OnabotulinumtoxinA injections in detrusor facilitate self-catheterisation in a patient with paraplegia and bladder outlet dyssynergia

This case report describes the case of improvement of clean intermittent catheterisation procedures after each intradetrusor administration of onabotulinumtoxinA in a 45-year-old man with L1 paraplegia with neurogenic detrusor overactivity and bladder outlet dyssynergia.On three occasions, improvement on clean intermittent catheterisation procedures appeared 10 to 14 days after intradetrusor injections of onabotulinumtoxinA and lasted for 9 months. We hypothesise a possible influence of intravesical injections of onabotulinumtoxinA on the storage reflex. We also discuss the possibility of a dispersion of onabotulinumtoxinA towards contiguous structures such as the urethral sphincter.

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Effect of hyaluronic acid with or without scaffold material on the regeneration of tympanic membrane perforations

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Preferred nasolabial angle in Middle Eastern population

Abstract

To define the preferred nasolabial angle measurement in Middle Eastern population. An observational study was conducted from January 2012 to January 2016 at the Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. A total of 1027 raters, 506 males, and 521 females were asked to choose the most ideal nasolabial angle for 5 males and 5 females lateral photographs whose nasolabial angle were modified with Photoshop into the following angles (85°, 90°, 95°, 100°, 105°, and 110°). Male raters preferred the angle of 89.5° ± 3.5° (mean ± SD) for males and 90.8° ± 5.6° for females. While female raters preferred the angle of 89.3° ± 3.8° for males and 90.5° ± 4.8° for females. ANOVA test compare means among groups: p: 0.342, and there is no statistically significant difference between groups. The results of our study showed an even more acute angles than degrees found in the literature. It shows that what young generation in our region prefers and clearly reflects that what could be explained as under rotation of the nasal tip in other cultures is just the ideal for some Middle Eastern population.

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Reply to the letter to the editor concerning: ‘Relationship between increased carotid artery stiffness and idiopathic subjective tinnitus’

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Relationship between increased carotid artery stiffness and idiopathic subjective tinnitus: methodological issues

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Idiopathic subglottic stenosis: an epidemiological single-center study

Abstract

A retrospective epidemiological study of patients treated for idiopathic subglottic stenosis (ISS) during 2003–2013 at Oslo University Hospital, Rikshospitalet, was undertaken to assess its incidence, management and treatment outcomes. Out of a total of 123 patients with subglottic stenosis (84 female, 39 men), 38 patients were diagnosed with ISS, all of whom were female. Of these, 23 lived in the South-Eastern Norway Regional Health Authority, representing an incidence of 0.2 per 100,000 (95% CI 0.13–0.3) in this region of 2.9 million inhabitants. Mean age at diagnosis was 54 years (range 20–85 years), and the mean interval between symptom onset and diagnosis was 3.1 years. The 38 patients with ISS underwent a total of 132 operations between 2003 and 2013. All patients were managed endoscopically using laser surgery, with or without corticosteroids and Mitomycin C, with dilatation by balloon or bougie. Eight patients (21.1%) required only one procedure, while 30 patients (78.9%) had multiple operations. The median follow-up for all patients from the first operation was 5.3 years. The mean interval between procedures was 1 year for patients aged 20–48 years, 1.3 years for patients aged 49–61 years and 3.0 years for patients aged 62–85 years. No clinically significant complications were observed. In conclusion, the symptoms of ISS can be treated effectively with laser surgery and dilatation but the recurrence rate remains high and the time interval between operations does not increase with time, making ISS a continuing challenge.

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Repetitive transcranial magnetic stimulation and drugs for tinnitus

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Perioperative complications and safety of type II thyroplasty (TPII) for adductor spasmodic dysphonia

Abstract

Type II thyroplasty (TPII) is one of the surgical options offered in the management of adductor spasmodic dysphonia (AdSD); however, there have been no detailed reports of its safety and associated complications during the perioperative period. Our aim was to assess the complications and safety of TPII. TPII was performed for consecutive 15 patients with AdSD from April 2012 through May 2014. We examined retrospectively the perioperative complications, the degree of surgical invasion, and recovery process from surgery. All patients underwent successful surgery under only local anesthesia. Vocal fold erythema was observed in 14 patients and vocal fold edema in 10 patients; however, all of them showed complete resolution within 1 month. No patient experienced severe complications such as acute airway distress or hemorrhage. Fourteen patients were able to have oral from the 1st postoperative morning, with the remaining patient able to have oral intake from the 2nd postoperative day. In addition, no patient experienced aspiration postoperatively. In conclusion, only minor complications were observed in association with TPII in this study. No dysphagia was observed postoperatively, which is an advantage over other treatments. The results of our study suggest that TPII is a safe surgical treatment for AdSD.

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Benchmarking of venous thromboembolism prophylaxis practice with ENT.UK guidelines

Abstract

The aim of this study was to benchmark our guidelines of prevention of venous thromboembolism (VTE) in ENT surgical population against ENT.UK guidelines, and also to encourage healthcare providers to utilize benchmarking as an effective method of improving performance. The study design is prospective descriptive analysis. The setting of this study is tertiary referral centre (Assir Central Hospital, Abha, Saudi Arabia). In this study, we are benchmarking our practice guidelines of the prevention of VTE in the ENT surgical population against that of ENT.UK guidelines to mitigate any gaps. ENT guidelines 2010 were downloaded from the ENT.UK Website. Our guidelines were compared with the possibilities that either our performance meets or fall short of ENT.UK guidelines. Immediate corrective actions will take place if there is quality chasm between the two guidelines. ENT.UK guidelines are evidence-based and updated which may serve as role-model for adoption and benchmarking. Our guidelines were accordingly amended to contain all factors required in providing a quality service to ENT surgical patients. While not given appropriate attention, benchmarking is a useful tool in improving quality of health care. It allows learning from others' practices and experiences, and works towards closing any quality gaps. In addition, benchmarking clinical outcomes is critical for quality improvement and informing decisions concerning service provision. It is recommended to be included on the list of quality improvement methods of healthcare services.

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Primary unclassified sarcoma of the parotid gland: a case of diagnostic and therapeutic challenge

Abstract

Malignant salivary gland sarcomas represent a clinically and histologically diagnostic challenge. Primary unclassified sarcomas of the parotid gland consist a rare salivary gland tumor. We report an unusual case of such a tumor, which occurred in the right parotid gland of a 54-year-old male and presented as an asymptomatic painless mass. The pathologoanatomical examination revealed a rhabdoid large-cell unclassified sarcoma. The patient was treated with superficial parotidectomy and adjuvant radiotherapy. No recurrence was noted in a 10-year follow-up period. Due to the rare occurrence of primary unclassified sarcomas, there is no evidence-based treatment of choice. An optimal approach is best planned in a multidisciplinary setting, taking into consideration the resectability of the tumor, individual patient characteristics, presence of local or distant metastatic activity, local infiltrative behavior and tumor stage. A close follow-up of the patient is strongly recommended.

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The variants of the retro- and hypotympanum: an endoscopic anatomical study

Abstract

The retro- and hypotympanum are hidden areas of the middle ear, only poorly recognized. Nevertheless, this region is of relevant clinical significance, since it is regularly affected by disease such as cholesteatoma. The aim of this study is to explore and describe the anatomical variants of the hypo- and retrotympanum by the means of transcanal endoscopy. We hypothesize a significant variability of this hidden region of the middle ear. Moreover, we believe that the minimal invasive, endoscopic access is suitable since angled scopes may be used to explore the region. To this end a total of 125 middle ears (83 cadaveric dissections, 42 surgical cases) were explored by the means of 3 mm straight and angled scopes. The variants were documented photographically and tabularized. The bony crests ponticulus, subiculum and finiculus were most frequently represented as ridges. The ponticulus showed the highest variability with 38% ridge, 35% bridge and 27% incomplete presentation. The subiculum was bridge-shaped only in 8% of the cases, the finiculus in 17%. The sinus tympani had a normal configuration in 66%. A subcochlear canaliculus was detectable in 50%. The retro- and hypotympanum were classified, respectively, to the present bony crests and sinus in a novel classification type I–IV. In conclusion, we found abundant variability of the bony structures in the retro- and hypotympanum. The endoscopic access is suitable and offers thorough understanding and panoramic views of these hidden areas.

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Post-tonsillectomy pain after using bipolar diathermy scissors or the harmonic scalpel: a randomised blinded study

Abstract

Objective

To compare the postoperative pain following bipolar diathermy scissors tonsillectomy (higher temperature dissection) with harmonic scalpel tonsillectomy (lower temperature dissection).

Methods

Sixty patients aged 7–40 years planned for tonsillectomy with no other concurrent surgery were randomised to either bipolar diathermy scissors or harmonic scalpel as surgical technique. Blinded to the surgical technique, the patients recorded their pain scores (VAS, 0–10) at awakening and the worst pain level of the day in the postoperative period. All intake of pain medication was also recorded.

Results

No statistically significant differences were found between the two groups regarding postoperative pain levels or consumption of pain medication.

Conclusion

Usage of the harmonic scalpel does not render less postoperative pain following tonsillectomy when compared with usage of the bipolar diathermy scissors.

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Application of a computer-assisted flexible endoscope system for transoral surgery of the hypopharynx and upper esophagus

Abstract

Zenker's diverticulum is a common pathology in the transition zone of the posterior hypopharynx and esophagus. Surgical treatment is routinely performed by ENT and general surgeons. Besides the traditional open transcervical diverticulectomy, the introduction of transoral rigid treatment led to a paradigm change and is now the preferred treatment option for patients who are fit for general anesthesia. The implementation of interventional flexible endoscopy has opened another new micro-invasive approach for patients with high morbidity. Here, we present the potential utilization of a flexible, single port, robot-assisted, and physician-controlled endoscope system to facilitate transoral surgical access to the hypopharynx and upper esophagus. Transoral surgery of the hypopharynx and upper esophagus was performed in human cadavers (n = 5) using the Flex System (Medrobotics, Raynham, USA). Anatomical landmarks were identified, and posterior cricothyroid myotomy was performed with compatible flexible instruments in all cases. The approach to the hypopharynx and upper esophagus using the Flex system is feasible in a cadaveric model. Myotomy with a flexible tool and needle knife (from the perspective of treatment of Zenker´s diverticulum) was successful in all cases. Visualization of the surgical site with the system's HD camera is suitable and the flexible instruments meet the special needs of a micro-invasive transoral approach. Zenker´s diverticulum can be potentially treated with a transoral minimally invasive approach using a computer-assisted flexible endoscope system. This setup could be of advantage in patients with reduced mobility of the cervical spine to prevent open transcervical surgery. In our study, the Flex system enabled advanced visualization of the surgical site and extended intervention options, compared to standard flexible endoscopic treatment. However, general anesthesia is mandatory for the presented approach. Application in live patients with actual pathologies of the hypopharynx and upper esophagus will have to prove suitability for the treatment of Zenker's diverticulum. Further development of the system could include improved instrumentation and an adoption by other disciplines with challenging anatomy such as colorectal surgery.

http://ift.tt/2nQNdAG

High blood tacrolimus and hyperkalemia in a heart transplant patient

Manoj Kumar Sahu, Sarvesh Pal Singh, Anupam Das, Atul Abraham, Balram Airan, Intekhab Alam, Ramesh Menon, V Devagourou, Anish Gupta

Annals of Cardiac Anaesthesia 2017 20(2):270-271



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Anger: An enemy of heart, raj yoga meditation is heart friendly

Usha Kiran, Suruchi Ladha

Annals of Cardiac Anaesthesia 2017 20(2):127-128



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Inverted left atrial appendage masquerading as a left atrial mass

Suresh Kumaran, Gladdy George, AV Varsha, Raj Sahajanandan

Annals of Cardiac Anaesthesia 2017 20(2):248-249

An inverted left atrial appendage after cardiac surgery is a rare finding and can be misinterpreted as a thrombus, mass, or vegetation. We report a case where intraoperative transesophageal echocardiography assisted in making an accurate diagnosis.

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Erratum: Percutaneous tracheostomy in patients on anticoagulants

Annals of Cardiac Anaesthesia 2017 20(2):282-282



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Artificial intelligence in mitral valve analysis

Jelliffe Jeganathan, Ziyad Knio, Yannis Amador, Ting Hai, Arash Khamooshian, Robina Matyal, Kamal R Khabbaz, Feroze Mahmood

Annals of Cardiac Anaesthesia 2017 20(2):129-134

Background: Echocardiographic analysis of mitral valve (MV) has become essential for diagnosis and management of patients with MV disease. Currently, the various software used for MV analysis require manual input and are prone to interobserver variability in the measurements. Aim: The aim of this study is to determine the interobserver variability in an automated software that uses artificial intelligence for MV analysis. Settings and Design: Retrospective analysis of intraoperative three-dimensional transesophageal echocardiography data acquired from four patients with normal MV undergoing coronary artery bypass graft surgery in a tertiary hospital. Materials and Methods: Echocardiographic data were analyzed using the eSie Valve Software (Siemens Healthcare, Mountain View, CA, USA). Three examiners analyzed three end-systolic (ES) frames from each of the four patients. A total of 36 ES frames were analyzed and included in the study. Statistical Analysis: A multiple mixed-effects ANOVA model was constructed to determine if the examiner, the patient, and the loop had a significant effect on the average value of each parameter. A Bonferroni correction was used to correct for multiple comparisons, and P = 0.0083 was considered to be significant. Results: Examiners did not have an effect on any of the six parameters tested. Patient and loop had an effect on the average parameter value for each of the six parameters as expected (P < 0.0083 for both). Conclusion: We were able to conclude that using automated analysis, it is possible to obtain results with good reproducibility, which only requires minimal user intervention.

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Forbidden word entropy of cerebral oximetric values predicts postoperative neurocognitive decline in patients undergoing aortic arch surgery under deep hypothermic circulatory arrest

Anna Dubovoy, Peter Chang, Carol Persad, Wei Lau, Elizabeth Jewell, Daniel Cox, Milo Engoren

Annals of Cardiac Anaesthesia 2017 20(2):135-140

Purpose: Up to 53% of cardiac surgery patients experience postoperative neurocognitive decline. Cerebral oximetry is designed to detect changes in cerebral tissue saturation and therefore may be useful to predict which patients are at risk of developing neurocognitive decline. Methods: This is a retrospective analysis of a prospective study originally designed to determine if treatment of cerebral oximetry desaturation is associated with improvement in postoperative cognitive dysfunction in patients undergoing aortic reconstruction under deep hypothermic circulatory arrest. Cognitive function was measured, preoperatively and 3 months postoperatively, with 15 neuropsychologic tests administered by a psychologist; the individual test scores were summed and normalized. Bilateral cerebral oximetry data were stored and analyzed using measures of entropy. Cognitive decline was defined as any decrease in the summed normalized score from baseline to 3 months. Results: Seven of 17 (41%) patients suffered cognitive decline. There was no association between baseline cerebral oximetry and postoperative cognitive dysfunction. Nor were changes in oximetry values associated with cognitive decline. However, cognitive decline was associated with loss of forbidden word entropy (FwEn) (correlation: Rho ρ = 0.51, P = 0.037 for left cerebral oximetry FwEn and ρ = 0.54, P = 0.025 for right cerebral oximetry FwEn). Conclusion: Postoperative cognitive decline was associated with loss of complexity of the time series as shown by a decrease in FwEn from beginning to end of the case. This suggests that regulation of cerebral oximetry is different between those who do and those who do not develop cognitive decline.

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Partial anomalous pulmonary venous return: Scimitar vein

Timothy Heinke, Scott R Stewart, Toby Steinberg, William R Hand, James H Abernathy

Annals of Cardiac Anaesthesia 2017 20(2):259-261

Scimitar syndrome is a rare association of congenital cardiopulmonary anomalies characterized by partial anomalous pulmonary venous return, in which an abnormal right pulmonary vein drains into the inferior vena cava. This case exemplifies the role of transesophageal echocardiography in perioperative management and surgical decision-making.

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An analysis of the factors producing multiple ventricular arrhythmias during pulmonary artery catheterization

Hajime Satoh, Yuka Miyata, Tomohiko Hayasaka, Tsutomu Wada, Yukio Hayashi

Annals of Cardiac Anaesthesia 2017 20(2):141-144

Background: The development of arrhythmias during placement of a pulmonary artery catheter (PAC) is common. Aims: This study was designed to examine factors influencing development of ventricular arrhythmias in adult patients undergoing cardiovascular operations during the catheter placement. Settings and Designs: Prospective, observational, cohort study. Methods: We prospectively studied 174 patients undergoing cardiovascular operations. A PAC was inserted through the right internal jugular vein by staff anesthesiologists. Electrocardiography tracings were recorded as the catheter was advanced from the right atrium to the pulmonary artery. Arrhythmias were classified as absent, single, or multiple (two or more consecutive) ventricular arrhythmias. We examined risk factors to produce ventricular arrhythmias during the placement. Statistical Analysis: The data were analyzed using logistic regression analysis to assess factors for the occurrence of ventricular arrhythmias after univariate analyses. Results: Ventricular arrhythmias (single and multiple) occurred in 149 patients (85.6%) and multiple arrhythmias were observed in 78 patients (44.8%). There were no factors to facilitate the ventricular arrhythmias (single and multiple), whereas it showed that valvular diseases (P = 0.049) and the placement time (P < 0.001) are significant factors to produce multiple arrhythmias. Conclusion: Both valvular diseases and long placement time were significant risk factors to produce multiple ventricular arrhythmias during placement of a PAC.

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Importance of 3D real time perioperative tee in ASD device embolisation

MS Sarvana Babu, Neelam Aggarwal, A Asha, Digraje Sunita Ashok, Thomas Koshy

Annals of Cardiac Anaesthesia 2017 20(2):278-278



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Carotid artery disease and periprocedural stroke risk after transcatheter aortic valve implantation

Parthasarathy D Thirumala, Sruthi Muluk, Reshmi Udesh, Amol Mehta, John Schindler, Suresh Mulukutla, Vinodh Jeevanantham, Lawrence Wechsler, Thomas Gleason

Annals of Cardiac Anaesthesia 2017 20(2):145-151

Objective/Background: To examine the role of carotid stenosis (CS) and other independent risk factors of perioperative stroke, following transcatheter aortic valve implantation (TAVI). Materials and Methods: Using data from the National Inpatient Sample database for analysis, patients who underwent TAVI were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Various preoperative and perioperative risk factors and their association with perioperative strokes were studied. Results: Data on 7566 patients who underwent a TAVI procedure from 2012 to 2013 were extracted. The average age of the patient population was 81.2 ± 0.32 years. The overall perioperative stroke rate in our patient cohort was 2.79%. Majority (94.6%) of the strokes were ischemic. Multivariate analysis showed the following independent risk factors for perioperative strokes after TAVI: female gender odds ratio (OR) = 2.25 (95% confidence interval [CI], 1.42–3.57), higher van Walraven score OR = 6.6 (95% CI = 3.71–11.73), bilateral CS OR = 4.46 (95% CI = 2.03–9.82), and TAVI with a cardiac procedure done under cardiopulmonary bypass OR = 2.84 (95% CI = 1.57–5.14). Conclusion: Bilateral carotid disease is a significant risk factor for perioperative strokes following TAVI. Preoperative screening with carotid Doppler to identify high-risk patients appears to be warranted. In addition, patients of female gender were found to have an increased risk for carotid disease.

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Transthoracic echocardiography versus transesophageal echocardiography for rupture sinus of Valsalva aneurysm

Ira Dhawan, Vishwas Malik, Kamal Prakash Sharma, Neeti Makhija, Neha Pangasa

Annals of Cardiac Anaesthesia 2017 20(2):245-246

We report a rare case of sinus of Valsalva aneurysm of both right and left coronary sinus (LCS), with perforation of the LCS opening into the left ventricle. The LCS aneurysm with its perforation was undiagnosed on transthoracic echocardiography emphasizing the role of transesophageal echocardiography in delineating the anatomy.

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Impact of dexmedetomidine on hemodynamic changes during and after coronary artery bypass grafting

Morteza Hashemian, Mehdi Ahmadinejad, Seyed Amir Mohajerani, Alireza Mirkheshti

Annals of Cardiac Anaesthesia 2017 20(2):152-157

Objective: To determine the effect of dexmedetomidine (Dex) on hemodynamic changes during cardiopulmonary pump and postoperative period in coronary artery bypass grafting (CABG). Methods and Design: This study is designed as a double-blinded, randomized clinical trial. Setting: University hospital and single center. Participants: patients candidate for elective CABG. Intervention: Dex 0.5 μg/kg/h or placebo was infused from the initiation of anesthesia up to extubation in Intensive Care Unit (ICU). Measurements: Heart rate (HR) and blood pressure (BP), pain score, and total morphine dose requirement were monitored and compared during cardiac pump up to 12 h postoperative in ICU. Results: Mean arterial pressure was significantly higher in Dex group in postoperation period at 1 (P = 0.010) and 2 h (P = 0.002) compared to control group. HR was significantly lower in Dex group in postcardiopulmonary bypass (CPB) time at 0 h (P = 0.001), 1 h (P = 0.0016), and 2 h (P = 0.001), and then in postoperative period in ICU at 1 h (P = 0.025), 2 h (P = 0.0012), and 4 h (P = 0.0025) compared to control group. Postoperative pain score was significantly lower during 12 h after surgery. Conclusion: Dex could effectively blunt hemodynamic response to surgical stress, particularly during CPB pump and afterward. Infusion of Dex maintains BP at higher range and HR at lower range compared to placebo.

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Mechanical cause for acute left lung atelectasis after neonatal aortic arch repair with arterial switch operation: Conservative management

Madan Mohan Maddali, Pranav Subbaraya Kandachar, Said Al-Hanshi, Mohammed Al Ghafri, John Valliattu

Annals of Cardiac Anaesthesia 2017 20(2):252-255

Respiratory complications due to mechanical obstruction of the airways can occur following pediatric cardiac surgery. Clinically significant intrathoracic vascular compression of the airway can occur when extensive dissection and mobilization of arch and neck vessels is involved as in repair of interrupted aortic arch. This case report describes a neonate who underwent interrupted aortic arch repair along with an arterial switch operation and developed a left lung collapse immediately after tracheal extubation. Fiber-optic bronchoscopy revealed vascular compression as the real culprit. The child was successfully managed conservatively.

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The role of Rajyoga meditation for modulation of anxiety and serum cortisol in patients undergoing coronary artery bypass surgery: A prospective randomized control study

Usha Kiran, Suruchi Ladha, Neeti Makhija, Poonam Malhotra Kapoor, Minati Choudhury, Sambhunath Das, Parag Gharde, Vishwas Malik, Balram Airan

Annals of Cardiac Anaesthesia 2017 20(2):158-162

Introduction: Rajyoga meditation is a form of mind body intervention that is promoted by the Brahma Kumaris World Spiritual University. This form of meditation can be easily performed without rituals or mantras and can be practiced anywhere at any time. The practice of Rajyoga meditation can have beneficial effects on modulating anxiety and cortisol level in patients undergoing major cardiac surgery. Materials and Methods: A prospective randomized control study was carried out in a single tertiary care center. One hundred and fifty patients undergoing elective coronary artery bypass surgery were enrolled in the study. The patients were randomized in two groups namely, Group 1 (Rajyoga group) and Group 2 (Control Group). Anxiety was measured on a visual analog scale 1–10 before the start of Rajyoga training or patient counseling (T1), on the morning of the day of surgery (T2), on the 2nd postoperative day (T3), and on the 5th postoperative day (T4). The serum cortisol level was measured in the morning of the day of surgery (T1), on the 2nd postoperative day (T2) and on the 5th postoperative day (T3), respectively. Results: In the study, it was seen that the anxiety level of the patients before the surgery (T1) and on the day of surgery (T2) were comparable between the two groups. However on the 2nd postoperative day (T3), the patients who underwent Rajyoga training had lower anxiety level in comparison to the control group (3.12 ± 1.45 vs. 6.12 ± 0.14, P < 0.05) and on the 5th postoperative day (T4) it was seen that Rajyoga practice had resulted in significant decline in anxiety level (0.69 ± 1.1 vs. 5.6 ± 1.38, P < 0.05). The serum cortisol level was also favorably modulated by the practice of Rajyoga meditation. Conclusion: Mindbody intervention is found to effective in reducing the anxiety of the patients and modulating the cortisol level in patients undergoing wellknown stressful surgery like coronary artery bypass surgery.

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Modified blalock-taussig shunt and levosimendan for left ventricular preparation in a child with transposition of great arteries and regressed ventricle undergoing rapid 2 stage arterial switch operation

Manoj Kumar Sahu, Anish Gupta, Intekhab Alam, Sarvesh Pal Singh, Ramesh Menon, V Devagouru

Annals of Cardiac Anaesthesia 2017 20(2):265-267

Rapid two-stage arterial switch operation (ASO) is very relevant as many patients of transposition of great arteries (TGA) present late to the hospital when primary switch either is not possible or carries a high risk of morbidity and mortality. Hence, other means apart from the traditional methods of left ventricle preparedness should be tried to help this category of patients, who are to undergo rapid two-stage ASO. We successfully used levosimendan and continuous positive airway pressure after 1st stage operation in a patient with dTGA and regressed ventricle, which helped in left ventricular preparedness, and the child underwent rapid two-stage ASO uneventfully.

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Conscious sedation for balloon mitral valvotomy: A comparison of fentanyl versus sufentanil

Shailendra Deochandra Modak, Deepa G Kane

Annals of Cardiac Anaesthesia 2017 20(2):163-168

Context: Analgesia and sedation are required for the comfort of patient and the cardiologist during balloon mitral valvotomy. Aims: In this study, efficacy of analgesia, sedation, and patient satisfaction with sufentanil was compared with fentanyl. Settings and Design: Single-centered, prospective single-blind study of sixty patients. Materials and Methods: Patients between 15 and 45 years of rheumatic mitral stenosis with valve area of 0.8–1 cm2 undergoing elective balloon mitral valvotomy, randomly divided to receive bolus injection fentanyl 1 mcg/kg (Group 1, n = 30) followed by infusion at 1 mcg/kg/h or bolus of injection sufentanil 0.1 mcg/kg (Group 2, n = 30) followed by continuous infusion at 0.1 mcg/h. Both the groups received injection midazolam bolus 0.02 mg/kg followed by infusion at 15 mcg/kg/h. Pain intensity (by visual analog score [VAS]), level of sedation (by Ramsay sedation scale), overall patient and operator's satisfaction, effect on cardiorespiratory parameters, and discharge score (by modified Aldrete score) were assessed. Statistical Analysis Used: Statistical analysis used Student's unpaired t-test and Chi-square test. P < 0.05 was considered statistically significant. Results: Mean number of bolus doses in fentanyl group was 0.9 versus 0.13 in sufentanil group (P < 0.01). The mean value of mean blood pressure in fentanyl group was 83.52 mmHg versus 88 mmHg in sufentanil group (P < 0.05), but the value was within normal range in both the groups. The mean VAS – patient's opinion in fentanyl group was 8.97 versus 9.53 in sufentanil group (P < 0.05). Mean discharge score in fentanyl group was 17.87 versus 18.23 in sufentanil group (P < 0.05). No statistically significant difference was found with respect to heart rate, respiratory rate, oxygen saturation, PaCO2values, and anxiety scores. Conclusion: Sufentanil was found to be better with respect to analgesia, patient satisfaction, and recovery however not cost-effective for continuous infusion technique.

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Role of MicroRNA in cardiac anesthesia: An innovative consequences and new possibility

Mayadhar Barik, Abhay Kumar, Pravash Ranjan Mishra, Poonam Malhotra Kapoor

Annals of Cardiac Anaesthesia 2017 20(2):274-275



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Serial semi-invasive hemodynamic assessment following pericardiectomy for chronic constrictive pericarditis

Ujjwal Kumar Chowdhury, Poonam Malhotra Kapoor, Adil Rizvi, Vishwas Malik, Sandeep Seth, Rajiv Narang, Mani Kalaivani, Sarvesh Pal Singh, Sathiya Selvam

Annals of Cardiac Anaesthesia 2017 20(2):169-177

Objectives: This study was designed to prospectively investigate the effects of pericardiectomy via median sternotomy on intra- and postoperative hemodynamics by a new semi-invasive device (Flotrac/VigileoTM monitor) using arterial pressure waveform analysis. Patients and Methods: Thirty consecutive patients aged 15 to 55 years (mean+SD, 31.73 + 13.53 years), who had undergone total pericardiectomy via median sternotomy underwent serial hemodynamic evaluation. FlotracTM Sensor – derived stroke volume, stroke volume variation, systemic vascular resistance index (SVRI), cardiac index and right atrial pressure were measured just before and after pericardiectomy, at 12 hours, 24 hours, 48 hours, 72 hours and at discharge postoperatively. Results: Majority of patients (73.33%) exhibited statistically significant reduction of right atrial pressure and SVRI along with improvement in cardiac index and oxygen delivery in the immediate and late postoperative period. However, the stroke volume and stroke volume variation did not increase proportionately on completion of surgery. Patients with low cardiac output syndrome exhibited persistently high central venous pressure with reduced cardiac index and echocardiographically abnormal diastolic filling characteristics. Conclusions: We conclude that there is early normalization of hemodynamics following pericardiectomy via median sternotomy and the adequacy of pericardiectomy can be accurately assessed by the new semi-invasive arterial pressure waveform analysis device. Stroke volume variation is a non-predictor of fluid requirement during and after pericardiectomy.

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Erratum: Annals of Cardiac Anesthesia: Beacon journey toward excellence: 2015–2017

Annals of Cardiac Anaesthesia 2017 20(2):280-280



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Methylene blue for postcardiopulmonary bypass vasoplegic syndrome: A cohort study

Michael Mazzeffi, Benjamin Hammer, Edward Chen, Mark Caridi-Scheible, James Ramsay, Christopher Paciullo

Annals of Cardiac Anaesthesia 2017 20(2):178-181

Background: Methylene blue (MB) has been used to treat refractory hypotension in a variety of settings. Aims: We sought to determine whether MB improved blood pressure in postcardiopulmonary bypass (CPB) vasoplegic syndrome (VS) in a complex cardiac surgery population. Furthermore, to determine variables that predicted response to MB. Setting and Design: This was conducted in a tertiary care medical center; this study was a retrospective cohort study. Materials and Methods: Adult cardiac surgery patients who received MB for post-CPB VS over a 2-year period were studied. Mean arterial blood pressure (MAP) and vasopressor doses were compared before and after MB, and logistic regression was used to model which variables predicted response. Results: Eighty-eight patients received MB for post-CPB VS during the study period. MB administration was associated with an 8 mmHg increase in MAP (P = 0.004), and peak response occurred at 2 h. Variables that were associated with a positive drug response were deep hypothermic circulatory arrest during surgery and higher MAP at the time of drug administration (P = 0.006 and 0.02). A positive response had no correlation with in-hospital mortality (P = 0.09). Conclusions: MB modestly increases MAP in cardiac surgery patients with VS. Higher MAP at the time of drug administration and surgery with deep hypothermic circulatory arrest predict a greater drug response.

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Multiple Nutritional Factors and the Risk of Hashimoto's Thyroiditis

Thyroid , Vol. 0, No. 0.


http://ift.tt/2njck35

Effects of two wattages of low-level laser therapy on orthodontic tooth movement

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): M. Milligan, Y. Arudchelvan, S.-G. Gong
IntroductionMixed outcomes have been found in animal and clinical studies with regard to the use of low-level laser therapy (LLLT) as a modality to accelerate orthodontic tooth movement (OTM). One major reason for the variable findings is the different methodologies and protocols for laser therapy use.ObjectiveThe aim of this study was to determine whether orthodontically moved molars exposed to two different wattages at the same energy density of LLLT exhibited differences in the amount of tooth movement and molecular and histological changes in the adjacent periodontal areas.MethodsAn orthodontic force was applied to rat upper first molars exposed to 500mW (EX-500) and 1000mW (EX-1000) of laser application, with a control group (CT) with no laser application. Gene expression in the periodontal ligament (PDL) and histology of the palatal gingiva of the molars were analyzed.ResultsThere was a statistically significant difference for OTM between EX-500 but not between EX-1000 and CT groups. RANKL and MMP-13 expression levels in the PDL of orthodontically moved molars, however, were increased significantly in laser-exposed groups compared to CT. Early signs of dysplasia were observed in over half of the animals in the EX-1000 group.ConclusionsOur results provide evidence for molecular changes and the potential dysplastic effects of laser on the surrounding soft tissues. Further studies are needed to better identify an optimum laser protocol to maximize the desired effect.



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Aims & Scope/Editorial board

Publication date: June 2017
Source:Archives of Oral Biology, Volume 78





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Allergen-specific immunoglobulin E and allergic rhinitis severity

http://ift.tt/2nJxdiY

Efficacy and safety of an intravenous C1-inhibitor concentrate for long-term prophylaxis in hereditary angioedema

http://ift.tt/2niTaKC

Flexible microsensor technology for real-time navigation tracking in balloon sinus ostial dilation

http://ift.tt/2nJAsqV

Quality-of-life improvement after endoscopic sinus surgery in patients with obstructive sleep apnea

http://ift.tt/2niMigm

Ossifying fibroma of the maxilla and sinonasal tract: Case series

http://ift.tt/2nJfSXE

Intrasinus penetration of a silastic malar implant, which resulted in chronic sinusitis: A case report and literature review

http://ift.tt/2niZHVt

Autoimmune-related nasal septum perforation: A case report and systematic review

http://ift.tt/2nJpq4T

The impact of total immunoglobulin E levels on outcomes of maximal medical therapy for chronic rhinosinusitis

http://ift.tt/2niBsa4

Effectiveness of radiotherapy+ozone on tumoral tissue and survival in tongue cancer rat model

Publication date: Available online 6 April 2017
Source:Auris Nasus Larynx
Author(s): Remzi Dogan, Aysenur Meric Hafız, Huriye Senay Kiziltan, Alper Yenigun, Nur Buyukpinarbaslili, Ali Hikmet Eris, Orhan Ozturan
ObjectiveThe objective of this study is to examine therapeutic effect of the combination of radiotherapy and ozone which features increasing of the destruction of cancer cells by increasing oxygen level of the body on advanced tongue cancer induced in rats.MethodsA total of 36 female rats were included in this study as 4 groups.Group 1 (Cancer, n=8): 4NQO.Group 2 (Cancer+Radiotherapy, n=10): 4NQO+Radiotherapy.Group 3 (Cancer+Ozone+Radiotherapy, n=10): 4NQO+Ozone+Radiotherapy.Group 4 (Cancer+Ozone, n=10): 4NQO+Ozone.Group 5 (Control, n=8): Physiological saline solution.At the end of the week 20, rats in Groups 1 and 5 were sacrified. The rats in Groups 2,3 and 4 were waited until oral food intake was disrupted. The necessary applicatione were then carried out and survivals were evaluated. Each rat was sacrified after death. Tongues of the rats were excised, stained with hematoxylin & eosin and histopathologically evaluated.ResultsHistopathologic evaluation: The model that we applied was seen to achieve success in Group 1 in which 7 of the rats developed squamous cell carcinoma and one rat developed dysplasia at the end of the week 20. In Group 2 squamous cell cancer was seen in 6 and dysplasia in 4 rats. Six rats presented normal tongue tissues and 4 rats developed hyperplasia in Group 3.In Group 4; 3 rats had squamous cell cancer, 2 rats dysplasia, 3 rats hyperplasia and 2 rats had normal tissue. In Group 5, normal tongue tissues were observed in all rats. A significant histopathological improvement was observed in Group 3 compared to Group 2 (p<0.05). Histopathologic scorings were similar in Groups 3 and 5 (p>0.05). No statistically significant difference was found in histopathologic scorings between Group 1 and Group 2 (p>0.05). A significant improvement was observed in Group 4 compared to Group 1 (p<0.05). Group 3 showed a significant histologic improvement compared to Group 4 (p<0.05).Evaluation of survival: Survival times were found as 3.4±1.3 days, 76.4±14.9days and 76.4±14.9 days in the Groups 2, 3 and 4; respectively. Survival was significantly longer in Group 3 than in Groups 2 and 4 (p<0.05). Survival was significantly longer in Group 4 compared to Group 2 (p<0.05).ConclusionIn this study, demonstrated that radiotherapy plus ozone application both provided histopathological improvement and prolonged survival in advanced tongue cancer rat model.



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The Emerging Role of 3-Dimensional Printing in Rhinology

Nasal septal perforations, particularly those that are large and irregular in shape, often present as challenging surgical dilemmas. New technology has allowed us to develop techniques using computed tomography imaging and 3-dimensional (3D) printers to design custom polymeric silicone septal buttons. These buttons offer patients an option that avoids a surgical intervention when standard buttons do not fit well or are not tolerated. Preliminary data suggest that buttons designed by 3D printer technology provide more comfort than standard commercially available or hand-carved buttons with equivalent reduction of symptoms.

http://ift.tt/2p7cTcD

Next-Generation Surgical Navigation Systems in Sinus and Skull Base Surgery

Over the past 25 years, rhinologists have adopted surgical navigation technology for endoscopic sinus and skull base procedures. Navigation systems often produce a wide target registration error (TRE). Ideally, next-generation systems will include a leap in target registration error reduce TRE through innovative hardware and software. Incorporation of microsensors will be another important innovation. Future systems are likely to include augmented reality, which can project overlays of critical anatomy on real-world endoscopic images. Recent trends in surgical navigation suggest a phase of rapid evolution.

http://ift.tt/2niw32U

Correlates of multiple basal cell carcinoma in a retrospective cohort study: Sex, histologic subtypes, and anatomic distribution

Basal cell carcinoma (BCC) is the most common malignancy in the United States.1 More than 41% of patients with 2 or more BCCs develop a subsequent BCC.2,3 Despite clinical awareness of risk factors for a second BCC, there remains a subset of individuals who develop significantly more BCCs than the average population. In this study, we sought to characterize the factors associated with high-frequency BCC, including sex, anatomic site, and histologic site.

http://ift.tt/2oKJBUy

Fontana-Masson stain in fungal infections

Fontana-Masson (FM) staining is a histopathology technique used to identify dematiaceous fungi. The result often guides initial species identification and antifungal treatment; however, there is evidence that nondematiaceous fungi might react with this stain. Few studies in the current literature address this issue.

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Assessment of major comorbidities in adults with atopic dermatitis using the Charlson comorbidity index

There is a growing interest in comorbidities of adults with atopic dermatitis (AD).

http://ift.tt/2oKIzYP

Burden and treatment patterns of advanced basal cell carcinoma among commercially insured patients in a United States database from 2010 to 2014

The burden of advanced basal cell carcinoma (aBCC) is not fully understood.

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Correction

Humphreys TR, Shah K, Wysong A, Lexa F, MacFarlane D. Answers to CME examination. J Am Acad Dermatol. 2017;76:607.

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Association between atopic dermatitis and contact sensitization: A systematic review and meta-analysis

It is unclear whether patients with atopic dermatitis (AD) have an altered prevalence or risk for contact sensitization. Increased exposure to chemicals in topical products together with impaired skin barrier function suggest a higher risk, whereas the immune profile suggests a lower risk.

http://ift.tt/2o2Sxln

Effectiveness of radiotherapy+ozone on tumoral tissue and survival in tongue cancer rat model

The objective of this study is to examine therapeutic effect of the combination of radiotherapy and ozone which features increasing of the destruction of cancer cells by increasing oxygen level of the body on advanced tongue cancer induced in rats.

http://ift.tt/2oGcUrG

Reduced post-tonsillectomy bleeding rates through a refined technique

The first documented tonsillectomy was performed in the first century A.D. by Cornelius Celsus in Rome. He used his finger to bluntly dissect an inflamed tonsil. Over time, better instruments and technical advances have allowed for the development of new techniques although cold-knife dissection has been the standard procedure for many years and is still used among many practicing otolaryngologists today [1].

http://ift.tt/2nQhPSR

Detection of endolymphatic hydrops using traditional MR imaging sequences

The purpose of this study was to determine whether Meniere's disease (MD) produces endolymphatic cavity size changes that are detectable using unenhanced high-resolution T2-weighted MRI.

http://ift.tt/2nitluh

Perioperative cardiac complications in patients undergoing head and neck free flap reconstruction

Limited data exists on cardiac complications following head and neck free flaps.

http://ift.tt/2nQthhi

Evaluation of Various Laryngeal Pathologies: Videolaryngoscopy Versus Videolaryngostroboscopy

Abstract

Voice disorders are common in various laryngeal pathologies. The aim of this study is to evaluate the diagnostic value of videolaryngostroboscopy (VLSS) over videolaryngoscopy (VLS) in laryngeal pathologies. This was a prospective observational study. Detailed examination was carried out for 80 cases which presented with different laryngeal pathologies. Cases were evaluated on the basis of VLS and VLSS in the same sitting and diagnosed separately. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to find out the relationship between diagnoses made by VLS and VLSS. The diagnostic value of VLSS is significant; it has 98.15% Sensitivity and 50% specificity over VLS in finding true vocal cord abnormalities. Around one third of the cases, i.e. 26 cases (32.50%) were misdiagnosed on VLS. Also, VLSS gave additional diagnosis in 6 cases (7.50%) which were missed on VLS. However, the diagnoses revealed by VLS and VLSS were same in 48 cases (60%). The diagnostic value of VLSS correlated with the type of laryngeal pathology. Through the present study, it has been deduced that VLSS is the superior modality for diagnosing laryngeal pathologies. It offers better visualisation of the finer aspects of the vocal cords. It has various advantages over VLS in terms of sensitivity and specificity.

http://ift.tt/2p5EDOV

Binaural Interaction Component of Middle Latency Response in Children Suspected to Central Auditory Processing Disorder

Abstracts

Binaural processing disorder is an important deficit in children with (C)APD so binaural processing evaluations are crucial. There are subjective and objective tests for assessing binaural processing. Subjective tests require patient attention and active so objective evaluation of binaural processing is important. The aim of present study was investigating binaural interaction component (BIC) of middle latency response (MLR) in children suspected to (C)APD. Sixty 8–12 year-old children suspected to (C)APD and sixty normal children were selected based on inclusion criteria. Both groups were matched in terms of sex (40 boys and 20 girls) and age (9.05 ± 1.25 years old). MLR test (monaural right ear, monaural left ear and binaural) was performed in all the cases and BIC was calculated by subtracting binaural response from summed monaural responses. Independent t test showed that latency of Pa and Na (ms), Pa–Na amplitude (µv), BIC latency (ms) and amplitude (µv) were significantly different from normal subjects (p value ≤0.001). Present study showed that MLR and BIC of MLR are clinically available and objective tests that can be used to determining children suspected to (C)APD. These tests might have the potential to separating normal children from children with (C)APD objectively.

http://ift.tt/2o0drBF

Comparative Study of Outcome of Endoscopic Myringoplasty in Active and Inactive Mucosal Chronic Otitis Media Patients

Abstract

The objective of this study was to compare graft uptake and hearing improvement in active and inactive mucosal chronic otitis media patients after endoscopic myringoplasty. This is prospective study conducted at a government medical college and hospital from February 2014 to August 2015. A total of 40 active (wet) ears with mucoid discharge and 40 inactive (dry) ears (at least 6 weeks dry before surgery) with mucosal chronic otitis media were operated on by endoscopic myringoplasty by transcanal approach. Graft uptake and hearing gain rates 3 months after surgery were compared for both groups. Endoscopic myringoplasty using temporal fascia graft via transcanal approach was used. The graft take rate was 77.5% for the active ear group and 85% for the inactive ear group. The hearing gain rate was 82.5% for the inactive ear group and 72.5% for the active ear group. Differences were found to be statistically insignificant for both graft uptake and hearing gain. The success of endoscopic myringoplasty is not adversely affected by the presence of mucoid ear discharge at the time of surgery, and outcomes are comparable to those of the operation done for inactive ear.

http://ift.tt/2nZUdfn

Acute aortic valvular regurgitation with pulmonary haemorrhage in Wegener's granulomatosis presenting as dyspnoea: a rare presentation

Mani Nallasivan<br />Dec 6, 2010; 2010:bcr1120092474-bcr1120092474<br />case-report

http://ift.tt/2oeZYZ5

Evaluation of Various Laryngeal Pathologies: Videolaryngoscopy Versus Videolaryngostroboscopy

Abstract

Voice disorders are common in various laryngeal pathologies. The aim of this study is to evaluate the diagnostic value of videolaryngostroboscopy (VLSS) over videolaryngoscopy (VLS) in laryngeal pathologies. This was a prospective observational study. Detailed examination was carried out for 80 cases which presented with different laryngeal pathologies. Cases were evaluated on the basis of VLS and VLSS in the same sitting and diagnosed separately. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to find out the relationship between diagnoses made by VLS and VLSS. The diagnostic value of VLSS is significant; it has 98.15% Sensitivity and 50% specificity over VLS in finding true vocal cord abnormalities. Around one third of the cases, i.e. 26 cases (32.50%) were misdiagnosed on VLS. Also, VLSS gave additional diagnosis in 6 cases (7.50%) which were missed on VLS. However, the diagnoses revealed by VLS and VLSS were same in 48 cases (60%). The diagnostic value of VLSS correlated with the type of laryngeal pathology. Through the present study, it has been deduced that VLSS is the superior modality for diagnosing laryngeal pathologies. It offers better visualisation of the finer aspects of the vocal cords. It has various advantages over VLS in terms of sensitivity and specificity.

http://ift.tt/2p5EDOV

Reply to: “Differential expression of serpins may selectively license distinct granzyme B functions including antigen cross-presentation”

Publication date: Available online 6 April 2017
Source:Molecular Immunology
Author(s): M.S. Mangan, J. Vega-Ramos, L.T. Joeckel, A.J. Mitchell, A. Rizzitelli, B. Roediger, D. Kaiserman, W.W. Weninger, J.A. Villadangos, P.I. Bird




http://ift.tt/2o2teji

Increased risk of sudden sensorineural hearing loss in patients with hepatitis virus infection

by Hsin-Chien Chen, Chi-Hsiang Chung, Chih-Hung Wang, Jung-Chun Lin, Wei-Kuo Chang, Fu-Huang Lin, Chang-Huei Tsao, Yung-Fu Wu, Wu-Chien Chien

The etiology of sudden sensorineural hearing loss (SSNHL) remains unclear. Possible causes of SSNHL include vascular diseases, viral infection, and autoimmune disorders. Therefore, we investigated whether hepatitis virus infection is correlated with the risk of SSNHL. Using data from the Taiwan Longitudinal Health Insurance Database, we conducted a retrospective matched-cohort study to compare patients diagnosed with hepatitis B or C virus (HBV/HCV) infections from January 1, 2000, to December 31, 2010, (N = 170,942) with frequency-matched controls (N = 512,826) at a ratio of 1:3 by sex, age, and index year. We followed each patient until the end of 2010 and evaluated the incidence of SSNHL. At the end of the follow-up period, 647 (0.38%, 647/170,942) patients developed SSNHL in the HBV/HCV group compared with 978 (0.19%, 978/512,826) in the control groups, with a statistical significance of P

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Importance of relying on examples for both anesthesiologists and other physicians to assign unbiased American Society of Anesthesiologists Physical Status Classifications

In this month's issue of the Journal of Clinical Anesthesia, Curatolo and colleagues compare American Society of Anesthesiologists' Physical Status (ASA PS) scoring by anesthesiologists and internal medicine physicians [1]. Using 20 cases (scenarios), they showed that internists assigned significantly lower ASA PS scores than did anesthesiologists [1]. The internists "had a 30–40% chance of under-rating the ASA PS of the patients in the clinical vignettes" compared with the anesthesiologists [1].

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Less postoperative sore throat after nasotracheal intubation using a fiberoptic bronchoscope than using a Macintosh laryngoscope: A double-blind, randomized, controlled study

To evaluate whether nasotracheal intubation using a fiberoptic bronchoscope reduces postoperative sore throat.

http://ift.tt/2p6K9Rf

Determining predictive value of preoperative tests for difficult intubation

In the recent article by Mahmoodpoor et al. [1] evaluating the predictive value of several preoperative tests for difficult intubation in a prospective descriptive study, they conclude that facial angle has a high sensitivity, positive and negative predictive value, and Youden index for prediction of difficult intubation, but the best result is achieved when facial angle is used in combination with either the modified Mallampati score or upper lip bit test. As difficult intubation prediction by preoperative tests is a crucial component of safe airway management algorithm [2], their findings have potential implications.

http://ift.tt/2oJT5Q4

Perioperative cardiac complications in patients undergoing head and neck free flap reconstruction

Publication date: Available online 6 April 2017
Source:American Journal of Otolaryngology
Author(s): Peter J. Ciolek, Kate Clancy, Michael A. Fritz, Eric D. Lamarre
BackgroundLimited data exists on cardiac complications following head and neck free flaps.DesignA retrospective review was performed on patients that underwent free flap reconstruction from 2012 to 2015.Results368 flaps were performed. 12.5% of patients experienced a cardiac event. Hypertension, coronary artery disease, heart failure, venous thromboembolism, and anticoagulation were associated with cardiac complications. ASA class was not predictive of cardiac events. 7.6% of patients required anticoagulation, which exhibited a strong association with surgical site hematoma. Cardiac complications led to a significantly increased length of stay.ConclusionsThere is a significant rate of cardiac events in this cohort. When estimating risk, a patient's total burden of comorbidities is more important than any one factor. ASA Class fails to demonstrate utility in this setting. Cardiac events have implications for quality-related metrics including length of stay and hematoma rate.



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PcMab-47: Novel Antihuman Podocalyxin Monoclonal Antibody for Immunohistochemistry

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


http://ift.tt/2nIvJpf

Endovascular recanalisation of a chronic occlusion of the retrohepatic IVC associated to a filter in a patient with antiphospholipid syndrome

Inferior vena cava (IVC) filters are useful adjuncts to prevent venous thromboembolism to the pulmonary circulation in the setting of contraindication for anticoagulation. Despite their proven decreased rate of pulmonary embolism, IVC filters are not without complications. We herein present the case of a 22-year-old man with a history of antiphospholipid antibody syndrome who was sent to our institution for evaluation with Budd-Chiari and post-thrombotic syndromes associated to a chronic retrohepatic complete IVC occlusion secondary to an IVC filter placed 5 years earlier. Via common femoral, transjugular and transhepatic accesses, we performed a successful endovascular recanalisation and reconstruction of the IVC with a 16 mmx60 mm covered stent; the hepatic outflow was restored with an 8x20 mm Palmaz stent. At 12-month follow-up, his symptoms have resolved, and his liver tests are within normal limits. He remains on systemic anticoagulation.

http://ift.tt/2ngVXUF

Isolated brachydactyly type E and idiopathic pancreatitis in a patient presenting to a lipid disorders clinic

An 18-year-old female tertiary student was referred to a lipid clinic with hypertriglyceridaemia discovered after presentation with acute pancreatitis. The patient's only medication was l-thyroxine for treatment of hypothyroidism. She was overweight, normotensive, with unremarkable facies. However, she had hypermobile hand joints and brachydactyly resulting in loss of left 3–5 and right 4 and 5 knuckle definitions. Radiography revealed shortening of metacarpals 3–5 on the left and 4 and 5 on the right. Her mother had similar skeletal changes, consistent with a dominant mode of inheritance. Abnormally short digits involving the metacarpals, classified as brachydactyly type E, can be isolated or occur as part of a syndrome. Turner syndrome, Albright hereditary osteodystrophy, hypertension with brachydactyly, chromosome 2q37 microdeletion and PTHLH mutations were excluded following clinical, biochemical and genetic testing. No specific treatment was required. Genetic testing for isolated and syndromic forms of brachydactyly facilitates family screening and prepregnancy counselling.

http://ift.tt/2nHSgm6

Delayed presentation of button battery ingestion: a devastating complication

A 12-month-old child presented with a prolonged history of fever, cough and difficulty breathing, which was initially treated as bronchiolitis. She was discharged but presented again to Accident and Emergency department 4 days later with worsening symptom. Following deterioration in the Emergency department, a chest X-ray revealed a button battery in the upper oesophagus. Emergency oesophagoscopy was performed where a 20 mm button battery was removed and a tracheoesophageal fistula was seen 12 mm above the carina. Near total oesophagectomy, cervical oesophagostomy and gastrostomy were performed with a patch repair of the trachea, followed by a bioabsorbable tracheal stent. The patient spent a prolonged period of time in intensive care and was treated with intravenous antibiotics for mediastinitis. This case highlights the difficulty in diagnosis of button batteries when there is no clear history and the devastating consequences of prolonged exposure.

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Analgesia and side effects of the addition of 10 or 20 µg fentanyl to articaine in spinal anesthesia for knee arthroscopy: a randomized and observer-blinded study

Abstract

Objectives

Articaine, a popular and rapidly acting local anesthetic in dentistry, has been also found to be beneficial in ambulatory spinal anesthesia. Analgesia in the intraoperative and immediate postoperative period may be further improved by adding fentanyl to the local anesthetic solution for spinal anesthesia. The aim was to evaluate dose-dependency of analgesia and side effects associated with intrathecal fentanyl additive to articaine for spinal anesthesia in knee arthroscopy patients.

Methods

In this randomized, observer- and patient-blinded study, 90 adult patients scheduled for elective ambulatory knee arthroscopy under spinal anesthesia were randomized into three groups: plain articaine 60 mg with saline (group AF0), articaine 60 mg with fentanyl 10 µg (group AF10) or 20 µg (group AF20) in a total volume of 1.9 ml. The blinded observer tested the sensory and the motor block, and performed telephone interviews on the first and seventh postoperative days.

Results

The median (IQR) duration of sensory block at the dermatomal level of T10 was significantly longer in groups AF10, 69 min (56) and AF20, 69 min (45) than in group AF0, 41 min (35) (p = 0.013). Motor block duration was similar in all groups (median 120 min). Group AF20 patients experienced pruritus significantly more often than patients in the other groups (p = 0.039). No acute or late anesthetic side effects occurred, and satisfaction with the anesthetic technique was the same in all groups (97% satisfied).

Conclusions

Fentanyl 10 or 20 µg as additive to articaine for spinal anesthesia prolonged the duration of sensory block significantly and similarly. Fentanyl 20 µg was more often associated with pruritus than fentanyl 10 µg.

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Industry Sponsorship of Research in Otolaryngology

This cross-sectional analysis quantifies research payments made by the health care industry to otolaryngologists and compares the field of otolaryngology with other surgical specialties.

http://ift.tt/2o1vVSn

Neurologic Evaluation in Children With Laryngeal Cleft

This medical record review proposes guidelines for neurologic evaluation and imaging techniques to identify or rule out neuromuscular dysfunction in children with laryngeal cleft.

http://ift.tt/2odNUH9

Superior Canal Dehiscence Syndrome Affecting 3 Families

This case series describes the features of superior canal dehiscence syndrome in the multiple affected members of 3 families and explores the prospect of a genetic origin.

http://ift.tt/2o1zOGQ

Implication for second primary cancer from visible oral and oropharyngeal premalignant lesions in betel-nut chewing related oral cancer

Abstract

Background

Visible oral and oropharyngeal premalignant lesions may be used to monitor for a second primary oral cancer. To control for bias, we focused on the visible oral and oropharyngeal premalignant lesions of patients with oral cancer with a positive betel-nut chewing habit. Visible oral and oropharyngeal premalignant lesions that can predict second primary oral cancers were studied.

Methods

Nine hundred ninety-seven patients with positive betel-nut chewing habits and oral cancer were enrolled in this retrospective cohort study. We analyzed the relevance of their visible oral and oropharyngeal premalignant lesion incidence and relative clinicopathological variables to the development of a second primary oral cancer.

Results

Second primary oral cancer risk was significantly higher in patients with positive visible oral and oropharyngeal premalignant lesions (P < .0001), especially in younger patients (P = .0023; ≤40 years: adjusted odds ratio [OR] 2.66; 40-60 years: adjusted OR 2.61). The heterogeneous leukoplakia was (adjusted OR 2.17) higher than homogeneous leukoplakia.

Conclusion

The predictive value and practicality of visible oral and oropharyngeal premalignant lesions make it a potentially valuable marker in follow-ups of patients with a positive betel-nut chewing habit with oral cancer, especially young patients with heterogeneous leukoplakia.

http://ift.tt/2ngCZgL

Discursive Representation within the Institutional Void: The Rise and Fall of a Governance Network on Sustainable Food in Belgium

Recently, democratic theorists have turned their attention to political representation. This renewed attention is inspired by a questioning of the formalist interpretation of representative government that presumes a strict division between elected political elites and deliberative participation in the public sphere. Several scholars argue that the standard account of representative democracy based on residence-based and electoral representation does not suffice to explain contemporary political practice. Representation , then, becomes a 'practice' in which the object of representation and the grounds on which it is defended, co-determine 'who' and 'what' is considered politically legitimate and how 'interests' are to be represented. In this paper we explore how discursive interaction on political representation takes place in an 'institutional void', i.e. a political setting in which there are no clear rules and norms to which politics is to be conducted. We base our analysis on an interpretative reconstruction of the rise and fall of a sustainability governance process in the Flemish agro-food domain called the New Food Frontier (NFF). We claim to have found several interacting political conceptions, that operated on both explicit and more tacit levels, which particularly shaped the political interventions within the institutional void of the NFF. Analysis reveals that the dominant/initial conception of the studied political process has strong affinities with Dryzek's ideas on discursive representation. Competing claims on how political representation should work were linked to neo-corporatism and transition management. We analyze how these competing conceptions play in the organization, articulation and disintegration of the governance network. Secondly, we relate this deliberative 'outcome' to the broader political setting in which the sustainability governance trajectory was embedded. In this context , a re-negotiation of the rules of the game within a new governance setting and the relationship with institutionalized politics proved to be important factors in explaining the discontinuity of the process of discursive representation.

http://ift.tt/2oIz10u

Ising model with conserved magnetization on the human connectome: Implications on the relation structure-function in wakefulness and anesthesia

Dynamical models implemented on the large scale architecture of the human brain may shed light on how function arises from the underlying structure. This is the case notably for simple abstract models, such as the Ising model. We compare the spin correlations of the Ising model and the empirical functional brain correlations, both at the single link level and at the modular level, and show that their match increases at the modular level in anesthesia, in line with recent results and theories. Moreover, we show that at the peak of the specific heat (the critical state) the spin correlations are minimally shaped by the underlying structural network, explaining how the best match between structure and function is obtained at the onset of criticality, as previously observed. These findings confirm that brain dynamics under anesthesia shows a departure from criticality and could open the way to novel perspectives when the conserved magnetization is interpreted in terms of an homeostatic principle imposed to neural activity.

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Using policy discourses to open up the conceptual space of farm education: inspiration from a Belgian farm education network

Farm education organized by farmers and directed towards students and groups of citizens is a relatively new practice often considered as one specific business strategy to diversify farmers' income. Although we endorse the importance of an economic rationale we argue that this conceptualization undermines a diversity of perspectives on educative processes that address societal transformation and the political role of intergroup and interpersonal deliberation. In this paper, we start from the observation that on the European level three different competing policy paradigms or discourses are being advocated. Reasoning from a discourse-analytical perspective these policy discourses cannot be considered as mere ideas floating in abstraction but constitute interpretative frames that have concrete implications for practices in the agro-food domain. Along these lines, we reveal three analytically distinct educative practices by specifying how each discourse articulates meaning to make sense of farm education in terms of goals, relations and actions. Our theoretical assumptions on education are informed by John Dewey's pragmatist conception of education which starts from the idea that the mutual recognition of social interests are co-constitutive for the experience of learning. We use a case study on a regional farm education network in Belgium to illustrate how farmer's educative efforts can be enrolled differently in educational practices according to different discursive frames and how these different educational practices enable or constrain social and educational arrangements that promote a sustainability transition. We conclude that farm education is a multifaceted educational practice and reflect on its potentialities and pitfalls to foster (emancipatory) agency to re-balance conflicting interests towards sustainable development.

http://ift.tt/2oIrVZL

Histamine H1 and H4 receptor expression on the ocular surface of patients with chronic allergic conjunctival diseases

Publication date: Available online 5 April 2017
Source:Allergology International
Author(s): Noriko Inada, Jun Shoji, Yukiko Shiraki, Hiroshi Aso, Satoru Yamagami
BackgroundThis study investigated the histamine H1 and H4 receptors mRNA (H1R and H4R, respectively) expression on the ocular surface of patients with chronic forms of allergic conjunctival diseases to determine whether they can serve as biomarkers for allergic inflammation in the conjunctiva.MethodsWe examined 19 patients with vernal or atopic keratoconjunctivitis (AKC/VKC group) and 15 healthy volunteers (control group). The AKC/VKC group was divided into active and stable stage subgroups. Specimens were obtained from the upper tarsal conjunctiva of each participant using a modified impression cytology method. H1R, H4R, and eotaxin-1, -2, and -3 mRNA (eotaxin-1, eotaxin-2, eotaxin-3, respectively) expression was determined by real-time RT-PCR. Immunohistochemical analysis for eosinophil cationic protein (ECP), eosinophil major basic protein (MBP), eotaxin-2, and histamine H4 receptor (H4R) were performed using conjunctival smears.ResultsThe number of H4R-positive patients was higher in the active than the stable stage subgroup and control group, whereas no difference was observed for H1R. H1R levels were higher in the active than in the stable stage subgroup, while those of H4R were higher in the active stage subgroup than in the control group. H1R and H4R levels were correlated with eotaxin-2 level. In immunohistochemical analysis, H4R revealed their expression on eosinophils in conjunctival smears of patients with AKC/VKC.ConclusionsH4R is useful as biomarkers of allergic inflammation on ocular surfaces. Most notably, H4R expressed on eosinophils is useful as a biomarker of eosinophilic inflammation of the ocular surface.



http://ift.tt/2nHwsXU

Maintenance of pathogenic Th2 cells in allergic disorders

Publication date: Available online 5 April 2017
Source:Allergology International
Author(s): Kenta Shinoda, Kiyoshi Hirahara, Toshinori Nakayama
Immunological memory is an important protective mechanism that enables host organisms to respond rapidly and vigorously to pathogens that have been previously encountered. In addition to the protective function, memory CD4⁺ T helper (Th) cells play a central role in the pathogenesis of chronic inflammatory disorders, including asthma. Recently, several investigators have identified phenotypically and functionally distinct memory Th2 cell subsets that produce IL-5. These memory Th2 cell subsets play an important role in the pathology of allergic inflammation and function as memory-type "pathogenic Th2 (Tpath2) cells" both in mice and humans. We review the role of lung Tpath2 cells in the development of allergic inflammation and, in the context of recent findings, propose a mechanism by which Tpath2 cells not only survive but also continue to function at the sites where antigens were encountered. A greater understanding of the functional molecules or signaling pathways that regulate the inflammatory niche for Tpath2 cells may aid in the design of more effective treatments for chronic inflammatory disorders.



http://ift.tt/2o6FLUQ

Ultra-high-resolution ex-vivo imaging of the BAPN mouse aorta

http://ift.tt/2p5y8eI

Bovi-Analytics: a platform to educate veterinary students Big Data in dairy cows An initiative to create the veterinary stethoscope version 3.0?

http://ift.tt/2ngtoGZ

Single-center experience with mechanical valve replacement in children and adolescents: a lifelong challenge

**Introduction**: Although valve repair is the preferred treatment of valve diseases in children and adolescents, valve replacement is sometimes unavoidable. The purpose of this study is to evaluate the late clinical and valve-related outcome of a pediatric population with a mechanical valve prosthesis. Methods: Retrospective investigation is performed of all patients, treated with a mechanical prosthesis before the age of 20 years, for a congenital or acquired heart valve disease during past 2 decades.Analysis focused on late outcome in terms of survival and freedom from valve- and anticoagulation (AC)-related events. **Results**: The study population comprised 40 patients, with a mean age of 11.6 y (95%CI 7.6-15.5), presenting dysfunction of the mitral (56%), aortic (24%), tricuspid (10%), pulmonary (5%) or multiple valves (5%). Etiology was primarily congenital in 80%, rheumatic in 12%, genetic in 5% and infectious in 3%. The majority of children (83%) underwent already previous valve surgery, of whom 39% more than 1 procedure. Survival at 20 years was 76±10%. Within a mean follow-up time of 9(95%CI 5-14) years, 60% of the patients remained free from any major valve-related event, which were predominantly thrombo-embolism, prosthetic dysfunction, endocarditis and major bleeding. Late valve-related reoperation was required in 39% of the patients for prosthesis outgrowth (33%), prosthesis dysfunction (3%) and endocarditis (3%). Major AC-related events were observed in 40%,of which occurred in 73% of the patients showing an INR variability ≥30%. Patients with INR-selfmonitoring (n=5) showed lower INR variability compared to INR control by the local physician: INR variation was 29±21% versus 43±21% (p=0.05). Patients with self-monitoring demonstrated no AC-related event: 0% versus 50% (p=0.04). **Conclusion**: This single-center study confirms that 40% of the patients receiving a mechanical heart valve prosthesis during childhood experience at least one serious adverse event during later life. Half of these events are related to the need for anticoagulation, through showing a high INR-variability in this young population. Self-monitoring of INR might decrease this specific complication rate.

http://ift.tt/2nOsZrk

Foreign Body Aspiration During Inhaled Bronchodilator Administration

Publication date: Available online 5 April 2017
Source:Archivos de Bronconeumología (English Edition)
Author(s): M. Teresa Gómez Hernández, Nuria M. Novoa, Marcelo F. Jiménez




http://ift.tt/2nOl9Of

'Nowhere else will take him' – Palliative care and homelessness

Stone, PC; Hudson, B; Shulman, C; (2017) 'Nowhere else will take him' – Palliative care and homelessness. European Journal of Palliative Care , 24 (2) p. 54. Green open access

http://ift.tt/2oI7bBw

International Osteoporosis Foundation and European Calcified Tissue Society Working Group. Recommendations for the screening of adherence to oral bisphosphonates

Diez-Perez, A; Naylor, KE; Abrahamsen, B; Agnusdei, D; Brandi, ML; Cooper, C; Dennison, E; Diez-Perez, A; Naylor, KE; Abrahamsen, B; Agnusdei, D; Brandi, ML; Cooper, C; Dennison, E; Eriksen, EF; Gold, DT; Guanabens, N; Hadji, P; Hiligsmann, M; Horne, R; Josse, R; Kanis, JA; Obermayer-Pietsch, B; Prieto-Alhambra, D; Reginster, J-Y; Rizzoli, R; Silverman, S; Zillikens, MC; Eastell, R; - view fewer (2017) International Osteoporosis Foundation and European Calcified Tissue Society Working Group. Recommendations for the screening of adherence to oral bisphosphonates. Osteoporosis International , 28 (3) pp. 767-774. 10.1007/s00198-017-3906-6 .

http://ift.tt/2o1eRvM

Assessment, accountability and the literacy curriculum: reimagining the future in the light of the past

Moss, G; (2017) Assessment, accountability and the literacy curriculum: reimagining the future in the light of the past. Literacy 10.1111/lit.12104 . (In press).

http://ift.tt/2oHSDBV

Does more education cause lower BMI, or do lower-BMI individuals become more educated? Evidence from the National Longitudinal Survey of Youth 1979

Benson, R; von Hippel, PT; Lynch, JL; (2017) Does more education cause lower BMI, or do lower-BMI individuals become more educated? Evidence from the National Longitudinal Survey of Youth 1979. Social Science & Medicine 10.1016/j.socscimed.2017.03.042 . (In press).

http://ift.tt/2o1j0zS

Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline

Wedzicha, JA; Miravitlles, M; Hurst, JR; Calverley, PMA; Albert, RK; Anzueto, A; Criner, GJ; Wedzicha, JA; Miravitlles, M; Hurst, JR; Calverley, PMA; Albert, RK; Anzueto, A; Criner, GJ; Papi, A; Rabe, KF; Rigau, D; Sliwinski, P; Tonia, T; Vestbo, J; Wilson, KC; Krishnan, JA; - view fewer (2017) Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. European Respiratory Journal , 49 (3) , Article 1600791. 10.1183/13993003.00791-2016 .

http://ift.tt/2oHQING

“Une telle apathie est presque coupable”. How in Belgium’s Journal des tribunaux the interest for the Congo Free State sparked off (1885-1908)

When the Congo Free State (CFS) was established in 1885, King Leopold II ruled it as its personal territory. At first Belgian politicians and lawyers seemed not to care about the colonial ambitions of its sovereign. That changed during the 1890s, when the Leopoldian CFS was internationally accused of committing crimes against humanity. Belgium's Parliament urged to find a solution in the annexation project during the first decade of the 20th century. How did Belgian lawyers perceive this issue ? Through means of legal periodicals, which reflect and shape opinions on certain topics, it is possible to reconstruct the annexation history of the CFS by Belgium in 1908. The Journal des tribunaux is the most relevant titles on this subject, as it is the primus inter pares of legal periodicals at that time and connected to all the relevant associations in the political, legal and colonial world.

http://ift.tt/2oN5EHq

Promoting sustainable development or legitimising free trade? Civil society mechanisms in EU trade agreements

This study critically reflects on the involvement of civil society actors in the sustainable development chapters of recent EU trade agreements. It discusses how civil society mechanisms may legitimise the underlying neoliberal orientation of the agreements through co-optation of critical actors. Starting from a critical perspective and drawing on evidence from innovative survey data, qualitative interviews and participatory observations, it concludes that, despite overall criticism, there is no clear evidence of co-optation. While being aware of the risks their participation entail, EU participants take a constructive position. Nevertheless, diverging perspectives between non-profit and business actors risk reinforcing existing power asymmetries.

http://ift.tt/2ngdPPt

Short-range correlations and meson-exchange currents in neutrino-nucleus scattering

http://ift.tt/2oMWmuU

Clinical experience with the European Ankylosing Spondylitis Infliximab Cohort (EASIC) : long-term extension over 7 years with focus on clinical efficacy and safety

Objective : Knowledge on the long-term effects of anti-TNF therapy in patients with ankylosing spondylitis (AS) is still limited. Our objective was to study the long-term efficacy and safety of anti-TNF therapy in AS. Methods : After having completed the first part of the EASIC trial a total of 71 patients were enrolled into this 96-week extension study. Patients were treated with the same dosages and dosing intervals of infliximab as in the EASIC core study. Efficacy was assessed by using standardised assessment tools such as BASDAI, BASFI, BASMI, patient global assessment, CRP levels and the proportion of patients without any sign of enthesitis or arthritis. Long-term safety was assessed by documenting adverse events (AE), serious adverse events (SAE) and reasons for dropping out. Results : Of the 71 patients included, 64 (90.1%) completed the trial, and 7 discontinued: one was lost to follow-up, 3 withdrew informed consent and in 3 patients therapy was stopped for different reasons: secondary loss of response, recurrent infections and basal cell carcinoma of the skin. The completers showed rather stable low scores of BASDAI (mean 2.4, median 2.52), BASFI (mean 3.1, median 2.76) and BASMI (mean 3.2, median 3) as well as patients global assessment and CRP. The vast majority of patients did not have enthesitis or arthritis. A total of 476 AE were observed, 13 of which were SAE. The majority of these were infections and most of them affected the respiratory tract. Two malignancies occurred: one basal cell carcinoma and one malignant melanoma. These were the only SAE judged to be possibly related to the study drug. Conclusion : Anti-TNF treatment with infliximab is efficacious over long periods of time in patients with AS. The observation of two skin related malignancies, including one melanoma, during the whole study period of 7 years is in line with reports from previous large AS data sets.

http://ift.tt/2ng6cZi

EU TRADE POLICY AND DEVELOPING COUNTRIES: TOWARDS A MORE ETHICAL AGENDA?

http://ift.tt/2oMQaTV

Do extra-articular manifestations influence outcome in ankylosing spondylitis? : 12-year results from OASIS

Objective : To assess in patients with ankylosing spondylitis (AS) whether extra-articular manifestations (EAMs) are associated with worse functioning, worse quality of life (QoL), and more radiographic damage over time. Methods : 12-year follow-up data from the Outcome in Ankylosing Spondylitis International Study were used, complemented with data on EAMs extracted from medical charts. Functioning was assessed by the BASFI and physical component of the SF-36, QoL by ASQoL and EuroQoL, and radiographic damage by the mSASSS. Generalised estimating equations analyses were made to assess whether EAMs were associated with these outcomes over time. Results : 216 patients were included (154 (71%) men, mean age 43.6 years (SD 12.7), mean symptom duration 20.5 years (SD 11.7), and mean follow-up 8.3 years (SD 4.3). In total, 58 (26.9%) patients had acute anterior uveitis (AAU), 24 (11.1%) inflammatory bowel disease (IBD), and 14 (6.5%) psoriasis. Univariably, IBD was associated with worse BASFI over time (B=1.26, 95%-CI 0.13 to 2.39, p=0.03), but not in a multivariable model. Furthermore, in a multivariable model, IBD was associated with EuroQoL over time (B=2.93, 95%-CI 0.14 to 5.72, p=0.04). Univariably, psoriasis was associated with radiographic damage (B=-7.25, 95%-CI -14.38 to -0.12, p=0.05) and ASQoL (B= -1.94, 95%-CI -3.32 to -0.57, p<0.01) over time, but not in a multivariable model. AAU was not associated with any outcome over time. Conclusion : In this longstanding AS cohort, the presence of EAMs was not associated with functional disability, QoL or radiographic damage over time, except for IBD, which was associated with a better EuroQoL.

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Divergent views on the charter norms on the use of force: a transatlantic divide?

http://ift.tt/2oN48Fp

Quantitative assessment of foot structure in rheumatoid arthritis by a foot digitizer: detection of deformities even in the absence of erosions

OBJECTIVE: Foot involvement is a major feature in rheumatoid arthritis (RA), leading to structural deformities. Methods to allow a 3-dimensional (3-D) evaluation of foot structure in RA to be applicable in daily clinical practice have not been evaluated. This study assessed the use of a foot digitizer, a noninvasive 3-D scanner collecting objective quantitative data of the feet, to evaluate the presence of foot structure abnormalities in an RA outpatient cohort. METHODS: Foot digitizer data of RA patients were compared with healthy controls. Subanalyses were performed to find relationships with erosive disease and the presence of swollen and/or tender joints. Linear mixed models were applied with correction, including sex, age, body weight and height, foot length, Disease Activity Score in 28 joints, and disease duration. RESULTS: Forty-one percent of the patients showed >1 abnormal parameter, measured with the 3-D foot scanner. Most differences found were located in the forefoot, the most frequently affected area of the RA foot. Strikingly, even in the absence of joint erosions, marked alterations were found. Comparable differences were also observed between the patients with and without swollen and/or tender joints. Additionally, alterations were not strongly related to foot pain and disability, suggesting the capacity of the foot digitizer to detect early changes in foot structure. CONCLUSION: The results highlight the impact of RA on foot structure, even in the absence of clinical signs of swelling or radiographic erosions. The foot digitizer offers a valuable tool to screen for such foot deformities before the presence of erosions.

http://ift.tt/2nggbhk

Endoscopic endonasal nasopharyngectomy: tensor veli palatine muscle as a landmark for the parapharyngeal internal carotid artery

Background

Endoscopic endonasal nasopharyngectomy(EEN) can be a promising option for select patients with recurrent nasopharyngeal carcinoma, but serious complications can occur in terms of parapharyngeal internal carotid artery (PPICA) injury. Several landmarks have been proposed for locating the PPICA. In this study, we investigated the spatial relationship between the tensor veli palatini (TVP) muscle and the PPICA in a cadaveric model.

Methods

Seven fresh cadaver heads were available for anatomic study. Eustachian tube and the levator veli palatine (LVP) muscle were partially sacrificed or truncated to maximize the surgical field, and the TVP muscle was carefully preserved. Complete dissection was defined as when the PPICA could be visualized. We then measured the distance between the posterior margin of the TVP muscle and PPICA (z-axis), and the distance from the midline of the nasopharynx to the PPICA (x-axis).

Results

Thirteen sides of the PPICA were successfully identified. The mean distance between the posterior margin of the TVP to the PPICA (z) was 20.3 mm (range, 12 to 28 mm), and the mean distance between the midline of the nasopharynx to the PPICA (x) was 19.6 mm (range, 15 to 24 mm).

Conclusion

The PPICA was located in the same sagittal plane as the TVP muscle during dissection posteriorly. The PPICA appeared to lie around 2 cm laterally from the midline at around 2 cm in depth from the posterior margin of the TVP muscle. However, the exact position of the PPICA should be assessed using preoperative magnetic resonance imaging and intraoperative image-guided systems.

http://ift.tt/2oHWzm3

Olfactory brain gray matter volume reduction in patients with chronic rhinosinusitis

Background

Chronic rhinosinusitis (CRS) is a common inflammatory condition and a major cause of olfactory loss. Olfactory dysfunction has been associated with reduced olfactory bulb (OB) volume and gray matter (GM) density in the olfactory-related brain areas. The aim of this study was to investigate brain GM structural and OB volume alterations in patients with CRS.

Methods

Structural brain images were collected from 21 CRS patients and 31 healthy controls on a 3-T scanner. Voxel-based morphometry (VBM) was performed to investigate GM. Olfactory bulb volumes were measured using AMIRA software. Psychophysical olfactory testing for odor threshold (T) and identification (I) was performed using the Sniffin' Sticks battery.

Results

CRS patients had significantly lower scores for Sniffin' Sticks olfactory tests than controls (p < 0.001 for T, I, and combined T and I [TI] scores). Region-of-interest analyses revealed no difference in GM volume between CRS patients and healthy controls; however, in CRS patients with severe olfactory dysfunction, GM reduction was observed in the gyrus rectus, orbitofrontal cortex, thalamus, and the insula. In addition, no difference was observed for OB volume in CRS patients compared with healthy controls.

Conclusion

In this study we identified a reduction in gray matter in olfactory brain regions in CRS patients with severe olfactory dysfunction.

http://ift.tt/2nObKq1

Outcomes of endoscopic optic nerve decompression in patients with idiopathic intracranial hypertension

Background

The conventional treatment for idiopathic intracranial hypertension involves weight loss, steroids, diuretics, and/or serial lumbar punctures; however, if the symptoms persist or worsen, surgical intervention is recommended. Surgical options include cerebrospinal fluid diversion procedures, such as ventriculoperitoneal and lumboperitoneal shunts, and optic nerve decompression with nerve sheath fenestration. The latter can be carried out using an endoscopic approach, but the outcomes of this technique have not been firmly established.

Methods

This systematic review examined the outcomes of performing endoscopic optic nerve decompression (EOND) in patients with idiopathic intracranial hypertension (IIH). Six studies were included for a total of 34 patients.

Results

The patients presented with visual field disturbances (32 of 32 [100%]), visual acuity disruptions (33 of 34 [97.1%]), papilledema (26 of 34 [76.5%]), and persistent headache (30 of 33 [90.1%]). The mean duration of symptoms ranged from 7 to 32 months. Overall, the patients showed post-EOND improvement in signs and symptoms associated with IIH, specifically visual field deficits (93.8%), visual acuity (85.3%), papilledema (81.4%), and headaches (81.8%). Interestingly, 11 cases showed postoperative improvement in their symptoms with bony decompression of the optic canal alone, without nerve sheath fenestration. There were no major adverse events or complications reported with this approach.

Conclusion

EOND appears to be a promising and safe surgical alternative for patients with IIH who fail to respond to medical treatment. Further studies are needed before we can attest to the clinical validity of this procedure.

http://ift.tt/2oI2GH3

Dialister as a microbial marker of disease activity in spondyloarthritis

Objective. Dysbiosis of the intestinal microbiota has been widely established in inflammatory bowel disease (IBD). There is significant clinical and genetic overlap between spondyloarthritis (SpA) and IBD, and up to 50% of all patients with SpA exhibit microscopic signs of bowel inflammation, often bearing particular resemblance to early Crohn's disease, a subtype of IBD. This study was undertaken to assess the relationship between intestinal microbial composition, gut histology, and disease activity markers in SpA. Methods. Gene analysis by 16S ribosomal RNA amplicon sequencing was used to compare the microbial composition in ileal and colonic biopsy specimens from 27 patients with SpA (14 with microscopic bowel inflammation, 13 without) and 15 healthy control subjects (ileal samples from all 15 subjects and colonic samples from 6). Spearman's rank correlation tests were used to assess correlations of the microbial composition with disease activity measures. Results. The intestinal inflammation status (histologically normal versus acute or chronic inflammation) was strongly associated with the mucosal microbiota profile of patients with SpA. In inflamed biopsy tissue, the detected bacterial community composition clustered separately from that in noninflamed biopsy tissue (P<0.05 by permutational multivariate analysis of variance, using hierarchical clustering on Bray-Curtis distances). Interestingly, abundance of the genus Dialister was found to be positively correlated with the Ankylosing Spondylitis Disease Activity Score (Spearman's rho=0.62, false discovery rate-corrected q<0.01). This finding was further supported by the low frequency of Dialister observed in noninflamed ileal and colonic biopsy tissue from patients with SpA and healthy controls. Conclusion. These findings demonstrate a significant difference in the intestinal microbial composition in patients with SpA who have microscopic gut inflammation compared to those without microscopic gut inflammation. Moreover, Dialister may represent a potential microbial marker of disease activity in SpA.

http://ift.tt/2o11Kun

Mother of the Nation and Women's Rights: Boadicea's Representation and Perception in British Art of the Long Nineteenth Century (1780-1916)

http://ift.tt/2ngdpsf

Tuning the reusability of cooperative aminated silica catalysts for continuous-flow aldol condensations

http://ift.tt/2o199tD

Cell-type-specific chromatin states differentially prime squamous cell carcinoma tumor-initiating cells for epithelial to mesenchymal transition

Epithelial to mesenchymal transition (EMT) in cancer cells has been associated with metastasis, stemness, and resistance to therapy. Some tumors undergo EMT while others do not, which may reflect intrinsic properties of their cell of origin. However, this possibility is largely unexplored. By targeting the same oncogenic mutations to discrete skin compartments, we show that cell-type-specific chromatin and transcriptional states differentially prime tumors to EMT. Squamous cell carcinomas (SCCs) derived from interfollicular epidermis (IFE) are generally well differentiated, while hair follicle (HF) stem cell-derived SCCs frequently exhibit EMT, efficiently form secondary tumors, and possess increasedmetastatic potential. Transcriptional and epigenomic profiling revealed that IFE and HF tumor-initiating cells possess distinct chromatin landscapes and gene regulatory networks associated with tumorigenesis and EMT that correlate with accessibility of key epithelial and EMT transcription factor binding sites. These findings highlight the importance of chromatin states and transcriptional priming in dictating tumor phenotypes and EMT.

http://ift.tt/2nHgv3V

Direct Synthesis of an Iridium(III) Bipyridine Metal-Organic Framework as a Heterogeneous Catalyst for Aerobic Alcohol Oxidation

The heterogenization of an Ir-III complex is accomplished by the modification of a nanoporous Ga-based metal-organic framework ( MOF), denoted as COMOC-4. The introduction of the Ir complex was performed successfully through two different strategies ( post-and prefunctionalization). The obtained Irbased MOF materials were compared in terms of the Ir loading, specific surface area, and crystallinity. In this case, the prefunctionalization approach was a powerful way to obtain a high Ir loading and surface area and preserve the formation of the de-sired MOF topology. The (IrCp)-Cp-III*Cl-COMOC-4 ( Cp*= 1,2,3,4,5-pentamethylcyclopentadienyl) material exhibits a good catalytic performance in the oxidation of benzyl alcohol using O-2 as a clean oxidant. Furthermore, the stability and reusability were examined and showed that the (IrCp)-Cp-III*Cl-COMOC-4 material could be reused for at least four cycles with no decrease in activity and selectivity. Additionally, no significant leaching of the Ir and Ga species or loss of the crystallinity was observed.

http://ift.tt/2ngcQyz

Regulatory microRNA network identification in bovine blastocyst development

Mammalian blastocyst formation is characterized by two lineage segregations resulting in the formation of the trophectoderm, the hypoblast, and the epiblast cell lineages. Cell fate determination during these early lineage segregations is associated with changes in the expression of specific transcription factors. In addition to the transcription factor-based control, it has become clear that also microRNAs (miRNAs) play an important role in the post-transcriptional regulation of pluripotency and differentiation. To elucidate the role of miRNAs in early lineage segregation, we compared the miRNA expression in early bovine blastocysts with the more advanced stage of hatched blastocysts. Reverse transcription-quantitative PCR-based miRNA expression profiling revealed eight upregulated miRNAs (miR-127, miR-130a, miR-155, miR-196a, miR-203, miR-28, miR-29c, and miR-376a) and four downregulated miRNAs (miR-135a, miR-218, miR-335, and miR-449b) in hatched blastocysts. Through an integrative analysis of matching miRNA and mRNA expression data, candidate miRNA-mRNA interaction pairs were prioritized for validation. Using an in vitro luciferase reporter assay, we confirmed a direct interaction between miR-218 and CDH2, miR-218 and NANOG, and miR-449b and NOTCH1. By interfering with the FGF signaling pathway, we found functional evidence that miR-218, mainly expressed in the inner cell mass, regulates the NANOG expression in the bovine blastocyst in response to FGF signaling. The results of this study expand our knowledge about the miRNA signature of the bovine blastocyst and of the interactions between miRNAs and cell fate regulating transcription factors.

http://ift.tt/2nHoP3D

Port governance in China since 2004: institutional layering and the growing impact of broader policies

This paper builds further on the work of Cullinane and Wang (2007) and more recent work on (port) governance in China. We argue that the market environment in which Chinese ports operate is quite different compared to ten years ago. The global and domestic economic slowdown and structural changes in the economic base have affected seaport volumes and freight traffic growth. Fears for port capacity shortages have made room for overcapacity. New geo-economic policies such as the 'Go West' strategy and the 'One Belt One Road' (OBOR) initiative, the implementation of modern corporate governance principles and the establishment of Free Trade Zones (FTZs) are affecting the Chinese container seaport system. The above factors have triggered a number of strategic and managerial implications on Chinese ports: (a) an increased focus on seaport integration and co-operation, (b) a strong orientation on hinterland development through corridors and dry ports, (c) a two-way opening up of the seaport sector by combining initiatives to attract foreign investments and trade to Chinese ports with an internationalisation of Chinese port-related companies. We demonstrate that these changes have triggered processes of institutional layering in port governance without breaking out of the development path initiated by the Port Law of 2004 and related policy initiatives.

http://ift.tt/2p55aLU

Social mobility and political distrust: cults of gratitude and resentment?

We study whether and how intergenerational social mobility affects political distrust. Mobile individuals may blame/praise the political system for their movement down/up the social ladder. Accordingly, we theorize how social mobility influences the way people evaluate the political system. We use Dutch survey data and apply diagonal reference models to study effects of intergenerational educational mobility. We find that—controlling for the influence of social positions of origin and destination—downward social mobility results in higher levels of distrust. This suggests that the downwardly mobile perceive their demise from a 'blame the system' perspective, while the upwardly mobile perceive their success from a meritocratic perspective. Presumably because upwardly and downwardly mobile individuals rely on a different narrative to frame their experience of mobility, only downward mobility has an impact on attitudes towards politics. As our results demonstrate political consequences of social mobility, they highlight that there is a need to include socialization experiences outside the political domain that take place after early childhood into the theoretical framework to explain political trust

http://ift.tt/2oHDikO

Stem cell differentiation into mature lymphocytes using the SCID mouse thymus chimera model

http://ift.tt/2p4Ll7E

Oral hairy leukoplakia arising in a patient with hairy cell leukaemia: the first reported case

Oral hairy leukoplakia (OHL) is an oral mucosal lesion that is associated with Epstein-Barr virus infection. It commonly presents as an asymptomatic, non-removable white patch on the lateral borders of the tongue in individuals who are immunocompromised. Historically, OHL was thought to be pathognomonic of HIV infection; however, it is now an established phenomenon in a range of conditions affecting immune competence. Hairy cell leukaemia (HCL) is a rare chronic B cell lymphoproliferative disease named after the distinctive cytology of the atypical cells. We report the first case of OHL arising in an individual with HCL that resolved following remission of the haematological malignancy.

http://ift.tt/2nfOKUw

Giant hiatal hernia: beware of the supine ICU chest X-ray!

Description

An 85-year old woman with a medical history of mild hiatal hernia was admitted to the medical intensive care unit for respiratory distress associated with hypoxaemia and hypercapnia. A diagnosis of cardiogenic oedema was suspected. The situation slightly improved after high-dose diuretics and non-invasive ventilation. The anteroposterior supine chest X-ray revealed a right thoracic opacity. The patient was transferred to the pulmonology unit. A classical erected posteroanterior chest X-ray revealed a large air-fluid level in the right hemithorax (figure 1). An hydropneumothorax or a lung abscess was suspected. A chest CT scan revealed a giant hiatal hernia containing the stomach, the first duodenum, the spleen, the caudal part of the pancreas and the left colic flexure, all elevated in the right hemithorax (figure 2A–C; ). A laparoscopic surgical procedure was performed which involved the excision of the hernia sac, a suture repair of...

http://ift.tt/2nNYZMe

Do Private Sustainability Standards Contribute to Income Growth and Poverty Alleviation ? A Comparison of Different Coffee Certification Schemes in Ethiopia

Private sustainability standards are increasingly important in food trade with developing countries, but the implications for smallholder farmers are still poorly understood. We analyze the implications of different coffee certification schemes in Ethiopia using cross-sectional survey data, and regression and propensity-score-matching techniques. We find that: Rainforest Alliance (RA) and double Fairtrade-Organic (FT-Org) certifications are associated with higher incomes and reduced poverty, mainly because of higher prices; Fairtrade (FT) certification hardly affects welfare; and Organic (Org) certification reduces incomes, chiefly due to lower yields. Cooperative heterogeneity importantly shapes these results. Results imply that private standards may not always deliver what they promise to consumers.

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The role of autonomic function in exercise-induced endogenous analgesia : a case-control study in myalgic encephalomyelitis/chronic fatigue syndrome and healthy people

BACKGROUND: Patients with myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) are unable to activate brain-orchestrated endogenous analgesia (or descending inhibition) in response to exercise. This physiological impairment is currently regarded as one factor explaining post-exertional malaise in these patients. Autonomic dysfunction is also a feature of ME/CFS. OBJECTIVES: This study aims to examine the role of the autonomic nervous system in exercise-induced analgesia in healthy people and those with ME/CFS, by studying the recovery of autonomic parameters following aerobic exercise and the relation to changes in self-reported pain intensity. STUDY DESIGN: A controlled experimental study. SETTING: The study was conducted at the Human Physiology lab of a University. METHODS: Twenty women with ME/CFS- and 20 healthy, sedentary controls performed a submaximal bicycle exercise test known as the Aerobic Power Index with continuous cardiorespiratory monitoring. Before and after the exercise, measures of autonomic function (i.e., heart rate variability, blood pressure, and respiration rate) were performed continuously for 10 minutes and self-reported pain levels were registered. The relation between autonomous parameters and self-reported pain parameters was examined using correlation analysis. RESULTS: Some relationships of moderate strength between autonomic and pain measures were found. The change (post-exercise minus pre-exercise score) in pain severity was correlated (r = .580, P = .007) with the change in diastolic blood pressure in the healthy group. In the ME/CFS group, positive correlations between the changes in pain severity and low frequency (r = .552, P = .014), and between the changes in bodily pain and diastolic blood pressure (r = .472, P = .036), were seen. In addition, in ME/CHFS the change in headache severity was inversely correlated (r = -.480, P = .038) with the change in high frequency heart rate variability. LIMITATIONS: Based on the cross-sectional design of the study, no firm conclusions can be drawn on the causality of the relations. CONCLUSIONS: Reduced parasympathetic reactivation during recovery from exercise is associated with the dysfunctional exercise-induced analgesia in ME/CFS. Poor recovery of diastolic blood pressure in response to exercise, with blood pressure remaining elevated, is associated with reductions of pain following exercise in ME/CFS, suggesting a role for the arterial baroreceptors in explaining dysfunctional exercise-induced analgesia in ME/CFS patients.

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