Letter to Editors: Detection of endolymphatic hydrops using traditional MR imaging sequences

We would like to comment on the manuscript entitled "Detection of endolymphatic hydrops using traditional MR imaging sequences." by Keller et al. [1]. It is of great clinical value if non-contrast MR imaging can be used to differentiate the endo- and perilymph space as the authors have stated. We read this article with great interest and thank the authors for citing our six papers. However, there are some critical points that need to be clarified in this paper.

http://ift.tt/2swYyaJ

Solitary fibrous tumour of the pleura presenting as a giant intrathoracic mass

Solitary fibrous tumours (SFTs) are relatively rare neoplasms thought to originate from the submesothelial connective tissue. SFTs have been described in a variety of sites, including the pleura, orbit, lower respiratory tract, peritoneal cavity and heart. These neoplasms are usually benign, though locally aggressive, and metastatic behaviour has been observed in some cases. We describe a case of a 61-year-old man presenting with weight loss, poor appetite, malaise, worsening dyspnoea on exertion and lower extremity oedema, who was found to have a gigantic—21x21 cm—tumour occupying the entire right hemithorax causing compression and displacement of the mediastinum and liver. Transthoracic CT-guided biopsy revealed SFT of the pleura. The patient underwent preoperative angiography and embolisation of the tumour followed by successful surgical resection via thoracotomy.

http://ift.tt/2sbubr1

Das endoskopische Browlift mittels Endotine Forehead Device bei Fazialisparese

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113040

Hintergrund: Die Augenpartie ist sowohl in funktioneller Hinsicht als auch für die Expression von Emotionen von zentraler Bedeutung. Eine chronische Fazialisparese mit Lähmung des Stirnastes kann zu einer Brauenptosis mit Einschränkungen des Gesichtsfeldes und einer deutlichen Asymmetrie des Gesichts führen. Das endoskopische Browlift mit resorbierbarem Endotine Forehead Device stellt ein attraktives Konzept zur Korrektur der Brauenptosis und Symmetrisierung der Stirn-/Brauenregion dar. Material und Methoden Das endoskopische Augenbrauen- und Stirnlift unter Anwendung des Endotine Forehead Devices wurde in unserer Klinik bisher an 9 Patienten mit Fazialisparese durchgeführt. Das intraoperative Handling, Komplikationen und das postoperative Ergebnis wurden analysiert. Die Symmetrisierung der Augenbrauen wurde durch die FACEgram-Software erfasst. Zur postoperativen Abfrage der Patientenzufriedenheit wurde nach durchschnittlich 10 Monaten der Glasgow Benefit Inventory Fragebogen eingesetzt. Ergebnisse Mit Hilfe des endoskopischen Stirnlifts mit dem Endotine Forehead Device gelang eine minimal-invasive, komplikationsarme Symmetrisierung der Stirn- und Augenbrauenregion. Operationsbedingte Morbiditäten wurden nicht kaum beobachtet. Folgende Komplikationen wurden beobachtet: Eine Patientin erlitt eine Rezidivptosis bei postoperativem Hämatom. Eine weitere empfand die Palpabilität des Device als störend. Die Patienten berichteten über eine postoperative Steigerung der Lebensqualität, d.er durchschnittliche Punktwert im Glasgow Benefit Inventory nach der Operation lag bei + 29,2 (SD 13,6). Schlussfolgerungen Das endoskopische Brow- und Stirnlift mit dem Endotine Forehead Device stellt eine erfolgreiche, komplikationsarme Therapieoption bei Brauenptosis in Folge einer Fazialisparese dar.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Hereditäre Innenohrdysplasie mit Betroffenheit von aufeinanderfolgenden Generationen einer Familie

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113039

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Musikalische Fähigkeiten bei Kindern mit auditiver Verarbeitungs- und Wahrnehmungsstörung

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113038

Hintergrund In der klinischen Praxis wurden bei Kindern mit auditiven Verarbeitungs- und Wahrnehmungsstörungen (AVWS) Schwierigkeiten bei der Lösung musikalischer Aufgaben beobachtet. Musikalität bei AVWS ist bisher wenig erforscht. Material und Methoden 15 AVWS-Patienten im Alter zwischen 6 und 11 Jahren wurden mit der Messung musikalischer Fähigkeiten (MMF) untersucht und mit 15 Kontrollprobanden verglichen. Ergebnisse AVWS-Patienten zeigen statistisch signifikante Defizite in den Aufgaben zur Tonhöhendifferenzierung, Reproduktion von Rhythmen und Melodien. Zusammenhänge zwischen sprachlichen und musikalischen Leistungen bei AVWS-Patienten wurden nachgewiesen. Schlussfolgerungen Musikalische Fähigkeiten sollten in der AVWS-Diagnostik mehr Beachtung finden. Positive Transfereffekte musikalischen Trainings auf die Sprachentwicklung und allgemeine kognitive Fähigkeiten wurden in zahlreichen Studien nachgewiesen. Bei Vorliegen musikalischer Defizite sollte musikalische Förderung als Therapiemethode bei AVWS diskutiert werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Progrediente Verschlechterung des Sprachverstehens nach Cochlea-Implantation

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113041

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2u8tRup

Incidence of Hepatitis B Viral Reactivation After Kidney Transplantation With Low-dose Rituximab Administration.

Background: In hematological malignancy patients intended to receive rituximab, hepatitis B virus (HBV) serology screening, viral reactivation monitoring, are recommended. However, the effect of single-dose rituximab (RIT) on HBV reactivation in kidney transplant patients with previous HBV infection is still unclear. Methods: In this retrospective cohort study consisting of 1294 kidney transplant patients, we identified 76 patients showing preoperative hepatitis B surface antigen-negative, hepatitis B core antibody-positive, and HBV-DNA negative results. A rituximab dose of 200mg/body was administered to 48 patients, 46 of whom did not receive prophylaxis (RIT+ group). Twenty-eight patients received neither rituximab nor prophylaxis (RIT- group). We monitored HBV-DNA by polymerase chain reaction every 1-3 months, and HBV reactivation was defined as detectable HBV-DNA. Results: HBV reactivation was found in 1 patient in the RIT+ group (2.2%) and 1 patient in the RIT- group (3.6%) at 6 weeks and 5.5 years posttransplant, respectively, but spontaneously cleared. Both patients showed positive hepatitis B surface antibody (anti-HBs) preoperatively. HBV reactivation was not found in 6 patients lacking anti-HBs preoperatively. Conclusions: Low-dose RIT administration in kidney transplant patients without prophylaxis is associated with low incidence of HBV reactivation. However, the comparisons amongst standard-dose RIT, low-dose RIT, and controls with high quality study design is necessary. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Aggregating Marginal Gains in Posttransplant CMV Risk Stratification.

No abstract available

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The use of Ex Vivo Generated Regulatory T Cell Preparations in a Canine Lung Allograft Model.

No abstract available

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Non-HLA Antibodies Impact on C4d staining, Stellate Cell Activation and Fibrosis in Liver Allografts.

Background: Recent data has shown an increased risk for rejection, fibrosis progression, and death in liver transplant (LT) recipients with preformed or de novo HLA donor-specific alloantibodies (DSA). However, the role of non-HLA autoantibodies and the interaction between HLA DSA and non-HLA autoantibodies remains uncharacterized. Methods: We analyzed 1269 primary LT recipients from 1/2000-4/2009 with known HLA DSA status for Angiotensin II Type-1 Receptor and Endothelin-1 Type A receptor autoantibodies(anti-AT1R-Abs and anti-ETAR-Abs respectively) pre-LT and year-1 post-LT. Results: Preformed non-HLA autoantibodies alone did not impact outcomes. In multivariable modeling, the combination of preformed non-HLA autoantibodies and HLA-DSA were associated with an increased risk for death [Hazard Ratio (HR)=1.66; p=0.02] especially if the HLA DSA was of the IgG3 subclass (HR=2.28; p=0.01). A single de novo non-HLA autoantibody was associated with an increased risk for TCMR or AMR rejection(68% vs. 41%, p=0.01) and fibrosis progression (HR=1.84; p=0.02). Biopsies with de novo non-HLA autoantibodies revealed a new sinusoidal C4d staining pattern when compared to HLA DSA(71% vs. 3%; p

http://ift.tt/2tzwOXR

Letter to the editor

Publication date: Available online 30 June 2017
Source:American Journal of Otolaryngology
Author(s): Satvinder Singh Bakshi




http://ift.tt/2sb767z

Letter to Editors: Detection of endolymphatic hydrops using traditional MR imaging sequences

Publication date: Available online 30 June 2017
Source:American Journal of Otolaryngology
Author(s): Shinji Naganawa, Michihiko Sone




http://ift.tt/2ttYcGx

Single-Injection Versus Multiple-Injection Technique of Ultrasound-Guided Paravertebral Blocks: A Randomized Controlled Study Comparing Dermatomal Spread.

Background and Objectives: The objective of this study was to investigate the extent of dermatomal spread following an ultrasound-guided thoracic paravertebral block (PVB) when equal volumes of local anesthetic are injected at 1 versus 5 vertebral levels. Methods: Seventy patients undergoing a unilateral mastectomy were randomized to receive either single or multiple injections of a PVB under real-time ultrasound guidance using a parasagittal approach. The patients in the single-injection group received a PVB at T3-T4 level with 25 mL of 0.5% ropivacaine and 4 subcutaneous sham injections. Patients in the multiple-injection group received 5 injections of a PVB from T1 to T5 level. Five milliliters of 0.5% ropivacaine was injected at each level. Evaluation of the sensory block was carried out 20 minutes following the completion of the PVB. Results: The median (interquartile range) dermatomal spread was not significantly different for the single-injection group (5 [4-6]) compared with the multiple-injection group (5 [5-6]), with a median difference of 0 segments (95% confidence interval, -1 to 0 segments; P = 0.22). The median time to performance of the single-injection PVB was shorter compared with the multiple-injection group (10 minutes), with a mean difference of -4 minutes (95% confidence interval, -6 to -3 minutes; P

http://ift.tt/2u82D7b

Neuralgic Amyotrophy Attributed Incorrectly to Block-Related Injury: Understanding Errors in Clinical Reasoning.

Objective: We report a case of misdiagnosed neuralgic amyotrophy (brachial plexus neuritis, Parsonage-Turner syndrome). Our primary objective is to review the scientific basis for errors in clinical reasoning. Case Report: We herein report a patient in whom signs and symptoms compatible with neuralgic amyotrophy presented after shoulder surgery. The patient's brachial plexopathy was attributed incorrectly as a complication of interscalene brachial plexus block. The true diagnosis was made only after the patient developed neuralgic amyotrophy in the contralateral upper extremity after a subsequent shoulder surgery on that side, this time without a brachial plexus block. Conclusions: Cognitive bias may lead to errors in clinical reasoning and consequent misdiagnosis. Temporal proximity may falsely implicate regional anesthesia as the causative agent. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

http://ift.tt/2tyX2d7

Allergic contact dermatitis in preservatives: current standing and future options

Purpose of review: Preservatives are well known skin sensitizers and represent one of the main causes of contact allergy. The purpose of this article is to review the current state of contact sensitization induced by preservatives and point future alternatives for products' preservation. Recent findings: Isothiazolinones currently are the most common preservatives responsible of contact allergy in Europe and in the United States, and although some regulatory interventions have been taken place, the current contact allergy outbreak is not yet under control. Despite the ban of methyldibromo glutaronitrile from cosmetics in Europe, sensitized patients are still diagnosed, suggesting other nonregulated sources of exposure. Sensitization rates to formaldehyde and formaldehyde-releasers are lower in Europe in comparison with the United States due to stricter regulations regarding their use. Prevalence of contact allergy to parabens has remained stable over the last decades, whereas iodopropynyl butylcarbamate is an emerging allergen with an increasing prevalence. Future alternatives for products' preservation look for a broad antimicrobial spectrum, but with a better safety profile (in terms of sensitization) than the currently available compounds. Summary: Given the high rates of sensitization reported over the last years, timely regulatory actions are urgently required for some preservatives that currently represent a concern for public health.

http://ift.tt/2tadbCS

Hypersensitivity reactions to gadolinium-based contrast agents

Purpose of review: Gadolinium-based contrast agents (GBCAs) have been utilized since the late 1980s to enhance the diagnostic value of MRI studies. They are known to have excellent safety profile and serious adverse reactions are uncommon despite widespread global use. However, immediate hypersensitivity reactions are well described in the literature, with urticaria the most common manifestation. Anaphylaxis can occur, though fatality is extremely rare. This review explores the incidence of GBCA-related hypersensitivity reactions and highlights potential risk factors. Recent findings: Emerging evidence suggests that immediate hypersensitivity reactions to GBCAs can be IgE-mediated. Skin testing may be informative in confirmation of causality and revealing cross-reactivity patterns. Summary: GBCA hypersensitivity is infrequent but can be serious. Familiarity with management of acute hypersensitivity reactions may be lifesaving. Appropriate use of diagnostic testing can be used to guide future management of patients who have suffered from such reactions.

http://ift.tt/2sqlEoj

Alternative treatments for chronic spontaneous urticaria beyond the guideline algorithm

Purpose of review: The international EAACI/GA2LEN/EDF/WAO guideline suggests a stepwise approach for the therapeutic management of chronic spontaneous urticaria (CSU), outlined in an algorithm. The aim of this article is to summarize and review the evidence available on alternative treatment options for CSU outside of this algorithm. Recent findings: Although CSU is a common disease, there are a limited number of high-quality studies, and only antihistamines and omalizumab are licensed for its treatment. Most studies regarding alternative therapies for CSU show methodological limitations and a high risk of bias. For many therapies, only case reports and uncontrolled studies exist. Recent publications on alternative treatments for chronic urticaria/CSU include reports on the use of adalimumab, rituximab, vitamin D, probiotics, histaglobulin, injection of autologous whole blood or serum, and phototherapy. Summary: Numerous treatments beyond the guideline algorithm have been evaluated in patients with refractory CSU. The global level of evidence to support their efficacy in CSU is low or very low. Further research is needed to assess the efficacy and safety of alternative therapies of CSU to manage adequately those patients who do not respond to the treatments included in the algorithm.

http://ift.tt/2sqRi4T

Reactions to cytostatic agents in children

Purpose of review: The current review will focus on drug hypersensitivity reactions to chemotherapy specifically to those drugs most used in children. We know that potentially all chemotherapeutic agents can cause infusion reactions, generally defined as adverse drug reactions. Of these, some are Type A, defined as expected and described in the characteristics of the drug and others, and Type B, defined as unexpected reactions which cannot be explained by the known toxicity profile of the drug. When an unexpected reaction occurs, drugs we can refer as hypersensitivity reactions (HSRs). Some of these (HSRs) are allergic reactions as they have an underlying immunologic mechanism. In general, the cytotoxic agents most commonly associated with HSRs are the platinum salts derivatives, taxanes, pegylated liposomal doxorubicin, L-asparaginase, procarbazine, etoposide, bleomycin, and cytarabin. Recent findings: HSRs may also occur in children with cancer, during the treatment with chemotherapeutic drugs. The most used drugs of this group in children to cause HSRs are: carboplatin, L-asparaginase, and methothrexate. The aim of this review is to summarize the incidence and the clinical features of HSRs occurring with these drugs in children. Summary: The aim of this review is to summarize the incidence and the clinical features of HSRs occurring with these drugs in children. The current review will focus on the most involved drugs in children, the type of reactions, the mechanisms involved, and the best way to manage them.

http://ift.tt/2sqRq4n

Molecular aspects of allergens in atopic dermatitis

Purpose of review: Molecular allergology uses pure, mainly recombinant and structurally defined allergen molecules and allergen-derived epitopes to study mechanisms of IgE-associated allergy, to diagnose, and even predict the development of allergic manifestations and to treat and prevent IgE-associated allergies. Atopic dermatitis, a chronic inflammatory skin disease is almost always associated with IgE sensitization to allergens. However, also non-IgE-mediated pathomechanisms seem to be operative in atopic dermatitis and it is often difficult to identify the disease-causing allergens. Here we review recent work showing the usefulness of molecular allergology to study mechanisms of atopic dermatitis, for diagnosis and eventually for treatment and prevention of atopic dermatitis. Recent findings: IgE sensitization to airborne, food-derived, microbial allergens, and autoallergens has been found to be associated with atopic dermatitis. Using defined allergen molecules and non-IgE-reactive allergen derivatives, evidence could be provided for the existence of IgE- and non-IgE-mediated mechanisms of inflammation in atopic dermatitis. Furthermore, effects of epicutaneous allergen administration on systemic allergen-specific immune responses have been studied. Multi-allergen tests containing micro-arrayed allergen molecules have been shown to be useful for the identification of culprit allergens in atopic dermatitis and may improve the management of atopic dermatitis by allergen-specific immunotherapy, allergen avoidance, and IgE-targeting therapies in a personalized medicine approach. Summary: Molecular allergology allows for dissection of the pathomechanisms of atopic dermatitis, provides new forms of allergy diagnosis for identification of disease-causing allergens, and opens the door to new forms of management by allergen-specific and T cells-targeting or IgE-targeting interventions in a personalized medicine approach.

http://ift.tt/2t9YqzO

Drug allergy/hypersensitivity in adults and children

No abstract available

http://ift.tt/2sqnGF1

Allergen immunotherapy for the treatment of respiratory allergies in the elderly

Purpose of review: Respiratory allergies, including asthma and allergic rhinitis can also occur in the elderly. Allergen immunotherapy for allergic diseases is the only disease-modifying treatment for patients with allergies available thus far. Here, we review current evidence supporting the use of allergen immunotherapy in the elderly and discuss its efficacy and utility for the treatment of respiratory allergic diseases in this setting. Recent findings: Subcutaneous and/or sublingual immunotherapy are effective therapeutic options in not only young but also older patients. Allergen immunotherapy reduces medication and symptom scores in the elderly and can thus be safely prescribed in this population. Summary: Elderly individuals with proven, clinically relevant immunoglobulin E sensitization to inhalant allergens may benefit from allergen immunotherapy for respiratory allergic diseases. Older patients without contraindications should therefore be considered for treatment, with the additional benefit of reduced medication and symptom scores.

http://ift.tt/2sqjJQl

Seasonal Allergic Rhinitis: A focused systematic review and practice parameter update

Purpose of review: The review compares and contrasts seven major United States and international allergic rhinitis guidelines from 2008 to 2017. Recent findings: Despite many treatment options for allergic rhinitis, patients often report lack of therapeutic control and a reduced quality of life. Guidelines intended to improve allergic rhinitis care have been evolving into evidence based, systematic reviews, with less reliance on consensus of expert opinion characteristic of more traditional guidelines. The first Grading of Recommendations Assessment, Development, and Evaluation-based guideline developed in the United States for seasonal allergic rhinitis was first published in 2017. Summary: When critically analyzing the allergic rhinitis guidelines that use the rigorous Grading of Recommendations Assessment, Development, and Evaluation methodology, different groups of expert authors, using the same reference articles, will, at times, reach different conclusions regarding the quality of the evidence and the strength of the recommendation. Factors potentially contributing to these divergent determinations include: lack of objective primary outcome measures in allergic rhinitis, poorly defined Minimal Clinically Important Difference, failure to include all interested parties in guideline development, for example, patients, and subjectivity inherent in the expert panel.

http://ift.tt/2sqBH5C

Aspirin challenge and desensitization: how, when and why

Purpose of review: To investigate the current approach to aspirin challenge (drug provocation) and/or desensitization in patients with histories of hypersensitivity reactions to it, particularly in those with cardiovascular diseases. Recent findings: The literature indicates that patients with coronary artery disease (CAD), including those with an acute coronary syndrome, may safely undergo low-dose aspirin challenge and/or desensitization. Recently, flowcharts regarding challenge/desensitization procedures with aspirin in patients with CAD and histories of aspirin hypersensitivity reactions have become available. Aspirin desensitization and continuous aspirin therapy constitute an effective option in patients with nonsteroidal anti-inflammatory drug-exacerbated respiratory diseases (NERD) who have suboptimally controlled asthma or rhinosinusitis, or require multiple revision polypectomies. Summary: The use of aspirin has proven to reduce morbidity and mortality associated with CAD. There is a general consensus on aspirin's effectiveness in secondary prevention of CAD. Therefore, aspirin desensitization is necessary in patients with CAD and histories of hypersensitivity reactions to it. The effectiveness of aspirin desensitization and continuous therapy in patients with NERD has been shown in numerous studies. However, shared selection criteria of candidates for aspirin challenge/desensitization procedures, and simple and homogeneous protocols are necessary. Moreover, preventive safety measures are still needed in order to reduce the potential risks of these procedures.

http://ift.tt/2sq8Deo

Editorial introductions

No abstract available

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Skin allergy

No abstract available

http://ift.tt/2t9RxOP

Pharmacotherapy of mast cell disorders

Purpose of review: Mast cell disorders (MCDs) comprise mastocytosis and disorders referred to as mast cell activation syndrome and are caused by abnormal accumulation and/or activation of mast cells in tissues. Clinical signs and symptoms are protean; therefore, finding suitable treatment options for individual patients entails a challenge for clinicians. The purpose of this manuscript is to review the literature on the available therapeutic interventions in patients with MCD. Recent findings: Pharmacotherapy is mainly directed against the effects of mast cells and their mediators. The current recommendations are exclusively based on expert opinions due to the lack of controlled clinical trials. The targeted therapies aiming at blocking mutant KIT variants and/or downstream signaling pathways are currently being developed and may be considered in severely affected, therapy-refractory patients. Summary: There is currently no method for predicting the best available approach to control symptoms in individual patients with MCD. Therefore, a stepwise, individual-based approach in pharmacotherapy options appears to be most successful strategy and is recommended in all patients. The core component of the treatment in most patients is to control symptoms caused by mast cell mediator release, whereas cytoreductive therapies are mainly reserved for patients with advanced/aggressive systemic mastocytosis.

http://ift.tt/2tah9Lq

Atopic dermatitis phenotypes and the need for personalized medicine

Purpose of review: To describe recent developments in therapies which target the molecular mechanisms in atopic dermatitis. Recent findings: Current advances in the understanding of the molecular basis of atopic dermatitis are leading to the stratification of different atopic dermatitis phenotypes. New therapies offer the option to target-specific molecules involved in the pathophysiology of atopic dermatitis. Current new therapies under investigation aim to modulate specific inflammatory pathways associated with distinctive atopic dermatitis phenotypes, which would potentially translate into the development of personalized, targeted-specific treatments of atopic dermatitis. Summary: Despite the unmet need for well tolerated, effective, and personalized treatment of atopic dermatitis, the current standard treatments of atopic dermatitis do not focus on the individual pathogenesis of the disease. The development of targeted, phenotype-specific therapies has the potential to open a new promising era of individualized treatment of atopic dermatitis.

http://ift.tt/2t9WAPj

Cholesteatoma as a complication of Langerhans Cell Histiocytosis of the temporal bone: A nationwide cross-sectional analysis

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Jonathan C. Simmonds, Mark Vecchiotti
ObjectiveTo determine if patients with Langerhans Cell Histiocytosis (LCH) of the temporal bone have a higher risk of developing cholesteatoma.MethodsReview of literature and cross-sectional weighted analysis of patients under 19 with a diagnosis of LCH from the National Inpatient Sample (NIS) and Kids' Inpatient Database (KID) from 2000 to 2013. ICD-9 codes and demographics were analyzed; pairwise comparisons and multivariate analyses were performed.ResultsOnly seven cases of cholesteatoma after the treatment for LCH of the temporal bone have been documented in the literature. No significant association between cholesteatoma and LCH was seen (OR 0.747 [0.149–3.751]). Patients with LCH did have a higher incidence of chronic otitis media, chronic otitis externa, chronic sinusitis, hearing loss, and otitis media with effusion.ConclusionOur results show that patients with Langerhans Cell Histiocytosis do not appear to have a higher risk of developing cholesteatoma. However they are more likely to be diagnosed with chronic otitis externa which should be differentiated from cholesteatoma or recurrence of LCH.



http://ift.tt/2sqGhR4

Pediatric head and neck bone sarcomas: An analysis of 204 cases

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Jacob S. Brady, Sei Y. Chung, Emily Marchiano, Jean Anderson Eloy, Soly Baredes, Richard Chan Woo Park
ObjectivesTo analyze the demographics, survival, and treatment efficacy of pediatric sarcomas of the facial skeleton and skull.MethodsRetrospective study of cases from the US National Cancer Institute's Surveillance, Epidemiology, and End Results database. Pediatric patients between the ages of 0 and 18 diagnosed with a malignant sarcoma of either the mandible or the bones of skull, face, and associated joints from 1973 to 2013 were studied.ResultsIn total, 204 patients were included in the analysis. The average age at diagnosis was 11.39 (±5.15) years with a male-to-female ratio of 1.4:1. Whites were the most commonly affected race (76.0%). Malignant mandible sarcomas accounted for 29.9% of the cohort (n = 61). The most common pathology was osteosarcoma, which accounted for 43.6% of the cohort (n = 89). Among patients with known histologic grade (n = 95), 26.0% were AJCC stage III or IV. Overall, 5-year disease-specific survival (DSS) was 80.6%. When stratified by treatment modality, 5-year DSS was 86.0% for surgery alone, 67.9% for radiation alone, and 75.3% for surgery with adjuvant radiotherapy (p = 0.041).ConclusionsOsteosarcoma, Ewing's sarcoma, and chondrosarcoma are the most common subtypes of pediatric head and neck bone sarcoma. Such sarcomas more commonly affect whites and males during pubertal ages. Disease-specific survival is not affected by primary site. Surgery alone is the mainstay of treatment, and demonstrates higher 5-year disease-specific survival compared to radiotherapy alone. Adjuvant radiotherapy does not seem to increase survival, but further investigation is warranted.



http://ift.tt/2tadH3y

Pathophysiology of esophageal impairment due to button battery ingestion

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Johannes Völker, Christine Völker, Philipp Schendzielorz, Sebastian P. Schraven, Andreas Radeloff, Robert Mlynski, Rudolf Hagen, Kristen Rak
BackgroundThe increased use of button batteries with high energy densities in devices of daily life presents a high risk of injury, especially for toddlers and young children. If an accidental ingestion of a button battery occurs, this foreign body can become caught in the constrictions of the esophagus and cause serious damage to the adjacent tissue layers. The consequences can be ulcerations, perforations with fistula formation and damage to the surrounding anatomical structures. In order to gain a better understanding of the pathophysiology after ingestion, we carried out systematic studies on fresh preparations of porcine esophagi.MethodsThe lithium button battery type CR2032, used most frequently in daily life, was exposed in preparations of porcine esophagi and incubated under the addition of artificial saliva at 37 °C. A total of eight esophagi were analysed by different methods. Measurements of the pH value around the battery electrodes and histological studies of the tissue damage were carried out after 0.5–24 h exposure time. In addition, macroscopic time-lapse images were recorded. Measurements of the battery voltage and the course of the electric current supplemented the experiments.FindingsThe investigations showed that the batteries caused an electrolysis reaction in the moist environment. The positive electrode formed an acidic and the negative electrode a basic medium. Consequently, a coagulation necrosis at the positive pole, and a deep colliquation necrosis at the minus pole occurred. After an exposure time of 12 h, tissue damage caused by the lye corrosion was observed on the side of the negative electrode up to the lamina muscularis. The corrosion progressed up to the final exposure time of 24 h, but the batteries still had sufficient residual voltage, such that further advancing damage would be expected.ConclusionsButton battery ingestion in humans poses an acute life-threatening danger and immediate endoscopic removal of the foreign body is essential. After only 2 h exposure time, significant damage to the tissue could be detected, which progressed continuously to complete esophageal perforation. The primary prevention of battery ingestion is therefore of particular importance.



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Paediatric injection medialisation laryngoplasty: Recent Great Ormond Street Hospital experience

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): K.A. Stephenson, L. Cavalli, A. Lambert, J. Fleming, E. Lawes, S. Gupta, C.G. Jephson, L.A. Cochrane
IntroductionUnilateral vocal fold paresis may significantly impair the vocal quality and laryngeal competence of a child. Relatively little literature relates to injection medialisation laryngoplasty (IML) in children and previous reports have involved small numbers of heterogenous cases.MethodsA retrospective review was conducted of paediatric patients managed by our multidisciplinary specialist voice clinic undergoing IML for unilateral vocal fold paresis. Cases of bilateral paresis, those characterised by vocal fold fixation, and patients without formal pre and post-operative voice evaluation were excluded.ResultsEighteen IML procedures were performed in 12 children eligible for inclusion between 2005 and 2015. The average age at time of procedure was 12 years (range 9–15 years). Autologous fat was used in 5 procedures, succeeded by calcium hydroxylapatite (Radiesse^® Voice) from 2011 (n = 13). A significant improvement in median GRBAS score components was observed after calcium hydroxylapatite injection in terms of grade (p = 0.008), breathiness (p = 0.002) and aesthenia (p = 0.016). A pre- and post-procedural Voice Handicap Index was self-completed by 6 patients receiving calcium hydroxylapatite injection; the median change in score was an improvement of 19 points (interquartile range 36.5).ConclusionWe describe the outcomes of a comparatively large paediatric series and have found IML using calcium hydroxylapatite to be a reliable technique associated with improved subjective outcome measures. Management of UVCP in the child is a challenge with particular investigative and interventional considerations. Further study supported by high quality subjective and, where possible, objective outcome measures, is required to better inform patient selection, timing of intervention and choice of injection material.



http://ift.tt/2tadiOO

Disparities in access to pediatric hearing health care.

Purpose of review: There are significant disparities in care facing children with hearing loss. The objective of this review is to assess the current disparities in pediatric hearing healthcare delivery, describe the barriers of efficient and effective pediatric hearing health care, and explore the innovations to improve pediatric hearing healthcare delivery. Recent findings: Children with hearing loss from certain geographic regions or ethnic background are significantly delayed in diagnosis and treatment. Multiple patient characteristics (presentation of hearing loss), parental factors (insurance status, socioeconomic status, educational status, and travel distance to providers), and provider barriers (specialist shortage and primary care provider challenges) prevent the delivery of timely hearing health care. Advances, such as improved screening programs and the expansion of care through remote services, may help to ameliorate these disparities. Summary: Timely identification and treatment of pediatric hearing loss is critical to prevent lifelong language complications. Children from vulnerable populations, such as rural residents, face significant disparities in care. Careful assessment of these barriers and implementation of culturally acceptable interventions are paramount to maximize communication outcomes of children with hearing loss. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2tabjKb

Disparities in access to pediatric hearing health care.

Purpose of review: There are significant disparities in care facing children with hearing loss. The objective of this review is to assess the current disparities in pediatric hearing healthcare delivery, describe the barriers of efficient and effective pediatric hearing health care, and explore the innovations to improve pediatric hearing healthcare delivery. Recent findings: Children with hearing loss from certain geographic regions or ethnic background are significantly delayed in diagnosis and treatment. Multiple patient characteristics (presentation of hearing loss), parental factors (insurance status, socioeconomic status, educational status, and travel distance to providers), and provider barriers (specialist shortage and primary care provider challenges) prevent the delivery of timely hearing health care. Advances, such as improved screening programs and the expansion of care through remote services, may help to ameliorate these disparities. Summary: Timely identification and treatment of pediatric hearing loss is critical to prevent lifelong language complications. Children from vulnerable populations, such as rural residents, face significant disparities in care. Careful assessment of these barriers and implementation of culturally acceptable interventions are paramount to maximize communication outcomes of children with hearing loss. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Cover 1

Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1





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Brief Overview of This Month's JACI

Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1





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Table of Contents

Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1





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Editorial Board

Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1





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Information for Readers

Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1





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News & Notes

Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1





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CME Activities Calendar

Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1





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Environmental determinants of allergy and asthma in early life

Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
Author(s): Allison J. Burbank, Amika K. Sood, Matthew J. Kesic, David B. Peden, Michelle L. Hernandez
Allergic disease prevalence has increased significantly in recent decades. Primary prevention efforts are being guided by study of the exposome (or collective environmental exposures beginning during the prenatal period) to identify modifiable factors that affect allergic disease risk. In this review we explore the evidence supporting a relationship between key components of the external exposome in the prenatal and early-life periods and their effect on atopy development focused on microbial, allergen, and air pollution exposures. The abundance and diversity of microbial exposures during the first months and years of life have been linked with risk of allergic sensitization and disease. Indoor environmental allergen exposure during early life can also affect disease development, depending on the allergen type, dose, and timing of exposure. Recent evidence supports the role of ambient air pollution in allergic disease inception. The lack of clarity in the literature surrounding the relationship between environment and atopy reflects the complex interplay between cumulative environmental factors and genetic susceptibility, such that no one factor dictates disease development in all subjects. Understanding the effect of the summation of environmental exposures throughout a child's development is needed to identify cost-effective interventions that reduce atopy risk in children.



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Environmental determinants of allergy and asthma in early life

Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1





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The environment, epigenome, and asthma

Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
Author(s): Ivana V. Yang, Catherine A. Lozupone, David A. Schwartz
Asthma prevalence has been on the increase, especially in North America compared with other continents. However, the prevalence of asthma differs worldwide, and in many countries the prevalence is stable or decreasing. This highlights the influence of environmental exposures, such as allergens, air pollution, and the environmental microbiome, on disease etiology and pathogenesis. The epigenome might provide the unifying mechanism that translates the influence of environmental exposures to changes in gene expression, respiratory epithelial function, and immune cell skewing that are hallmarks of asthma. In this review we will introduce the concept of the environmental epigenome in asthmatic patients, summarize previous publications of relevance to this field, and discuss future directions.



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An exposome perspective: Early-life events and immune development in a changing world

Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
Author(s): Harald Renz, Patrick G. Holt, Michael Inouye, Alan C. Logan, Susan L. Prescott, Peter D. Sly
Advances in metagenomics, proteomics, metabolomics, and systems biology are providing a new emphasis in research; interdisciplinary work suggests that personalized medicine is on the horizon. These advances are illuminating sophisticated interactions between human-associated microbes and the immune system. The result is a transformed view of future prevention and treatment of chronic noncommunicable diseases, including allergy. Paradigm-shifting gains in scientific knowledge are occurring at a time of rapid global environmental change, urbanization, and biodiversity losses. Multifactorial and multigenerational implications of total environmental exposures, the exposome, require coordinated interdisciplinary efforts. It is clear that the genome alone cannot provide answers to urgent questions. Here we review the historical origins of exposome research and define a new concept, the metaexposome, which considers the bidirectional effect of the environment on human subjects and the human influence on all living systems and their genomes. The latter is essential for human health. We place the metaexposome in the context of early-life immune functioning and describe how various aspects of a changing environment, especially through microbiota exposures, can influence health and disease over the life course.



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The Editors' Choice

Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
Author(s): Cezmi A. Akdis, Zuhair K. Ballas




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News Beyond Our Pages

Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
Author(s): Marc E. Rothenberg, Jean Bousquet




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The Journal of Allergy and Clinical Immunology: An update on style and substance

Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
Author(s): Cezmi A. Akdis, Justin Byrne, Zuhair K. Ballas




http://ift.tt/2tz1GrH

Association of Insurance and Community-Level Socioeconomic Status With Treatment and Outcome of Squamous Cell Carcinoma of the Pharynx.

Association of Insurance and Community-Level Socioeconomic Status With Treatment and Outcome of Squamous Cell Carcinoma of the Pharynx.

JAMA Otolaryngol Head Neck Surg. 2017 Jun 29;:

Authors: Shin JY, Yoon JK, Shin AK, Blumenfeld P, Mai M, Diaz AZ

Abstract
Importance: Community-level socioeconomic status, particularly insurance status, is increasingly becoming important as a possible determinant in patient outcomes.
Objective: To determine the association of insurance and community-level socioeconomic status with outcome for patients with pharyngeal squamous cell carcinoma (SCC).
Design, Setting, and Participants: This study extracted data from more than 1500 Commission on Cancer-accredited facilities collected in the National Cancer Database. A total of 35 559 patients diagnosed with SCC of the pharynx from 2004 through 2013 were identified. The χ2 test, Kaplan-Meier method, and Cox regression models were used to analyze data from April 1, 2016, through April 16, 2017.
Main Outcomes and Measures: Overall survival was defined as time to death from the date of diagnosis.
Results: Among the 35 559 patients identified (75.6% men and 24.4% women; median age, 61 years [range, 18-90 years]), 15 146 (42.6%) had Medicare coverage; 13 061 (36.7%), private insurance; 4881 (13.7%), Medicaid coverage; and 2471 (6.9%), no insurance. Uninsured patients and Medicaid recipients were more likely to be younger, black, or Hispanic; to have lower median household income and lower educational attainment; to present with higher TNM stages of disease; and to start primary treatment at a later time from diagnosis. Those with private insurance (reference group) had significantly better overall survival than uninsured patients (hazard ratio [HR], 1.72; 95% CI, 1.59-1.87), Medicaid recipients (HR, 1.99; 95% CI, 1.88-2.12), or Medicare recipients (HR, 2.07; 95% CI, 1.99-2.16), as did those with median household income of at least $63 000 (reference) vs $48 000 to $62 999 (HR, 1.19; 95% CI, 1.13-1.26), $38 000 to $47 999 (HR, 1.31; 95% CI, 1.24-1.38), and less than $38 000 (HR, 1.51; 95% CI, 1.43-1.59). On multivariable analysis, insurance status and median household income remained independent prognostic factors for overall survival even after accounting for educational attainment, race, Charlson/Deyo comorbidity score, disease site, and TNM stage of disease.
Conclusions and Relevance: Insurance status and household income level are associated with outcome in patients with SCC of the pharynx. Those without insurance and with lower household income may significantly benefit from improving access to adequate, timely medical care. Additional investigations are necessary to develop targeted interventions to optimize access to standard medical treatments, adherence to physician management recommendations, and subsequently, prognosis in these patients at risk.

PMID: 28662244 [PubMed - as supplied by publisher]

http://ift.tt/2sZWkEn

Use of Audiometric Measurement for Assessment of Vocal-Fold Function in Postextubation Infants.

Use of Audiometric Measurement for Assessment of Vocal-Fold Function in Postextubation Infants.

JAMA Otolaryngol Head Neck Surg. 2017 Jun 29;:

Authors: Liu YC, Varier I, Ongkasuwan J

Abstract
Importance: Infants with vocal-fold motion impairment (VFMI) have an increased risk of aspiration and pulmonary complications. Flexible nasolaryngoscopy (FNL) is the gold standard for evaluation of vocal-fold mobility. Although safe, FNL causes measurable physiologic changes. Noxious stimuli, especially in neonates in the cardiovascular intensive care unit, may cause imbalance between the pulmonary and systemic circulations and potentially circulatory collapse.
Objective: To examine whether bedside measurement of infant cry volume using a smartphone application can be a screening tool for vocal-fold movement in FNL.
Design, Study, and Participants: This case-control study performed from December 1, 2013, through January 31, 2015, included 42 infants in the intensive care unit at Texas Children's Hospital, Houston.
Main Outcomes and Measures: Patient cry volume in decibels was recorded using a smartphone application placed 12 in from their mouth.
Results: Forty-two infants were identified at the intensive care unit (median age, 33 days; 20 [48%] female and 22 [52%] male), 21 with VFMI and 21 without, based on FNL findings. A statistically significant difference was found in the mean cry volume of infants with (76.60 dB) and without (85.72 dB) VFMI. The absolute difference in the mean cry volume was 9.12 dB (95% CI, 2.74-15.50 dB). A cry volume of 90 dB or greater had a sensitivity of 90.4% (95% CI, 71%-97%) for identification of normal vocal-fold mobility. A cry volume of 75 dB or less had a specificity of 90.5% (95% CI, 71%-97%) for the identification of VFMI. The mean (SE) area under the receiver operating characteristic curve was 0.721 (0.080) (95% CI, 0.565-0.877). The cry volume, however, was not a good screen for aspiration.
Conclusions and Relevance: Bedside measurement of the cry volume with a smartphone application can be used by untrained health care professionals to screen patients for further evaluation of vocal-fold mobility using FNL.

PMID: 28662238 [PubMed - as supplied by publisher]

http://ift.tt/2usqUEa

Control of Pain After Tonsillectomy in Children: A Review.

Control of Pain After Tonsillectomy in Children: A Review.

JAMA Otolaryngol Head Neck Surg. 2017 Jun 29;:

Authors: Tan GX, Tunkel DE

Abstract
Importance: The relief of pain after tonsillectomy in children remains challenging and even controversial. While the need for pain control after this surgery is understood, recent debate has centered around the risks of opioids in children with obstructive sleep apnea syndrome (OSAS) and the possible increases in posttonsillectomy hemorrhage with the use of alternative nonsteroidal anti-inflammatory drugs (NSAIDs).
Observations: We discuss the multiple facets of posttonsillectomy pain control in children. A variety of pharmacologic and nonpharmacologic interventions used before, during, and after surgery are reviewed, presenting the evidence for efficacy and possible adverse effects. We also review the various surgical techniques used in tonsillectomy with a focus on reducing postoperative pain.
Conclusions and Relevance: Clinicians should understand effective methods of analgesia after tonsillectomy in children, and know the potential consequences of each option. Caution should be employed when using opioids, particularly in young children with severe OSAS. Although large studies of NSAID use have shown effective pain management without an increase in posttonsillectomy bleeding frequency, the potential for more severe bleeding events has been debated. Cold dissection techniques lead to less pain, but hot techniques remain popular, with less intraoperative blood loss and shorter operative time. Partial (intracapsular) tonsillectomy seems to reduce pain as well.

PMID: 28662233 [PubMed - as supplied by publisher]

http://ift.tt/2tua2zS

Unilateral Nasal Congestion in an Elderly Man.

Unilateral Nasal Congestion in an Elderly Man.

JAMA Otolaryngol Head Neck Surg. 2017 Jun 29;:

Authors: Cai Y, Parasher AK, Palmer JN

PMID: 28662224 [PubMed - as supplied by publisher]

http://ift.tt/2us6gnG

Antipodocalyxin Antibody chPcMab-47 Exerts Antitumor Activity in Mouse Xenograft Models of Colorectal Adenocarcinomas

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.


http://ift.tt/2tysmJ8

Different levels of let-7d expression modulate response of FaDu cells to irradiation and chemotherapeutics

by Katarzyna Monika Lamperska, Tomasz Kolenda, Anna Teresiak, Anna Kowalik, Marta Kruszyna-Mochalska, Weronika Jackowiak, Renata Bliźniak, Weronika Przybyła, Marta Kapałczyńska, Piotr Kozlowski

The implication of the let-7 family in cancer development is multifaceted. The family acts as tumor suppressor miRNA although overexpression of let-7 has also been described in many types of cancer, including head and neck squamous cell carcinoma (HNSCC). The aim of this study includes whether different expression levels of let-7d has an influence on chemo- and radiosensitivity. FaDu cell line models with a gradually increased level of let-7d (models from A to E) were generated with the lentiviral system. Expression levels of pluripotency, chemo-radioresistance/apoptosis, and targets of mRNAs were analyzed by real-time reverse transcription-PCR (qRT-PCR). Radiosensitivity was analyzed using a clonogenic assay after irradiation. Response to cisplatin, 5-FU, doxorubicin, and paclitaxel was done with MTT assay. Statistically significant decrease of K-RAS (p = 0.0369) and CASPASE3 (p = 0.0342) were observed with the growing expression level of let-7d. Cisplatin, 5-FU and doxorubicin caused similar decreased of cell survival with the increase of let-7d level (p = 0.004, post-trend p = 0.046; p = 0.004, post trend p = 0.0005 and pp = 0.0001, respectively). All models were resistant to paclitaxel, irrespective of let-7d expression levels. Only two of the generated models (A and C) were radiosensitive (p = 0.0002). Conclusion: the above results indicated that the level of let-7d expression is an important factor for cell response to irradiation and chemotherapeutics.

http://ift.tt/2tufxyv

DIS on a polarized spin-1 target with spectator tagging

We discuss the process of deep-inelastic electron scattering (DIS) on the polarized deuteron with detection of a nucleon in the nuclear fragmentation region ("spectator tagging"). We cover (a) the general structure of the semi-inclusive DIS cross section on a spin-1 target; (b) the tagged structure functions in the impulse approximation, where deuteron structure is described by the NN light-front wave function; (c) the extraction of free neutron structure through on-shell ex- trapolation in the recoil proton momentum. As an application we consider the extraction of the neutron structure function F 2n and spin structure function g 1n through electron scattering on the (un)polarized deuteron with proton tagging and on-shell extrapolation. Such measurements would be possible at an Electron-Ion Collider (EIC) with polarized deuteron beams and forward proton detectors.

http://ift.tt/2us9sQd

Tensor-polarized structure function b1 in the standard convolution description of the deuteron

Tensor-polarized structure functions of a spin-1 hadron are additional observables, which do not exist for the spin-1/2 nucleon. They could probe novel aspects of the internal hadron structure. Twist-2 tensor-polarized structure functions are b1 and b2, and they are related by the Callan-Gross-like relation in the Bjorken scaling limit. In this work, we theoretically calculate b1 in the standard convolution description for the deuteron. Two different theoretical models, a basic convolution description and a virtual nucleon approximation, are used for calculating b1, and their results are compared with the HERMES measurement. We found large differences between our theoretical results and the data. Although there is still room to improve by considering higher-twist effects and in the experimental extraction of b1 from the spin asymmetry Azz, there is a possibility that the large differences require physics beyond the standard deuteron model for their interpretation. Future b1 studies could shed light on a new field of hadron physics. In particular, detailed experimental studies of b1 will start soon at the Thomas Jefferson National Accelerator Facility. In addition, there are possibilities to investigate tensor-polarized parton distribution functions and b1 at Fermi National Accelerator Laboratory and a future electron-ion collider. Therefore, further theoretical studies are needed for understanding the tensor structure of the spin-1 deuteron, including a new mechanism to explain the large differences between the current data and our theoretical results.

http://ift.tt/2tujRO7

Tagged spectator DIS on a polarized spin-1 target

We discuss the process of deep-inelastic electron scattering (DIS) on the polarized deuteron with detection of a nucleon in the nuclear fragmentation region ("spectator tagging"). We cover (a) the general structure of the semi-inclusive DIS cross section on a spin-1 target; (b) the tagged structure functions in the impulse approximation, where deuteron structure is described by the $NN$ light-front wave function; (c) the extraction of free neutron structure through on-shell extrapolation in the recoil proton momentum. As an application we consider the extraction of the neutron spin structure function $g_{1n}$ through polarized electron scattering on the longitudinally polarized deuteron with proton tagging and on-shell extrapolation. Such measurements would be possible at an Electron-Ion Collider (EIC) with polarized deuteron beams and forward proton detectors.

http://ift.tt/2us03IE

Different levels of let-7d expression modulate response of FaDu cells to irradiation and chemotherapeutics

by Katarzyna Monika Lamperska, Tomasz Kolenda, Anna Teresiak, Anna Kowalik, Marta Kruszyna-Mochalska, Weronika Jackowiak, Renata Bliźniak, Weronika Przybyła, Marta Kapałczyńska, Piotr Kozlowski

The implication of the let-7 family in cancer development is multifaceted. The family acts as tumor suppressor miRNA although overexpression of let-7 has also been described in many types of cancer, including head and neck squamous cell carcinoma (HNSCC). The aim of this study includes whether different expression levels of let-7d has an influence on chemo- and radiosensitivity. FaDu cell line models with a gradually increased level of let-7d (models from A to E) were generated with the lentiviral system. Expression levels of pluripotency, chemo-radioresistance/apoptosis, and targets of mRNAs were analyzed by real-time reverse transcription-PCR (qRT-PCR). Radiosensitivity was analyzed using a clonogenic assay after irradiation. Response to cisplatin, 5-FU, doxorubicin, and paclitaxel was done with MTT assay. Statistically significant decrease of K-RAS (p = 0.0369) and CASPASE3 (p = 0.0342) were observed with the growing expression level of let-7d. Cisplatin, 5-FU and doxorubicin caused similar decreased of cell survival with the increase of let-7d level (p = 0.004, post-trend p = 0.046; p = 0.004, post trend p = 0.0005 and pp = 0.0001, respectively). All models were resistant to paclitaxel, irrespective of let-7d expression levels. Only two of the generated models (A and C) were radiosensitive (p = 0.0002). Conclusion: the above results indicated that the level of let-7d expression is an important factor for cell response to irradiation and chemotherapeutics.

http://ift.tt/2tufxyv

Industry relationships are associated with performing a greater number of sinus balloon dilation procedures

Background

Industry outreach promotes awareness of novel technologies. However, concerns have been raised that such relationships may also unduly impact medical decision-making. Our objective in this study was to evaluate industry relationships among practitioners who frequently employ balloon dilation (BD), characterizing whether there is any association between financial relationships and BD utilization.

Methods

Provider utilization data (FY-2014) was accessed for individuals billing BD procedures to Medicare, the largest healthcare payor in the United States. The names of individuals included in these data sets were cross-referenced with the Centers for Medicare and Medicaid Services Open Payment site to determine the extent of industry relationships during this same year. Individuals included in this analysis were organized by those with "significant" ($1,000 to $10,000) and "major" (> $10,000) industry relationships. Practice setting, training, and experience were also evaluated.

Results

Of the 302 otolaryngologists who billed enough BDs for inclusion in this data set, 99.3% were in private practice, 89.7% were board-certified, 8.3% had facial plastic and reconstructive fellowship training, and 1.3% had rhinology fellowship training. There was a significant increase in BDs performed with increasing BD company financial contributions (analysis of variance, p = 0.0003). Individuals without "significant" relationships with BD companies billed fewer BDs than those with at least "significant" (>$1,000) relationships (57.0 ± 4.3 vs 87.7 ± 10.0, p = 0.001).

Conclusion

There is an association between receiving money from industry and the frequency with which otolaryngologists employ BD. Although our analysis demonstrates an association, these results in no way imply causation. Further analysis exploring the reasons for this association may be necessary.

http://ift.tt/2ty0d4E

Prognostic value of nasal cytology and clinical factors in nasal polyps development in patients at risk: can the beginning predict the end?

Background

We evaluated the prognostic value of nasal cytology and clinical factors in predicting nasal polyp (NP) development in patients with history of nonallergic chronic sinonasal inflammation.

Methods

This was a retrospective case-control study of 295 patients followed at our institution for a mean of 85.70 ± 19.41 months. According to the inclusion criteria we enrolled 84 cases with persistent eosinophilic nonallergic sinonasal inflammation (group A) and 106 cases with neutrophilic inflammation (group B), both without evidence of NPs at the baseline. We considered as controls 105 patients affected by nonallergic noninfectious vasomotor rhinitis without evidence of inflammation at nasal cytology (group C). Patients were checked every 6 months for NPs. Temporal analyses was performed by Kaplan-Mayer curves and odds ratios were evaluated by logistic regression analyses.

Results

The percentage of patients that developed NPs was higher in group A (29/84 [34.52%]) than in group B (17/106 [16.03%]) and group C (5/104 [4.7%]) (p < 0.05). Logistic regression analyses showed that eosinophilic patients had a higher risk of NP development over the years than neutrophilic patients compared to controls (odds ratio [OR], 10.55 vs 3.2). We also demonstrated that hypereosinophilia, asthma, and aspirin intolerance may increase the OR differently in eosinophilic patients.

Conclusion

Our data suggest that early identification of inflammatory patterns and associated clinical factors in patients affected by chronic nonallergic sinonasal inflammation have a prognostic value that can help to identify patients with different risks of NP development. Our data confirm that detection of nasal eosinophilic inflammation represents an early marker for identification of a more aggressive inflammatory phenotype.

http://ift.tt/2u7mIKV

Quality measurement for rhinosinusitis: a review from the Quality Improvement Committee of the American Rhinologic Society

Background

Measuring quality outcomes is an important prerequisite to improve quality of care. Rhinosinusitis represents a high value target to improve quality of care because it has a high prevalence of disease, large economic burden, and large practice variation. In this study we review the current state of quality measurement for management of both acute (ARS) and chronic rhinosinusitis (CRS).

Methods

The major national quality metric repositories and clearinghouses were queried. Additional searches included the American Academy of Otolaryngology–Head and Neck Surgery database, PubMed, and Google to attempt to capture any additional quality metrics.

Results

Seven quality metrics for ARS and 4 quality metrics for CRS were identified. ARS metrics focused on appropriateness of diagnosis (n = 1), antibiotic prescribing (n = 4), and radiologic imaging (n = 2). CRS quality metrics focused on appropriateness of diagnosis (n = 1), radiologic imaging (n = 1), and measurement of patient quality of life (n = 2). The Physician Quality Reporting System (PQRS) currently tracks 3 ARS quality metrics and 1 CRS quality metric. There are no outcome-based rhinosinusitis quality metrics and no metrics that assess domains of safety, patient-centeredness, and timeliness of care.

Conclusions

The current status of quality measurement for rhinosinusitis has focused primarily on the quality domain of efficiency and process measures for ARS. More work is needed to develop, validate, and track outcome-based quality metrics along with CRS-specific metrics. Although there has been excellent work done to improve quality measurement for rhinosinusitis, there remain major gaps and challenges that need to be considered during the development of future metrics.

http://ift.tt/2tyqPCT

Increased expression of TIPE2 in alternatively activated macrophages is associated with eosinophilic inflammation and disease severity in chronic rhinosinusitis with nasal polyps

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial disorder characterized by exaggerated local immune responses. Tumor necrosis factor-α–induced protein 8–like 2 (TIPE2) is a novel protein with potential immune modulating function. The expression and function of TIPE2 in human airway diseases are unclear.

Methods

The expression of TIPE2 in sinonasal mucosal samples was assessed by means of quantitative reverse transcript–polymerse chain reaction, immunohistochemistry, and Western blotting. The human monocytic/macrophage cell line, THP-1 cells, was stimulated with various cytokines. Computed tomography (CT) scan images, endoscopic findings, and symptoms were scored.

Results

Compared with non-eosinophilic polyps and control mucosa, the mRNA and protein expression of TIPE2 was significantly upregulated in eosinophilic polyps, with a further increase in those with asthma. The number of CD68⁺CD163⁺ alternatively activated (M2) macrophages was increased in eosinophilic polyps. TIPE2 was mainly expressed by M2 macrophages in sinonasal mucosa and its expression was upregulated in M2 macrophages in eosinophilic polyps. Interleukin (IL)-4 and IL-13, but not interferon (IFN)-γ or IL-17A, induced TIPE2 expression in differentiated THP-1 cells. The mRNA levels of IL-4 and IL-13 correlated with the mRNA levels of TIPE2 and M2 macrophage markers in sinonasal mucosa. Importantly, the number of TIPE2⁺ cells, particularly TIPE2⁺CD163⁺CD68⁺ M2 macrophages, correlated positively with the number of eosinophils and total inflammatory cells in sinonasal mucosa, as well as disease duration, CT scores, hyposmia scores, and polyp size in CRSwNP.

Conclusion

The T-helper 2 milieu is able to induce TIPE2 expression in macrophages. TIPE2-positive M2 macrophages potentially contribute to eosinophilic inflammation and disease progression in CRSwNP.

http://ift.tt/2u718Gv

Het Belgisch Nederlands anno 2017: verspreiding, juridische status en variationele structuur

http://ift.tt/2tsCZMV

Tussen droom en daad. De consequenties van de verander(en)de standaardtaalrealiteit voor de taaldocent

http://ift.tt/2s9Pb1c

Pectobacterium aroidearum and Pectobacterium carotovorum subsp carotovorum as causal agents of potato soft rot in Lebanon

To identify bacteria causing severe soft rot on potato in Lebanon, pectinolytic bacteria were isolated from diseased samples collected in the Bekaa valley and the Akkar region, during 2009-2010. Six isolates that induced a hypersensitive reaction in tobacco plants and caused a marked soft rot when inoculated in potato tubers or stem, DAPP-PG 752 to DAPP-PG 757, were further characterized. Analysis of 16S-23S intergenic transcribed spacer-regions, digested with RsaI and CfoI, demonstrated that isolates DAPP-PG 753 to DAPP-PG 757 showed electrophoretic profiles similar to that of LMG 2408, a strain misclassified as Pectobacterium carotovorum subsp. carotovorum, and different from that of DAPP-PG 752. Phylogenetic analysis using partial malate dehydrogenase gene sequences, clustered DAPP-PG 752 in a clade that contained the type strain of P. carotovorum subsp. carotovorum, while DAPP-PG 753 to DAPP-PG 757, together with LMG 2408, fell in a clade including strains of the recently described species Pectobacterium aroidearum. Multilocus sequence analysis of concatenated partial sequences of the atpD, gyrB, infB and rpoB genes confirmed the results obtained with the mdh gene sequences and identified DAPP-PG 752 as P. carotovorum, and LMG 2408 and the five related Lebanese isolates as P. aroidearum. The Lebanese P. aroidearum isolates were phenotypically similar to known P. aroidearum strains, based on API 50 CHE data. They showed identical BOX- and ERIC-PCR profiles that resembled profiles of known P. aroidearum strains. This study represents the first official report of P. aroidearum as causal agent of soft rot on potato plants and the first occurrence of P. carotovorum subsp. carotovorum on potato plants in Lebanon.

http://ift.tt/2tsut0q

Lutibacter holmesii sp nov., a marine bacterium of the family Flavobacteriaceae isolated from the sea urchin Strongylocentrotus intermedius, and emended description of the genus Lutibacter

Seven Gram-staining-negative, strictly aerobic, pale-yellow-pigmented, rod-shaped and nonmotile strains were isolated from the sea urchin Strongylocentrotus intermedius collected from Troitsa Bay, Sea of Japan. Phylogenetic analyses based on 16S rRNA gene sequences showed that these isolates were affiliated with the family Flavobacteriaceae. The novel isolates showed 99.9-100 % 16S rRNA gene sequence similarity to each other and were closely related to the type strains of the recognized members of the genus Lutibacter with sequence similarities of 95.8-98.4 %. The G + C content of the genomic DNA was 35-36 mol%. DNA-DNA relatedness among the sea urchin isolates was 95-99 % and between strain KMM 6277(T) and its most closely related type strains, Lutibacter agarilyticus KCTC 23842(T) and Lutibacter litoralis JCM 13034(T), was 38 and 27 %, respectively. The prevalent fatty acids were iso-C-15 (: 0), anteiso-C-15 (: 0), summed feature 3 (comprising iso-C-15 : 0 2-OH and/or C-16 : 1 omega 7c fatty acids), iso-C-15 : 1 and C-15 : 0. The polar lipid profile was composed of the phosphatidylethanolamine, one unknown aminolipid and one unknown lipid. The main respiratory isoprenoid quinone was MK-6. The results of phylogenetic, phenotypic and genotypic analyses indicated that the novel strains represent a novel species within the genus Lutibacter, for which the name Lutibacter holmesii sp. nov. is proposed. The type strain is KMM 6277(T) (= CCUG 62221(T) = LMG 26737(T)).

http://ift.tt/2sa2ZZF

Lutibacter holmesii sp. nov., a marine bacterium of the family Flavobacteriaceae isolated from the sea urchin Strongylocentrotus intermedius, and emended description of the genus Lutibacter

http://ift.tt/2tsKwvd

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Thanyawat Sasanakietkul, Tobias Carling

Survival in Patients with Medullary Thyroid Cancer After Less Extensive Operations
Reese W. Randle, Maria F. Bates, David F. Schneider, Rebecca S. Sippel, Susan C. Pitt

Personalized Selection Criteria for Radioiodine Administration in Low- and Intermediate-Risk Papillary Thyroid Carcinoma
Clinton D. Bahler, Viraj Maniar, Kristen N. Marley, Steven V. Kheyfets, Cheuk Fan Shum, Chandru P. Sundaram

 

The post VideoEndocrinology™ High-Impact Videos appeared first on American Thyroid Association.

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Approach for quantitative analysis of hordein peptides in gluten-free malt beers with High-Resolution-Orbitrap-MS

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Erwinia gerundensis sp nov., a cosmopolitan epiphyte originally isolated from pome fruit trees

A survey to obtain potential antagonists of pome fruit tree diseases yielded two yellow epiphytic bacterial isolates morphologically similar to Pantoea agglomerans, but showing no biocontrol activity. Whole-cell MALDI-TOF mass spectrometry and analysis of 16S rRNA gene and gyrB sequences suggested the possibility of a novel species with a phylogenetic position in either the genus Pantoea or the genus Erwinia. Multi-locus sequence analysis (MLSA) placed the two strains in the genus Erwinia and supported their classification as a novel species. The strains showed general phenotypic characteristics typical of this genus and results of DNA DNA hybridizations confirmed that they represent a single novel species. Both strains showed a DNA G +C content, as determined by HPLC, of 54.5 mol% and could be discriminated from phylogenetically related species of the genus Erwinia by their ability to utilize potassium gluconate, potassium 2-ketogluconate, maltose, melibiose and raffinose. Whole-genome sequencing of strain EM595(T) revealed the presence of a chromosomal carotenoid biosynthesis gene cluster similar to those found in species of the genera Cronobacter and Pantoea that explains the pigmentation of the strain, which is atypical for the genus Erwinia. Additional strains belonging to the same species were recovered from different plant hosts in three different continents, revealing the cosmopolitan nature of this epiphyte. The name Erwinia gerundensis sp. nov. is proposed, with EM595(T) (=LMG 28990(T)=CCOS 903(T)) as the designated type strain.

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Multiple Locus Variable number of tandem repeat Analysis: A molecular genotyping tool for Paenibacillus larvae

American Foulbrood, caused by Paenibacillus larvae, is the most severe bacterial disease of honey bees (Apis mellifera). To perform genotyping of P.larvae in an epidemiological context, there is a need of a fast and cheap method with a high resolution. Here, we propose Multiple Locus Variable number of tandem repeat Analysis (MLVA). MLVA has been used for typing a collection of 209 P.larvae strains from which 23 different MLVA types could be identified. Moreover, the developed methodology not only permits the identification of the four Enterobacterial Repetitive Intergenic Consensus (ERIC) genotypes, but allows also a discriminatory subdivision of the most dominant ERIC type I and ERIC type II genotypes. A biogeographical study has been conducted showing a significant correlation between MLVA genotype and the geographical region where it was isolated.

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Impact of plant growth-promoting rhizobacteria on root colonization potential and life cycle of Rhizophagus irregularis following co-entrapment into alginate beads

AimsThis study aimed at evaluating the impact of seven plant growth-promoting rhizobacteria (PGPR) on root colonization and life cycle of Rhizophagus irregularis MUCL 41833 when co-entrapped in alginate beads. Methods and ResultsTwo invitro experiments were conducted. The first consisted of the immobilization of R. irregularis and seven PGPR isolates into alginate beads to assess the effect of the bacteria on the pre-symbiotic growth of the fungus. In the second experiment, the best performing PGPR from experiment 1 was tested for its ability to promote the symbiotic development of the AMF in potato plantlets from three cultivars. Results showed that only one isolate identified as Pseudomonas plecoglossicida (R-67094) promoted germ tube elongation and hyphal branching of germinated spores during the pre-symbiotic phase of the fungus. This PGPR further promoted the symbiotic development of the AMF in potato plants. ConclusionsThe co-entrapment of Ps. plecoglossicida R-67094 and R. irregularis MUCL 41833 in alginate beads improved root colonization by the AMF and its further life cycle under the experimental conditions. Significance and Impact of the StudyCo-entrapment of suitable AMF-PGPR combinations within alginate beads may represent an innovative technology that can be fine-tuned for the development of efficient consortia-based bioformulations.

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De stadsenclave. Van militair hospitaal tot Groen Kwartier

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Genetic characterization of strains named as Xanthomonas axonopodis pv. dieffenbachiae leads to a taxonomic revision of the X-axonopodis species complex

Xanthomonas axonopodis pv. dieffenbachiae (Xad) is the causal agent of anthurium bacterial blight and listed as an A2 quarantine organism by EPPO. However, the name Xad covers a variety of strains. Here, 25 Xad strains and 88 phylogenetically related strains, including Xanthomonas type strains and representatives of other pathovars, were examined using a polyphasic taxonomic approach. Multilocus sequence analysis of seven genes showed that strains isolated from Dieffenbachia, Philodendron and Anthurium cluster into three phylogenetic groups (PG I, II and III), while the type strain of X. axonopodis clustered into a fourth group (PG IV). PG I included the type strains of X. citri subsp. citri, X. citri subsp. malvacearum, X. fuscans subsp. fuscans and X. fuscans subsp. aurantifolii. PG II included the type strains of X. euvesicatoria, X. perforans, X. alfalfae subsp. alfalfae and X. alfalfae subsp. citrumelonis. PG III included the type strains of X. phaseoli. Each PG was shown to represent a single species, based on average nucleotide identity values, DNA-DNA hybridization data and phenotypic characteristics. Therefore, strains named as Xad belong to PG I, PG II and PG III, and not to X. axonopodis (PG IV). Taxonomic proposals are made: emendations of the descriptions of X. citri, X. phaseoli and X. axonopodis, to encompass the strains of PG I, PG III and PG IV, respectively; and reclassification of X. perforans and X. alfalfae as X. euvesicatoria and emendation of the description of X. euvesicatoria to encompass all strains of PG II.

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City

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De kwaliteit van de gehechtheidsrelaties in kaart brengen: vertaling van een onderzoekstraditie naar de klinische praktijk

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Gehechtheid voor (cognitieve) gedragstherapeuten. Van het 'vage'vuur naar een belangrijke component van succesvolle behandeling?

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24th European Childhood Obesity Group (ECOG) Meeting, Austria

Dit is een WOS aanvaard artikel maar, het betreft een special issue waar ik editor van ben

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Impact of the freeze-drying process on product appearance, residual moisture content, viability, and batch uniformity of freeze-dried bacterial cultures safeguarded at culture collections

In this study, causes of collapsed bacterial cultures in glass ampoules observed after freeze-drying were investigated as well as the influence of collapse on residual moisture content (RMC) and viability. Also, the effect of heat radiation and post freeze-drying treatments on the RMC was studied. Cake morphologies of 21 bacterial strains obtained after freeze-drying with one standard protocol could be classified visually into four major types: no collapse, porous, partial collapse, and collapse. The more pronounced the collapse, the higher residual moisture content of the freeze-dried product, ranging from 1.53 % for non-collapsed products to 3.62 % for collapsed products. The most important cause of collapse was the mass of the inserted cotton plug in the ampoule. Default cotton plugs with a mass between 21 and 30 mg inside the ampoule did not affect the viability of freeze-dried Aliivibrio fischeri LMG 4414(T) compared to ampoules without cotton plugs. Cotton plugs with a mass higher than 65 mg inside the ampoule induced a full collapsed product with rubbery look (melt-back) and decreasing viability during storage. Heat radiation effects in the freeze-drying chamber and post freeze-drying treatments such as exposure time to air after freeze-drying and manifold drying time prior to heat sealing of ampoules influenced the RMC of freeze-dried products. To produce uniform batches of freeze-dried bacterial strains with intact cake structures and highest viabilities, inserted cotton plugs should not exceed 21 mg per ampoule. Furthermore, heat radiation effects should be calculated in the design of the primary drying phase and manifold drying time before heat sealing should be determined as a function of exposure time to air.

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Description of Pseudomonas gregormendelii sp nov., a Novel Psychrotrophic Bacterium from James Ross Island, Antarctica

During the microbiological research performed within the scope of activities of Czech expeditions based at the Johann Gregor Mendel Station at James Ross Island, Antarctica, two psychrotrophic gram-stain negative non-fluorescent strains CCM 8506T and CCM 8507 from soil were extensively characterized using genotypic and phenotypic methods. Initial characterization using ribotyping with HindIII restriction endonuclease and phenotyping implies that both isolates belong to a single Pseudomonas species. Sequencing of rrs, rpoB, rpoD and glnA genes of strain CCM 8506(T) confirmed affiliation of investigated strains within the genus Pseudomonas. Further investigation using automated ribotyping with EcoRI (RiboPrinter(A (R)) Microbial Characterisation System), whole-cell protein profiling using the Agilent 2100 Bioanalyzer system, extensive biochemical testing and DNA-DNA hybridization experiments confirmed that both investigated strains are members of a single taxon which is clearly separated from all hitherto described Pseudomonas spp. Based on all findings, we describe a novel species Pseudomonas gregormendelii sp. nov. with the type strain CCM 8506(T) (=LMG 28632T).

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Michael Miller Named Director of Biomedical Engineering

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Role of sialendoscopy in juvenile recurrent parotitis (JRP)

Publication date: Available online 29 June 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Berta, G. Angel, F. Lagarde, B. Fonlupt, L. Noyelles, G. Bettega
Juvenile recurrent parotitis (JRP) is a rare disease of childhood occurring between the ages of 3 and 5 years, characterized by recurrent non-suppurative parotitis, spontaneously evolving towards parotid gland dysfunction. Clinically, JRP presents in the form of unilateral or bilateral, usually asynchronous, swelling of the parotid gland. The diagnosis is based on ultrasound characteristics. Widespread use of sialendoscopy has opened up new prospects for the management of this disease. This review of the literature evaluates the role of sialendoscopy in the management of JRP. A Medline search retrieved 68 articles, 18 of which concerned JRP. Standard treatment consists of antibiotics for at least 10 days at the acute phase of the disease. All studies demonstrated the diagnostic value of sialendoscopy by visualizing strictures, hypovascularization and whitish intraductal debris. Sialendoscopy is also useful for treatment, by allowing intraductal lavage and, when possible, dilatation of strictures. Lavage is performed with saline solution, hydrocortisone, antibiotics or a combination of these solutions, with no significant differences in terms of efficacy. The mode of administration with or without sialendoscopy also appears to provide similar results. Sialendoscopy appears to be a diagnostic and therapeutic option, although it has not been shown to be more effective than simple lavage. All lavage solutions appear to be effective.



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Bronchoprotective tolerance with indacaterol is not modified by concomitant tiotropium in persistent asthma

Abstract

Background

Tiotropium is a long acting antimuscarinic (LAMA), licenced as triple therapy with inhaled corticosteroid and long acting beta-agonist (ICS/LABA). There may be a synergistic benefit between LAMA and LABA as a consequence of receptor cross-talk, which in turn could modify beta-2 receptor down-regulation and associated tolerance induced by LABA.

Objective

We hypothesise this mechanism may result in a reduction of airway hyperresponsiveness (AHR) when using triple therapy.

Methods

We evaluated 14 non-smoking asthmatics using an open-label, randomized crossover design. ICS with Indacaterol and Tiotropium (IND/TIO) vs ICS with Indacaterol (IND) over 4 weeks with challenge performed after 1^st and last doses at trough.

Results

We found no significant difference in mannitol sensitivity, expressed as the provocative dose of mannitol required to reach a 15% drop in FEV₁, or mannitol reactivity, expressed as the response dose ratio (RDR: max % fall in FEV1 / cumulative dose), when comparing ICS/IND/TIO to ICS/IND. Geometric mean fold differences for RDR comparing single and chronic dosing were 3.26 fold (95%CI 1.46-7.29) and 2.51 fold (95%CI 1.32-4.79) for IND and IND/TIO respectively. Furthermore, salbutamol recovery post challenge was significantly blunted after chronic compared to single dosing with either IND (P<0.005) or IND/TIO (P<0.05).

Conclusion & Clinical Relevance

Our data suggests that concomitant tiotropium does not modify the bronchoprotective tolerance induced by Indacaterol, in turn suggesting that cross-talk may not be clinically relevant when using triple therapy. This study was registered on clinicaltrials. gov as NCT02039011.

This article is protected by copyright. All rights reserved.

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Comorbidities in adults with asthma: population-based cross-sectional analysis of 1.4 million adults in Scotland

Abstract

Background

Comorbidity in people with asthma can significantly increase asthma morbidity and lower adherence to asthma guidelines.

Objective

The objective of this study was to comprehensively measure the prevalence of physical and mental health comorbidities in adults with asthma using a large nationally representative population.

Methods

Cross-sectional analysis of routine primary care electronic medical records for 1,424,378 adults in the UK, examining the prevalence of 39 comorbidities in people with and without asthma, before and after adjustment for age, sex, social deprivation and smoking status using logistic regression.

Results

Of 39 comorbidities measured, 36 (92%) were significantly more common in adults with asthma. 62.6% of adults with asthma had ≥1 comorbidity vs. 46.2% of those without, and 16.3% had ≥4 comorbidities vs. 8.7% of those without. Comorbidities with the largest absolute increase in prevalence in adults with asthma were: COPD (13.4% vs 3.1%), depression (17.3% vs 9.1%), painful conditions (15.4% vs 8.4%), and dyspepsia (10.9% vs 5.2%). Comorbidities with the largest relative difference in adults with asthma compared to without were: COPD (adjusted odds ratio [aOR] 5.65, 95%CI 5.52-5.79), bronchiectasis (aOR 4.65, 95%CI 4.26-5.08), eczema/psoriasis (aOR 3.30, 95%CI 3.14-3.48), dyspepsia (aOR 2.20, 95%CI 2.15-2.25) and chronic sinusitis (aOR 2.12, 95%CI 1.99-2.26). Depression and anxiety were more common in adults with asthma (aOR 1.60, 95%CI 1.57-1.63, and aOR 1.53, 95%CI 1.48-1.57 respectively).

Conclusions and Clinical Relevance

Physical and mental health comorbidity is the norm in adults with asthma. Appropriate recognition and management should form part of routine asthma care.

This article is protected by copyright. All rights reserved.

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Critical airways, critical language

British Journal of Anaesthesia, 2017; 118(5): 649–54, DOI 10.1093/bja/aex075

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Predicting delirium: are we there yet?

Postoperative delirium is an extremely common complication after all types of surgery in the elderly, with an incidence as high as 65% in patients admitted for hip fracture repair.¹ The implications of an episode of delirium are serious and include an increased risk of dementia, increased length of stay, increased costs, and increased risk of mortality.¹ Delirium is associated with progression of cognitive decline even in those with normal baseline cognition.² It is widely acknowledged that delirium is a preventable complication, with the Australian Council for Safety and Quality in Health Care (ACSQHC), the National Institute for Health and Clinical Excellence (NICE, UK),³ and the American Society of Anesthesiologists (ASA) defining risk-prevention models for implementation in all hospitals. In Australia, the ACSQHC 'Cognitive Care' package⁴ has been distributed as a set of Clinical Care Standards highlighting the importance of preoperative cognitive assessment; NICE in the UK includes similar Clinical Guidelines; while in the USA, the ASA has commenced the 'Brain Health Initiative'.⁵ These organizations have developed guidelines for identifying at-risk patients, strategies for prevention, and for targeting research areas specific to reducing delirium.

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Association of intraoperative changes in brain-derived neurotrophic factor and postoperative delirium in older adults

Abstract

Background. Delirium is common after surgery, although the aetiology is poorly defined. Brain-derived neurotrophic factor (BDNF) is a neurotrophin important in neurotransmission and neuroplasticity. Decreased levels of BDNF have been associated with poor cognitive outcomes, but few studies have characterized the role of BDNF perioperatively. We hypothesized that intraoperative decreases in BDNF levels are associated with postoperative delirium.Methods. Patients undergoing spine surgery were enrolled in a prospective cohort study. Plasma BDNF was collected at baseline and at least hourly intraoperatively. Delirium was assessed using rigorous methods, including the Confusion Assessment Method (CAM) and CAM for the intensive care unit. Associations of changes in BDNF and delirium were examined using regression models.Results. Postoperative delirium developed in 32 of 77 (42%) patients. The median baseline BDNF level was 7.6 ng ml⁻¹ [interquartile range (IQR) 3.0–11.2] and generally declined intraoperatively [median decline 61% (IQR 31–80)]. There was no difference in baseline BDNF levels by delirium status. However, the percent decline in BDNF was greater in patients who developed delirium [median 74% (IQR 51–82)] vs in those who did not develop delirium [median 50% (IQR 14–79); P=0.03]. Each 1% decline in BDNF was associated with increased odds of delirium in unadjusted {odds ratio [OR] 1.02 [95% confidence interval (CI) 1.00–1.04]; P=0.01}, multivariable-adjusted [OR 1.02 (95% CI 1.00–1.03); P=0.03], and propensity score–adjusted models [OR 1.02 (95% CI 1.00–1.04); P=0.03].Conclusions. We observed an association between intraoperative decline in plasma BDNF and delirium. These preliminary results need to be confirmed but suggest that plasma BDNF levels may be a biomarker for postoperative delirium.

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Pemphigus : vers une réduction drastique de la corticothérapie grâce au rituximab

Publication date: Available online 29 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): P. Joly




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Éducation thérapeutique du patient dans la dermatite atopique : où en est-on ?

Publication date: Available online 29 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): S. Barbarot




http://ift.tt/2soEqMM

La photographie en dermatologie. Questions éthiques

Publication date: Available online 29 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M. Moyal-Barracco, J.-M. Debarre, A. Petit, L. Haddad, L. Martin, D. Penso-Assathiany




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Traitement de la maladie de Hailey-Hailey par toxine botulique : étude rétrospective de huit cas

Publication date: Available online 29 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): L. Dousset, A. Pham-Ledard, M.-S. Doutre, M. Beylot-Barry, O. Cogrel
IntroductionLa maladie de Hailey-Hailey (MHH) est caractérisée par des poussées de lésions érythémateuses et suintantes en particulier dans les zones de friction ou de macération. Sa prise en charge thérapeutique est difficile. Plusieurs séries ou cas ponctuels ont montré l'intérêt de la toxine botulique.ObjectifRapporter les données cliniques et évolutives de 8 cas de MHH traités par injections de toxine botulique A (BTX-A) après avoir résisté à plusieurs lignes thérapeutiques.Patients et méthodesHuit patients (trois hommes et cinq femmes), d'âge médian 52,5 ans (31–80), ont été inclus dans cette étude rétrospective. Une histoire familiale était notée chez 75 % d'entre eux. Les lésions atteignaient les régions axillaires dans 62 % des cas, sous-mammaires chez quasiment toutes les femmes, inguinales dans 75 % des cas, génitale dans 25 %. La dose moyenne injectée par site et par séance était de 300UI de Dysport^®. L'évaluation clinique était appréciée sur des clichés photographiques pris avant traitement et 6 mois plus tard.RésultatsL'effet sur la sudation était rapide, dès le quatrième jour. En moyenne, les patients ressentaient le bénéfice de l'injection dans un délai de 7jours, avec disparition de l'érythème et cicatrisation des rhagades. À 6 mois, une réponse clinique complète était constatée sur 80 % des zones traitées (12 sites sur 15), une réponse partielle au niveau de 3 zones profuses (sous-mammaires et inguinales). Des séances d'entretien ont été mises en place chez 6 des 8 patients en raison de récidives au-delà du sixième mois.ConclusionLa toxine botulique semble une alternative thérapeutique dans les formes résistantes de MHH, en traitement séquentiel ou en adjuvant de traitements plus radicaux comme le laser CO2. Ces données rétrospectives, ainsi que les modalités optimales en matière de doses et de rythme des injections, doivent être précisées par des études prospectives.BackgroundHailey-Hailey disease (HHD) is characterised by episodes of weeping erythematous lesions, particularly in areas subject to friction or maceration. Treatment is complex. The value of botulinum toxin has been demonstrated in several studies and in individual cases.AimTo report clinical and progressive data for 8 patients treated for HHD with injections of botulinum toxin A (BTX-A), following the failure of several other therapeutic approaches.Patients and methodsEight patients (three males and five females), of median age 52.5 years (31–80), were included in this retrospective study. Familial history of the disease was noted in 75% of cases. The lesions affected the axillary regions (62% of cases), the sub-mammary region (almost all female patients), the inguinal region (75%) and the genital area (25%). The mean dose injected per site and per session was 300IU of Dysport^®. Clinical evaluation was based on photographs taken before treatment and then after 6 months.ResultsEffects on sweating were rapid and occurred as of the fourth day treatment. On average, patient felt the benefits of the injection within 7 days, with subsidence of their erythema and healing of the rhagades. At 6 months, complete clinical response was noted in 80% of the treated zones (12 sites of 15), with partial response in 3 profuse zones (sub-mammary and inguinal). Maintenance sessions were initiated for 6 of the 8 patients due to relapse beyond six months.ConclusionBotulin toxin appears to offer a therapeutic alternative in resistant forms of HHD, either as follow-on treatment or as an adjuvant to more radical forms of therapy such as CO2 laser. These retrospective data, as well as the optimal doses and injection rates, require further refinement by means of prospective studies.



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Phenotypic and molecular insights into CASK-related disorders in males

Background: Heterozygous loss-of-function mutations in the X-linked CASK gene cause progressive microcephaly with pontine and cerebellar hypoplasia (MICPCH) and severe intellectual disability (ID) in females. Different CASK mutations have also been reported in males. The associated phenotypes range from nonsyndromic ID to Ohtahara syndrome with cerebellar hypoplasia. However, the phenotypic spectrum in males has not been systematically evaluated to date. Methods: We identified a CASK alteration in 8 novel unrelated male patients by targeted Sanger sequencing, copy number analysis (MLPA and/or FISH) and array CGH. CASK transcripts were investigated by RT-PCR followed by sequencing. Immunoblotting was used to detect CASK protein in patient-derived cells. The clinical phenotype and natural history of the 8 patients and 28 CASK-mutation positive males reported previously were reviewed and correlated with available molecular data. Results: CASK alterations include one nonsense mutation, one 5-bp deletion, one mutation of the start codon, and five partial gene deletions and duplications; seven were de novo, including three somatic mosaicisms, and one was familial. In three subjects, specific mRNA junction fragments indicated in tandem duplication of CASK exons disrupting the integrity of the gene. The 5-bp deletion resulted in multiple aberrant CASK mRNAs. In fibroblasts from patients with a CASK loss-of-function mutation, no CASK protein could be detected. Individuals who are mosaic for a severe CASK mutation or carry a hypomorphic mutation still showed detectable amount of protein. Conclusions: Based on eight novel patients and all CASK-mutation positive males reported previously three phenotypic groups can be distinguished that represent a clinical continuum: (i) MICPCH with severe epileptic encephalopathy caused by hemizygous loss-of-function mutations, (ii) MICPCH associated with inactivating alterations in the mosaic state or a partly penetrant mutation, and (iii) syndromic/nonsyndromic mild to severe ID with or without nystagmus caused by CASK missense and splice mutations that leave the CASK protein intact but likely alter its function or reduce the amount of normal protein. Our findings facilitate focused testing of the CASK gene and interpreting sequence variants identified by next-generation sequencing in cases with a phenotype resembling either of the three groups.

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Postnatal Maturation of the Glomerular Filtration Rate in Conventional Growing Piglets As Potential Juvenile Animal Model for Preclinical Pharmaceutical Research

Adequate animal models are required to study the preclinical pharmacokinetics (PK), pharmacodynamics (PD) and safety of drugs in the pediatric subpopulation. Over the years, pigs were presented as a potential animal model, since they display a high degree of anatomical and physiological similarities with humans. To assess the suitability of piglets as a preclinical animal model for children, the ontogeny and maturation processes of several organ systems have to be unraveled and compared between both species. The kidneys play a pivotal role in the PK and PD of various drugs, therefore, the glomerular filtration rate (GFR) measured as clearance of endogenous creatinine (Jaffe and enzymatic assay) and exo-iohexol was determined in conventional piglets aging 8 days (n = 16), 4 weeks (n = 8) and 7 weeks (n = 16). The GFR data were normalized to bodyweight (BW), body surface area (BSA) and kidney weight (KW). Normalization to BSA and KW showed an increase in GFR from 46.57 to 100.92 mL/min/m2 and 0.49 to 1.51 mL/min/g KW from 8 days to 7 weeks of age, respectively. Normalization to BW showed a less pronounced increase from 3.55 to 4.31 mL/min/kg. The postnatal development of the GFR was comparable with humans, rendering the piglet a convenient juvenile animal model for studying the PK, PD and safety of drugs in the pediatric subpopulation. Moreover, to facilitate the assessment of the GFR in growing piglets in subsequent studies, a formula was elaborated to estimate the GFR based on plasma creatinine and BW, namely eGFR =1.879 × BW^1.092/Pcr^0.600.

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