Patulous Eustachian tube obliteration using endovascular coils: A novel technique (2018)

Type of publication:
Journal article

Author(s):
*Jolly K.; *Darr A.; Chavda S.V.; Ahmed S.K.

Citation:
Journal of Laryngology and Otology; Jun 2018; vol. 132 (no. 6); p. 564-566

Abstract:
Background: Patulous Eustachian tube is a distressing condition characterised by chronic patency of the Eustachian tube and its failure to close. Patients typically present with symptoms of autophony and aural fullness. In patients requiring surgical intervention, a variety of different procedures have been demonstrated (both transtympanic and endonasal), with limited success. Evidence of the effectiveness of a number of surgical interventions is limited to small case series only.
Objective(s): This paper describes a novel treatment for patulous Eustachian tube using a 3 mm VortX Diamond endovascular coil. Case report: A transnasal endoscopic approach was adopted, with cannulation of the Eustachian tube orifice using a Relieva sinus guide suction tube from a balloon sinuplasty set. The coil was deployed 1.5 cm deep into the Eustachian tube. Post-operative imaging was used to confirm correct positioning. Regular follow up was arranged. The patient reported complete resolution of her symptoms.
Conclusion(s): The technique has so far proved highly effective and minimally invasive. It will be employed in more patients to fully establish its effectiveness in treating patulous Eustachian tube.

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The safety and efficacy of laparoscopic ventral mesh rectopexy – Can excellent outcomes be achieved in a district general (2018)

Type of publication:
Conference abstract

Author(s):
*Yassin N.A.; *Orfanos G.; *Farquharson A.L.; *Lacy-Colson J.C.H.

Citation:
Surgical Endoscopy; Dec 2018; vol. 32; Supplement 2, p. S553

Abstract:
Introduction: Laparoscopic ventral mesh rectopexy (VMR) is a popular treatment for symptoms of obstructive defecation in patients suffering with rectal prolapse and rectorectal intussusception. The procedure is technically challenging and may result in serious complications, such as mesh erosions. This study examines the clinical and functional outcomes of patients undergoing VMR in a district general hospital.
Method(s): A retrospective analysis was made of a prospectively maintained database of all laparoscopic VMR procedures. All cases performed by 2 surgeons between February 2012 and June 2016 were included. Length of stay, post-operative complications and functional outcomes were assessed.
Result(s): One hundred patients underwent a laparoscopic VMR procedure during the study period. The mean age was 59.7 years. Nineteen of the patients had external prolapse and 81 had functional bowel symptoms with internal prolapse (rectocele and/or intussusception) as demonstrated on proctography. Pre-operative investigations and pelvic floor multi-disciplinary team (MDT) discussions were performed in all cases. Forty percent of patients had previous pelvic surgery. In the external prolapse group there were 2/19 recurrences (10%). Functional improvement was reported in 96% of the patients. There was only 1 mesh complication (1%).
Conclusion(s): Laparoscopic VMR is an effective and safe procedure for the treatment of symptoms of obstructive defecation. This procedure can be safely performed in the district general hospital setting with excellent clinical and functional outcomes. Thorough preoperative investigations, MDT discussions and standardisation of the surgical technique lead to excellent outcomes.

Genetic Deletion of the Lipid Raft Protein Caveolin-1 Leads to Worsening Renal Fibrosis (2018)

Type of publication:
Journal article

Author(s):
*Chand S , Hazeldine J, Smith S, Borrows R.

Citation:
Journal of Clinical Nephrology and Renal Care 2018 Jun;4(1):037

Abstract:
Background
Renal disease is a major global public health issue. Renal interstitial fibrosis is the characteristic histopathological finding in all progressive renal disease. Caveolin-1 is the essential structural protein for lipid rafts called caveolae that are ubiquitously distributed among fibroblasts, endothelial and epithelial cells. Caveolin-1 acts as an intracellular signalling pathway chaperone in fibrotic disease. Presently, caveolin-1 expression is associated with more severe renal disease in human and previous murine studies. In non-renal fibrosis, caveolin-1 protects against fibrosis. The purpose of this study was to investigate if caveolin-1 knockout led to an increased fibrotic phenotype using the unilateral ureteric obstruction model of renal fibrosis.
Methods
Using 2 time-points of the unilateral ureteric obstruction model, wild-type and caveolin-1 knockout mouse kidneys were analysed for caveolin-1 expression and markers of fibrosis using histology, Gomori staining, real-time quantified polymerase chain reaction, Western blotting and confocal microscopy.
Results
Confocal microscopy shows caveolin-1 staining mainly in glomerulus, lining of tubules as well as the vasculature. There was increased caveolin-1 expression the longer the unilateral obstruction occurred as well as in the contralateral compensating non-obstructed kidney. Caveolin-1 knockout had less fibrosis at day 3 histologically but more at day 14 as compared to wild-type. There were significantly more F4/80 positive staining cells at day 3 and day 14 in the wild-type injured kidney as compared to the caveolin-1 knockout mouse.
Conclusion
Caveolin-1 knockout leads to a worse fibrosis upon unilateral ureteric obstruction. Caveolin-1 expression manipulation timing remains to be elucidated in reducing renal fibrosis.

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Strategies for investigating the genetics of chronic kidney disease (2018)

Type of publication:
Journal article

Author(s):
*Chand S.

Citation:
Scientific Journal of Genetics and Gene Therapy. 2018 July 4(1): 004-006.

Abstract:
This short review describes the strategies employed for investigating genetic variation in chronic kidney disease as well as highlighting potential shortfalls that should be overcome in future studies.

Link to full-text [no password required]

Caveolin-1 in renal disease (2018)

Type of publication:
Journal article

Author(s):
*Chand S.

Citation:
Scientific Journal of Genetics and Gene Therapy. 2018 July: 007-014.

Abstract:
Caveolin-1 is the essential structural formation for lipid raft formation. It has been ascribed to several
disease processes in humans due to its ubiquitous distribution. Patients with chronic kidney disease suffer
great morbidity and mortality where manipulation of caveolin-1 could lead to new potential therapeutic
targets in this patient group. This review highlights caveolin-1 structure, signalling and provides examples
of studies of caveolin-1 single nucleotide polymorphism in chronic kidney disease.

Link to full-text [no password required]

Risk-Based Maintenance of Medical Devices for use with Humans (2018)

Type of publication:
Dissertation

Author(s):
*Nigel Watkinson

Citation:
University of Derby

Abstract:
Medical devices continue to increase in quantity and complexity, and as they have a direct correlation with human health and safety their correct use and operation is paramount. This includes effective maintenance to retain serviceability and extend service life. Hospital Clinical Engineering departments are responsible for developing and operating Equipment Management Programs to ensure the safety and reliability of devices whilst optimising lifecycle costs for the organisation. Maintenance of engineering assets traditionally involves following manufacturers predetermined servicing activity at fixed intervals; however, alternative approaches have been employed in many engineering industries to optimise maintenance management resources with reduced risk. Risk-based maintenance (RBM) strategies being the most recent development are evaluated in this paper to consider their appropriateness with medical devices in UK hospitals. A mixed methods approach is used for the research study with a literature review of RBM in engineering industries, analysis of a survey of 74 UK medical engineering professionals and equipment service data
from local organisation. The current and future position of RBM is discussed including development of RBM methodology to be employed with medical devices in UK hospitals.

The study identifies strong endorsement of RBM principles by medical engineering professionals, including widespread employment of RBM, yet with no standardisation. Opposition to RBM is also encountered in favour of traditional approaches with variations in attitude to risk. Recommendations include collaboration of UK professionals for further research and development of medical device specific RBM with standardisation of methodology and approach with engagement of healthcare regulatory authorities.

TPS-calculated vs. measured dose around a prosthetic hip implant (2018)

Type of publication:
Poster presentation

Author(s):
*Maryke Fox, *Mike Alexander

Citation:
IPEM Medical Physics & Engineering Conference & Biennial Radiotherapy Meeting Proceedings, York, UK. September 2018

Abstract:
An increasing number of patients presenting for prostate radiotherapy have prosthetic hips. It is well known
that modern treatment planning systems are unable to accurately model dose in the vicinity of high density
prostheses. This work sought to characterise how dose is modelled by the Eclipse TPS around a hip prosthesis in a water phantom by comparing the modelled dose with dose measured by a Farmer chamber and find estimate dose due to scatter. Transmission, lateral scatter and back scatter were measured at a range of distances from the prosthesis and compared to the Eclipse modelled dose. It was found that dose distal to the prosthesis was underestimated by over 20%, backscatter was not modelled at all by Eclipse but lateral scatter was adequately modelled. The dose due to backscatter and lateral scatter from the prosthesis were not significant contributors to dose. These results indicate that planners should avoid treating through prosthetic hips, and that dose due to scatter was unlikely to cause ill effects.

Link to poster [PDF]