Ten-year survival outcomes for patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy: An analysis of 614 patients from a single center

Publication date: June 2017
Source:Oral Oncology, Volume 69
Author(s): Li-Rong Wu, Ya-Tian Liu, Ning Jiang, Yan-Xin Fan, Jing Wen, Sheng-Fu Huang, Wen-Jie Guo, Xiu-Hua Bian, Fei-Jiang Wang, Feng Li, Dan Song, Jian-Feng Wu, Xue-Song Jiang, Ju-Ying Liu, Xia He
ObjectivesIntensity-modulated radiotherapy (IMRT) has been applied in nasopharyngeal carcinoma (NPC) for nearly twenty years, while little is known about the ten-year survival outcomes. This study aimed at evaluating the 10-year survival outcomes for patients with NPC receiving IMRT.Materials and methodsData on 614 patients with newly diagnosed, non-disseminated NPC treated by IMRT between 2004 and 2008 were retrospectively reviewed. Survival outcomes stratified by tumor stage were compared.ResultsThe median follow-up duration was 112.7months (range, 7.6–156.8months) for the entire cohort. The 10-year local relapse-free survival rates for T1, T2 and T3 were 94.2%, 92.5% and 91.4% (P>0.05), respectively, and significantly higher than that of T4 disease (79.3%, P<0.05 for all rates). As N category increased from N0 to N3, the 10-year distant metastasis-free survival rates significantly decreased accordingly (P<0.01 for all rates). Furthermore, the 10-year overall survival rates were 100%, 87.1%, 75.5% and 55.6% for stage I, II, III and IV, respectively (P<0.05 except stage I and II). Multivariate analysis established tumor stage and age as independent prognostic factors. Late toxicities were assessable for 495 (80.6%) patients and most were Grade I/II damages. Xerostomia (387 of 489, 79.1%) and hearing impairment (212 of 495, 42.8%) remained the most troublesome.ConclusionIMRT could achieve satisfactory survival outcomes for NPC patients with acceptable late toxicities. However, distant control still remains poor, especially for patients with N3 disease.



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Viral Reactivations and Associated Outcomes in Context of Immune Reconstitution after Pediatric Hematopoietic Cell Transplantation

Publication date: Available online 7 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Rick Admiraal, Coco de Koning, Caroline A. Lindemans, Marc B. Bierings, Annemarie M.J. Wensing, A. Birgitta Versluys, Tom F.W. Wolfs, Stefan Nierkens, Jaap Jan Boelens
BackgroundViral reactivations (VR) following hematopoietic cell transplantation (HCT) contribute to significant morbidity and mortality. Timely immune reconstitution (IR) is suggested to prevent VR.ObjectivesWe studied the relation between IR (as a continuous over-time-predictor) and VR (as time-varying-predictor), and the relation between VR and other clinical outcomes.MethodsIn this retrospective analysis, all patients receiving a first HCT between January-2004 and September-2014 were included. IR (CD3/CD4/CD8 T-cells, NK- and B-cells) was measured bi-weekly until 12 weeks, and monthly thereafter. Main outcomes of interest were VR of adenovirus (AdV), Epstein-Barr-virus (EBV), human-herpesvirus 6 (HHV6), cytomegalovirus (CMV), and BK-virus, screened weekly. Clinical outcomes included overall-survival (OS), event-free-survival, non-relapse-mortality (NRM), and graft-versus-host-disease (GvHD). Cox-proportional-hazard- and Fine-Gray-competing-risk-models were used.Results273 patients (0.1-22.7 years; median follow-up 58 months) were included. Delayed CD4-reconstitution predicted reactivation of AdV (HR 0.995; p=0.022), EBV (HR 0.994, p=0.029), and HHV6 (HR 0.991, p=0.012), but not CMV (p=0.31) and BK (p=0.27). Duration of AdV-reactivation was shorter with timely CD4-reconstitution, defined as ≥50*10⁶ cells/L within 100-days. AdV-reactivation predicted lower OS (HR 2.17, p=0.0039) and higher NRM (HR 2.96, p=0.0008). Concomitant CD4-reconstitution abolished this negative effect of AdV-reactivation: OS (p=0.67) and NRM (p=0.64). EBV- and HHV6-reactivations were predictors for occurrence of GvHD, while CMV- and BK-reactivations did not predict clinical outcomes.ConclusionThese results stress the importance of timely CD4-reconstitution. Strategies to improve CD4-reconstitution may improve HCT-outcomes, including survival, and reduce the need for toxic anti-viral therapies.



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Outcome of Hematopoietic Cell Transplantation for DNA-Double Strand Breakage Repair Disorders

Publication date: Available online 7 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): James Slack, Michael H. Albert, Dmitry Balashov, Bernd H. Belohradsky, Alice Bertaina, Jack Bleesing, Claire Booth, Jochen Büchner, Rebecca H. Buckley, Marie Ouachée-Chardin, Elena Deripapa, Katarzyna Drabko, Mary Eapen, Tobias Feuchtinger, Andrea Finocchi, H Bobby Gaspar, Sujal Ghosh, Alfred Gillio, Luis I. Gonzalez-Granado, Eyal Grunebaum, Tayfun Güngör, Carsten Heilmann, Merja Helminen, Kohei Higuchi, Kohsuke Imai, Krzysztof Kalwak, Nubuo Kanazawa, Gülsün Karasu, Zeynep Y. Kucuk, Alexandra Laberko, Andrzej Lange, Nizar Mahlaoui, Roland Meisel, D. Moshous, Hideki Muramatsu, Suhag Parikh, Srdjan Pasic, Irene Schmid, Catharina Schuetz, Ansgar Schulz, Kirk R. Schultz, Peter J. Shaw, Mary A. Slatter, Karl-Walter Sykora, Shinobu Tamura, Mervi Taskinen, Angela Wawer, Beata Wolska-Kuśnierz, Morton J. Cowan, Alain Fischer, Andrew R. Gennery
BackgroundRare DNA breakage-repair disorders predispose to infection and lympho-reticular malignancies. Hematopoietic cell transplantation (HCT) is curative but co-administered chemo- or radio-therapy is damaging due to systemic radio-sensitivity. We collected HCT outcome data for Nijmegen Breakage syndrome (NBS), DNA ligase IV deficiency (LIG4), Cernunnos-XLF deficiency and ataxia-telangiectasia.MethodsData from 38 centres worldwide, including indication, donor, conditioning regimen, graft-versus-host disease (GvHD) and outcome were analyzed. Conditioning was classified as myeloablative (MAC) if it contained radiotherapy or alkylators and reduced intensity (RIC) if no alkylators and/or fludarabine ≤150 mg/m² and cyclophosphamide ≤ 40 mg/kg were used.Results55 new, 14 updated and 18 previously published patients were analyzed. Median age at HCT was 48 (range 1.5 – 552) months. 29 were transplanted for infection, 21 malignancy, 13 bone marrow failure, 13 pre-emptively, 5 had multiple indications, and 6 had no information. 22 received MAC, 59 RIC, 4 were infused;- information unavailable for 2. 73/77 patients with LIG4, Cernunnos-XLF deficiency or NBS received conditioning. Survival was 53/77 (69%), worse for MAC than RIC (p=0.006). Most deaths occurred early post-transplant suggesting poor tolerance of conditioning. Survival in ataxia-telangiectasia patients was 25%. 41/83 patients experienced aGvHD (49%): less in RIC compared to MAC, 26/56 (46%) vs 12/21 (57%) (p=0.45). Median follow-up was 35 (range 2-168) months. No secondary malignancies were reported during 15 years follow-up. Growth and developmental delay remained post-HCT; immune-mediated complications resolved.ConclusionRIC-HCT resolves DNA repair disorder-associated immunodeficiency. Long-term follow-up is required for secondary malignancy surveillance. Routine HCT for ataxia-telangiectasia is not recommended.

Teaser

Hematopoietic cell transplant cures DNA breakage-repair disorders. Cernunnos-XLF deficiency, LIG4 and Nijmegen breakage syndrome patients receiving alkylator or radiotherapy pre-conditioning have worse survival than those receiving reduced intensity conditioning.


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Interplay Between the Skin Barrier and Immune Cells in Patients with Atopic Dermatitis Unraveled by Means of Mathematical Modeling

Publication date: Available online 7 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): David Bending, Masahiro Ono




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Is IL-1β inhibition the next therapeutic target in asthma?

Publication date: Available online 8 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): R. Stokes Peebles




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Efficacy of tofacitinib for the treatment of nail psoriasis: Two 52-week, randomized, controlled phase 3 studies in patients with moderate-to-severe plaque psoriasis

Tofacitinib is an oral Janus kinase inhibitor. Efficacy and safety of tofacitinib in patients with moderate-to-severe plaque psoriasis have been demonstrated.

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The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis

Androgenetic alopecia, or male pattern hair loss, is a hair loss disorder mediated by dihydrotestosterone, the potent form of testosterone. Currently, minoxidil and finasteride are Food and Drug Administration (FDA)–approved, and HairMax LaserComb, which is FDA-cleared, are the only treatments recognized by the FDA as treatments of androgenetic alopecia.

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Yellow Fever Virus Modulates the Expression of Key Proteins Related to the microRNA Pathway in the Human Hepatocarcinoma Cell Line HepG2

Viral Immunology , Vol. 0, No. 0.


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Development of mPMab-1, a Mouse–Rat Chimeric Antibody Against Mouse Podoplanin

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


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LpMab-23: A Cancer-Specific Monoclonal Antibody Against Human Podoplanin

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


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The association of Enamelin, Lactoferrin, and Tumour necrosis factor alpha gene polymorphisms with high caries susceptibility in Chinese children under 4 years old

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Mengchen Wang, Man Qin, Bin Xia
ObjectiveThe aim of this study was to assess the role of ENAM rs3796703, LTF rs1126478, and TNF-α rs1800629 in high caries susceptibility.DesignThe present case–control study included 1005 unrelated children under 4 years old: 505 with severe caries (dmft index ≥4) and 500 who were caries-free (dmft index=0 and without white-spot lesions). Questionnaires were obtained from parents and gardians about the children's diet and oral behavioural habits. All the children received dental examinations and oral swabbing for human genomic DNA collection. ENAM rs3796703, LTF rs1126478, and TNF-α rs1800629 were genotyped by Sanger sequencing.ResultsThe frequency of the ENAM rs3796703T allele (6.7% in the caries group and 4.2% in the caries-free group), CT genotype (12.7% in the caries group and 8.4% in the caries-free group), TNF-α rs1800629 A allele (4.8% in the caries group and 6.8% in the caries-free group), and AG genotype (8.7% in the caries group and 13.2% in the caries-free group) were significantly different between the caries and caries-free groups (p<0.05). No significant difference was found in the LTF rs1126478 allele frequency and genotype distribution between the two groups. The ENAM rs3796703 CT genotype increased caries susceptibility by 60.9% compared to the CC genotype (β=0.746, OR=1.609), and the TNF-α rs1800629 AG genotype reduced caries susceptibility by 47.4% compared to the GG genotype (β=−0.642, OR=0.526). In terms of habits covariates, prolongation of night feeding time by 1 month increased caries susceptibility by 3.3% (β=0.033, OR=1.033); additionally, sweets and acidic drinks consumption 1–2 times per day increased caries susceptibility by 218.2% (β=1.158, OR=3.182), and consumption 3 or more times pe/r day increased susceptibility by 883.5% (β=2.286, OR=9.835) compared to non-consumption. Topical fluoride application decreased caries susceptibility by 43.0% (β=−0.562, OR=0.570).ConclusionsThe ENAM and TNF-α genes are likely associated with caries experience in Chinese children. The ENAM rs3796703 CT genotype might be involved in caries susceptibility, while TNF-α rs1800629 AG genotype might be involved in caries protection.



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The Rosai–Dorfman Disease: A Differential Diagnosis in Cervical Swelling

Abstract

Rosai–Dorfman disease also known as sinus histiocytosis with massive lymphadenopathy is a rare benign disorder of unknown etiology. It is a benign condition which causes significant cervical lymphadenopathy in children and young adults. These cases are frequently misdiagnosed as lymphoma, and thus it is important to distinguish Rosai–Dorfman disease from other causes of neck swelling because of different treatment modalities. We report here a case of Rosai–Dorfman disease presenting with massive right cervical lymphadenopathy.

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Acquired Angioedema: A Rare Manifestation of Angioimmunoblastic T Cell Lymphoma

Abstract

The clinical presentation except age of onset is similar in different types of angioedema. A lymphoproliferative disorder like angioimmunoblastic T cell lymphoma (AITL) rarely presents with symptoms of angioedema. We present extremely rare case of elderly male with recurrent tongue swelling, pruritus with normal levels of complements and C1 esterase inhibitor protein featuring as acquired angioedema, a rare manifestation of AITL. Initial response to corticosteroids may be misleading and occurs as a result of immunosuppression of AITL. High index of suspicion may prompt need for histopathological diagnosis of lymph node biopsy. Definitive chemotherapeutic treatment may achieve long term remission.

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A Rare Case of Basal Cell Adenocarcinoma of Parotid Gland with Intracranial Extension

Abstract

Basal cell adenocarcinoma (BCAC) is a rare tumour entity. Despite its tendency to be infiltrative and destructive tumour with propensity to recur, it rarely metastasizes and long-term outcome following surgery is favourable. This paper presents a 42-year-old male with residual BCAC of parotid gland that had extended into infratemporal fossa and intracranial. The important aspect of this case is the rarity occurrence of BCAC of parotid with intracranial extension and its surgical approaches to achieve tumour clearance.

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Managing the Dorsum in Rhinoplasty

Facial plast Surg 2017; 33: 119-119
DOI: 10.1055/s-0037-1598032

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Cartilage Scales Embedded in Fibrin Gel

Facial plast Surg 2017; 33: 225-232
DOI: 10.1055/s-0037-1598184

Multiple techniques have been described for dorsal nasal augmentation in rhinoplasty. In this article, we review common surgical techniques for raising the dorsum or eliminating dorsal irregularities, by highlighting inherent advantages and disadvantages of each method. Within the past few years, the use of diced cartilage grafts has become the workhorse in this field of interest. To overcome drawbacks of methods based on diced cartilage, we present a new concept for autologous augmentation, using regenerative medicine protocols. A mix of cartilage scales with cartilage pâté was embedded in platelet-rich fibrin (PRF). Since December 2015, a total of 48 patients were treated with this technique. Based on our preliminary results, cartilage scales in PRF appear to be a promising and reliable alternative to existing procedures for dorsal nasal augmentation.
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Dorsal Augmentation Using Autologous Costal Cartilage or Microfat-Infused Soft Tissue Augmentation

Facial plast Surg 2017; 33: 162-178
DOI: 10.1055/s-0037-159914

Costal cartilage grafting is increasing in popularity with increased demand for augmentation rhinoplasty and increased need for grafting material for structure rhinoplasty techniques. Use of costal cartilage for dorsal grafting is both art and science. The art is demonstrated in the act of carving a dorsal graft that will reflect the actual contour of the nasal dorsum. The science is linked to the methodology of how the grafts are contoured to match the patient's desires and how the graft is fixed to the bony dorsum to minimize the risk of warping and displacement. Variations in dorsal graft design and methods of fixation are described. Use of the perichondrial interface between dorsal graft and perforated/rasped nasal dorsum acts to ossify the dorsal graft to the underlying bone, creating an immobile and natural appearing nasal dorsum. The fixation of the dorsal graft limits movement and hence decreases the likelihood of warping or deformity. Use of microfat in rhinoplasty has tremendous potential for camouflage and to promote healing of compromised tissues. Using microfat-infused soft tissue augmentation (MISTA), the surgeon is able to deliver microfat to an open surgical field, promote healing, and provide soft tissue augmentation. In this technique, microfat is injected into soft tissue carriers (perichondrium, temporalis fascia, etc.) and then implanted into the surgical field. MISTA has tremendous potential utility in many areas of cosmetic and reconstructive surgery.
[...]

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Understanding Approaches to the Dorsal Hump

Facial plast Surg 2017; 33: 125-132
DOI: 10.1055/s-0037-1598033

Dorsal hump reduction is a central component of western aesthetic rhinoplasty. Surgical success begins with knowledge of aesthetic ideals and accurate preoperative analysis. Knowledge of the patient's distortion from aesthetic ideals informs approach, technique, and instrument selection. Both endonasal and external approaches are suitable for dorsal hump reduction, though the latter affords more versatility when other surgical modifications are necessary. The main techniques consist of en bloc, Skoog, and component resection. Each has their distinct advantage, though a surgeon's comfort level with each should impact technique selection. Completion of the dorsal reduction often leaves a defect that must be reconstructed. Failure to anticipate the potential long-term sequelae and appropriately manage the dorsal defect can lead to a poor result and patient dissatisfaction.
[...]

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Dorsal Augmentation with Homologous Rib

Facial plast Surg 2017; 33: 195-201
DOI: 10.1055/s-0037-1598031

Dorsal augmentation grafts are used to reconstruct and raise the nasal dorsum in patients with dorsal saddling due to trauma, infection, or previous nasal surgery, as well as in patients with a narrow, congenitally low, and/or wide dorsum. Alloplastic implants and various biomaterials are available for grafting, each with advantages and disadvantages. Although autologous septal cartilage is a preferable and often convenient source of cartilage, it is frequently not sufficient for large volume dorsal augmentation, nor is it available in patients who have had septoplasty, infection, previous rhinoplasty with grafting, or significant trauma. Ear cartilage may be used but it is difficult to make homogenous and smooth, and dorsal irregularities can be seen in the long term especially in thin-skinned patients. For these reasons, we frequently use irradiated costal cartilage from tissue banks as our grafting source, thereby eliminating the morbidity of harvesting the patient's own rib. Proper surgical techniques, the use of antibiotics, and proper sculpting and placement of the cartilage limits complications such as warping, resorption, infection, and extrusion. Irradiated homograft costal cartilage grafts have been used successfully in large numbers of patients with long-term follow-up with low complication rates and serve as a welcome alternative to harvesting a patient's rib cartilage.
[...]

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Aesthetics of the Nasal Dorsum: Proportions, Light, and Shadow

Facial plast Surg 2017; 33: 120-124
DOI: 10.1055/s-0037-1598626

Due to its central location, the nose plays a prominent role in facial aesthetics. As tastes have shifted and techniques have advanced, the accepted "ideal" appearance and proportions of the nose have evolved over time. By assessing the aesthetics of the nasal dorsum through the use of lines and angles, one can more precisely elucidate a goal for the patient's postoperative nasal shape, which should, in turn, guide the surgeon to execute specific operative maneuvers needed to achieve that contour. In assessing the aesthetics of the nasal dorsum, practitioners calculate and observe aspects such as the paired dorsal aesthetic lines, the nasofrontal angle, and the nasofacial angle. There is also additional consideration given to nasal tip position as this must fit harmoniously with the shape of the dorsum. In contrast to the established aesthetic lines and angles, using nasal geometric polygons for the aesthetic evaluation and development of operative goals in rhinoplasty has recently been described in the literature. Constructed ideals, in the form of proportions, lines, and angles, should be used with caution, as there are many factors to consider in the aesthetic analysis of the nasal dorsum, including ethnic differences, and subjective and changing views of beauty.
[...]

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Safety of 2-Octyl Cyanoacrylate in Spreader Grafting

Facial plast Surg 2017; 33: 213-216
DOI: 10.1055/s-0036-1597998

Cyanoacrylate adhesives can make the placement of spreader grafts in open septorhinoplasty technically easier, but its use is off-label beneath the skin. There is a theoretical risk of toxicity from cyanoacrylate breakdown products, but this risk has not been thoroughly studied in rhinoplasty. The objective was to evaluate the effects of subcutaneous cyanoacrylate use during spreader graft placement in rhinoplasty in a retrospective review of open septorhinoplasties in which 2-octyl cyanoacrylate was used to aid placement of spreader grafts. The review was carried out in a tertiary care military academic medical center. A total of 140 adults underwent open septorhinoplasty between September 2013 and May 2016 with spreader graft placement. The authors excluded patients in whom 2-octyl cyanoacrylate was not used to aid graft placement and those who did not follow up postoperatively in our clinic. 108 (85 males and 23 females) patients were included in the final analysis. Nine (8.3%) patients had inflammatory reactions possibly attributable to 2-octyl cyanoacrylate toxicity. The overall rate of postoperative inflammation possibly attributable to 2-octyl cyanoacrylate was 17% among females and 5.9% among males, and this difference was not statistically significant (p = 0.07). However, the rate of postoperative inflammation attributable to 2-octyl cyanoacrylate that required an intervention (incision and drainage or antibiotics) was 2.7% overall, 13% among women and 0% among men, and this difference was significant based on chi-square testing (p < 0.001). Further, revision cases were significantly more likely to develop abnormal postoperative inflammation than initial cases (p = 0.02). Herein, the authors present the largest series of patients in whom 2-octyl cyanoacrylate was used to assist placement of cartilage spreader grafts during open septorhinoplasty. While 2-octyl cyanoacrylate is an effective adjunct to facilitate graft placement, they recommend against its use, as the risk of postoperative inflammation is significant.
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Midvault Reconstruction in Primary Rhinoplasty

Facial plast Surg 2017; 33: 133-138
DOI: 10.1055/s-0036-1598016

The nasal midvault is an important consideration in rhinoplasty. This region is defined by the attachment of the upper lateral cartilages (ULCs) to the nasal bones superiorly and the cartilaginous septum medially. Inadequate management of the nasal midvault can have negative functional and aesthetic ramifications. Indications for midvault reconstruction in primary rhinoplasty include a narrow midvault, dorsal hump resection, a deviated midvault, and an asymmetric midvault, with an additional relative indication of zone 1 lateral wall insufficiency (LWI), defined as dynamic collapse of a weakened lateral nasal wall at the level of the ULC. Numerous techniques for midvault reconstruction have been described, dating back to Sheen's description of the spreader graft in the 1980s, which remains the gold standard for repair. Herein, the various indications for midvault reconstruction are described, along with a discussion of the most commonly used techniques for successful reconstruction.
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Facial Augmentation using Expanded Polytetrafluoroethylene Covered Silicone

Facial plast Surg 2017; 33: 241-243
DOI: 10.1055/s-0037-1599093

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Treating the Deviated or Wide Nasal Dorsum

Facial plast Surg 2017; 33: 139-156
DOI: 10.1055/s-0037-1598034

Both deviation and excessive width of the nasal dorsum result in conspicuous facial disharmony and are often attended by nasal airway dysfunction. Whether the result of developmental growth disturbances, nasal trauma, failed nasal surgery, or combinations therein, deviation and splaying of the nasal dorsum can be exceedingly difficult to treat. Individualized treatment is paramount because contour variations are seemingly endless, and a careful preoperative assessment of the anatomic, physiologic, cosmetic, and psychosocial factors that characterize the deformity is necessary to devise an effective patient-specific treatment plan. Ensuring the linearity, strength, alignment, and aesthetically pleasing profile dimensions of the nasal L-strut is the requisite first step in successful treatment. Releasing all deformed components in a controlled and precise manner using powered instrumentation (whenever possible) to facilitate minimally traumatic and effective repositioning, followed by structural reconstitution of the skeletal framework using autologous graft materials, and then consolidation of the newly created construct with suture fixation completes the transformation to normalcy. Paying equal attention to both cosmetic and functional wellness, while simultaneously seeking to maximize structural stability, serves to optimize the final outcome.
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Revision of the Nasal Dorsum

Facial plast Surg 2017; 33: 202-206
DOI: 10.1055/s-0036-1598017

Revision of the dorsum in secondary rhinoplasty is challenging, regardless of the cause. Dorsal deformities should be evaluated for both aesthetic and functional. The authors briefly outline the presentation, etiology, pathogenesis, and treatment choices backed by evidence-based data, when applicable, for the following dorsal revision indications in secondary rhinoplasty: inverted-V and midvault narrowing, overresected dorsum, irregular dorsum, saddle nose, and pollybeak.
[...]

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Correcting Deviations of the Lower Third of the Nose

Facial plast Surg 2017; 33: 157-161
DOI: 10.1055/s-0036-1598018

By convention, a "deviated nose" is one in which the lower third is asymmetric with regard to the midline. The lower third of the nose is composed of the lower cartilages, as well as the dorsal and caudal nasal septum. Not only does the deviated nose cause a cosmetic deformity that is often disconcerting for patients, but it may also be associated with functional problems. Airway obstruction may result from a narrowed internal nasal valve in the middle third or from a deviated caudal septum in the lower third. The most common deviation involves both the middle and lower thirds and often requires addressing the underlying dorsal and caudal septum. The most effective technique to correct this type of deviation is the principle of extracorporeal septoplasty, either the traditional or modified, such as the anterior septal reconstruction (ASR) technique combined with the clocking suture. An isolated middle third deviation may be treated with a camouflage graft or a unilateral spreader graft. An isolated lower third deviation involving the septum should be treated with ASR. When an isolated lower third deviation only involves the lower cartilages, it may be corrected using suture techniques, cartilage division techniques, or grafting.
[...]

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Rhinoplasty Results Are Influenced by Non-nasal Features

Facial plast Surg 2017; 33: 207-212
DOI: 10.1055/s-0036-1597997

Rhinoplasty results are evaluated both objectively and subjectively following any procedure by plastic surgeons and nonplastic surgeons at meetings, in publications, and online. We aim to evaluate whether subjective aesthetics of non-nasal features, such as the eyes and lips, would influence the overall evaluation of rhinoplasty results. We matched pairs of photographs of patients who had undergone aesthetic rhinoplasty by sex, age, and skin tone. We transferred the eyes/eyebrows and lips from the photographs of the donor patient onto the photographs of the original patient to create composite photographs. Plastic surgeons were asked to rate the rhinoplasty results objectively, and non-plastic surgeons were asked to rate the overall attractiveness of 16 sets of photographs (8 originals and 8 composites). Postoperative photographs that were deemed to be more attractive were associated with higher ratings of rhinoplasty improvement. The objective nasal result may be influenced by non-nasal aesthetic factors as rhinoplasty surgeons gave higher ratings to more attractive faces. Greater emphasis on neutralizing non-nasal factors in pre- and postoperative photographs should be considered.
[...]

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Dorsal Augmentation-Diced Cartilage Techniques: The Diced Cartilage Glue Graft

Facial plast Surg 2017; 33: 179-188
DOI: 10.1055/s-0037-1598185

The quest for the ideal method for augmenting the nasal dorsum continues to be a matter of debate, with both most surgeons and patients preferring autologous tissue. This article reviews the current use of diced cartilage for nasal augmentation, emphasizing the diced cartilage in fibrin glue (DCG) graft. It offers the first collation of unfavorable outcomes and complications of the DCG graft seen in a series of 108 patients treated at the author's institution. The DCG graft continues to be a versatile graft that is stable over time and combines unique features. It has proved to be particularly well suited for segmental augmentations of the dorsum. Resorption of the graft has been rare and infrequent unfavorable outcomes have all been amenable to successful minor surgical revisions.
[...]

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Interest in Aesthetic Rhinoplasty Scale

Facial plast Surg 2017; 33: 217-224
DOI: 10.1055/s-0036-1597999

Interest in cosmetic surgery is increasing, with rhinoplasty being one of the most popular surgical procedures. It is essential that surgeons identify patients with existing psychological conditions before any procedure. This study aimed to develop and validate the Interest in Aesthetic Rhinoplasty Scale (IARS). Four studies were conducted to develop the IARS and to evaluate different indices of validity (face, content, construct, criterion, and concurrent validities) and reliability (internal consistency, split-half coefficient, and temporal stability) of the scale. The four study samples included a total of 463 participants. Statistical analysis revealed satisfactory psychometric properties in all samples. Scores on the IARS were negatively correlated with self-esteem scores (r = –0.296; p < 0.01) and positively associated with scores for psychopathologic symptoms (r = 0.164; p < 0.05), social dysfunction (r = 0.268; p < 0.01), and depression (r = 0.308; p < 0.01). The internal and test–retest coefficients of consistency were found to be high (α = 0.93; intraclass coefficient = 0.94). Rhinoplasty patients were found to have significantly higher IARS scores than nonpatients (p < 0.001). Findings of the present studies provided evidence for face, content, construct, criterion, and concurrent validities and internal and test–retest reliability of the IARS. This evidence supports the use of the scale in clinical and research settings.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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Dorsal Augmentation using Alloplastic Implants

Facial plast Surg 2017; 33: 189-194
DOI: 10.1055/s-0036-1598015

Dorsal augmentation is an essential procedure not only for Asians, who generally have indistinct and poorly developed nasal bridges, but also for Africans and Caucasians, who have similar dorsal deficiencies. There is no single ideal implant or graft for dorsal augmentation. Dorsal augmentation with autologous materials is considered ideal by many surgeons. However, harvesting autologous material is associated with donor-site complications, and these materials are difficult to handle and shape. Despite concerns over complications such as infection, extrusion, and deviation, alloplastic implant materials such as silicone or Gore-Tex have a critically important role in typical cosmetic dorsal augmentation due to their ease of use in producing a cosmetically appealing outcome and evading donor-site complications. A thorough understanding of the shape of an aesthetically pleasing nose, appropriate surgical technique, and proper management methods for complications are the mainstay for the success of dorsal augmentation using alloplastic implants.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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Absorbable Implant to Treat Nasal Valve Collapse

Facial plast Surg 2017; 33: 233-240
DOI: 10.1055/s-0037-1598655

Objective To evaluate the safety and effectiveness of an absorbable implant for lateral cartilage support in subjects with nasal valve collapse (NVC) with 12 months follow-up. Methods Thirty subjects with Nasal Obstruction Symptom Evaluation (NOSE) score ≥ 55 and isolated NVC were treated; 14 cases were performed in an operating suite under general anesthesia and 16 cases were performed in a clinic-based setting under local anesthesia. The implant, a polylactic acid copolymer, was placed with a delivery tool within the nasal wall to provide lateral cartilage support. Subjects were followed up through 12 months postprocedure. Results Fifty-six implants were placed in 30 subjects. The mean preoperative NOSE score was 76.7 ± 14.8, with a range of 55 to 100. At 12 months, the mean score was 35.2 ± 29.2, reflecting an average within-patient reduction of –40.9 ± 31.2 points. The majority (76%) of the subjects were responders defined as having at least one NOSE class improvement or a NOSE score reduction of at least 20%. There were no adverse changes in cosmetic appearance at 12 months postprocedure. Three implants in three subjects required retrieval within 30 days postprocedure and resulted in no clinical sequelae. Conclusion This study demonstrates safety and effectiveness of an absorbable implant for lateral cartilage support in subjects with NVC at 12 months postprocedure.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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Erratum: Hyaluronic Acid Fillers in Soft Tissue Regeneration

Facial plast Surg 2017; 33: 244-244
DOI: 10.1055/s-0037-1601851

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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The Importance of Facts and the Role of Academic Publishers in Today's World—A Publisher's View

Facial plast Surg 2017; 33: vii-vii
DOI: 10.1055/s-0037-1602425

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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Detection of endolymphatic hydrops using traditional MR imaging sequences

Publication date: Available online 6 April 2017
Source:American Journal of Otolaryngology
Author(s): John H. Keller, Barry E. Hirsch, Ryan S. Marovich, Barton F. Branstetter
PurposeThe 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.Materials & methodsThis retrospective case-control study included patients with documented MD who had a high-resolution T2-weighted or steady-state free procession MRI of the temporal bones within one month of diagnosis, between 2002 and 2015. Patients were compared to age- and sex- matched controls. Cross sectional area, length, and width of the vestibule and utricle were measured in both ears along with the width of the basal turn of the cochlea and its endolymphatic space. Absolute measurements and ratios of endolymph to perilymph were compared between affected, contralateral, and control ears using analysis of variance and post-hoc pairwise comparisons.ResultsEighty-five case-control pairs were enrolled. Mean utricle areas for affected, contralateral, and control ears were 0.038cm², 0.037cm², and 0.033cm². Mean area ratios for affected, contralateral, and control ears were 0.32, 0.32, and 0.29. There was a statistically significant difference between groups for these two variables; post-hoc comparisons revealed no difference between affected and contralateral ears in Meniere's patients, while ears in control patients were different from the ears of patients with MD. All other measurements failed to show significant differences.ConclusionsEnlargement of the endolymphatic cavity can be detected using non-contrast T2-weighted MRI. MRI, using existing protocols, can be a useful diagnostic tool for the evaluation of MD, and intratympanic or delayed intravenous contrast may be unnecessary for this diagnosis.



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Reduced post-tonsillectomy bleeding rates through a refined technique

Publication date: Available online 6 April 2017
Source:American Journal of Otolaryngology
Author(s): Kent Burton, Stephanie Hanke, Anil Gungor




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Correction to: Viral Immunol 2013;26:259–267

Viral Immunology Apr 2017, Vol. 30, No. 3: 250-250.


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MicroRNA-155 Deficiency in Kupffer Cells Ameliorates Liver Ischemia-Reperfusion Injury in Mice.

Background: MicroRNA-155 (miR-155) is known to be involved in autoimmune diseases, inflammation, and transplantation. However, its role in a warm hepatic ischemia-reperfusion (IR) model has not been fully elucidated. Methods: Partial hepatic IR was performed in wild-type and miR-155-deficient mice treated with or without GdCl3, and then the serum transaminase concentration and histology were analyzed. Kupffer cells (KCs) were isolated from the liver after IR, and immunohistochemistry was used to evaluate activation and polarization. In addition, the mRNA concentrations of various inflammatory cytokines were measured. Macrophages were obtained from the abdominal cavity and challenged with or without lipopolysaccharide to determine the influence of miR-155 deficiency on macrophage polarization in vitro. Furthermore, we used in vitro coculture assays to determine the effect of miR-155 deficiency on hepatocyte apoptosis induced directly by KCs. Results: miR-155 deficiency ameliorated liver ischemia-reperfusion injury, and inhibition of KCs by GdCl3 abolished this protective effect. miR-155 deficiency decreased CD80, CD86, and MHC-II expression in KCs following IR and tipped the M1/M2 balance toward an anti-inflammatory profile, where proinflammatory cytokine secretion was suppressed and interleukin-10 (IL-10) was enhanced. In addition, hepatocyte apoptosis was reduced in coculture with miR-155-deficient KCs in vitro. Conclusion: miR-155 deficiency plays an effective role in attenuating liver IRI likely by regulating the activation and inflammatory response, as well as modifying the polarization of KCs. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Human Herpesvirus 6 Reactivation in DRESS With Acute Liver Failure: A Missing Key Factor.

No abstract available

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Octogenarian Liver Grafts Reaching Centennial Age after Transplantation.

No abstract available

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Sleep-Disordered Breathing, Postoperative Delirium, and Cognitive Impairment.

Sleep-disordered breathing (SDB) is highly prevalent in the general population and has been associated with cognitive impairment in older individuals. Delirium is an acute decline in cognitive function and attention that often occurs after surgery, especially in older individuals. Several recent studies suggest an association between SDB and postoperative delirium. The aim of this systematic review is to examine the current literature on SDB, postoperative delirium, and cognitive impairment and to discuss the pathophysiology and perioperative considerations. A literature search was performed of Medline (1946-2016), Medline In-Process (June 2016), Embase (1947-2016), Cochrane Central Register of Controlled Trials (May 2016), and Cochrane Database of Systematic Reviews (2005 to June 2016). Inclusion criteria for studies were (1) polysomnography confirmed SDB; (2) postoperative delirium or cognitive impairment confirmed by a validated diagnostic tool; and (3) publications in the English language. All study designs including randomized controlled trials and observational studies were included. The literature search identified 2 studies on SDB and postoperative delirium, 15 studies on SDB and cognitive impairment, and 5 studies on the effect of continuous positive airway pressure on cognitive impairment and delirium in older individuals. SDB was associated with cognitive impairment, and this systematic review revealed that SDB may be a risk factor for postoperative delirium, especially in older individuals. Although the pathophysiology of SDB and postoperative delirium is unclear and effective treatments for SDB to reduce the incidence of delirium have not been studied extensively, preliminary evidence suggests that continuous positive airway pressure therapy may lower the risk of delirium. Health care professionals need to be aware that undiagnosed SDB may contribute to postoperative delirium. Preoperative screening for SDB and strategies to reduce the risk for postoperative delirium may be helpful in older individuals. Further studies are needed to clarify the relationship between SDB and postoperative delirium and elucidate the pathophysiology of postoperative delirium through SDB. (C) 2017 International Anesthesia Research Society

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Computational and In Vitro Experimental Investigation of Intrathecal Drug Distribution: Parametric Study of the Effect of Injection Volume, Cerebrospinal Fluid Pulsatility, and Drug Uptake.

BACKGROUND: Intrathecal drug delivery is an attractive option to circumvent the blood-brain barrier for pain management through its increased efficacy of pain relief, reduction in adverse side effects, and cost-effectiveness. Unfortunately, there are limited guidelines for physicians to choose infusion or drug pump settings to administer therapeutic doses to specific regions of the spine or the brain. Although empiric trialing of intrathecal drugs is critical to determine the sustained side effects, currently there is no inexpensive in vitro method to guide the selection of spinal drug delivery parameters. The goal of this study is to demonstrate current computational capabilities to predict drug biodistribution while varying 3 parameters: (1) infusion settings, (2) drug chemistry, and (3) subject-specific anatomy and cerebrospinal fluid dynamics. We will discuss strategies to systematically optimize these 3 parameters to administer drug molecules to targeted tissue locations in the central nervous system. METHODS: We acquired anatomical data from magnetic resonance imaging (MRI) and velocity measurements in the spinal cerebrospinal fluid with CINE-MRI for 2 subjects. A bench-top surrogate of the subject-specific central nervous system was constructed to match measured anatomical dimensions and volumes. We generated a computational mesh for the bench-top model. Idealized simulations of tracer distribution were compared with bench-top measurements for validation. Using reconstructions from MRI data, we also introduced a subject-specific computer model for predicting drug spread for the human volunteer. RESULTS: MRI velocity measurements at 3 spinal regions of interest reasonably matched the simulated flow fields in a subject-specific computer mesh. Comparison between the idealized spine computations and bench-top tracer distribution experiments demonstrate agreement of our drug transport predictions to this physical model. Simulated multibolus drug infusion theoretically localizes drug to the cervical and thoracic region. Continuous drug pump and single bolus injection were successful to target the lumbar spine in the simulations. The parenchyma might be targeted suitably by multiple boluses followed by a flush infusion. We present potential guidelines that take into account drug specific kinetics for tissue uptake, which influence the speed of drug dispersion in the model and potentially influence tissue targeting. DISCUSSION: We present potential guidelines considering drug-specific kinetics of tissue uptake, which determine the speed of drug dispersion and influence tissue targeting. However, there are limitations to this analysis in that the parameters were obtained from an idealized healthy patient in a supine position. The proposed methodology could assist physicians to select clinical infusion parameters for their patients and provide guidance to optimize treatment algorithms. In silico optimization of intrathecal drug delivery therapies presents the first steps toward a possible care paradigm in the future that is specific to personalized patient anatomy and diseases. (C) 2017 International Anesthesia Research Society

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Total Spinal Anesthesia Failure: Have You Assessed the Sensory Anesthesia in Sacral Dermatomes?.

Intrathecal local anesthetic maldistribution is a well-known cause of spinal anesthesia failure (SAF). This could potentially result in sensory blockade restricted to the sacral dermatomes. We sought to determine the overall incidence of SAF and the role of sacral dermatomes in differentiating between total and partial failures. Of the 3111 spinals prospectively examined, 194 (6.2%) were classified as failures. Of the 72 presumed total failures based on the initial assessment, evaluation of the sacral dermatomes revealed sensory blockade in 32 (44%; 95% confidence interval, 32.7%-56.6%). Sacral dermatome assessment after SAF may be important in safely guiding subsequent anesthetic management. (C) 2017 International Anesthesia Research Society

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How Long Is Too Long? The Prespiked Intravenous Debate.

BACKGROUND: As the number of operative cases increases, there is a greater emphasis on reducing inefficiency while maintaining patient safety. Recently, the issue of prespiking intravenous (IV) bags was raised. No study has assessed whether the risk of infection is related to the length of time a sterile (IV) fluid bag has been spiked. After completion of a pilot study revealed no microbial growth within 24 hours of an IV spike, a larger formal study was undertaken to determine whether there was an increased infection risk within 4 hours of spiking an intravenous fluid bag. METHODS: Five IV administration sets were spiked and hung in busy perioperative areas once a week for a 5-week period. Five samples were drawn from each IV set. Approximately 10 mL was collected per sample. All samples were inoculated in 2 separate growth media. If any growth was noted, the sample was marked as positive. RESULTS: A total of 125 samples were collected over a period of 5 weeks, yielding 250 specimens. No samples were excluded from the study. No growth was identified in any of the specimens. The 95% confidence interval was estimated to be 0, 0.063. DISCUSSION: There was no bacterial growth in prespiked normal saline IV bags in a perioperative environment. Thus, prespiking of normal saline IV bags in advance should pose no risk of infection to a patient if prepared within 4 hours. (C) 2017 International Anesthesia Research Society

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The Association of Frailty With Outcomes and Resource Use After Emergency General Surgery: A Population-Based Cohort Study.

BACKGROUND: Older patients undergoing emergency general surgery (EGS) experience high rates of postoperative morbidity and mortality. Studies focused primarily on elective surgery indicate that frailty is an important predictor of adverse outcomes in older surgical patients. The population-level effect of frailty on EGS is poorly described. Therefore, our objective was to measure the association of preoperative frailty with outcomes in a population of older patients undergoing EGS. METHODS: We created a population-based cohort study using linked administrative data in Ontario, Canada, that included community-dwelling individuals aged >65 years having EGS. Our main exposure was preoperative frailty, as defined by the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. The Adjusted Clinical Groups frailty-defining diagnoses indicator is a binary variable that uses 12 clusters of frailty-defining diagnoses. Our main outcome measures were 1-year all-cause mortality (primary), intensive care unit admission, length of stay, institutional discharge, and costs of care (secondary). RESULTS: Of 77,184 patients, 19,779 (25.6%) were frail. Death within 1 year occurred in 6626 (33.5%) frail patients compared with 11,366 (19.8%) nonfrail patients. After adjustment for sociodemographic and surgical confounders, this resulted in a hazard ratio of 1.29 (95% confidence interval [CI] 1.25-1.33). The risk of death for frail patients varied significantly across the postoperative period and was particularly high immediately after surgery (hazard ratio on postoperative day 1 = 23.1, 95% CI 22.3-24.1). Frailty was adversely associated with all secondary outcomes, including a 5.82-fold increase in the adjusted odds of institutional discharge (95% CI 5.53-6.12). CONCLUSIONS: After EGS, frailty is associated with increased rates of mortality, institutional discharge, and resource use. Strategies that might improve perioperative outcomes in frail EGS patients need to be developed and tested. (C) 2017 International Anesthesia Research Society

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Creation and Validation of an Automated Algorithm to Determine Postoperative Ventilator Requirements After Cardiac Surgery.

BACKGROUND: In medical practice today, clinical data registries have become a powerful tool for measuring and driving quality improvement, especially among multicenter projects. Registries face the known problem of trying to create dependable and clear metrics from electronic medical records data, which are typically scattered and often based on unreliable data sources. The Society for Thoracic Surgery (STS) is one such example, and it supports manually collected data by trained clinical staff in an effort to obtain the highest-fidelity data possible. As a possible alternative, our team designed an algorithm to test the feasibility of producing computer-derived data for the case of postoperative mechanical ventilation hours. In this article, we study and compare the accuracy of algorithm-derived mechanical ventilation data with manual data extraction. METHODS: We created a novel algorithm that is able to calculate mechanical ventilation duration for any postoperative patient using raw data from our EPIC electronic medical record. Utilizing nursing documentation of airway devices, documentation of lines, drains, and airways, and respiratory therapist ventilator settings, the algorithm produced results that were then validated against the STS registry. This enabled us to compare our algorithm results with data collected by human chart review. Any discrepancies were then resolved with manual calculation by a research team member. RESULTS: The STS registry contained a total of 439 University of California Los Angeles cardiac cases from April 1, 2013, to March 31, 2014. After excluding 201 patients for not remaining intubated, tracheostomy use, or for having 2 surgeries on the same day, 238 cases met inclusion criteria. Comparing the postoperative ventilation durations between the 2 data sources resulted in 158 (66%) ventilation durations agreeing within 1 hour, indicating a probable correct value for both sources. Among the discrepant cases, the algorithm yielded results that were exclusively correct in 75 (93.8%) cases, whereas the STS results were exclusively correct once (1.3%). The remaining 4 cases had inconclusive results after manual review because of a prolonged documentation gap between mechanical and spontaneous ventilation. In these cases, STS and algorithm results were different from one another but were both within the transition timespan. This yields an overall accuracy of 99.6% (95% confidence interval, 98.7%-100%) for the algorithm when compared with 68.5% (95% confidence interval, 62.6%-74.4%) for the STS data (P

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Anesthesiologists and Disaster Medicine: A Needs Assessment for Education and Training and Reported Willingness to Respond.

BACKGROUND: Anesthesiologists provide comprehensive health care across the emergency department, operating room, and intensive care unit. To date, anesthesiologists' perspectives regarding disaster medicine and public health preparedness have not been described. METHODS: Anesthesiologists' thoughts and attitudes were assessed via a Web-based survey at 3 major academic institutions. Frequencies, percentages, and odds ratios (ORs) were used to assess self-reported perceptions of knowledge and skills, as well as attitudes and beliefs regarding education and training, employee development, professional obligation, safety, psychological readiness, efficacy, personal preparedness, and willingness to respond (WTR). Three representative disaster scenarios (natural disaster [ND], radiological event [RE], and pandemic influenza [PI]) were investigated. Results are reported as percent or OR (95% confidence interval). RESULTS: Participants included 175 anesthesiology attendings (attendings) and 95 anesthesiology residents (residents) representing a 47% and 51% response rate, respectively. A minority of attendings indicated that their hospital provides adequate pre-event preparation and training (31% [23-38] ND, 14% [9-21] RE, and 40% [31-49] PI). Few residents felt that their residency program provided them with adequate preparation and training (22% [14-33] ND, 16% [8-27] RE, and 17% [9-29] PI). Greater than 85% of attendings (89% [84-94] ND, 88% [81-92] RE, and 87% [80-92] PI) and 70% of residents (81% [71-89] ND, 71% [58-81] RE, and 82% [70-90] PI) believe that their hospital or residency program, respectively, should provide them with preparation and training. Approximately one-half of attendings and residents are confident that they would be safe at work during response to a ND or PI (55% [47-64] and 58% [49-67] of attendings; 59% [48-70] and 48% [35-61] of residents, respectively), whereas approximately one-third responded the same regarding a RE (31% [24-40] of attendings and 28% [18-41] of residents). Fewer than 40% of attendings (34% [26-43]) and residents (38% [27-51]) designated who would take care of their family obligations in the event they were called into work during a disaster. Regardless of severity, 79% (71-85) of attendings and 73% (62-82) of residents indicated WTR to a ND, whereas 81% (73-87) of attendings and 70% (58-81) of residents indicated WTR to PI. Fewer were willing to respond to a RE (63% [55-71] of attendings and 52% [39-64] of residents). In adjusted logistic regression analyses, those anesthesiologists who reported knowing one's role in response to a ND (OR, 15.8 [4.5-55.3]) or feeling psychologically prepared to respond to a ND (OR, 6.9 [2.5-19.0]) were found to be more willing to respond. Similar results were found for RE and PI constructs. Both attendings and residents were willing to respond in whatever capacity needed, not specifically to provide anesthesia. CONCLUSIONS: Few anesthesiologists reported receiving sufficient education and training in disaster medicine and public health preparedness. Providing education and training and enhancing related employee services may further bolster WTR and help to build a more capable and effective medical workforce for disaster response. (C) 2017 International Anesthesia Research Society

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Surveying the Literature: Synopsis of Recent Key Publications.

No abstract available

http://ift.tt/2nTpU9u

Generative Retrieval Improves Learning and Retention of Cardiac Anatomy Using Transesophageal Echocardiography.

BACKGROUND: Transesophageal echocardiography (TEE) is a valuable monitor for patients undergoing cardiac and noncardiac surgery as it allows for evaluation of cardiovascular compromise in the perioperative period. It is challenging for anesthesiology residents and medical students to learn to use and interpret TEE in the clinical environment. A critical component of learning to use and interpret TEE is a strong grasp of normal cardiovascular ultrasound anatomy. METHODS: Fifteen fourth-year medical students and 15 post-graduate year (PGY) 1 and 2 anesthesiology residents without prior training in cardiac anesthesia or TEE viewed normal cardiovascular anatomy TEE video clips; participants were randomized to learning cardiac anatomy in generative retrieval (GR) and standard practice (SP) groups. GR participants were required to verbally identify each unlabeled cardiac anatomical structure within 10 seconds of the TEE video appearing on the screen. Then a correctly labeled TEE video clip was shown to the GR participant for 5 more seconds. SP participants viewed the same TEE video clips as GR but there was no requirement for SP participants to generate an answer; for the SP group, each TEE video image was labeled with the correctly identified anatomical structure for the 15 second period. All participants were tested for intermediate (1 week) and late (1 month) retention of normal TEE cardiovascular anatomy. Improvement of intermediate and late retention of TEE cardiovascular anatomy was evaluated using a linear mixed effects model with random intercepts and random slopes. RESULTS: There was no statistically significant difference in baseline score between GR (49% +/- 11) and SP (50% +/- 12), with mean difference (95% CI) -1.1% (-9.5, 7.3%). At 1 week following the educational intervention, GR (90% +/- 5) performed significantly better than SP (82% +/- 11), with mean difference (95% CI) 8.1% (1.9, 14.2%); P = .012. This significant increase in scores persisted in the late posttest session at one month (GR: 83% +/- 12; SP: 72% +/- 12), with mean difference (95% CI) 10.2% (1.3 to 19.1%); P = .026. Mixed effects analysis showed significant improvements in TEE cardiovascular anatomy over time, at 5.9% and 3.5% per week for GR and SP groups respectively (P = .0003), and GR improved marginally faster than SP (P = .065). CONCLUSIONS: Medical students and anesthesiology residents inexperienced in the use of TEE showed both improved learning and retention of basic cardiovascular ultrasound anatomy with the incorporation of GR into the educational experience. (C) 2017 International Anesthesia Research Society

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It Takes a Village to Deliver Effective and Efficient Care: Team-Based Performance.

No abstract available

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Sevoflurane Posttreatment Attenuates Lung Injury Induced by Oleic Acid in Dogs.

BACKGROUND: In animal models, both sevoflurane and propofol protect against acute lung injury (ALI), especially when administered prior to ALI onset. We hypothesized that when compared to propofol, sevoflurane administration after the onset of acute respiratory distress syndrome would mitigate oleic acid (OA)-induced ALI in dogs. METHODS: Dogs were randomly assigned to receive intravenous OA to induce ALI (n = 7 for each OA group) or saline as an OA control (n = 6 for each control). Dogs were then mechanically ventilated for 6 hours during which propofol (5 mg/kg/h) or sevoflurane (1.0 minimum alveolar concentration) was administered for sedation. Study end points included PO2/FIO2 ratio, pulmonary arterial pressure, pulmonary edema, histology, and tumor nuclear factor-[alpha]. RESULTS: In OA-injured animals, oxygenation was worse at 1, 2, 3, and 4 hours after 6-hour mechanical ventilation in sevoflurane-sedated animals compared with propofol-sedated animals, with mean difference (95% confidence interval; propofol minus sevoflurane) of 75 (39-111), 87 (55-119), 66 (44-87), and 67 (27-107) mm Hg for the respective time points. However, sevoflurane reduced the elevated pulmonary arterial pressure and vascular resistance, attenuated pulmonary edema as evidenced by reduced extravascular lung water index, and decreased tumor nuclear factor-[alpha] and diffuse alveolar damage score compared with propofol in the OA-injured lungs. CONCLUSIONS: When compared with propofol, sevoflurane attenuates OA-induced lung damage. However, despite this effect on lung histology and inflammation, sevoflurane worsened oxygenation in OA-induced ALI, possibly via inhibition of hypoxic pulmonary vasoconstriction. (C) 2017 International Anesthesia Research Society

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Does Bariatric Surgery Decrease Levothyroxine Requirements among Hypothyroid Patients?

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 157-158.


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Postoperative Thyroglobulin and Neck Ultrasound Are Useful for Risk Restratification and Decision to Perform 131I Ablation

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 136-139.


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Thyroid Nodules Do Not Increase in Size During Pregnancy

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 150-152.


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Intensity of 18F-FDG Uptake in Metastatic Differentiated Thyroid Cancer Fails to Predict Growth in Individual Metastatic Lesions

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 140-142.


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Levothyroxine Therapy of Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy Does Not Improve Cognitive Function in the Offspring

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 132-135.


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Rare Cases of Differentiated Thyroid Cancer with Low-Risk Histology and Distant Metastases Have High Prevalence of RAS and TERT Mutations

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 143-145.


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Hyperthyroidism with Severe Liver Dysfunction Can Be Managed by RAI and Extracorporeal Albumin Dialysis and Hemodialysis

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 153-156.


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In Patients with Congenital Hypothyroidism, Prolonged Delay in Performing Neck Ultrasound May Provide Misleading Information

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 146-149.


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Could Measuring a Spectrum of Metabolites and Proteins Be a Useful Way to Assess Thyroid Function in Some Problematic Patients?

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 159-161.


http://ift.tt/2pa77XM

Novel Anticoagulant Agents in the Perioperative Setting

Publication date: Available online 7 April 2017
Source:Anesthesiology Clinics
Author(s): Allyson Lemay, Alan D. Kaye, Richard D. Urman

Teaser

An increasing number of oral anticoagulants have become available over the past decade. Each of these agents has differing implications on both regional and neuraxial anesthetic techniques. This article describes the pharmacology, pharmacokinetics, and pharmacodynamics of the most commonly used novel oral anticoagulants (NOACs). It also outlines recent guidelines for the use of NOACs in the perioperative setting, especially with regard to neuraxial anesthesia.


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Erratum

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General anesthetic actions on GABA A receptors in vivo are reduced in phospholipase C-related catalytically inactive protein knockout mice

Abstract

Purpose

The aim of this study was to investigate the action of general anesthetics in phospholipase C-related catalytically inactive protein (PRIP)-knockout (KO) mice that alter GAB_A receptor signaling.

Methods

PRIP regulates the intracellular trafficking of β subunit-containing GABA_A receptors in vitro. In this study, we examined the effects of intravenous anesthetics, propofol and etomidate that act via β subunit-containing GABA_A receptors, in wild-type and Prip-KO mice. Mice were intraperitoneally injected with a drug, and a loss of righting reflex (LORR) assay and an electroencephalogram analysis were performed.

Results

The cell surface expression of GABA_A receptor β3 subunit detected by immunoblotting was decreased in Prip-knockout brain compared with that in wild-type brain without changing the expression of other GABA_A receptor subunits. Propofol-treated Prip-KO mice exhibited significantly shorter duration of LORR and had lower total anesthetic score than wild-type mice in the LORR assay. The average duration of sleep time in an electroencephalogram analysis was shorter in propofol-treated Prip-KO mice than in wild-type mice. The hypnotic action of etomidate was also reduced in Prip-KO mice. However, ketamine, an NMDA receptor antagonist, had similar effects in the two genotypes.

Conclusion

PRIP regulates the cell surface expression of the GABA_A receptor β3 subunit and modulates general anesthetic action in vivo. Elucidation of the involved regulatory mechanisms of GABA_A receptor-dependent signaling would inform the development of safer anesthetic therapies for clinical applications.

http://ift.tt/2oQVrcZ

Diagnostic Tools in Ocular Allergy

Abstract

Ocular allergy (OA) includes a group of common and less frequent hypersensitivity disorders frequently misdiagnosed and not properly managed. The diagnosis of OA is usually based on clinical history and signs and symptoms, with the support of in vivo and in vitro tests when identification of the specific allergen is required. To date, no specific test is available for the diagnosis of the whole spectrum of the different forms of OA. The lack of recommendations on diagnosis of OA is considered a medical need not only for allergists but also for ophthalmologists.

This position paper aims to provide a comprehensive overview of the currently available tools for diagnosing OA to promote a common nomenclature and procedures to be used by different specialists. Questionnaires, sign and symptom grading scales, tests and potential biomarkers for OA are reviewed. We also identified several unmet needs in the diagnostic tools to generate interest, increase understanding and inspire further investigations. Tools, recommendations and algorithms for the diagnosis of OA are proposed for use by both allergists and ophthalmologists. Several unmet needs in the diagnostic tools should be further improved by specific clinical research in OA.

This article is protected by copyright. All rights reserved.

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Work productivity in rhinitis using cell phones: The MASK pilot study

Abstract

Allergic rhinitis often impairs social life and performance. The aim of this cross-sectional study was to assess the impact of uncontrolled rhinitis assessed by visual analogue score VAS on work productivity using cell phone data collection.

A mobile phone app Allergy Diary, Android and Apple stores collects daily visual analogue scales VAS data for overall allergic symptoms VAS-global measured, nasal VAS-nasal, ocular VAS-ocular, asthma symptoms VAS-asthma and work VAS-work. A combined nasal-ocular score is calculated. Allergy Diary is available in 20 countries. The App includes the Work Productivity and Activity Impairment Allergic Specific Questionnaire WPAI:AS questionnaire in 6 EU countries. All consecutive users who filled the VAS-work from June 1 to October 31, 2016 were included in the study.

A total of 1,136 users filled in 5,818 days of VAS-work. Symptoms of allergic rhinitis were controlled VAS-global<20 in approximately 60% of days. In users with uncontrolled rhinitis, approximately 90% had some work impairment and over 50% had severe work impairment VAS-work>50. There was a significant correlation between VAS-global calculated and VAS-work Rho=0.83, p<0.00001, Spearman rank test. In 144 users, there was a significant correlation between VAS-work and WPAI:AS Rho=0.53, p<0.0001.

This article is protected by copyright. All rights reserved.

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Whipple’s disease in granulomatous disguise: a challenging diagnosis with many histopathological pitfalls

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Not little adults: The uniqueness of the pediatric airways

The following is paid content sponsored by Ambu. By Jonathan Lee for EMS1 BrandFocus Kids are not little adults. Everyone has heard this cliché, but why is it so common and what does it mean in terms of pediatric airways" While it is true that pediatric airways are absolutely smaller than their adult counterparts, there also are important differences in structure and function that affect the ...

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CARD14-Mediated Activation of Paracaspase MALT1 in Keratinocytes: Implications for Psoriasis

Mutations in caspase recruitment domain-containing protein 14 (CARD14) have been linked to susceptibility to psoriasis. CARD14 is an intracellular scaffold protein that regulates proinflammatory gene expression. Recent studies have offered novel insights into the mechanisms of CARD14-mediated signaling in keratinocytes and the molecular impact of psoriasis-associated CARD14 mutations. CARD14 forms a signaling complex with BCL10 and the paracaspase MALT1, and this process is enhanced upon pathogenic CARD14 mutation, culminating in the activation of MALT1 protease activity and psoriasis-associated gene expression. This review summarizes the current knowledge of CARD14/MALT1-mediated signaling in keratinocytes and its therapeutic implications in psoriasis.

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Type I lnterferons Modulate CD8(+) T Cell Immunity to mRNA Vaccines

mRNA vaccines have emerged as potent tools to elicit antitumor T cell immunity. They are characterized by a strong induction of type I interferons (IFNs), potent inflammatory cytokines affecting T cell differentiation and survival. Recent reports have attributed opposing roles for type I IFNs in modulating CD8(+) T cell immunity to mRNA vaccines, from profoundly stimulatory to strongly inhibitory. The mechanisms behind this duality are unclear. Disentangling the factors governing the beneficial or detrimental impact of type I IFNs on CD8(+) T cell responses is vital to the design of mRNA vaccines of increased potency. In light of recent advancements regarding the complex role of type I IFNs in regulating CD8(+) T cell immunity to infectious diseases, we posit that the dual outcome of type I IFNs on CD8(+) T cell responses to mRNA vaccination is determined by the timing and intensity of type I IFN induction relative to T cell receptor (TCR) activation.

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Bioinspired, biomimetic, double-enzymatic mineralization of hydrogels for bone regeneration with calcium carbonate

Hydrogels are popular materials for tissue regeneration. Incorporation of biologically active substances, e.g. enzymes, is straightforward. Hydrogel mineralization is desirable for bone regeneration. Here, hydro gels of Gellan Gum (GG), a biocompatible polysaccharide, were mineralized biomimetically with CaCO3 using a double enzymatic approach. The enzymes urease (U) and carbonic anhydrase (CA) were incorporated in GG hydrogels. Hydrogels were incubated in a mineralization solution containing U substrate (urea) and calcium ions. U converts urea to ammonia (which raises pH) and CO2. CA catalyses the reaction of CO2 with water to form HCO3, which undergoes deprotonation to form CO32-, which react with Ca2+ to form insoluble CaCO3. All hydrogels containing U+CA were mineralized more with calcite and stiffer than hydrogels containing U. Mineralization with calcite promoted proliferation and spreading of osteoblast-like cells. (C) 2016 Elsevier B.V. All rights reserved.

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Procedure of informed assent/consent for clinical trials in pediatric hemato-oncology: the adelescents' and parent's point of view

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Off-label and unlicensed use in a pediatric hemato-oncology unit

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Predicting outcomes for children with neuroblastoma

One of the main challenges in clinical cancer research remains to be accurate outcome prediction at the time of diagnosis. Although not frequent in absolute terms, neuroblastoma represents an important clinical challenge, as it is fatal in almost half of the patients despite advances in multimodal anti-cancer therapies. Four major risk stratification systems for neuroblastoma patients are currently being used in various parts of the world. Systems are based on a combination of various clinical, histopathological, and biological factors. Accordingly, different therapeutic schemes exist ranging from wait-and-see approaches to intensive multimodal therapies. Clinical experience with the currently used risk stratification systems suggests that the stratification of patients for treatment is useful, but patients with the same clinico-pathological parameters, receiving the same treatment, can have markedly different clinical courses. Therefore, the challenge remains to identify additional tumor-specific and sensitive prognostic markers for improved risk estimation at the time of diagnosis and to improve the choice of risk-related therapy. Various studies have put forward new prognostic markers, including copy number aberrations, gene expression signatures, and epigenetic markers.

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GATA4 and GATA5 are potential tumor suppressors and biomarkers in colorectal cancer

Purpose: The transcription factors GATA4 and GATA5 are involved in gastrointestinal development and are inactivated by promoter hypermethylation in colorectal cancer. Here, we evaluated GATA4/5 promoter methylation as potential biomarkers for noninvasive colorectal cancer detection, and investigated the role of GATA4/5 in colorectal cancer. Experimental Design: Promoter methylation of GATA4/5 was analyzed in colorectal tissue and fecal DNA from colorectal cancer patients and healthy controls using methylation-specific PCR. The potential function of GATA4/5 as tumor suppressors was studied by inducing GATA4/5 overexpression in human colorectal cancer cell lines. Results: GATA4/5 methylation was observed in 70% (63/90) and 79% (61/77) of colorectal carcinomas, respectively, and was independent of clinicopathologic features. Methylation frequencies in normal colon tissues from noncancerous controls were 6% (5 of 88, GATA4; P < 0.001) and 13% (13 of 100, GATA5; P < 0.001). GATA4/5 overexpression suppressed colony formation (P < 0.005), proliferation (P < 0.001), migration (P < 0.05), invasion (P < 0.05), and anchorage-independent growth (P < 0.0001) of colorectal cancer cells. Examination of GATA4 methylation in fecal DNA from two independent series of colorectal cancer patients and controls yielded a sensitivity of 71% [95% confidence interval (95% Cl), 55-88%] and specificity of 84% (95% Cl, 74-95%) for colorectal cancer detection in the training set, and a sensitivity of 51% (95% Cl, 37-65%) and specificity of 93% (95% Cl, 84-100%) in the validation set. Conclusions: Methylation of GATA4/5 is a common and specific event in colorectal carcinomas, and GATA4/5 exhibit tumor suppressive effects in colorectal cancer cells in vitro. GATA4 methylation in fecal DNA may be of interest for colorectal cancer detection.

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Pharmacologic unmasking of epigenetically silenced genes in breast cancer

Purpose: Aberrant promoter hypermethylation of several known or putative tumor suppressor genes occurs frequently during the pathogenesis of various cancers including breast cancer. Many epigenetically inactivated genes involved in breast cancer development remain to be identified. Therefore, in this study we used a pharmacologic unmasking approach in breast cancer cell lines with 5-aza-2'-deoxycytidine (5-aza-dC) followed by microarray expression analysis to identify epigenetically inactivated genes in breast cancer. Experimental Design: Breast cancer cell lines were treated with 5-aza-dC followed by microarray analysis to identify epigenetically inactivated genes in breast cancer. We then used bisulfite DNA sequencing, conventional methylation-specific PCR, and quantitative fluorogenic real-time methylation-specific PCR to confirm cancer-specific methylation in novel genes. Results: Forty-nine genes were up-regulated in breast cancer cells lines after 5-aza-dC treatment, as determined by microarray analysis. Five genes (MAL, FKBP4, VGF OGDHL, and KIF1A) showed cancer-specific methylation in breast tissues. Methylation of at least two was found at high frequency only in breast cancers (40 of 40) as compared with normal breast tissue (0 of 10; P < 0.0001, Fisher's exact test). Conclusions: This study identified new cancer-specific methylated genes to help elucidate the biology of breast cancer and as candidate diagnostic markers for the disease.

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Transabdominal wall lipoma

Description

A 60-year-old man presented with a painful, enlarged palpable mass in the left iliac fossa. A CT scan of the abdomen and pelvis demonstrated a large heterogeneous mass extending through the abdominal wall musculature (figure 1), which was suspected to be an atypical lipomatous tumour (ALT) or well-differentiated liposarcoma (WD-LPS).

Figure 1

Lipoma passing through the abdominal wall musculature.

Intraoperatively, a large firm lipomatous mass was noted in close proximity to the left spermatic cord. It extended into the retroperitoneal space and transgressed the internal oblique to lie deep to the external oblique aponeurosis, adopting an unusual 'dumbbell' shape. Due to clinical uncertainty as to whether the mass was simply in close proximity to the spermatic cord or a cord liposarcoma, a left radical orchidectomy was performed en bloc with the tumour.

Lipomas are the most common soft tissue mesenchymal tumour,1 and are...

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Doing the Food Allergy Diagnosis

Alejandra Medina-Hernandez, Guadalupe Zaldivar-Lelo de Larrea and Carlos F Sosa-Ferreyra

Review Article: Otolaryngol (Sunnyvale) 2016, 6:284

DOI: 10.4172/2161-119X.1000284

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Non Hodgkin Lymphoma in Supraglottis: Case Report

Norton Tasso Junior, Thiago Messias Zago, Henrique Furlan Pauna, Agricio Nubiato Crespo

Case Report: Otolaryngol (Sunnyvale) 2016, 6:285

DOI: 10.4172/2161-119X.1000285

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Allergic Rhinitis does Exist in Young Children

Herberto Chong Neto and Nelson Augusto Rosario Filho

Commentary: Otolaryngol (Sunnyvale) 2016, 6:286

DOI: 10.4172/2161-119X.1000286

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Large Sublingual Dermoid Cyst in the Floor of Mouth and Submental Space

Mohamed Saleh Elarbi, Hamza Alshawish and Osama Khalifa

Case Report: Otolaryngol (Sunnyvale) 2016, 6:287

DOI: 10.4172/2161-119X.1000287

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Cervicofacial Actinomycosis of the Maxilla and HIV Infection: A Case Report.

Mariana Klein, Vinícius Coelho Carrard and Maria Cristina Munerato

Case Report: Otolaryngol (Sunnyvale) 2016, 6:288

DOI: 10.4172/2161-119X.1000288

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Surgical to Interim–Chairside Management of Hemimaxillectomy Patient

Fathima Banu Raza, Minati Choudhary, Anand Kumar, Athiban Inbarajan, Madhan Kumar and Parthasarathy Natarajan

Case Report: Otolaryngol (Sunnyvale) 2016, 6:289

DOI: 10.4172/2161-119X.1000289

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Ear Anatomy Presentation

Ghada Wageih

PPT Presentation: Otolaryngol (Sunnyvale) 2016, 6:290

DOI: 10.4172/2161-119X.1000290

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Stapes Surgery Using Stapedotomy versus Partial Stapedectomy

Farid Alzhrani, Abdulsalam Baqays and Hisham Almutawa

Research Article: Otolaryngol (Sunnyvale) 2016, 6:291

DOI: 10.4172/2161-119X.1000291

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Utilizing Acupuncture and Osteopathic Manipulative Treatment (OMT) in the Integrative Treatment of TMDs

Leonard B Goldstein, David Shoup and Victoria Troncoso

Mini Review: Otolaryngol (Sunnyvale) 2016, 6:292

DOI: 10.4172/2161-119X.1000292

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Structured Analysis of Nose to Achieve Natural Results in Rhinoplasty

Sanjay Parashar and Aniketh Venkataram

Review Article: Otolaryngol (Sunnyvale) 2016, 6:293

DOI: 10.4172/2161-119X.1000293

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Response to Combination Intranasal Corticosteroid and Intranasal Antihistamine in Allergic Rhinitis, A Questionnaire Based Study in ENT Outpatients

Amtul Salam Sami, Sabahat Ahmed, Nida Ahmed

Research Article: Otolaryngol (Sunnyvale) 2016, 6:294

DOI: 10.4172/2161-119X.1000294

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