alternatives to TEs is evident; less invasive interventions with fewer perioperative complications and lifelong morbidities warrant further research. To prevent unnecessary adverse outcomes, healthcare providers should opt for more selective and evidence-based TE recommendations. Meanwhile, it is also imperative that physicians clearly communicate the potential quality of life implications associated with TEs. Healthcare and social mores surrounding TEs need to change towards a more evidence-based practice that focuses on improving patients’ quality of life. This commentary examines the current role of TEs, their long-term outcomes, and the implications of overtreatment.

The dual nature of obesity in metabolic programming: quantity versus quality of adipose tissue

2020 ◽  
Vol 134 (18) ◽  
pp. 2447-2451
Author(s):  
Anissa Viveiros ◽  
Gavin Y. Oudit
Keyword(s):  
Adipose Tissue ◽  
Environmental Factors ◽  
Maternal Obesity ◽  
Metabolic Programming ◽  
Dual Nature ◽  
Prevalence Of Obesity ◽  
Adipose Tissue Volume ◽  
Males And Females ◽  
Metabolically Healthy

Abstract The global prevalence of obesity has been rising at an alarming rate, accompanied by an increase in both childhood and maternal obesity. The concept of metabolic programming is highly topical, and in this context, describes a predisposition of offspring of obese mothers to the development of obesity independent of environmental factors. Research published in this issue of Clinical Science conducted by Litzenburger and colleagues (Clin. Sci. (Lond.) (2020) 134, 921–939) have identified sex-dependent differences in metabolic programming and identify putative signaling pathways involved in the differential phenotype of adipose tissue between males and females. Delineating the distinction between metabolically healthy and unhealthy obesity is a topic of emerging interest, and the precise nature of adipocytes are key to pathogenesis, independent of adipose tissue volume.

Thinking Beyond Language: Intervention for Severe Aphasia

2009 ◽  
Vol 19 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Nina Simmons-Mackie
Keyword(s):  
Quality Of Life ◽  
Communication Training ◽  
Language Intervention ◽  
Specific Training ◽  
Environmental Support ◽  
Total Communication ◽  
Communication Partners

Abstract Purpose: This article addresses several intervention approaches that aim to improve life for individuals with severe aphasia. Because severe aphasia significantly compromises language, often for the long term, recommended approaches focus on additional domains that affect quality of life. Treatments are discussed that involve increasing participation in personally relevant life situations, enhancing environmental support for communication and participation, and improving communicative confidence. Methods: Interventions that have been suggested in the aphasia literature as particularly appropriate for people with severe aphasia include training in total communication, training of communication partners, and activity specific training. Conclusion: Several intervention approaches can be implemented to enhance life with severe aphasia.

Communication Disordered: Program Implementation in Long-Term Care

2016 ◽  
Vol 1 (15) ◽  
pp. 64-67
Author(s):  
George Barnes ◽  
Joseph Salemi
Keyword(s):  
Program Implementation ◽  
Long Term Care ◽  
Family Satisfaction ◽  
Regulatory Compliance ◽  
Care Staff ◽  
Term Care ◽  
Staff Members ◽  
Change Policy

The organizational structure of long-term care (LTC) facilities often removes the rehab department from the interdisciplinary work culture, inhibiting the speech-language pathologist's (SLP's) communication with the facility administration and limiting the SLP's influence when implementing clinical programs. The SLP then is unable to change policy or monitor the actions of the care staff. When the SLP asks staff members to follow protocols not yet accepted by facility policy, staff may be unable to respond due to confusing or conflicting protocol. The SLP needs to involve members of the facility administration in the policy-making process in order to create successful clinical programs. The SLP must overcome communication barriers by understanding the needs of the administration to explain how staff compliance with clinical goals improves quality of care, regulatory compliance, and patient-family satisfaction, and has the potential to enhance revenue for the facility. By taking this approach, the SLP has a greater opportunity to increase safety, independence, and quality of life for patients who otherwise may not receive access to the appropriate services.

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