Αρχειοθήκη ιστολογίου

Τρίτη 23 Αυγούστου 2016

Congress considering stocking albuterol in schools

VIENNA, Va. — With millions of children heading back to school this month and in September, it's important that albuterol inhalers are available to provide emergency relief to students experiencing an asthma flare.

Schoolchildren with asthma have had the right to self-carry and self-administer their albuterol inhalers at school since legislation was passed in 2004, but what happens if their inhaler is left at home or lost during the school day?

Pending legislation in Congress – the School-Based Asthma Management Program Act (H.R. 4662) would give federal funding preference to states that encourage schools to stock albuterol inhalers.

The bill would also allow trained school personnel to administer the inhaler when necessary, and implement school-based asthma management programs to ensure a safe and healthy learning environment for children with asthma.

Asthma is a significant health concern in the United States, with 6.3 million children diagnosed with the condition, according to the U.S. Centers for Disease Control and Prevention (CDC).

"Asthma flares should be treated at the first sign of symptoms – any delay increases the risk for hospitalization," said Tonya Winders, President and CEO of Allergy & Asthma Network. "By ensuring schools have emergency supplies of stock albuterol on site, we can keep all children with asthma safe."



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Mulberry hypertrophy and accompanying sinonasal pathologies: A review of 68 cases

Davut Akduman, MD; Mehmet Haksever, MD; Muhammed Yanilmaz, MD; Fevzi Solmaz, MD

Abstract

Mulberry hypertrophy occasionally coexists with sinonasal pathologies. There are very few reports in the literature on this clinical entity. We conducted a retrospective study to draw attention to this condition in the context of accompanying sinonasal pathologies. Our study group was made up of 68 patients-51 males and 17 females, aged 13 to 57 years (mean: 34.9)-who had been diagnosed with mulberry hypertrophy and at least one accompanying sinonasal pathology. All patients had a long-standing chronic discharge. Forty-nine of these patients (72.1%) had unilateral mulberry hypertrophy. The most common concomitant pathologies were chronic rhinosinusitis and ostiomeatal complex disease; others included septal deviation, nasal polyposis, allergic rhinitis, and concha bullosa. Thirty-six patients (52.9%) with varying degrees of choanal/nasal obstruction were operated on with endoscopic excision to treat the mulberry hypertrophy. In all, most patients underwent some sort of surgery to treat either the mulberry hypertrophy or the accompanying sinonasal pathology. Based on our findings, we suggest a clinical staging system to serve as a way to standardize management and guide future basic and clinical research.

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A case of radiation-induced mucosal melanoma in an immunohistochemically S-100-negative patient

Michael Rodriguez, DO; Yash Patil, MD; Arun Gupta, DO, MPH

Abstract

We report a case of radiation-induced mucosal melanoma in a 41-year-old woman with a history of childhood rhabdomyosarcoma of the nasal cavity that had been treated with radiotherapy. During the workup for the melanoma, the patient was found to be negative for S-100 protein on immunostaining. While many melanotic markers for the histologic confirmation of melanoma exist, they can be negative in some cases, such as ours. To the best of our knowledge, only 1 case of radiation-induced melanoma has been previously reported in the English-language literature, and in that case the patient was S-100-positive. Although our case is rare, it suggests another possible long-term adverse effect of radiotherapy. We also describe the morphologies and histology associated with diagnosing melanoma in an S-100-negative patient.

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Blastomycosis of the nose: A case report

Thomas M. Jetmore, MD; Jennifer Phan, MD; Abideen O. Yekinni, MD, FACS

Abstract

Blastomyces dermatitidis is a thermally dimorphic fungus endemic to the North American soil near the Mississippi, Ohio, and St. Lawrence river valleys, as well as the Great Lakes Basin. It is responsible for blastomycosis, a systemic pyogranulomatous disease. Blastomycosis of the head and neck is decidedly uncommon and often mistaken for cancer. There are only 3 previous case reports of blastomycosis presenting as an intranasal lesion. We report the unusual case of a 24-year-old man with blastomycosis presenting with a 4-week history of a progressively enlarging intranasal mass who had complete resolution of symptoms after treatment with itraconazole and surgical excision of the lesion.

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Postoperative hypofunctioning of the thyroid gland after total laryngectomy

Sirshak Dutta, MS, DLO; Kaustuv Das Biswas, MS, DLO; Soumya Ghatak, MS; Dibakar Haldar, MD; Indranil Sen, MS; Ramanuj Sinha, MS, DNB

Abstract

Primary laryngeal carcinoma is a common cancer, predominantly affecting males. Hypothyroidism is an undesirable sequela of both surgery and radiotherapy, the two most commonly used modalities of treatment. For advanced cases, standard treatment protocol includes total laryngectomy and neck dissection along with pre- or postoperative radiotherapy. Hemithyroidectomy is also routinely performed as an integral part of total laryngectomy. In the present study, assessment of the function of the remaining half of the thyroid gland has been done in cases of total laryngectomies in combination with uni- or bilateral neck dissection and pre- or postoperative radiotherapy. This prospective, observational study was carried out for a period of 5 years in the Otolaryngology Department of R.G. Kar Medical College and Hospital, Kolkata, India, involving a dynamic cohort of patients with advanced laryngeal carcinoma (stage T3 or T4a) who underwent total laryngectomy (including hemithyroidectomy) and bilateral or unilateral neck dissection for primary laryngeal cancer along with preoperative and postoperative radiotherapy. Assessment of the thyroid function was based on the measurement of serum thyroid-stimulating hormone and free thyroxine levels. The results revealed that 23.8%, 45.2%, and 73.8% patients developed either clinical or subclinical hypothyroid state at 6, 12, and 24 weeks, respectively, after the surgery. The estimation of relative risk (RR) was found to be most prominent among the group belonging to the "preoperative radiation with bilateral neck dissection" group at all levels of assessments, but all of the RRs were found to be insignificant per their 95% confidence intervals. Superiority of any method could not be established or refuted firmly due to the small sample size of the study. We presume that in the future, a study with a larger sample size, involving a meta-analysis of multicentric data, would be the most suitable method to throw some light on this issue.

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Surgical management of a high jugular bulb

Daniel S. Roberts, MD, PhD; Brian Chen, MD; William Slattery, MD

Patient selection for surgical repair of a high dehiscent jugular bulb should include the presence of a codominant sigmoid sinus to avoid elevated postoperative intracranial pressure.

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Epithelioid hemangioendothelioma of tongue presenting as a papilloangioma in a pregnant woman

Mainak Dutta, MS; Kuntal Roy, MD

Otolaryngologists dealing with proliferative, vessel-rich oral lesions should consider epithelioid hemangioendothelioma as one of the possibilities because it might recur or metastasize, requiring aggressive management.

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Idiopathic nasal bone osteitis: A preliminary report on a recently recognized entity

Yotam Shkedy, MD; Ohad Ronen, MD; Sarah Gips, MD; Avi Front†; Tal Marshak, MD; Nechama Uri, MD

Abstract

Osteitis of the nasal bones is a rare disease; when it occurs, it usually has a known etiology. To the best of our knowledge, idiopathic nasal bone osteitis (NBO) has not been described before. We conducted a study to analyze the behavior of idiopathic NBO and its outcome and to determine a cutoff level for diagnosis using technetium-99m-methylene-diphosphonate (Tc-MDP) bone scanning. This retrospective, controlled analysis involved 9 women (mean age: 44 yr) who had been admitted to an otolaryngology department in Israel with idiopathic NBO over a 5-year period. Clinical evaluation, isotopic evaluation, and computed tomography were done. A lesion-to-nonlesion ratio was calculated between an area of interest on the nasal bone and a reference point (L/R ratio). The same ratio was calculated for a control group of 20 subjects. All the Tc-MDP scans in the study group were suggestive of osteitis. Intravenous antibiotic treatment was effective in all cases. A high degree of accuracy was achieved with cutoff L/R ratios of 2.05 for planar views and 2.34 for single-photon emission computed tomography views.

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Audiologic changes after pinna augmentation

Kavit Amin, MBBS, BSc(Hons), MRCS(Eng); Robert Hone, MBBS, MRCS; Rahul Kanegaonkar, BSc, DLO, FRCS(ORL-HNS)

Abstract

No studies to date have objectively assessed whether pinna morphology affects sound intensity detected within the external auditory canal (EAC). Commonly performed procedures on the EAC are carried out for acquired and congenital pathology, together with correction of ear deformities. Our aim was to use an experimental model to identify whether a relationship exists between pinna shape and its subsequent effect on the hearing subject. An anatomically accurate and life-size model made of rubber composite was used for this study. Serial sections (small wedge, defect open; small wedge, defect closed; large wedge, defect open; large wedge, defect closed [equivalent to a protruding ear]; and pinnectomy) were undertaken, and the sound intensity changes assessed at the junction between the EAC and middle ear (tympanic membrane position) using an AURICAL Plus (Otometrics; Taastrup, Denmark) sound processor. A statistically significant loss was demonstrated for wedge-excised models, which was greatest at 180° azimuth. This loss was significantly reduced when the wedge defects were closed. A statistically significant improvement was demonstrated in the protruding ("bat") ear model compared with the normal ear at 0° azimuth. In this model, gain in sound intensity is adversely affected by pinna wedge resection. Because this change may be increased in those with protruding ears, this factor is important to consider for all cosmetic and noncosmetic operations to the pinna, and it supports the notion that the pinna is not a simple funnel.

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Balloon dilation of the sphenoid sinus ostium for recurrent sphenoid sinusitis

Ken Yanagisawa, MD, FACS; Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

The natural sphenoid sinus ostium is often amenable to balloon dilation, which can be performed in the office under local anesthesia or in the operating room under general anesthesia.

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Vocal fold granulomas

Helen Lesser, BS; Amy Rutt, DO; Robert T. Sataloff, MD, DMA, FACS

Occasionally, even after excellent reflux control, surgical removal and steroid injection into the base of the granulomas, application of mitomycin C, and voice therapy, patients develop recurrent granulomas.

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Do women change their breast cancer mammogram screening behaviour after BRCA1/2 testing?

Abstract

Little is known about the change in mammograms use by women after BRCA1/2 genetic testing. We compared the rate of bilateral mammograms after and prior to BRCA1/2 testing, according to test result. Information from the Quebec Health Insurance Board database was used to identify all registered mammograms delivered between May 1, 1998 and March 31, 2012 to a cohort of 396 unaffected French Canadian women tested for BRCA1/2 mutations. Mammograms incidence density ratios were calculated using the Cox proportional hazards model for repeated events. BRCA1/2 mutation carriers and women with an inconclusive result had more mammograms after, than prior to, genetic testing. Non-carriers did not receive more mammograms. The observed increase in mammography screening in BRCA1/2 carriers is consistent with the high risk of developing breast cancer in this group. The estimation of the cancer risk associated with an inconclusive result is based on familial cancer history, and women who received this result appear to have received follow-up as if at high risk. The fact that non-carriers did not change their use of mammograms after genetic testing may possibly reflect a 'defensive medicine' approach by some physicians or the women's preference.



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Missing patients in “Major Trauma Registry” of Navarre: incidence and pattern

Abstract

Background

Trauma registries (TR) collect information about trauma patients according to inclusion criteria, and it helps to establish protocols to improve care. However, all TR deal with incompleteness. The aim of this study is to assess the number of patients not included despite fulfilling inclusion criteria in our regional TR and identifying the predictors for being missing.

Methods

The sample was randomly selected. Two months of each year from 2010 to 2014 (5 years) were selected, and medical files of all patients attended in the emergency department room during those months were studied. Patients who were already correctly included in the TR were assigned to the 'included' group, and patients who should have been but were not to the 'missing' group. The multivariable logistic regression analysis was performed to identify predictors for being missed from the TR.

Results

Of a total of 200, 79 (40 % approximately) were identified as missing. We defined the characteristic profiles of missing patients and found that the hospital RTS and the number of injuries are independent predictors to be missing in our trauma registry, with an adjusted odds ratio of 1844 [95 % (1092–3114) and 0.574 (95 % CI 0.428–0.770)], respectively.

Conclusions

Overall, 40 % of the patients who met the inclusion criteria of the TR were not included in the registry. Our results can be generalized to other trauma records based on Utstein style, because we think probably that this fact is also happening in other databases.



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Hypothesis: overestimation of Chernobyl consequences

2016-08-23T15-53-31Z
Source: Journal of Environmental and Occupational Science
Sergei V. Jargin.



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Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma in Situ

Publication date: Available online 24 June 2016
Source:Practical Radiation Oncology
Author(s): Monica Morrow, Kimberly J. Van Zee, Lawrence J. Solin, Nehmat Houssami, Mariana Chavez-MacGregor, Jay R. Harris, Janet Horton, Shelley Hwang, Peggy L. Johnson, M. Luke Marinovich, Stuart J. Schnitt, Irene Wapnir, Meena S. Moran
PurposeControversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation.Methods and materialsA multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 20 studies including 7883 patients and other published literature as the evidence base for consensus.ResultsNegative margins halve the risk of IBTR compared with positive margins defined as ink on DCIS. A 2-mm margin minimizes the risk of IBTR compared with smaller negative margins. More widely clear margins do not significantly decrease IBTR compared with 2-mm margins. Negative margins narrower than 2 mm alone are not an indication for mastectomy, and factors known to affect rates of IBTR should be considered in determining the need for re-excision.ConclusionUse of a 2-mm margin as the standard for an adequate margin in DCIS treated with whole-breast irradiation is associated with lower rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs. Clinical judgment should be used in determining the need for further surgery in patients with negative margins narrower than 2 mm.



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Antinociceptive Effects of Botulinum Toxin Type A on Trigeminal Neuropathic Pain

Previous studies have demonstrated that botulinum toxin type A (BoNT-A) attenuates orofacial nociception. However, there has been no evidence of the participation of the voltage-gated sodium channels (Navs) in the antinociceptive mechanisms of BoNT-A. This study investigated the cellular mechanisms underlying the antinociceptive effects of BoNT-A in a male Sprague-Dawley rat model of trigeminal neuropathic pain produced by malpositioned dental implants. The left mandibular second molar was extracted under anesthesia, followed by a miniature dental implant placement to induce injury to the inferior alveolar nerve. Mechanical allodynia was monitored after subcutaneous injection of BoNT-A at 3, 7, or 12 d after malpositioned dental implant surgery. Subcutaneous injections of 1 or 3 U/kg of BoNT-A on postoperative day 3 significantly attenuated mechanical allodynia, although 0.3 U/kg of BoNT-A did not affect the air-puff threshold. A single injection of 3 U/kg of BoNT-A produced prolonged antiallodynic effects over the entire experimental period. Treatment with BoNT-A on postoperative days 7 and 12, when pain had already been established, also produced prolonged antiallodynic effects. Double treatments with 1 U/kg of BoNT-A produced prolonged, more antiallodynic effects as compared with single treatments. Subcutaneous administration of 3 U/kg of BoNT-A significantly inhibited the upregulation of Nav isoform 1.7 (Nav1.7) expression in the trigeminal ganglion in the nerve-injured animals. These results suggest that antinociceptive effects of BoNT-A are mediated by an inhibition of upregulated Nav1.7 expression in the trigeminal ganglion. BoNT-A is therefore a potential new therapeutic agent for chronic pain control, including neuropathic pain.



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Pain and Disability in the Jaw and Neck Region following Whiplash Trauma

The relationship between whiplash trauma and chronic orofacial pain is unclear, especially with regard to the time elapsed from trauma to development of orofacial pain. The aim was to analyze prevalence of jaw pain and disability, as well as the relationship between pain and disability in the jaw and neck regions in the early nonchronic stage after whiplash trauma. In this case-control study, 70 individuals (40 women, 30 men, mean age 35.5 y) who visited an emergency department with neck pain following a car accident were examined within 3 wk of trauma (group 1) and compared with 70 individuals (42 women, 28 men, mean age 33.8 y), who declined to attend a clinical examination but agreed to fill in questionnaires (group 2). The 2 case groups were compared with a matched control group of 70 individuals (42 women, 28 men, mean age 37.6 y) without a history of neck trauma. All participants completed questionnaires regarding jaw pain and dysfunction, rating pain intensity in jaw and neck regions on the Numerical Rating Scale, the Neck Disability Index, and Jaw Disability Checklist. Compared with controls, individuals with a recent whiplash trauma reported more jaw pain and dysfunction. Furthermore, there was a moderate positive correlation between jaw and neck pain ratings for group 1 (r = 0.61, P < 0.0001) and group 2 (r = 0.59, P < 0.0001). In the logistic regression analysis, cases showed higher odds ratios (range, 6.1 to 40.8) for jaw and neck pain and disability compared with controls. Taken together, the results show that individuals with a recent whiplash trauma report more jaw pain and disability compared with controls without a history of neck trauma. Furthermore, the correlation between jaw and neck pain intensity implies that intensity of neck pain in the acute stage after whiplash trauma might be a possible risk factor also for development of chronic orofacial pain.



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Painful Temporomandibular Disorder: Decade of Discovery from OPPERA Studies

In 2006, the OPPERA project (Orofacial Pain: Prospective Evaluation and Risk Assessment) set out to identify risk factors for development of painful temporomandibular disorder (TMD). A decade later, this review summarizes its key findings. At 4 US study sites, OPPERA recruited and examined 3,258 community-based TMD-free adults assessing genetic and phenotypic measures of biological, psychosocial, clinical, and health status characteristics. During follow-up, 4% of participants per annum developed clinically verified TMD, although that was a "symptom iceberg" when compared with the 19% annual rate of facial pain symptoms. The most influential predictors of clinical TMD were simple checklists of comorbid health conditions and nonpainful orofacial symptoms. Self-reports of jaw parafunction were markedly stronger predictors than corresponding examiner assessments. The strongest psychosocial predictor was frequency of somatic symptoms, although not somatic reactivity. Pressure pain thresholds measured at cranial sites only weakly predicted incident TMD yet were strongly associated with chronic TMD, cross-sectionally, in OPPERA's separate case-control study. The puzzle was resolved in OPPERA's nested case-control study where repeated measures of pressure pain thresholds revealed fluctuation that coincided with TMD's onset, persistence, and recovery but did not predict its incidence. The nested case-control study likewise furnished novel evidence that deteriorating sleep quality predicted TMD incidence. Three hundred genes were investigated, implicating 6 single-nucleotide polymorphisms (SNPs) as risk factors for chronic TMD, while another 6 SNPs were associated with intermediate phenotypes for TMD. One study identified a serotonergic pathway in which multiple SNPs influenced risk of chronic TMD. Two other studies investigating gene-environment interactions found that effects of stress on pain were modified by variation in the gene encoding catechol O-methyltransferase. Lessons learned from OPPERA have verified some implicated risk factors for TMD and refuted others, redirecting our thinking. Now it is time to apply those lessons to studies investigating treatment and prevention of TMD.



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Spatial and Temporal Brain Responses to Noxious Heat Thermal Stimuli in Burning Mouth Syndrome

Burning mouth syndrome (BMS) is an idiopathic orofacial pain condition. Although the pathophysiology of BMS is not clearly understood, central and peripheral neuropathic mechanisms are thought to be involved. The authors compared brain response to noxious heat stimuli in 16 right-handed women with primary BMS and 15 sex- and age-matched right-handed healthy female controls. A thermal stimulus sequence of 32 °C to 40 °C to 32 °C to 49 °C was repeated 4 times in a cycle. Warm and noxious heat stimuli were delivered with a Peltier thermode placed on the right palm or right lower lip for 32 s each in a session. Functional magnetic resonance imaging data were obtained by recording echoplanar images with a block design. Statistical Parametric Mapping 8 software was used to analyze the data. Patients and controls both reported feeling more pain during palm stimulation than during lip stimulation. Repetition of noxious heat stimulus on the lower lip but not on the palm induced habituation in brain activity in the cingulate cortex without reduction in pain perception. Multiple regression analysis revealed a correlation between perceived pain intensity and suppression of brain activity in the anterior cingulate cortex when the repeated thermal sequence was applied at the lower lip. Furthermore, the response of the parahippocampal area differed in BMS patients and controls when the same repeated thermal sequence was applied at the palm. The authors' findings indicate that BMS patients show specific brain responses due to impaired function of the central and peripheral nervous systems (clinical trial registration: UMIN000015002).



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The Evolution of TMD Diagnosis: Past, Present, Future

This review explores the principles and process associated with the diagnosis of temporomandibular disorders (TMDs). TMD diagnosis has evolved substantially over the past 25 y. Previously, diagnosis focused solely on aberrations in oral structures, largely without empirical evidence. The Research Diagnostic Criteria for TMD (RDC/TMD) were developed on core principles of 1) a dual-axis system reflecting the biopsychosocial model, 2) a clear operationalization for reliability, and 3) the allowance of multiple diagnoses. These principles were retained in the subsequent validation research of the RDC/TMD, and the current diagnostic system—the Diagnostic Criteria for TMD (DC/TMD)—has improved on those principles as well as on diagnostic validity and protocols for assessing the psychosocial domain. Further investigations into etiology and its potential contribution to taxonomy revision are described, particularly within the context of complex disease. The review concludes with an outline of major research areas already underway that will support future revisions of the DC/TMD.



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Molecular Changes Involving MEK3-p38 MAPK Activation in Chronic Masticatory Myalgia

The exact mechanism underlying chronic masticatory myalgia (CMM), a conspicuous symptom in temporomandibular disorders, remains unclear. This investigation compared gene expression profiles between CMM patients and healthy subjects. Peripheral blood leukocytes were collected in 8 cases and 8 controls and subjected to whole genome microarray analyses. Data were analyzed with Gene Ontology and interactive pathways analyses. According to Gene Ontology analysis, categories such as ion transport, response to stimuli, and metabolic process were upregulated. The pathway analysis suggested overexpression of the mitogen-activated protein kinase (MAPK) pathway in CMM patients and to a higher degree in a pathway network. Overexpression of representative members of the MAPK pathway—including MAPK kinase 3 (MEK3), calcium voltage-gated channel auxiliary subunit gamma 2 (CACNG2), and growth arrest and DNA damage–inducible gamma (GADD45G)—was validated with real-time polymerase chain reaction. The upregulation of MEK3 was negatively correlated with the age of the CMM group. In the next step, the authors focused on MEK3, the gene that exhibited the greatest degree of differential expression, and its downstream target protein p38 MAPK. The results revealed upregulation of MEK3, as well as phosphorylated MEK3 and phosphorylated p38 MAPK, in CMM patients. These results provide a "fingerprint" for mechanistic studies of CMM in the future and highlight the importance of MEK3–p38 MAPK activation in CMM.



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Using synchrotron X-ray phase-contrast micro-computed tomography to study tissue damage by laser irradiation

Background and Objective

The aim of this study was to determine if X-ray micro-computed tomography could be used to locate and characterize tissue damage caused by laser irradiation and to describe its advantages over classical histology for this application.

Study Design/Materials and Methods

A surgical CO2 laser, operated in single pulse mode (100 milliseconds) at different power settings, was used to ablate different types of cadaveric animal tissues. Tissue samples were then harvested and imaged with synchrotron X-ray phase-contrast and micro-computed tomography to generate stacks of virtual sections of the tissues. Subsequently, Fiji (ImageJ) software was used to locate tissue damage, then to quantify volumes of laser ablation cones and thermal coagulation damage from 3D renderings of tissue image stacks. Visual comparisons of tissue structures in X-ray images with those visible by classic light microscopy histology were made.

Results

We demonstrated that micro-computed tomography could be used to rapidly identify areas of surgical laser ablation, vacuolization, carbonization, and thermally coagulated tissue. Quantification and comparison of the ablation crater, which represents the volume of ablated tissue, and the thermal coagulation zone volumes were performed faster than we could by classical histology. We demonstrated that these procedures can be performed on fresh hydrated and non-sectioned plastic embedded tissue.

Conclusion

We demonstrated that the application of non-destructive micro-computed tomography to the visualization and analysis of laser induced tissue damage without tissue sectioning is possible. This will improve evaluation of new surgical lasers and their corresponding effect on tissues. Lasers Surg. Med. © 2016 Wiley Periodicals, Inc.



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Evaluation of a novel device, high-intensity focused ultrasound with a contact cooling for subcutaneous fat reduction

Background

Non-invasive devices for fat reduction involving high-intensity focused ultrasound (HIFU) are attracting attention. HIFU can deliver energy to the desired depth and can ablate subcutaneous adipose tissue (SAT), but purpura and pain may still limit its use.

Objectives

The aim of this study was to investigate the effects of a novel HIFU device for fat destruction with a contact cooling system compared to HIFU without contact cooling.

Methods

A group of three pigs were administered a series of four HIFU treatments with or without contact cooling over a period of 12 weeks. Energy fluence parameters ranged from 60 to 300 J/cm2. Immediately after the treatment and at 1, 4, and 12 weeks, the tissue was studied by hematoxylin and eosin (H&E), Masson-trichrome, toluidine blue, CD68 staining, and transmission electron microscopy. Three human volunteers also received treatment with this HIFU device with cooling and were evaluated subjectively and objectively by computed tomography (CT).

Results

HIFU treatment with a contact cooling decreased the skin surface temperature and prevented epidermal damage. Ecchymosis was observed on the non-cooled area immediately after HIFU treatment, but not on the cooled area. Histological analyses on both areas (cooled and non-cooled) revealed disrupted adipocytes in the treatment area immediately, at 1 and 4 weeks following treatment. Lipophagic histiocytic fat necrosis was evident at 4 weeks. Finally, at 12 weeks all inflammation subsided, and the lobules were markedly atrophied with reduced SAT thickness. The human volunteers experienced reduction of a few centimeter-range reduction in waist circumference after 4 weeks and pain was tolerable without bruising.

Conclusions

HIFU treatment with a cooling system efficiently destroyed adipocytes. This novel HIFU device with an added contact cooling system may provide an effective, safe and less painful treatment as a non-invasive device for fat reduction. Lasers Surg. Med. © 2016 Wiley Periodicals, Inc.



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Improvement of erythema dyschromicum perstans using a combination of the 1,550-nm erbium-doped fractionated laser and topical tacrolimus ointment

Background and Objective

Erythema dyschromicum perstans (EDP) is a cosmetically distressing, acquired pigmentary disorder of unknown etiology for which few successful therapies exist. Herein, we present the successful use of non-ablative fractional photothermolysis in combination with topical tacrolimus ointment.

Study Design/Patients and Methods

A 35-year-old female with biopsy-confirmed EDP underwent a series of fractionated non-ablative treatment sessions utilizing the 1,550 nm erbium-doped fiber laser in combination with topical tacrolimus ointment over a period of 5 months.

Results

The patient's EDP improved by greater than 75% and results were maintained at the 8-month follow-up visit.

Conclusion

The combination of non-ablative fractional photothermolysis and topical tacrolimus ointment is a potential safe and effective therapeutic option for erythema dyschromicum perstans. Additional prospective, comparative studies are warranted. Lasers Surg. Med. © 2016 Wiley Periodicals, Inc.



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Postoperative carcinoembryonic antigen level has a prognostic value for distant metastasis and survival in rectal cancer patients who receive preoperative chemoradiotherapy and curative surgery: a retrospective multi-institutional analysis

Abstract

The cut-off value and prognostic significance of postoperative carcinoembryonic antigen (CEA) level in rectal cancer after preoperative chemoradiotherapy (CRT) and curative surgery are still unclear. 1559 rectal cancer patients staged with cT3-4N0-2M0 received preoperative CRT and total mesorectal excision (TME). CEA levels were measured before CRT and 3–4 weeks after surgery. Clinicopathologic factors that could be associated with tumor recurrence and patient survival were analyzed. The cumulative probability of tumor recurrence showed a steep increase with a cutoff value of 2.5 ng/mL for postoperative CEA level, and the gradient decreased as the CEA levels increased above 2.5 ng/mL. After a median follow-up time of 46.7 months, patients with postoperative CEA level >2.5 ng/mL had significantly lower relapse-free survival (RFS) (65.2 vs. 75.6 %, P < 0.001) and overall survival (OS) (78.1 vs. 88.3 %, P < 0.001) at 5 years than patients with postoperative CEA level ≤2.5 ng/mL. On the multivariate analysis, postoperative CEA level was a significant prognostic factor for RFS (HR 1.561; 95 % CI 1.221–1.996; P < 0.001) and OS (HR 2.073; 95 % CI 1.498–2.869; P < 0.001). Postoperative CEA level independently affected RFS irrespective of pre-CRT CEA level. Postoperative CEA level was a significant predictor for distant recurrence (P = 0.004), but not for locoregional recurrence (P = 0.472). Postoperative CEA level >2.5 ng/ml is a predictor of distant metastasis and a negative prognostic factor for survival in rectal cancer patients who receive preoperative CRT and curative surgery.



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Cultural and linguistic validation of the NHQ-2 Questionnaire: a specific instrument for assessing patient’s usability of inhalation devices

An increasing number of inhalation devices are presently available in the market. They are differently characterized in terms of their handling and usability, both factors which may affect the outcomes of resp...

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Use of cyanoacrylate tissue adhesive to prevent a saliva leak post neck dissection

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Publication date: Available online 23 August 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): M.K. Alibhai, M. Amin




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Chirurgie gutartiger Stimmlippenbefunde

Zusammenfassung

Die Indikation für chirurgische Eingriffe bei gutartigen Stimmlippenbefunden ergibt sich entweder aus der Notwendigkeit zur histologischen Klärung der Dignität oder aus funktionellen Gründen. In beiden Fällen sind die Prinzipien der Phonochirurgie zu wahren. Die zur Anwendung kommenden phonochirurgischen Techniken hängen von der Art des Stimmlippenbefundes ab. Das Ziel der Phonochirurgie ist abhängig vom Befund entweder der Erhalt oder die Besserung der Stimmqualität. Zur Evaluation der operativen Ergebnisse ist eine klinische und funktionelle Diagnostik erforderlich, welche neben der Lupenlaryngoskopie die Videostroboskopie und Stimmanalyse einschließt.



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Auditory Brainstem Response Thresholds to Air- and Bone-Conducted CE-Chirps in Neonates and Adults

Purpose
The purpose of this study was to compare auditory brainstem response (ABR) thresholds to air- and bone-conducted CE-Chirps in neonates and adults.
Method
Thirty-two neonates with no physical or neurologic challenges and 20 adults with normal hearing participated. ABRs were acquired with a starting intensity of 30 dB normal hearing level (nHL). The lowest stimulus intensity level at which a wave V was identifiable and replicable was considered the ABR threshold.
Results
ABR thresholds to air-conducted CE-Chirps were 9.8 dB nHL for neonates and adults. ABR thresholds to bone-conducted CE-Chirps were 3.8 and 13.8 dB nHL for neonates and adults, respectively. The difference in ABR thresholds to bone-conducted CE-Chirps was significantly different (p p 2 = .45). Adults had significantly larger wave V amplitudes to air- (p p 2 = .50) and bone-conducted (p = .013, ηp2 = .15) CE-Chirps at a stimulus intensity of 30 dB nHL. At the same intensity, adults evidenced significantly shorter wave V latencies (p p 2 = .49) only with air-conducted CE-chirps.
Conclusion
The difference in ABR thresholds and wave V latencies to air- and bone-conducted CE-Chirps between neonates and adults may be attributed to a disparity in effective signal delivery to the cochlea.

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Un Congrès 2016 bien articulé

Publication date: Available online 23 August 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): F. Cheynet




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Articulation temporomandibulaire (ATM) : hypercondylie et condylectomie

Publication date: Available online 23 August 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): J. Ferri, G. Raoul, J. Potier, R. Nicot
Le condyle mandibulaire est une structure particulière. Son embryologie, sa physiologie, confèrent à l'ATM un comportement particulier qui explique la survenue de pathologies spécifiques. L'hypercondylie est l'une de ces pathologies. Elle s'explique par une dérégulation des cellules préchondroblastiques de la coiffe cartilagineuse, aboutissant à une augmentation volumique de l'unité condylienne puis de la branche montante et finalement de toute l'hémiface atteinte. La déformation de la mandibule est basale avec des conséquences dento-alvéolaires de rattrapage. Bien que le traitement soit controversé, la condylectomie est réalisée par beaucoup de praticiens. L'intervention permet de stopper l'évolution de la maladie et de rattraper certaines compensations dento-alvéolaires. Dans certains cas, une chirurgie orthognathique complémentaire sera nécessaire.The mandibular condyle is a special structure. Its embryology and physiology provide to the TMJ a particular behavior that explains the occurrence of specific diseases. Condyle hyperplasia is one of these disorders. It can be explained by a dysregulation of the prechondroblasts cells layer within the cartilage cap providing an increase of the condyle volume then of the ramus and eventually of the affected face. Mandible deformation affected the basal bone with dento-alveolar deformations related to compensations attempts. Despite controversial treatments, condylectomy is performed by many surgeons. The surgery stops the disease evolution and provides a retroactive action on the dento-alveolar deformities. In some patients, a traditional orthognathic surgery will be required to achieve a perfect result.



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Les différents types d’injection pour traiter les dysfonctions de l’articulation temporomandibulaire

Publication date: Available online 23 August 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): D. Batifol
IntroductionLes injections intramusculaires de toxine botulique de type A (BoNTA) peuvent relâcher les muscles manducateurs et cervicaux. Les injections intra-articulaires soulagent les douleurs, voire les bruits et les blocages articulaires lors de l'ouverture buccale.MéthodesL'injection intramusculaire de BoNTA est utilisée dans notre service depuis 2002. Les muscles injectés sont les masséters et les temporaux. Ultérieurement ont été ajoutées des injections intra-articulaires d'hyaluronate de sodium (Arthrum®) puis des injections intra-articulaires de BoNTA chez les patients présentant des douleurs supérieures à 5/10 sur une échelle visuelle analogique.RésultatsQuatre-vingt-cinq pour cent des patients traités par injections intramusculaires de BoNTA ont été soulagés. Un soulagement total ou partiel a été observé dans 95 % des cas après injections intra-articulaires d'hyaluronate de sodium. Soixante-seize pour cent des 56 patients traités par injection intra-articulaire de BoNTA, ont été soulagés, certains présentant une disparition complète des douleurs.DiscussionMême si elles ne révolutionnent pas les traitements des dysfonctions temporomandibulaires, ces différentes techniques ont une efficacité avérée. Entre les mains de praticiens expérimentés, elles sont peu risquées, bien acceptées et peu coûteuses.IntroductionIntramuscular injections of botulinum toxin of type A (BoNTA) can release tension from masticatory and cervical muscles. Intra-articular injections relieve pain and sometimes diminish joint clicking and locking that occur during mouth opening.MethodsIntramuscular injection of BoNTA is performed in our department since 2002. Injected muscles are masseter and temporal muscles. Later on, intra-articular injections of sodium hyaluronate were added, followed on a later stage by intra-articular injections of BoNTA for patients presenting with pain higher than 5/10 on an analogic visual scale.ResultsEighty-five percent of the patients treated with intramuscular BoNTA injection improved. Total or partial pain relief was obtained in 95 % of the patients after intra-articular sodium hyaluronate injections. Seventy-six percent of the 56 patients treated by mean of intra-articular BoNTA injections improved, sometimes with a complete pain relief.DiscussionThese different techniques allow for good results, even if they do not represent a revolution in the treatment of temporomandibular disorders. In the hands of experienced practitioners, they have a low morbidity, are well accepted and are cost-effective.



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Alpha 5/6 helix domains together with N-terminus determine the apoptotic potency of the Bcl-2 family proteins

Abstract

A critical process in apoptosis is the permeabilization of the mitochondrial outer membrane (MOM). This process is known to be regulated by the multi-domain Bcl-2 family proteins. For example, the pro-apoptotic proteins Bax and Bak are responsible for forming pores at MOM. The anti-apoptotic proteins (including Bcl-2, Mcl-1 and Bcl-xL), on the other hand, can inhibit this pore-forming process. Interestingly, although these two subgroups of proteins perform opposite apoptotic functions, their structures are very similar. This raises two highly interesting questions: (1) Why do these structurally similar proteins play opposite roles in apoptosis? (2) What are the roles of different functional domains of a Bcl-2 family protein in determining its apoptotic property? In this study, we generated a series of deletion mutants and substitution chimera, and used a combination of molecular biology, bio-informatics and living cell imaging techniques to answer these questions. Our major findings are: (1) All of the Bcl-2 family proteins appear to possess an intrinsic pro-apoptotic property. (2) The N-termini of these proteins play an active role in suppressing their pro-apoptotic function. (3) The apoptotic potency is positively correlated with membrane affinity of the alpha 5/6 helix domains. (4) Charge distribution flanking the alpha 5/6 helices is also important for the apoptotic potency. These findings explain why different members of Bcl-2 family proteins with similar domain composition can function oppositely in the apoptotic process.



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To Your Health: NLM update: NIH MedlinePlus magazine Summer 2016


Listen to the NLM Director's Comments

Listen to the To Your Health: NLM update on NIH MedlinePlus magazine Summer 2016. The transcript is also available.

The new edition of NIH MedlinePlus magazine covers the Zika virus, oral health, as well as endometriosis...



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TWiV Special: DA Henderson, smallpox eradicator

Donald "D.A." Henderson, a physician, educator, and epidemiologist who led the World Health Organization's campaign to eradicate smallpox, died at 87 years of age on Aug. 19, 2016. Vincent was fortunate to have the opportunity to speak with DA Henderson in 2014 about his career, the smallpox era...

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Indole 3-acetic acid-Photodynamic Therapy in the treatment of multiple Actinic Keratoses: a Proof of Concept Pilot Study”

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Publication date: Available online 23 August 2016
Source:Photodiagnosis and Photodynamic Therapy
Author(s): Vieri Grandi, Irene Baldi, Pietro Cappugi, Moira Mori, Nicola Pimpinelli
BackgroundActinic Keratoses (AK) are considered a form of in situ Squamous Cell Carcinoma (SCC) arising on chronically photoexposed skin. PDT with ALA or MAL is an effective treatment for multiple AK due its high Overall Response Ratio (ORR) but is burdened by important drawbacks: time-consumption, pain and high costs. Indole-3 acetic acid (IAA) is a newly described photosensitizer with proven clinical efficacy on seborrheic dermatitis and acne vulgaris. The aim of the study was to assess efficacy, safety and tolerability of a cycle of IAA-PDT at 0.015% in liposomal gel in the treatment of multiple AK of face or scalp.Methodswe treated 12 patients affected by multiple AK on face/scalp with 4 weekly applications. The product was applied for 15minutes under occlusion; medicated area was then irradiated for 15minutes with a LED light at 520nm wavelength for a total fluency of 9J/cm2.Resultsno grade 3/4 SAE have been reported; all 12 patients successfully completed the cycle. CR at 3 months follow-up was 25%, with an ORR of 50%. Patients reported almost no pain during irradiations, with mean overall Visual Analogic Scale (VAS) score of 0.3±0.7. IAA-PDT led to a significant improve on Disease Life Quality Index (DLQI) mean score, but no variations on Actinic Keratosis Quality of Life (AKQoL) mean score.ConclusionsAlthough larger studies are needed, this is a first "proof of concept" of IAA- PDT as a possible treatment for multiple AK on face/scalp.



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Issue Information



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Fetal MRI: incidental findings in the mother

Abstract

Background

Fetal magnetic resonance imaging (MRI) is a routinely used tool in prenatal diagnosis; however, there is a lack of studies evaluating incidental findings observed in the mother.

Objective

This study describes and quantifies incidental findings observed in the mother during fetal MRI.

Materials and methods

We reviewed all fetal MRI studies at the University of Minnesota Medical Center from February 2008 to September 2014. Two pediatric radiologists retrospectively conducted a consensus evaluation. The maternal findings were categorized into neurologic, gynecologic, urinary, gastrointestinal and musculoskeletal. Hydronephrosis consistent with the stage of pregnancy was recorded but was not included as an abnormal finding. Abnormal findings were classified into three groups, depending on their clinical significance: level I (low), level II (medium) and level III (high).

Results

We evaluated 332 pregnant patients with a mean age of 29.3 years and a mean gestational age of 29 weeks. Of these, 55.4% had at least 1 incidental finding, for a total of 262 incidental maternal findings. Of the 262 abnormalities, 113 (43.1%) were neurologic, 69 were gynecologic (26.3%), 36 (13.7%) urinary, 24 (9.2%) gastrointestinal and 20 (7.6%) musculoskeletal. Of the 262 incidental findings, 237 (90.5%) were level I, 24 (9.2%) were level II and 1 (0.4%) was level III.

Conclusion

Our results suggest that although the vast majority of incidental maternal findings are benign, more significant findings are still encountered and should be expected.



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Erratum to: Thromboprophylaxis using combined intermittent pneumatic compression and pharmacologic prophylaxis versus pharmacologic prophylaxis alone in critically ill patients: study protocol for a randomized controlled trial



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An agenda for knowledge-oriented research on bilingualism in children with developmental disorders

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Publication date: Available online 23 August 2016
Source:Journal of Communication Disorders
Author(s): Johanne Paradis




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Implementation of the ECHO® telementoring model for the treatment of patients with hepatitis C

Abstract

Objectives

To implement the ECHO telementoring model for hepatitis C and to evaluate its outcomes in the health providers.

Methods

Following the ECHO model, an hepatitis C teleECHO clinic was established at the Hospital Italiano in Argentina. The teleECHO clinic provides support and training to physicians from Patagonia who treat patients with hepatitis C. In order to evaluate the teleECHO clinic outcomes, physicians completed a survey focused on skills and competence in hepatitis C before and after six months of participating in the project. The survey consisted of 10 questions, which participants rated from 1 to 7 (1 no ability; 7 highest ability). To analyze the difference before and after participation in the project, Wilcoxon signed-rank test was used.

Results

During the first six months of implementation of the model, a total of 14 physicians from 12 sites in Patagonia agreed to participate in the survey. The median age of the participants was 42 years. Participants' primary specialties were Hepatology (55%), Infectious Diseases (25%), General Practice (10%), and other (10%). A significant improvement was observed in all the evaluated fields after six month of the participation in the teleECHO clinic, namely fibrosis staging, determining appropriate candidates for treatment, and selecting appropriate HCV treatment. In addition, their general interest in hepatitis C increased.

Conclusions

We successfully replicated and implemented the first teleECHO clinic in Argentina. Physicians improved their ability to provide best practice care for patients with Hepatitis C. This article is protected by copyright. All rights reserved



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MicroRNA expression profiles in patients with acute Crimean Congo Hemorrhagic Fever reveal possible adjustments to cellular pathways

ABSTRACT

Several viral diseases are associated with altered microRNA (miRNA) expression, which can provide vital information about how cellular pathways respond to infection. However, the miRNA profile of Crimean Congo Hemorrhagic Fever (CCHFV) infections are not known. To address this gap, we performed real-time PCR-based miRNA analysis in individuals with acute Crimean Congo Hemorrhagic Fever (CCHFV) infections, with the goal of identifying pathways this might be associated with this disease. Peripheral blood mononuclear cells were analysed in eight individuals with detectable viral RNA and compared to 5 healthy subjects. A total of 106 differentially expressed miRNAs were identified, of which 19 miRNAs were either 5-fold prominently up- or downregulation. Several miRNAs associated with cytokine expression, some of which were previously associated with Dengue and Hantavirus infections were revealed. Moreover, possible mechanisms related to secretion of adhesion molecules and viral escape from innate immunity were identified. Pathway enrichment analyses further revealed the putative involvement of TNF-alfa, TGF-beta, MAPK, WNT and neurotrophin signaling pathways in disease pathogenesis. This article is protected by copyright. All rights reserved



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Epidemiological profile and risk factors of HIV and HBV/HCV co-infection in Fujian Province, southeastern China

Abstract

Objective

This study aimed to investigate the epidemiological features of HIV-infected subjects co-infected with HBV/HCV in Fujian Province, southeastern China, and identify the risk factors.

Methods

Blood samples were collected from 2,028 HIV antibody-positive subjects in Fujian Province. Serum HBsAg and anti-HCV antibody were detected, and CD4+ T cell count was measured.

Results

Of the 2,028 subjects, the prevalence of HIV-HBV, HIV-HCV and HIV-HBV-HCV co-infections was 16.22%, 3.7% and 0.79%, respectively. Man (OR = 1.912, 95% CI: 1.371–2.667), key population (OR = 0.756, 95% CI: 0.57–0.976) and detainee (OR = 0.486, 95% CI: 0.259–0.909) were risk factors of HIV-HBV co-infection, and man (OR = 2.227, 95% CI: 1.096–4.525), minority (OR = 5.04, 95% CI: 1.696–14.98), junior high school or lower education (OR = 2.32, 95% CI: 1.071–5.025), intravenous drug use (OR = 38.46, 95% CI: 11.46–129.11) and detainee (OR = 5.687, 95% CI: 2.44–13.25) were risk factors of HIV-HCV co-infection. In addition, a lower mean CD4+ T cell count was measured in HIV/HBV and HIV/HCV co-infected subjects than in HIV-infected subjects among the untreated individuals, while in the treated populations, a higher mean CD4+ T cell count was detected in HIV/HBV and HIV/HCV co-infected subjects than in HIV-infected subjects.

Conclusion

HIV co-infection with HBV or HCV, notably HIV-HBV co-infection, is widespread in southeastern China. Hepatitis virus screening should be included in monitoring of HIV infection, and HIV and hepatitis virus co-infection should be considered during the development of HIV antiretroviral therapy scheme. This article is protected by copyright. All rights reserved



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Status of alloplastic total temporomandibular joint replacement procedures performed by members of the American Society of Temporomandibular Joint Surgeons

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Publication date: Available online 23 August 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A. Lotesto, M. Miloro, L.G. Mercuri, C. Sukotjo
The purpose of this study was to assess the number of alloplastic total temporomandibular joint replacement (TMJ TJR) devices implanted and the complications encountered by members of the American Society of Temporomandibular Joint Surgeons (ASTMJS). A questionnaire was developed using REDCap (Chicago, IL) and an on-line link was e-mailed four times over a 6-week period (February to March 2015) to all members of the ASTMJS. The questionnaire included eight questions related to the surgeon's TMJ TJR experience. A Likert scale was included to assess the respondents' opinions concerning the future demand for TMJ TJR and their thoughts on potential device improvements. The study sample was composed of 36 ASTMJS respondents (42.4%). TMJ TJR is performed successfully and in relatively high numbers by members of the American Society of Temporomandibular Joint Surgeons.



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In reply to commentary on “Does the piezoelectric surgical technique produce fewer postoperative sequelae after lower third molar surgery than conventional rotary instruments? A systematic review and meta-analysis”

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Publication date: Available online 23 August 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): E.A. Al-Moraissi, A.S. Alkhutari, Y.A. Al-Sharaee




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Management and Outcome of Periprocedural Cardiac Perforation and Tamponade with Radiofrequency Catheter Ablation of Cardiac Arrhythmias: A Single Medium-Volume Center Experience

Abstract

Introduction

Cardiac tamponade (CT) is a life-threatening complication of radiofrequency ablation (RFA). The course and outcome of CT in low-to-medium volume electrophysiology centers are underreported.

Methods

We analyzed the incidence, management and outcomes of CT in 1500 consecutive RFAs performed in our center during 2011–2016.

Results

Of 1500 RFAs performed in 1352 patients (age 55 years, interquartile range: 41–63), 569 were left-sided procedures (n = 406 with transseptal access). Conventional RFA or irrigated RFA was performed in 40.9% and 59.1% of procedures, respectively. Ablation was performed mostly for atrioventricular nodal reentrant tachycardia (25.4%), atrial fibrillation (AF; 18.5%), atrial flutter (18.4%), accessory pathway (16.5%) or idiopathic ventricular arrhythmia (VA; 12.3%), and rarely for structural VA (2.1%). CT occurred in 12 procedures (0.8%): 10 AF ablations, 1 idiopathic VA and 1 typical atrial flutter ablation. Factors significantly associated with CT were older age, pre-procedural oral anticoagulation, left-sided procedures, transseptal access, AF ablation, irrigated RFA and longer fluoroscopy time (on univariate analysis), and AF ablation (on multivariable analysis). The perforation site was located in the left atrium (n = 7), right atrium (n = 3), or in the left ventricle or coronary sinus (n = 1 each). Upon pericardiocentesis, two patients underwent urgent cardiac surgery because of continued bleeding. There was no fatal outcome. During the follow-up of 19 ± 14 months, eight patients were arrhythmia free.

Conclusion

Incidence of RFA-related CT in our medium-volume center was low and significantly associated with AF ablation. The outcome of CT was mostly favorable after pericardiocentesis, but readily accessible cardiothoracic surgery back-up should be mandatory in RFA centers.



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Diabetic Peripheral Neuropathy as a Predictor of Asymptomatic Myocardial Ischemia in Type 2 Diabetes Mellitus: A Cross-Sectional Study

Abstract

Introduction

Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes and has been associated with cardiovascular disease, the leading cause of mortality in diabetes. As asymptomatic myocardial ischemia (MI) is frequent in diabetes, we hypothesized that DPN may be associated with MI in patients with type 2 diabetes mellitus and no history of cardiovascular events.

Methods

Eighty-two patients with DPN (n = 41) or without DPN (n = 41) were included. Among the DPN group, 15 had active foot ulcers. All subjects underwent Technetium-99 m sestamibi single-photon emission computed tomographic imaging for the estimation of myocardial ischemia, expressed as Summed Stress Score (SSS). The Neuropathy Disability Score (NDS) was used to quantify DPN and abnormal ratio of the longest electrocardiographic RR interval between the 28th and 32nd beats, after standing to the shortest interval between the 13th and 17th beats (RR ratio) was used as an index of cardiovascular autonomic neuropathy (CAN).

Results

Abnormal SSS was observed in 9.8% of patients without DPN and in 46.3% of patients with DPN (p < 0.001). In the multivariate analysis, NDS was the strongest predictor for SSS (β = 0.32, p = 0.003). When excluding patients with abnormal RR ratio (β = 0.32, p = 0.003) or with foot ulcers (β = 0.24, p = 0.04), this association remained significant. The RR ratio was also significantly associated with SSS in univariate (ρ = −0.30, p = 0.005) and multiple regressions (β = 0.24, p = 0.02).

Conclusions

MI was strongly associated with DPN, and this association remained significant in patients with normal RR ratio. These results suggest that DPN assessment could help in identifying patients at risk of cardiovascular disease (CVD).



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Zika Virus Infectious Cell Culture System and the In Vitro Prophylactic Effect of Interferons

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Zika Virus (ZIKV), an emerging pathogen, is linked to fetal developmental abnormalities and microcephaly. The establishment of an effective infectious cell culture system is crucial for studies of ZIKV replication as well as vaccine and drug development. In this study, various virological assays pertaining to ZIKV are illustrated and discussed.

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Language Sampling for Preschoolers With Severe Speech Impairments

Purpose
The purposes of this investigation were to determine if measures such as mean length of utterance (MLU) and percentage of comprehensible words can be derived reliably from language samples of children with severe speech impairments and if such measures correlate with tools that measure constructs assumed to be related.
Method
Language samples of 15 preschoolers with severe speech impairments (but receptive language within normal limits) were transcribed independently by 2 transcribers. Nonparametric statistics were used to determine which measures, if any, could be transcribed reliably and to determine if correlations existed between language sample measures and standardized measures of speech, language, and cognition.
Results
Reliable measures were extracted from the majority of the language samples, including MLU in words, mean number of syllables per utterance, and percentage of comprehensible words. Language sample comprehensibility measures were correlated with a single word comprehensibility task. Also, language sample MLUs and mean length of the participants' 3 longest sentences from the MacArthur–Bates Communicative Development Inventory (Fenson et al., 2006) were correlated.
Conclusion
Language sampling, given certain modifications, may be used for some 3-to 5-year-old children with normal receptive language who have severe speech impairments to provide reliable expressive language and comprehensibility information.

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Editorial Board

Publication date: August 2016
Source:Clinical Immunology, Volume 169





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