Does the Presence of Endometriosis Affect Prognosis of Ovarian Cancer?

Ovarian cancers diagnosed between 2000 and 2013 were examined and cases with and without endometriosis compared. Among 139 epithelial ovarian, there were 49 (35%) with endometriosis and 90 (65%) without endometriosis. Endometriosis associated ovarian cancers were more likely to be confined to the pelvis (54% vs. 9%, p < 0.0001) and lower grade (51% vs. 29%, p = 0.014). Younger age and earlier stage independently predicted the presence of endometriosis (p = 0.0011 and p < 0.0001, respectively). Ovarian cancer patients with endometriosis had improved PFS and OS [(HR = 0.20; 95% CI, 0.09-0.43), (HR = 0.18; 95% CI, 0.04-0.81)], compared to patients without endometriosis; however, endometriosis had no independent prognostic significance.

Sniff and Muller manoeuvres to measure diaphragmatic muscle strength.

We hypothesized that peak values of oesophageal (Poes) and transdiaphragmatic pressure (Pdi) swings during a maximal sniff manoeuvre and a maximal static inspiratory manoeuvre (Muller manoeuvre) are comparable or give complementary information for assessing diaphragmatic and global inspiratory muscle strength. We studied 98 patients with suspected diaphragmatic dysfunction. Poes and Pdi swings were measured during maximal sniff manoeuvres (sniff), maximal Muller manoeuvres (max), and cervical magnetic phrenic nerve stimulation (cervical Tw). Eighty eight patients were able to perform both volitional manoeuvres. Among them, mean Poes sniff was significantly higher than mean Poes max (48.7+/-28.7 cm H(2)O vs. 42.9+/-27.4 cm H(2)O, p<0.05) and mean Pdi sniff was higher than mean Pdi max (49.2+/-35.1cm H(2)O vs. 42.9+/-33.3 cm H(2)O, respectively, p=0.05). Cervical Pdi Tw correlated better with Pdi sniff (p<0.0001, r=0.62) than with Pdi max (p<0.0001, r=0.44). Poes and Pdi swings were greatest during the sniff manoeuvre in 42 patients (48%) and during the Muller manoeuvre in 29 patients (33%). Among the 17 remaining patients, nine had the greatest Poes swing during a maximal sniff manoeuvre and the greatest Pdi swing during a maximal static inspiratory manoeuvre; the opposite occurred in the other eight patients. The combination of Muller manoeuvre and sniff manoeuvre increased the diagnosis of normal diaphragmatic strength from 18 patients (20%) to 21 patients (24%), and the additional analysis of cervical Pdi Tw further increased the diagnosis of normal diaphragmatic strength to 27 patients (31%). In conclusion, though sniff manoeuvre gave significantly higher values than Muller manoeuvre, both volitional manoeuvres and cervical Pdi Tw are complementary and should be used in combination to evaluate diaphragmatic muscle strength.

Oxygen consumption during machine-assisted and unassisted walking: a pilot study in hemiplegic and healthy humans.

OBJECTIVE: To determine whether a gait-training (GT) machine influenced walking time duration and oxygen consumption in hemiplegic patients. DESIGN: Repeated measures with comparison of 2 groups. SETTING: Physiology laboratories in a rehabilitation hospital. PARTICIPANTS: Seven patients with stroke-related hemiplegia (2 men, 5 women; age, 46+/-11y; time since stroke, 12+/-9wk) and 7 healthy subjects (3 men, 4 women; age, 30+/-7y). INTERVENTIONS: Floor walking (FW) and GT-assisted walking with and without 50% body-weight support (BWS). MAIN OUTCOME MEASURES: Walking time duration, oxygen consumption (Vo(2)), minute ventilation (V(E)), and heart rate. RESULTS: When the condition effect was analyzed independently from the group, mean Vo(2) was higher during FW than during the GT tests (post hoc analysis: FW vs GT, P=.017; FW vs GT+BWS, P<.002). When the groups were compared independently of the condition, the group with hemiplegia had a significantly shorter walking time duration (analysis of variance [ANOVA], P<.001) and a significantly higher Vo(2) as a percentage of baseline (ANOVA, P=.03), compared with the controls. Walking time duration was influenced by walking condition (ANOVA, P<.001; post hoc analysis: FW vs GT, P<.001; FW vs GT+BWS, P<.001). Ve was influenced by walking condition (ANOVA, P=.043; not significant in the post hoc analysis) and was higher in the group with hemiplegia (ANOVA, P=.02). Heart rate was not influenced by walking condition (P=.11). A group effect was found with heart rate in cycles per minute (P=.035) but not as a percentage of baseline. No interaction was found between the ANOVA group-effect factor and the ANOVA walking-condition effect factor. CONCLUSIONS: Compared with FW, GT assistance increased walking time duration and reduced Vo(2) in patients with severe hemiplegia.

Continuous stimulation of transected distal nerves fails to prolong action potential propagation.

Wallerian degeneration of the distal portion of a cut nerve is considered irreversible. A possible reason for degeneration is lack of axon stimulation in the distal, cut nerves. We hypothesized greater rates of stimulation of distal nerve stumps would prolong time to action potential propagation failure, and uncut nerves would not be damaged by implanted nerve stimulators. We also hypothesized that action potentials measured from the body of the sciatic nerve would show similar response as motor-evoked potentials measured in the muscles innervated by branches of the sciatic nerve. We implanted a nerve stimulator onto distal cut sciatic nerves of rats and recorded motor-evoked potentials. Three groups were stimulated at 1 Hz (once per second), 0.1 Hz (once per 10 seconds), and 0.01 Hz (once per 100 seconds) respectively. Motor-evoked potentials progressively declined after nerve transection, failing faster at 1 Hz (26.8 hours +/- 108 minutes) and 0.1 Hz (22 hours +/- 66 minutes) compared with stimulation at 0.01 Hz (36.75 hours +/- 83 minutes). Intact axons were not damaged by implanted nerve stimulators. Action potentials recorded directly from nerves were equivalent to motor- evoked potentials. Failure of motor-evoked potential transmission in a transected nerve is accelerated by a greater rate of continuous stimulation of the distal stump.

Is forced oscillation technique useful in the diagnosis of occupational asthma?

OBJECTIVE: The aim of the study was to determine whether the forced oscillation technique (FOT), which does not require active cooperation, may be useful to assess bronchial responsiveness in patients with suspected occupational asthma (OA). METHODS: Changes in resistances evaluated by FOT, and DeltaFEV1 measured during methacholine challenge test were compared in 77 adults referred for suspected OA. Spearman correlations and ROC curves were used. RESULTS: R0 at the final dose of methacholine (R0hmd) and DeltaR0 were strongly correlated with DeltaFEV1 (p < 0.001). The ROC curves showed that R0hmd >or= 240% predicted was the best cut-off value to discriminate subjects with OA from nonasthmatic subjects (sensitivity: 80%, specificity: 76%). CONCLUSION: FOT can be proposed as an alternative method for the assessment of bronchial responsiveness in subjects with suspected OA, unable to correctly perform forced expiratory maneuvers.

Cough determinants in patients with neuromuscular disease.

Neuromuscular disease leads to cough impairment. Cough augmentation can be achieved by mechanical insufflation (MI) or manually assisted coughing (MAC). Many studies have compared these two methods, but few have evaluated them in combination. In 155 neuromuscular patients, we assessed determinants of peak cough flow (PCF) using stepwise correlation. Maximal inspiratory capacity contributed 44% of the variance (p<0.001), expiratory reserve volume 13%, and maximal expiratory pressure 2%. Thus, augmenting inspiration seems crucial. However, parameters dependent on expiratory muscles independently influence PCF. We measured vital capacity and PCF in 10 neuromuscular patients during cough augmentation by MI, MAC, or both. MI or MAC significantly improved VC and PCF (p<0.01) as compared to the basal condition and VC and PCF were higher during MI plus MAC than during MAC or MI alone (p<0.01). In conclusion, combining MAC and MI is useful for improving cough in neuromuscular patients.

Assessing inspiratory muscle strength by sniff nasal inspiratory pressure.

The sniff nasal inspiratory pressure (SNIP) consists in the measurement of pressure through an occluded nostril during sniffs performed through the controlateral nostril. It is an accurate and noninvasive approximation of esophageal pressure swing during sniff maneuvers. However SNIP can underestimate esophageal pressure swing in subjects with nasal obstruction, patients with chronic obstructive pulmonary disease and severe neuromuscular patients. Nevertheless, since SNIP maneuver has predicted normal values, is noninvasive and is easier to perform than maximal inspiratory pressure (MIP) maneuver, it could be considered as the first simple test to use in order to assess inspiratory muscle weakness. In addition, because it is as reproducible as MIP, it can be suitable to follow inspiratory muscle function in chronic neuromuscular patients. Because, of the important limit of agreement between SNIP and MIP, these two methods are not interchangeable but complementary.