Source:Journal of Allergy and Clinical Immunology
Author(s): Helene F. Rosenberg, Elizabeth A. Jacobsen, Bruce S. Bochner, Peter F. Weller
http://ift.tt/2oRUEZB
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Τετάρτη 19 Απριλίου 2017
In lasting tribute: Dr James J. Lee (1958-2017)
Source:Journal of Allergy and Clinical Immunology
Author(s): Helene F. Rosenberg, Elizabeth A. Jacobsen, Bruce S. Bochner, Peter F. Weller
http://ift.tt/2oRUEZB
Asthma and risk of coronary heart disease
Source:Annals of Allergy, Asthma & Immunology
Author(s): Huai Liu, Ying Fu, Kunpeng Wang
BackgroundFew studies have investigated the incidence of coronary heart disease (CHD) in patients with asthma, and their results remain inconclusive.ObjectiveTo conduct a meta-analysis to determine whether asthma increases the risk of CHD.MethodsA systematic literature search of the PubMed and Embase databases from inception to August 2016, complemented with references screening of relevant articles and reviews, was performed to identify eligible studies. Only longitudinal cohort studies were included in our meta-analysis.ResultsThe retrieval process yielded 7 studies (12 asthma cohorts) with 495,024 patients. Data pooling across the cohorts revealed that asthma was associated with an increased risk of CHD (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.30–1.57; P < .001), without significant heterogeneity across the studies (I2 = 26%, P = .19). This epidemiologic association was more pronounced in female than in male patients (female: HR, 1.50; 95% CI, 1.41–1.59; male: HR, 1.31; 95% CI, 1.16–1.47; P for interaction = .046). In addition, subgroup and sensitivity analyses supported the positive correlation between asthma and incident CHD.ConclusionAsthma is related to an increased incidence of CHD, particularly in women. Clinicians should be aware of this association when faced with a patient with asthma. Further investigations are required to examine how this excess risk should be managed in routine practice.
http://ift.tt/2piigto
Skeletal myositis as the sole feature of relapsing drug reaction with eosinophilia and systemic symptoms syndrome
Source:Annals of Allergy, Asthma & Immunology
Author(s): Jennifer Massey, Kishore Kumar, Karl Ng, James Yun, Suran Fernando
http://ift.tt/2pi5XNK
Proptosis and vision loss as grave complications of allergic fungal sinusitis and polyposis
Source:Annals of Allergy, Asthma & Immunology
Author(s): Shane A. Bobart, Ves Dimov, Darby Sider, Esteban Gallego
http://ift.tt/2pTU9gX
Efficacy of Helicobacter pylori eradication therapies in Korea: A systematic review and network meta-analysis
Abstract
Background
The efficacy of Helicobacter pylori eradication regimens may depend on the country where the studies were performed because of the difference in antibiotic resistance. We aimed to analyze the efficacy of H. pylori eradication regimens in Korea where clarithromycin resistance rate is high.
Methods
We searched for all relevant randomized controlled trials published until November 2016 that investigated the efficacy of H. pylori eradication therapies in Korea. A network meta-analysis was performed to calculate the direct and indirect estimates of efficacy among the eradication regimens.
Results
Forty-three studies were identified through a systematic review, of which 34 studies, published since 2005, were included in the meta-analysis. Among 21 included regimens, quinolone-containing sequential therapy for 14 days (ST-Q-14) showed the highest eradication rate (91.4% [95% confidence interval [CI], 86.9%-94.4%] in the intention-to-treat [ITT] analysis). The eradication rate of the conventional triple therapy for 7 days, standard sequential therapy for 10 days, hybrid therapy for 10-14 days, and concomitant therapy for 10-14 days was 71.1% (95% CI, 68.3%-73.7%), 76.2% (95% CI, 72.8%-79.3%), 79.4% (95% CI, 75.5%-82.8%), and 78.3% (95% CI, 75.3%-80.9%), respectively, in the ITT analysis. In the network meta-analysis, ST-Q-14 showed a better comparative efficacy than the conventional triple therapy, standard sequential therapy, hybrid therapy, and concomitant therapy. In addition, tolerability of ST-Q-14 was comparable to those regimens.
Conclusion
In Korea, ST-Q-14 showed the highest efficacy in terms of eradication and a comparable tolerability, compared to the results reported for the conventional triple therapy, standard sequential therapy, hybrid therapy, and concomitant therapy.
http://ift.tt/2phYlLd
Hypothyroidism and Hyponatremia: Rather Coincidence Than Causality
http://ift.tt/2o6htvx
Racial Disparities In Differentiated Thyroid Cancer: Have We Bridged The Gap?
Thyroid , Vol. 0, No. 0.
http://ift.tt/2op81j3
Garlic Dermatitis on the Neck of an Infant Treated for Nasal Congestion
Abstract
The health benefits of garlic (Allium sativum) as a naturopathic remedy have been well documented, but topical application of garlic has been linked to allergic and irritant contact dermatitis. We present a case of severe irritant contact dermatitis due to application of a fresh garlic necklace to the neck of infant for treatment of nasal congestion.
http://ift.tt/2pTDtX1
“Nails Only” Phenotype and Partial Dominance of p.Glu170Lys Mutation in a Family with Epidermolysis Bullosa Simplex
Abstract
Epidermolysis bullosa (EB) is a heterogeneous group of rare, chronic, inherited skin disorders characterized by marked mechanical fragility of epithelial tissues, with blistering and erosions after minor trauma. We present the first report of a nails-only phenotype in two patients with epidermolysis bullosa simplex (EBS) and a heterozygous pGlu170Lys mutation and the second reported case of EBS associated with a homozygous p.Glu170Lys mutation in the KRT5 gene. Our findings may be relevant for genetic counseling and for understanding the inheritance pattern of EBS.
http://ift.tt/2oXqHt9
Dissecting Cellulitis of the Scalp with Excellent Response to Isotretinoin
Abstract
An 18-year-old man presented for evaluation of a 1-year history of painful nodules on the scalp with associated hair loss. Physical examination revealed multiple confluent, fluctuant, boggy nodules on the scalp with overlying alopecic patches. Based on these findings, a diagnosis of dissecting cellulitis of the scalp was made and the patient was successfully treated with oral isotretinoin therapy.
http://ift.tt/2pTE5Ml
Treatment Update of Chronic Migraine
Abstract
Purpose of Review
Although chronic migraine (CM) is a common disorder that severely impacts patient functioning and quality of life, it is usually underdiagnosed, and treatment responses often remain poor even after diagnosis. In addition, effective treatment options are limited due to the rarity of randomized controlled trials (RCTs) involving patients with CM. In the present review, we discuss updated pharmacological, non-pharmacological, and neurostimulation treatment options for CM.
Recent Findings
Pharmacological treatments include both acute and preventive measures. While acute treatment options are similar between CM and episodic migraine (EM), preventive treatment with topiramate and botulinum toxin A exhibited efficacy in more than two RCTs. In addition, several studies have revealed that behavioral interventions such as cognitive behavioral therapy, biofeedback, and relaxation techniques are associated with significant improvements in symptoms. Thus, these treatment options are recommended for patients with CM, especially for refractory cases. Neurostimulation procedures, such as occipital stimulation, supraorbital transcutaneous stimulation, non-invasive vagal nerve stimulation, and transcranial direct current stimulation, have shown promising results in the treatment of CM. However, current studies on neurostimulation suffer from small sample size, no replication, or negative results.
Summary
Although CM is less responsive to treatment compared to EM, recent advance in pharmacological, non-pharmacological, and neurostimulation treatments may provide more chance for successful treatment of CM.
http://ift.tt/2o62odt
Sporadic Insulinoma as a Rare Cause of Recurrent Hypoglycemia in Children
Insulinoma is a rare pancreatic tumor in children and adolescents. As a result of insulin hypersecretion, signs and symptoms are more commonly consequences of the pathophysiologic responses to hypoglycemia. According to rarity of this tumor in children and nonspecificity of clinical presentations, diagnosis of insulinoma in this group of patients is usually delayed. Early diagnosis is very important for preventing neurologic damage. In this case report, we present the case of a 10-year-old boy with signs and symptoms of hypoglycemia and final diagnosis of insulinoma.
http://ift.tt/2oXhr8o
Acoustic Analysis of Indian Teachers’ Voice: Pre and Post Teaching Circumstances
Abstract
Compared to people employed in other occupations, teachers are more likely to report having voice problems. They are more likely to perceive that their voice problems limit their current job performance and also adversely affect their future career options. The current study examines the acoustic parameters that are sensitive to vocal loading in pre and post teaching circumstances and adds to the existing literature. Voice samples were recorded from 30 primary school teachers, 15 females and 15 males in the age range of 28–35 years (mean age 29.3 years), with teaching experience of 10–12 years. Mean pitch, minimum pitch, maximum pitch, number of voice breaks, jitter local, shimmer local and mean harmonic to noise ratio were estimated using PRAAT software before and after a typical teaching day. Significant difference was seen when number of voice breaks was compared in pre and post teaching conditions in both males (p = 0.02) and females (p = 0.02) in the conversation task. Moreover, significant differences in mean pitch was observed in the task of slogan repetition (p = 0.03), but only in males. These parameter can be used as indicators of vocal fatigue among teachers and can be used in objective determination of at risk population.
http://ift.tt/2oMEkLu
News in Thyroid Research and Care: A Q&A with the American Thyroid Association
A leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders, the American Thyroid Association president-elect, Dr. Charles Emerson, spoke with WomensHealth.com. Read the Interview
The post News in Thyroid Research and Care: A Q&A with the American Thyroid Association appeared first on American Thyroid Association.
http://ift.tt/2o5lkZP
Correction: Impact of self-reported symptoms of allergic rhinitis and asthma on sleep disordered breathing and sleep disturbances in the elderly with polysomnography study
by Sae-Hoon Kim, Ha-Kyeong Won, Sung-Do Moon, Byung-Keun Kim, Yoon-Seok Chang, Ki-Woong Kim, In-Young Yoon
http://ift.tt/2pCS9KO
Correction: Impact of self-reported symptoms of allergic rhinitis and asthma on sleep disordered breathing and sleep disturbances in the elderly with polysomnography study
by Sae-Hoon Kim, Ha-Kyeong Won, Sung-Do Moon, Byung-Keun Kim, Yoon-Seok Chang, Ki-Woong Kim, In-Young Yoon
http://ift.tt/2pCS9KO
Perioperative risks of narcolepsy in patients undergoing general anesthesia: A case-control study
To compare the perioperative outcomes between patients with narcolepsy and matched controls undergoing anesthetic management.
http://ift.tt/2pDW8cQ
Proptosis and vision loss as grave complications of allergic fungal sinusitis and polyposis
Allergic fungal sinusitis and polyposis are noninvasive, but aggressive, inflammatory responses to mold that occur in immunocompetent patients with chronic sinusitis and nasal polyposis.1 An association of these conditions with vitamin D deficiency has been reported.2 In severe cases, patients with allergic fungal sinusitis present with ophthalmic signs and symptoms, such as proptosis, diplopia, and, in extreme cases, vision loss.3 Most cases require surgical intervention, corticosteroids, and ongoing surveillance.
http://ift.tt/2oQTGNu
Skeletal myositis as the sole feature of relapsing drug reaction with eosinophilia and systemic symptoms syndrome
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome represents a potentially life-threatening systemic immune response to medication. It is characterized by rash, fever, lymphadenopathy, eosinophilia, and internal organ involvement, most commonly hepatitis. We report a case of DRESS syndrome caused by sulfasalazine with acute morbilliform rash, fever, eosinophilia, and hepatitis with subsequent skeletal muscle involvement. To date, literature reports of skeletal muscle involvement with DRESS syndrome have been limited to 2 cases, only one of which involved histopathologic evidence of eosinophilic infiltration on skeletal muscle biopsy.
http://ift.tt/2phjsgK
Asthma and risk of coronary heart disease
Few studies have investigated the incidence of coronary heart disease (CHD) in patients with asthma, and their results remain inconclusive.
http://ift.tt/2oQHY5i
The risk of bias in randomized controlled trials in otorhinolaryngology: hardly any improvement since 1950
Randomized Controlled Trials (RCTs) represent the most valuable study design to evaluate the effectiveness of therapeutic interventions. However, flaws in design, conduct, analysis, and reporting of RCTs can c...
http://ift.tt/2oQHxYC
Acoustic Analysis of Indian Teachers’ Voice: Pre and Post Teaching Circumstances
Abstract
Compared to people employed in other occupations, teachers are more likely to report having voice problems. They are more likely to perceive that their voice problems limit their current job performance and also adversely affect their future career options. The current study examines the acoustic parameters that are sensitive to vocal loading in pre and post teaching circumstances and adds to the existing literature. Voice samples were recorded from 30 primary school teachers, 15 females and 15 males in the age range of 28–35 years (mean age 29.3 years), with teaching experience of 10–12 years. Mean pitch, minimum pitch, maximum pitch, number of voice breaks, jitter local, shimmer local and mean harmonic to noise ratio were estimated using PRAAT software before and after a typical teaching day. Significant difference was seen when number of voice breaks was compared in pre and post teaching conditions in both males (p = 0.02) and females (p = 0.02) in the conversation task. Moreover, significant differences in mean pitch was observed in the task of slogan repetition (p = 0.03), but only in males. These parameter can be used as indicators of vocal fatigue among teachers and can be used in objective determination of at risk population.
http://ift.tt/2oMEkLu
Insights into the diversity of NOD-like receptors: Identification and expression analysis of NLRC3, NLRC5 and NLRX1 in rainbow trout
Source:Molecular Immunology, Volume 87
Author(s): Claudio A. Álvarez, Felipe Ramírez-Cepeda, Paula Santana, Elisa Torres, Jimena Cortés, Fanny Guzmán, Paulina Schmitt, Luis Mercado
Nucleotide-binding oligomerization domain (NOD)-like receptors (NLRs) are efficient soluble intracellular sensors that activate defense mechanisms against pathogens. In teleost fish, the involvement of NLRs in the immune response is not well understood. However, recent work has evidenced the expression of different NLRs in response to some pathogen associated molecular patterns (PAMPs). In the present work, the cDNA sequence encoding three new NOD-like receptors were identified in Oncorhynchus mykiss, namely OmNLRC3, OmNLRC5 and OmNLRX1. Results showed that their sequences coded for proteins of 1135, 836 and 1010 amino acids, respectively. The deduced protein sequences of all receptors showed characteristic domains of this receptor family, such as leucine rich repeats and NACHT domain. Phylogenetic analysis revealed a high degree of identity with other NOD-like receptors and they are clustered into different families. Transcript expression analysis indicated that OmNLRs are constitutively expressed in liver, spleen, intestine, gill, skin and brain. OmNLR expression was upregulated in kidney and gills from rainbow trout in response to LPS. In order to give new insights into the function of these new NLR members, an in vitro model of immune stimulation was established using the rainbow trout cell line RTgill-W1. Expression analysis revealed that RTgill-W1 overexpressed proinflammatory cytokines in response to LPS and poly I:C alongside with a differential overexpression of OmNLRC3, OmNLRC5 and OmNLRX1. The expression of OmNLRC5 was further verified at the protein level by immunofluorescence. Finally, the effect of the overexpressed cytokines on the OmNLR expression by RTgill-W1 cells was assessed, suggesting a regulatory mechanism on OmNLRC3 expression. Overall, results suggest that O. mykiss NOD-like receptors could play a key role in the defense mechanisms of teleost through PAMP recognition. Future studies will focus on gills which could be related with a key sensor mucosal system in one of the most environmentally fish exposed tissues.
http://ift.tt/2oQoMEV
Prospective double blind randomized placebo-controlled clinical trial of the pectoral nerves (Pecs) block type II
The aim of this clinical trial was to test the hypothesis whether adding the pectoral nerves (Pecs) block type II to the anesthetic procedure reduces opioid consumption during and after breast surgery.
http://ift.tt/2oMzAFH
Nitrous oxide for labor analgesia: Utilization and predictors of conversion to neuraxial analgesia
We examined the characteristics of women who choose nitrous oxide for labor analgesia and identified factors that predict conversion from nitrous oxide to labor neuraxial analgesia.
http://ift.tt/2osZTx6
The analysis of expression of p16 protein in group of 53 patients treated for sinonasal inverted papilloma
Publication date: Available online 19 April 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Roland Zydroń, Andrzej Marszałek, Magdalena Bodnar, Paweł Kosikowski, Grażyna Greczka, Małgorzata Wierzbicka
IntroductionSinonasal Inverted Papilloma (IP) constitute relevant therapeutic problem due to destructive character of growth, tendency to recur and the possibility of malignant transformation. Therefore, many attempts to identify risk factors for IP occurrence have been undertaken, as well as research to find markers that would allow for the earlier detection of tumors and the application of adequate therapy. A widely known risk factor of IP is HPV infection. One of the markers of HPV infection and the ongoing effect of this change (although arousing some controversy) is the expression of the p16 protein.ObjectiveThe aim of the study was to analyze the correlation between the expression of p16 as a surrogate of HPV infection in analyzed histopathological material and epidemiological variables, recurrences or malignant transformation.MethodsThe retrospective study includes a group of 53 patients (18 women and 35 men) undergoing treatment for sinonasal IP in the period of 2002–2012. The intensity of the p16 protein in histopathological material was scored as: 0 – no expression, 1 – diffuse expression (borderline) and 2 – positive expression; or 0 – no expression/diffuse expression (borderline); 1 – positive expression. The Ethics Committee agreement was obtained (1089/12; 245/13).Results and conclusionThere was no statistically significant relationship between the expression of p16 and the age of patients, cigarette smoking, tumor location, tumor staging according to the Krouse and Cannady classification, the presence of dysplasia or the occurrence of relapse.
http://ift.tt/2oMayGP
CD80CD86 deficiency disrupts regulatory CD4+FoxP3+T cell homeostasis and induces autoimmune-like alopecia
Abstract
Alopecia areata (AA) is an autoimmune disease that results in spot baldness in humans. Adequate animal models for AA are currently lacking. The objective of this study was to elucidate the mechanism of autoimmune-like alopecia (ALA) in C57BL/6.CD80CD86-deficient (B6.CD80CD86-/-) mice.
Incidence and severity of alopecia were analyzed in 58 B6.CD80CD86-/- mice by using histological examination, flow cytometry, multiplex enzyme-linked immunosorbent assay, quantitative RT-PCR, and CD25 inhibition test. Both male and female B6.CD80CD86-/- mice showed almost 100% incidence of hair loss at 40 weeks of age. Moreover, CD4+FoxP3+Treg (Treg) cell population in B6.CD80CD86-/- mice was significantly lower than in B6 mice, which presumably underlined autoimmune reaction. Histologically, B6.CD80CD86-/- mice showed CD4+ and CD8+ T-cell infiltration around terminal follicle region and exhibited hair follicle destruction in the anagen or catagen stage. Negative correlation between the number of CD4+FoxP3+ Tregs and ALA was confirmed by the CD25 depletion test in B6 mice, as follicle destruction was similar to that observed in B6.CD80CD86-/- animals.
CD80CD86 deficiency disrupted CD4+FoxP3+ Treg homeostasis and prompted the development of ALA. We demonstrated that B6.CD80CD86-/- mice might have several advantages as an ALA model, because they exhibited high incidence of disease phenotype and epipathogenesis similar to that observed in human AA.
This article is protected by copyright. All rights reserved.
http://ift.tt/2oPqczB
Combined activity of temozolomide and the mTOR inhibitor temsirolimus in metastatic melanoma involves DKK1
Abstract
The BRAFV600E inhibitor vemurafenib achieves remarkable clinical responses in patients with BRAF-mutant melanoma, but its effects are limited by the onset of drug resistance. In the case of resistance, chemotherapy can still be applied as second line therapy. However, it yields low response rates and strategies are urgently needed to potentiate its effects. In a previous study, we showed that the inhibition of the PI3K-AKT-mTOR pathway significantly increases sensitivity of melanoma cells to chemotherapeutic drugs (1).
In the current study the combination of the mTOR inhibitor temsirolimus with the chemotherapeutic agent temozolomide significantly increases growth inhibition and apoptosis in melanoma cells compared to temsirolimus or temozolomide alone. The combination of temozolomide with temsirolimus is not only effective in established but also in newly isolated and vemurafenib-resistant metastatic melanoma cell lines. These effects are associated with the down-regulation of the antiapoptotic protein Mcl-1 and the up-regulation of the Wnt antagonist Dickkopf homolog 1 (DKK1). Knockdown of DKK1 suppresses apoptosis induction by the combination of temsirolimus and temozolomide.
These data suggest that the inhibition of the mTOR pathway increases sensitivity of melanoma cells towards temozolomide. Chemosensitization is associated with enhanced expression of the Wnt antagonist DKK1.
This article is protected by copyright. All rights reserved.
http://ift.tt/2oM8ONA
A novel JAK inhibitor JTE-052 reduces skin inflammation and ameliorates chronic dermatitis in rodent models: comparison with conventional therapeutic agents
Abstract
Janus kinases (JAKs) are required for several inflammatory cytokine signaling pathways and are implicated in the pathogenesis of chronic dermatitis, including atopic dermatitis and psoriasis. JAK inhibitors are therefore promising therapeutic candidates for chronic dermatitis. In this study, we evaluated the effects of the novel JAK inhibitor JTE-052 on inflammatory responses associated with chronic dermatitis, and compared its profile with those of conventional therapeutic agents in rodent models of chronic dermatitis. JTE-052 inhibited the Th1-, Th2-, and Th17-type inflammatory responses of human T cells and mast cells in vitro. Oral administration of JTE-052 inhibited skin inflammation in hapten-induced chronic dermatitis in mice, associated with reduced levels of inflammatory cytokines in the skin and immunoglobulin (Ig) E in serum. In contrast, although ciclosporin partly inhibited skin inflammation, it did not reduce interleukin (IL)-4 production in skin, and enhanced IgE production in serum. Oral administration of JTE-052 also inhibited skin inflammation in mouse models of atopic dermatitis and psoriasis induced by a mite extract, thymic stromal lymphopoietin, or IL-23. The maximal efficacy of JTE-052 in these dermatitis models was superior to the conventional therapeutic agents, ciclosporin and methotrexate. Topical application of JTE-052 ointment ameliorated hapten-induced chronic dermatitis in rats more effectively than tacrolimus ointment. Furthermore, JTE-052 ointment did not cause the thinning of normal skin associated with topical corticosteroids. These results indicate that JTE-052 is a promising candidate as an anti-inflammatory drug for various types of chronic dermatitis, with a distinctly different profile from conventional therapy following either oral or topical application.
This article is protected by copyright. All rights reserved.
http://ift.tt/2pCDUbH
Helping your Kids Transition to Middle School with Dr. Dehra Harris
Transitioning from elementary school to middle school is a huge step on independence for your child. Not sure what to expect? Talk honestly with other moms and never judge yourself off someone else's Facebook family! Planning and having open conversation with your kid will help smooth the transition in middle school.
The post Helping your Kids Transition to Middle School with Dr. Dehra Harris appeared first on ChildrensMD.
http://ift.tt/2pCbQW5
Thoracic Surgery Combined With Intrathoracic Hyperthermic Perfusion for Advanced Lung Cancer / Esophageal Cancer
Conditions: Esophageal Cancer; Lung Cancer; Hyperthermic Perfusion
Intervention: Other: hyperthermic perfusion
Sponsor: Henan Cancer Hospital
Recruiting - verified April 2017
http://ift.tt/2pCeTxf
Intervention: Other: hyperthermic perfusion
Sponsor: Henan Cancer Hospital
Recruiting - verified April 2017
http://ift.tt/2pCeTxf
Leonine Facies, Flushing, and Systemic Symptoms
A man in his 50s with history of hypertension and pulmonary tumor resected 10 years earlier presented with generalized phymatous changes over his entire face as well as pustular lesions and a diffuse erythema that gave him an appearance of leonine facies. What is your diagnosis?
http://ift.tt/2oOJGV1
http://ift.tt/2oOJGV1
Typographical Errors and Missing Table Footnote
In the article titled "Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Standard Reporting and Evaluation Guidelines: Results of a National Institutes of Health Working Group," there were typographical errors in both the Figure and the Table, and there was a missing footnote in the Table. This article has been corrected online.
http://ift.tt/2o3QSiD
http://ift.tt/2o3QSiD
Internal Store-and-Forward System in an Existing Electronic Health Record
This pilot study describes a store-and-forward teledermatology workflow within an existing electronic health record system, assesses its effectiveness in improving access to care, validates its reliability, and evaluates its ability to capture meaningful outcomes.
http://ift.tt/2oOTeiJ
http://ift.tt/2oOTeiJ
Multiple Facial Trichoepitheliomas and Vulval Cysts
This case study describes a unique incidence of multiple trichoepitheliomas in combination with epidermoid cysts of the vulva in association with a novel pathogenic mutation in CYLD, extending the phenotypic spectrum.
http://ift.tt/2o3S3ik
http://ift.tt/2o3S3ik
An Unusual Case of SCACPIS With Macular Amyloidosis
This case report describes an unusual case of syringocystadenocarcinoma papilliferum in situ with macular amyloidosis.
http://ift.tt/2oOHDQH
http://ift.tt/2oOHDQH
Declining Melanoma Rates in New England States
To the Editor The research letter "Comparison of Regional and State Differences in Melanoma Rates in the United States: 2003 vs 2013" was insightful and valuable. In speculating about the decline in New England melanoma incidence and death rates during the 10-year period, the authors attributed the results to skin cancer prevention programs and specifically cited the influence of the Melanoma Foundation of New England (MFNE).
http://ift.tt/2o49UWb
http://ift.tt/2o49UWb
Efficacy and Safety of Propranolol vs Steroid for Infantile Hemangioma
This randomized clinical trial compares propranolol vs steroid therapies for efficacy and safety in the treatment of infantile hemangioma.
http://ift.tt/2oOXFtJ
http://ift.tt/2oOXFtJ
Diversity in Dermatology
This Viewpoint focuses on underrepresented minorities in the field of dermatology and presents 5 actions endorsed by the Association of Professors of Dermatology to grow a more diverse dermatology workforce.
http://ift.tt/2o3OMPT
http://ift.tt/2o3OMPT
New Evidence: Defective HIV Proviruses Hinder Immune System Response and Cure
Researchers at Johns Hopkins and George Washington universities report new evidence that proteins created by defective forms of HIV long previously believed to be harmless actually interact with our immune systems and are actively monitored by a specific type of immune cell, called cytotoxic T cells.
http://ift.tt/2o3KCI1
International and multidisciplinary expert recommendations for the use of biologics in systemic lupus erythematosus
Source:Autoimmunity Reviews
Author(s): Jean-François Kleinmann, Florence Tubach, Véronique Le Guern, Alexis Mathian, Christophe Richez, David Saadoun, Karim Sacre, Jérémie Sellam, Raphaèle Seror, Zahir Amoura, Emmanuel Andres, Sylvain Audia, Brigitte Bader-Meunier, Gilles Blaison, Bernard Bonnotte, Patrice Cacoub, Sophie Caillard, Laurent Chiche, Olivier Chosidow, Nathalie Costedoat-Chalumeau, Claire Daien, Eric Daugas, Nairouz Derdèche, Andrea Doria, Olivier Fain, Fadi Fakhouri, Dominique Farge, Cem Gabay, Sylvie Guillo, Eric Hachulla, Najia Hajjaj-Hassouni, Mohamed Hamidou, Frédéric A. Houssiau, Noémie Jourde-Chiche, Isabelle Koné-Paut, Aïcha Ladjouz-Rezig, Olivier Lambotte, Dan Lipsker, Xavier Mariette, Nicolas Martin-Silva, Thierry Martin, François Maurier, Roderich Meckenstock, Arsène Mékinian, Olivier Meyer, Shirine Mohamed, Jacques Morel, Bruno Moulin, Denis Mulleman, Thomas Papo, Vincent Poindron, Xavier Puéchal, Leonardo Punzi, Pierre Quartier, Laurent Sailler, Amar Smail, Martin Soubrier, Agnès Sparsa, Zoubida Tazi-Mezalek, Leith Zakraoui, Stéphane Zuily, Jean Sibilia, Jacques-Eric Gottenberg
Background/PurposeDespite conventional immunosuppressants, active and steroid-dependent systemic lupus erythematosus (SLE) represents a therapeutic challenge. Only one biologic, belimumab, has been approved, but other biologics are sometimes used off-label. Given the lack of evidence-based data in some clinical situations encountered in real life, we developed expert recommendations for the use of biologics for SLE.MethodsThe recommendations were developed by a formal consensus method. This method aims to formalise the degree of agreement among experts by identifying, through iterative ratings with feedback, the points on which experts agree, disagree or are undecided. Hence, the recommendations are based on the agreed-upon points. We gathered the opinion of 59 French-speaking SLE experts from 3 clinical networks dedicated to systemic autoimmune diseases (FLEUR, IMIDIATE, FAI2R) from Algeria, Belgium, France, Italy, Morocco, Switzerland and Tunisia. Represented medical specialities were internal medicine (49%), rheumatology (34%), nephrology (7%), dermatology (5%), pediatrics (3%) and cardiology (2%). Two methodologists and 3 strictly independent SLE expert groups contributed to developing these recommendations: a steering group (SG) (n=9), an evaluation group (EG) (n=28) and a reading group (RG) (n=22). Preliminary recommendations were drafted by the SG, then proposed to the EG. Each EG member rated the degree of agreement from 1 to 9 (1: lowest; 9: strongest) for each recommendation. After 2 rating rounds, the SG submitted a new version of the recommendations to the RG. With comments from the RG, the SG finalised the recommendations.ResultsA total of 17 final recommendations were formulated by the SG, considering all agreement scores and comments by the EG and RG members and the two methodologists. These recommendations define the subset of patients who require a biologic; the type of biologics to use (belimumab, rituximab, etc.) depending on the organ involvement and associated co-treatments; what information should be given to patients; and how to evaluate treatment efficacy and when to consider discontinuation.ConclusionOverall, 17 recommendations for the good use of biologics in SLE were formulated by a large panel of SLE experts to provide guidance for clinicians in daily practice. These recommendations will be regularly updated according to the results of new randomized trials and increasing real life experience.
http://ift.tt/2oLyied
Assessment of factors influencing the within-batch seroprevalence of human enteropathogenic Yersinia spp. of pigs at slaughter age and the analogy with microbiology
The microbiologically and serologically-based prevalence of human enteropathogenic Yersinia spp. at moment of slaughter varies between pig farms due to different herd-level factors. A face-to-face questionnaire concerning a broad range of farm aspects (e.g., management and housing system, biosecurity, and hygiene measurements) was performed on one hundred farms. Factors influencing the seropositivity of 7047 pigs against human pathogenic Yersinia spp. were determined and compared to the microbiology. At the slaughterhouse, pieces of diafragm of on average 70 slaughter pigs per batch were sampled to determine the level of antibodies against enteropathogenic Yersinia spp. After univariable mixed effect logistic regressions, variables that were related to the seropositivity (p <0.05) were included in a multivariable model (p < 0.1). The factors remaining significantly associated in the latter model were an increasing number of piglet suppliers (zero up to eleven suppliers) (Odds Ratio = 1.4), a high density of pig farms in the area (high versus low density) (Odds Ratio =2.3), the use of semislatted floors in the fattening pig unit (semi slatted floor versus fully slatted floor) (Odds Ratio =3.8) and the possibility of snout contact in the fattening pig unit (snout contact or not) (Odds Ratio = 0.1). Decreasing the risk of infection with human enteropathogenic Yersinia spp. at moment of slaughter or during rearing is possible by changing farm management factors. (C) 2016 Elsevier B.V. All rights reserved.
http://ift.tt/2oLznm9
Social interactions in the Burkholderia cepacia complex : biofilms and quorum sensing
Burkholderia cepacia complex bacteria are opportunistic pathogens that cause respiratory tract infections in susceptible patients, mainly people with cystic fibrosis. There is convincing evidence that B. cepacia complex bacteria can form biofilms, not only on abiotic surfaces (e.g., glass and plastics), but also on biotic surfaces such as epithelial cells, leading to the suggestion that biofilm formation plays a key role in persistent infection of cystic fibrosis lungs. This article presents an overview of the molecular mechanisms involved in B. cepacla complex biofilm formation, the increased resistance of sessile B. cepacia complex cells and the role of quorum sensing in B. cepacia complex biofilm formation.
http://ift.tt/2oLgT5k
High-fiber and high-protein diets shape different gut microbial communities, which ecologically behave similarly under stress conditions, as shown in a gastrointestinal simulator
The aim of this work was to investigate the relationship between the structure of gut microbial communities fed with different diets (i.e. high-protein-HP-versus high-fiber-HF-diet) and their functional stability when challenged with mild and acute doses of a mix of amoxicillin, ciprofloxacin, and tetracycline. We made use of the Simulator of the Human Intestinal Microbial Ecosystem (SHIME (R))-a continuous model of the gastrointestinal tract-coupled with 16S-targeted Illumina and metabolomics (i.e. UHPLC-HRMS) analyses. Independently of the diet, the sudden exposure to an acute stress led to a modification of the microbial community structure, selecting for species belonging to Bacillus spp.; Clostridium cluster XIVa; Enterococci; Bacteroides; and Enterobacteriaceae. The antibiotic treatment led to a decrease in the number of operational taxonomic units (at least -10%). Cluster analysis of untargeted metabolic data showed that the antibiotic treatment affected the microbial activity. The impact on metabolites production was lower when the community was preexposed to mild doses of the antibiotic mix. This effect was stronger in the proximal colon for the HF diet and in the distal colon for the HP diet. Different diets shaped different gut microbial communities, which ecologically behaved similarly under stress conditions.
http://ift.tt/2pBEIKW
Proximal aortic stiffening in Turner patients may be present before dilation can be detected: a segmental functional MRI study
Background:To study segmental structural and functional aortic properties in Turner syndrome (TS) patients. Aortic abnormalities contribute to increased morbidity and mortality of women with Turner syndrome. Cardiovascular magnetic resonance (CMR) allows segmental study of aortic elastic properties. Method:We performed Pulse Wave Velocity (PWV) and distensibility measurements using CMR of the thoracic and abdominal aorta in 55 TS-patients, aged 13-59y, and in a control population (n= 38;12-58y). We investigated the contribution of TS on aortic stiffness in our entire cohort, in bicuspid (BAV) versus tricuspid (TAV) aortic valvemorphology subgroups, and in the younger and older subgroups. Results:Differences in aortic properties were only seen at the most proximal aortic level. BAV Turner patients had significantly higher PWV, compared to TAV Turner (p= 0.014), who in turn had significantly higher PWV compared to controls (p= 0.010). BAV Turner patients had significantly larger ascending aortic (AA) luminal area and lower AA distensibility compared to both controls (allp< 0.01) and TAV Turner patients. TAV Turner had similar AA luminal areas and AA distensibility compared to Controls. Functional changes are present in younger and older Turner subjects, whereas ascending aortic dilation is prominent in older Turner patients. Clinically relevant dilatation (TAV and BAV) was associated with reduced distensibility. Conclusion:Aortic stiffening and dilation in TS affects the proximal aorta, and is more pronounced, although not exclusively, in BAV TS patients. Functional abnormalities are present at an early age, suggesting an aortic wall disease inherent to the TS. Whether this increased stiffness at young age can predict later dilatation needs to be studied longitudinally.
http://ift.tt/2o3sEVV
Nocardia infection in solid organ transplant recipients : a multicenter European case-control study
Background. Nocardiosis is a rare, life-threatening opportunistic infection, affecting 0.04% to 3.5% of patients after solid organ transplant (SOT). The aim of this study was to identify risk factors for Nocardia infection after SOT and to describe the presentation of nocardiosis in these patients. Methods. We performed a retrospective case-control study of adult patients diagnosed with nocardiosis after SOT between 2000 and 2014 in 36 European (France, Belgium, Switzerland, the Netherlands, Spain) centers. Two control subjects per case were matched by institution, transplant date, and transplanted organ. A multivariable analysis was performed using conditional logistic regression to identify risk factors for nocardiosis. Results. One hundred and seventeen cases of nocardiosis and 234 control patients were included. Nocardiosis occurred at a median of 17.5 (range, 2-244) months after transplant. In multivariable analysis, high calcineurin inhibitor trough levels in the month before diagnosis (odds ratio [OR], 6.11; 95% confidence interval [CI], 2.58-14.51), use of tacrolimus (OR, 2.65; 95% CI, 1.17-6.00) and corticosteroid dose (OR, 1.12; 95% CI, 1.03-1.22) at the time of diagnosis, patient age (OR, 1.04; 95% CI, 1.02-1.07), and length of stay in the intensive care unit after SOT (OR, 1.04; 95% CI, 1.00-1.09) were independently associated with development of nocardiosis; low-dose cotrimoxazole prophylaxis was not found to prevent nocardiosis. Nocardia farcinica was more frequently associated with brain, skin, and subcutaneous tissue infections than were other Nocardia species. Among the 30 cases with central nervous system nocardiosis, 13 (43.3%) had no neurological symptoms. Conclusions. We identified 5 risk factors for nocardiosis after SOT. Low-dose cotrimoxazole was not found to prevent Nocardia infection. These findings may help improve management of transplant recipients.
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Comparison of the mechanical properties of different skin sites for auricular and nasal reconstruction
Autologous and synthetic nasal and auricular frameworks require skin coverage. The surgeon's decides on the appropriate skin coverage for reconstruction based on colour matching, subcutaneous tissue thickness,...
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Noninvasive Imaging Test Shown Accurate in Ruling out Kidney Cancers
The latest in a series of studies led by researchers at Johns Hopkins Medicine shows that addition of a widely available, noninvasive imaging test called 99mTc-sestamibi SPECT/CT to CT or MRI increases the accuracy of kidney tumor classification. The research team reports that the potential improvement in diagnostic accuracy will spare thousands of patients each year in the United States alone from having to undergo unnecessary surgery.
http://ift.tt/2pBcFOJ
Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis
This systematic review and meta-analysis examines the impact of quality improvement interventions on central line-associated bloodstream infections in adult intensive care units. Studies were identified through Medline and manual searches (1995-June 2012). Random-effects meta-analysis obtained pooled odds ratios (ORs) and 95% confidence intervals (CIs). Meta-regression assessed the impact of bundle/checklist interventions and high baseline rates on intervention effect. Forty-one before-after studies identified an infection rate decrease (OR, 0.39 [95% CI,.33-.46]; P <.001). This effect was more pronounced for trials implementing a bundle or checklist approach (P = .03). Furthermore, meta-analysis of 6 interrupted time series studies revealed an infection rate reduction 3 months postintervention (OR, 0.30 [95% CI,.10-.88]; P = .03). There was no difference in infection rates between studies with low or high baseline rates (P = .18). These results suggest that quality improvement interventions contribute to the prevention of central line-associated bloodstream infections. Implementation of care bundles and checklists appears to yield stronger risk reductions.
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Development of a definition for Rapid Progression (RP) of renal function in HIV-positive persons: the D:A:D study
Background: No consensus exists on how to define abnormally rapid deterioration in renal function (Rapid Progression, RP). We developed an operational definition of RP in HIV-positive persons with baseline estimated glomerular filtration rate (eGFR) >90 ml/min/1.73 m(2) (using Cockcroft Gault) in the Data Collection on Adverse Events of Anti-HIV Drugs (D: A: D) study from 2004 to 2011. Methods: Two definitions were evaluated; RP definition A: An average eGFR decline (slope) >= 5 ml/min/1.73 m(2)/year over four years of follow-up with >= 3 eGFR measurements/year, last eGFR <90 ml/min/1.73 m(2) and an absolute decline >= 5 ml/min/1.73 m(2)/year in two consecutive years. RP definition B: An absolute annual decline >= 5 ml/min/1.73 m(2)/year in each year and last eGFR <90 ml/min/1.73 m(2). Sensitivity analyses were performed considering two and three years' follow-up. The percentage with and without RP who went on to subsequently develop incident chronic kidney disease (CKD; 2 consecutive eGFRs <60 ml/min/1.73 m(2) and 3 months apart) was calculated. Results: 22,603 individuals had baseline eGFR >= 90 ml/min/1.73 m(2). 108/3655 (3.0%) individuals with >= 4 years' follow-up and >= 3 measurements/year experienced RP under definition A; similar proportions were observed when considering follow-up periods of three (n=195/6375; 3.1%) and two years (n=355/10756; 3.3%). In contrast under RP definition B, greater proportions experienced RP when considering two years (n=476/10756; 4.4%) instead of three (n=48/6375; 0.8%) or four (n=15/3655; 0.4%) years' follow-up. For RP definition A, 13 (12%) individuals who experienced RP progressed to CKD, and only (21) 0.6% of those without RP progressed to CKD (sensitivity 38.2% and specificity 97.4%); whereas for RP definition B, fewer RP individuals progressed to CKD. Conclusions: Our results suggest using three years' follow-up and at least two eGFR measurements per year is most appropriate for a RP definition, as it allows inclusion of a reasonable number of individuals and is associated with the known risk factors. The definition does not necessarily identify all those that progress to incident CKD, however, it can be used alongside other renal measurements to early identify and assess those at risk of developing CKD. Future analyses will use this definition to identify other risk factors for RP, including the role of antiretrovirals.
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Invasive aspergillosis in patients with cirrhosis, a case report and review of the last 10 years
Background: Untreated invasive aspergillosis (IA) is lethal, yet diagnosis is often delayed. Recognising the risk factors can lead to earlier diagnosis. We present a case of an invasive pulmonary aspergillosis in a patient with cirrhosis, who had been treated with corticosteroids for 2.5 weeks for alcoholic hepatitis. He was successfully treated with liposomal amphotericin B and caspofungin (first in combination, then caspofungin monotherapy). Purpose: to evaluate the role of aspergillosis in cirrhosis Methods: A literature search on aspergillosis in cirrhosis and liver failure patients was conducted in Pub-Med/Medline (2002-dec 2012), according to pre-set selection criteria. Results: 20 out of 330 articles were retrieved, representing 43 patients with cirrhosis and/or liver failure who had an aspergillosis infection. Most Aspergillus (A.) infections were due to A. fumigatus and the lungs were the most frequent organ involved (42/43). 58% of the patients used steroids and mortality was 53,5%. The most frequent used antifungal was caspofungin. Discussion: Diagnosis of IA is difficult and there might be a delay in diagnosis since cirrhosis is not recognised as one of the classical risk factors. Mortality was 53,5%, but this is lower than in previous decades. Since voriconazole is hepatotoxic, treatment with caspofungin and /or amphotericin is preferable. Conclusion: Early recognition of aspergillosis in a cirrhosis/liver failure patient is crucial and should prompt direct treatment.
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Seroepidemiological study of ovine toxoplasmosis in East and West Shewa Zones of Oromia Regional State, Central Ethiopia
Background: Toxoplasmosis is a globally distributed zoonosis. Consumption of raw or undercooked meat, which is among the main risk factors for acquiring human infection, is a popular tradition in Ethiopia. However, studies on toxoplasmosis in food animals used for human consumption in Ethiopia are very scarce. Thus, the objectives of the present study were to estimate the seroprevalence and the risk factors of T. gondii infection in sheep in Ambo, Ada'a-Liben and Fentale districts of Central Ethiopia. Sera from 1130 sheep were analyzed for Toxoplasma gondii specific IgG antibodies using an indirect enzyme linked immunosorbent assay (ELISA) with the P30 antigen. A questionnaire was administered to assess potential risk factors for T. gondii seropositivity. Association of seroprevalence with potential risk factors related to altitude, host and farm characteristics were analyzed by univariable and multivariable logistic regression. Results: Overall flock and animal level seroprevalences were 70.48% (160/227; 95% CI: 64.51, 76.46) and 31.59% (357/1130; 95% CI: 28.88, 34.31), respectively. The multivariable logistic regression model indicated that the probability of acquiring T. gondii was higher in sheep from highland (2300 - 3200 meters above sea level) [Odds ratio (OR) = 4.11, 95% confidence interval (CI): 2.65, 6.36; P < 0.001] and midland (OR = 4.54, 95% CI: 2.76, 7.49; P < 0.001) than from lowland (< 1500 meters above sea level), in females than in males (OR = 1.60, 95% CI: 1.04, 2.43, P = 0.033), in adult than in young animals (OR = 2.93, 95% CI: 1.97, 4.35, P < 0.001), in small than in large flocks (OR = 3.34, 95% CI: 1.26, 8.86, P = 0.016), and in sheep that were given tap water (OR = 4.07, 95% CI: 1.07, 15.42, P = 0.039) and river water (OR = 4.18, 95% CI: 1.54, 11.35, P = 0.005) than in those that drunk water from mixed sources (i.e., river, well, lake and pond). Conclusions: The high flock and animal level seroprevalence of toxoplasmosis in sheep is a good marker of the potential risk for human infections. Altitude, sex, age, flock size and source of water were identified as important risk factors to acquire the infection. Public education and awareness training are imperative in order to alleviate the danger posed to consumers. Further detailed studies to assess the impact of infections are warranted.
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Vaccination against herpes zoster and postherpetic neuralgia in France: a cost-effectiveness analysis
This study assesses the cost-effectiveness of vaccination against herpes zoster (HZ) and postherpetic neuralgia in France, using a published Markov model. The cost-effectiveness of vaccinating individuals aged from 65 years or between 70 and 79 years was evaluated over their lifetime, from a third-party payer perspective. French-specific data were combined with results from clinical studies and international quality-of-life-based (EuroQol five-dimension questionnaire) utilities from the literature. HZ vaccination was highly cost effective in both populations. Incremental cost-effective ratios were estimated between (sic)9513 and 12,304 per quality-adjusted life year gained, corresponding to (sic)2240-2651 per HZ case avoided and (sic)3539-4395 per postherpetic neuralgia case avoided. In addition to epidemiological and clinical evidence, economic evidence also supports the implementation of HZ vaccination in France.
http://ift.tt/2pRguMq
Can parenting practices explain the differences in beverage intake according to socio-economic status : the Toybox-Study
Previous research indicated that preschoolers of lower socioeconomic status (SES) consume less healthy beverages than high SES preschoolers. The purpose of this study is to investigate the mediating role of parenting practices in the relationship between SES and plain water, soft drink and prepacked fruit juice (FJ) consumption in European preschoolers. Parents/caregivers of 3.5 to 5.5 years old (n = 6776) recruited through kindergartens in six European countries within the ToyBox-study completed questionnaires on socio-demographics, parenting practices and a food frequency questionnaire. Availability of sugared beverages and plain water, permissiveness towards sugared beverages and lack of self-efficacy showed a mediating effect on SES-differences in all three beverages. Rewarding with sugared beverages significantly mediated SES-differences for both plain water and prepacked FJ. Encouragement to drink plain water and awareness significantly mediated SES-differences for, respectively, plain water and prepacked FJ consumption. Avoiding negative modelling did not mediate any associations. Overall, lower SES preschoolers were more likely to be confronted with lower levels of favourable and higher levels of unfavourable parenting practices, which may lead to higher sugared beverage and lower plain water consumption. The current study highlights the importance of parenting practices in explaining the relation between SES and both healthy and unhealthy beverage consumption.
http://ift.tt/2oNsaAh
Complete Ectopia Cordis: A Case Report and Literature Review
Ectopia cordis is a congenital heart exposure defined as complete or partial protrusion of heart through ventral defect in the thoracoabdominal wall alone or with other viscera in cases of pentalogy of Cantrell. This condition was first described by Haller et al. in 1706; since then many advances have been made. Diagnosis of ectopia cordis is done prenatally in well-equipped health facility by antenatal ultrasound scan so that early diagnosis and management plan can be initiated. The index case was delivered to uneducated rural family and admitted at 3 days of life and survived for seven days, even though most literatures state that majority died within four days even with surgery. So, in view of this, we presented this case report to deliberately draw the attention of paediatrician/obstetrician to the fact that even though this condition is rare, proactive search and diagnosis should be made and early treatment should be instituted, so that such a child may be salvaged.
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Clinical phenotypes in asthma during childhood
Abstract
In the 21st century, the heterogeneity of asthma and allergic diseases in childhood will be characterized by multiple phenotypes related to different pathophysiologic pathways or endotypes. From a medical point of view, improved understanding of disease etiology and mechanisms will lead to optimal management including personalized targeted treatment.
This article is protected by copyright. All rights reserved.
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Multilayer Optimisation for Day-Ahead Energy Planning in Microgrids
In the search for low carbon, reliable and affordable ways to provide electricity, an increased attention is going to the microgrid, a small-scale power system that uses a combination of energy generation and storage devices to serve local customers. The most promising feature of the microgrid is its flexibility to act as a standalone source of electricity for remote communities, and to be connected to the main power system, selling and purchasing power as required. Additionally, a microgrid can be considered as a coordinated system approach for incorporating intermittent renewable sources of energy. Microgrid customers can have power from their batteries or distributed generators, they can buy it from the utility grid, or they can reduce their consumption.When designing a new optimal planning tool for a microgrid, a major challenge (and opportunity) is to decide on what units to operate in order to meet the demand. The question is what mix will provide the performance needed at the lowest cost, or with the lowest possible emissions. Unfortunately, both objectives are often contradictory. Generally, low costs mean high emissions, and vice versa. A microgrid system operator may care more about achieving lower costs rather than lower emissions. Given the preferences, the operator needs to decide how to configure and operate the microgrid while satisfying all technical requirements, such as voltage stability and power balance. In order to control and manage the microgrid units in real-time while fully exploiting the benefit of long-term prediction, an off-line optimisation approach imposes itself to devise the online microgrid management. In this PhD thesis, an efficient multilayer control approach is developed which obtains a day-ahead unit commitment method to provide an economically and environmentally viable unit commitment (UC) that is physically feasible in terms of voltage violations. With the multilayer control approach, the future operational states of the controllable units within the microgrid are determined ahead of time. The proposed concept follows the idea of a day-ahead coordination including the unit commitment problem (scheduling layer), an off-line power flow calculation (executive layer) and a security check with feedback control (adjustment layer). Since the complete multilayer control concept works on a day-ahead time scale, the model can be considered as an off-line optimisation approach. The power reference set points provided by the multilayer control approach can, in turn, be used for an online microgrid implementation to achieve real-time system state updates.
http://ift.tt/2pATPHI
Sensitivity of ultrasound screening for congenital anomalies in unselected pregnancies
Objective: To assess the influence of heart defect frequency and severity on screening sensitivity of the entire spectrum of congenital anomalies (CA) and on detection rate of congenital heart defect (CHD) when performing routine ultrasound screening in unselected pregnant women. Study design: Secondary analysis was performed on data from Eurofetus, a large international collaborative study of ultrasound screening for CA in unselected populations. The present study addressed the relations (i) between the frequency of CHD in the screened population and the global sensitivity of ultrasound in detecting CA; (ii) between frequency of ventricular septum defect (VSD) and detection rate of CA and CHD; and (iii) between seriousness of CHD and CHD sensitivity. Results: A negative correlation (p<0.001) between CHD frequency and CA sensitivity was observed in this study. Likewise, a negative correlation was also found between frequency of VSD and sensitivity for CA or CHD detection (p<0.001). In addition, a positive significant relationship (p<0.001) was observed between sensitivity and severity of CHD. Conclusion: A low CHD frequency introduces bias in CA and CHD sensitivity evaluation. Incomplete assessment of fetal and neonatal malformations brings on systematic error, leading to the pre-eminence of severe defects in the studied population sample and artificially improving sensitivity figures. On the other hand, from a clinician's viewpoint, the higher sensitivity for severe defect is welcomed, since their detection is most crucial for appropriate management.
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A Young Man With Proptosis Causing Decreased Visual Acuity.
A Young Man With Proptosis Causing Decreased Visual Acuity.
JAMA Otolaryngol Head Neck Surg. 2017 Apr 13;:
Authors: Ghulmiyyah JM, Khademian ZP, Reilly BK
PMID: 28418522 [PubMed - as supplied by publisher]
http://ift.tt/2ommOLr
Association of Preoperative Calcium and Calcitriol Therapy With Postoperative Hypocalcemia After Total Thyroidectomy.
Association of Preoperative Calcium and Calcitriol Therapy With Postoperative Hypocalcemia After Total Thyroidectomy.
JAMA Otolaryngol Head Neck Surg. 2017 Apr 13;:
Authors: Maxwell AK, Shonka DC, Robinson DJ, Levine PA
Abstract
Importance: Hypocalcemia is the most common complication after total thyroidectomy and can result in prolonged hospital admissions and increased hospital charges.
Objective: To determine the effectiveness of preoperative calcium and calcitriol supplementation in reducing hypocalcemia following total thyroidectomy.
Design, Setting, and Participants: A retrospective cohort study was conducted at a tertiary care center in 65 patients undergoing total thyroidectomy by a single surgeon. Patients were divided into 2 groups: those receiving preoperative as well as postoperative supplementation with calcium carbonate, 1000 to 1500 mg, 3 times daily and calcitriol, 0.25 to 0.5 µg, twice daily, and those receiving only postoperative supplementation with those agents at the same dosages. Data on patients who underwent surgery between January 1, 2008, and December 31, 2011, were acquired, and data analyses were conducted from March through June 2012, and from October through December 2016.
Interventions: Calcium and calcitriol therapy.
Main Outcomes and Measures: Postoperative serum calcium levels and development of postoperative hypocalcemia.
Results: Of the 65 patients who underwent total thyroidectomy 27 (42%) were men; mean (SD) age was 49.7 (16.7) years. Thirty-three patients received preoperative calcium and calcitriol supplementation, and 32 patients received only postoperative therapy. In the preoperative supplementation group, 15 of 33 (45%) patients underwent complete central compartment neck dissection and 11 of 33 (33%) had lateral neck dissection, compared with 16 of 32 (50%) and 12 of 32 (38%), respectively, patients without preoperative supplementation. The mean measured serum calcium level in those without preoperative supplementation vs those with supplementation are as follows: preoperative, 9.6 vs 9.4 mg/dL (absolute difference, 0.16; 95% CI, -0.12 to 0.49 mg/dL); 12 hours postoperative, 8.3 vs 8.6 mg/dL (absolute difference, -0.30; 95% CI, -0.63 to 0.02 mg/dL); and 24 hours postoperative, 8.4 vs 8.5 mg/dL (absolute difference, -0.13; 95% CI, -0.43 to 0.16 mg/dL). In patients not receiving preoperative supplementation, 5 of 32 (16%) individuals became symptomatically hypocalcemic vs 2 of 33 (6%) in the preoperative supplementation group; an absolute difference of 10% (95% CI, -6.6% to 26.3%). Compared with the group not receiving preoperative supplementation, the mean [SD] length of stay was significantly shorter in the preoperative supplementation group (3.8 [1.8] vs 2.9 [1.4] days; absolute difference, -0.9; 95% CI, -1.70 to -0.105 days). Preoperative supplementation resulted in an estimated $2819 savings in charges per patient undergoing total thyroidectomy.
Conclusions and Relevance: Preoperative calcium and calcitriol supplementation, in addition to routine postoperative supplementation, was associated with a reduced incidence of symptomatic hypocalcemia, length of hospital stay, and overall charges following total thyroidectomy.
PMID: 28418509 [PubMed - as supplied by publisher]
http://ift.tt/2o2HRX2
Association of Oral Cavity and Oropharyngeal Cancer Biomarkers in Surgical Drain Fluid With Patient Outcomes.
Association of Oral Cavity and Oropharyngeal Cancer Biomarkers in Surgical Drain Fluid With Patient Outcomes.
JAMA Otolaryngol Head Neck Surg. 2017 Apr 13;:
Authors: Lassig AAD, Joseph AM, Lindgren BR, Yueh B
Abstract
Importance: Survival rates for head and neck cancer have been relatively stable for several decades. Individualized prognostic indicators are needed to identify patients at risk for poorer outcomes.
Objective: To determine whether biomarker levels in surgical drain fluid of patients with head and neck cancer are associated with poor cancer outcomes.
Design, Setting, and Participants: This prospective cohort study enrolled patients with squamous cell carcinoma (SCC) of the oral cavity and oropharynx who required surgical treatment from April 1, 2011, to February 1, 2016, at a tertiary or academic care center. Twenty patients, including 14 with stage IV disease, had complete specimen collection. Differences in cytokine and MMP levels by disease outcomes were evaluated.
Interventions: Patients underwent surgical treatment with drain placement as dictated by the standard of care. Drain fluid samples were collected every 8 hours postoperatively until drains were removed because of clinical criteria. Levels of cytokines and matrix metalloproteinases (MMPs) were measured using electrochemiluminescent, patterned array, multiplex technology.
Main Outcomes and Measures: The primary clinical outcome measures were survival outcome and recurrence. The biomarkers measured included the cytokines basic fibroblastic growth factor, vascular endothelial growth factor isoform A, soluble fms-like tyrosine kinase-1 (sFlt-1), and placental growth factor (PIGF) and MMP-1, MMP-3, and MMP-9. Other clinical and pathologic cancer characteristics were recorded.
Results: In this cohort of 20 patients with SCC (15 men and 5 women; mean [SD] age, 63.5 [9.9] years), a significant association with recurrence was found for levels of MMP-1 (relative difference between groups, 2.78; 95% CI, 1.23-6.29), MMP-3 (relative difference between groups, 5.29; 95% CI, 2.14-13.05), and sFlt-1 (relative difference between groups, 3.75; 95% CI, 1.84-7.65). No biomarkers were associated with disease outcome. Vascular endothelial growth factor isoform A was associated with nodal metastasis (relative difference between groups, 1.98; 95% CI, 1.12-3.51), and basic fibroblastic growth factor was associated with lymphovascular invasion (relative difference between groups, 1.74; 95% CI, 1.02-2.97).
Conclusions and Relevance: In this pilot sample of patients with SCC of the oral cavity and oropharynx, MMP-1, MMP-3, and sFlt-1 levels in wound fluid were associated with poor clinical cancer outcomes in the form of recurrence. This finding is consistent with the literature of tumor microenvironment in saliva, serum, and tumor tissue biomarkers. To our knowledge, this report is the first of such findings in surgical drain fluid, an easily accessible means of cytokine measurement. Measurement of these biomarkers in surgical fluid potentially represents a novel means of assessing cancer prognosis in this population.
PMID: 28418447 [PubMed - as supplied by publisher]
http://ift.tt/2oml5Wr
Inaugural Symposium on Advanced Surgical Techniques in Adult Airway Reconstruction: Proceedings of the North American Airway Collaborative (NoAAC).
Inaugural Symposium on Advanced Surgical Techniques in Adult Airway Reconstruction: Proceedings of the North American Airway Collaborative (NoAAC).
JAMA Otolaryngol Head Neck Surg. 2017 Apr 13;:
Authors: Daniero JJ, Ekbom DC, Gelbard A, Akst LM, Hillel AT
PMID: 28418443 [PubMed - as supplied by publisher]
http://ift.tt/2o2GZ4Z
Efficacy and tolerance of ruxolitinib in refractory sclerodermatous chronic Graft-Versus-Host Disease
Abstract
Chronic graft-versus-host disease (cGVHD) is frequent and severe after allogeneic hematopoietic stem cell transplantation (AHSCT), with unmet therapeutic needs.1 A recent retrospective study has shown the potential efficacy of ruxolitinib, a selective Janus Kinase (JAK) 1/2 inhibitor, for the treatment of acute (n=54) and chronic GVHD (n=41) with a 81.5% and 85.4% overall response rate for acute and chronic GVHD respectively.3 There are no specific studies evaluating the efficacy of ruxolitinib in sclerodermatous skin cGVHD, a rare and difficult-to-treat form of cGVHD.
This article is protected by copyright. All rights reserved.
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Mythologie voor christenen en Bijbels in hexameters. Eruditie en traditie in de late oudheid.
When pagan religion 'lost' and Christianity 'won' – the reign of Theodosius (384-392) was an important turning point – the cultural, religious and symbolical status of the pagan Greco-Roman gods arguably changed. Today, they are part of our cultural heritage, without any religious connotations. But how did Christians in Late Antiquity deal with the heritage of their still omnipresent past? A closer look at the literature from this period of change (4th-6th century AD) can offer a – partial – answer, but only when Christian and 'pagan' (or better 'secular') literature are studied together and in relation to one another. Nonnus of Panopolis (5th AD) is an interesting case. He wrote a 48-book epic poem on the God Dionysus and a hexametrical Paraphrase of the gospel of John. Can Dionysus represent Christ? Or is Nonnus' interest in mythology (like ours) purely antiquarian? What is the effect of the Gospel's transformation into an epic poem? This contribution combines a central focus on Nonnus with a few explorations of the broader Late Antique (Greco-Roman) context.
http://ift.tt/2pAyGNx
Werknemersfraude, de privédetective en het privaat onderzoek in België
Werknemersfraude, de privédetective en het privaat onderzoek in België
http://ift.tt/2pBhMeT
Immunostaining for Hu C/D and CD56 is useful for a definitive histopathological diagnosis of congenital and acquired isolated hypoganglionosis
Abstract
Isolated hypoganglionosis (IHG) has been proposed as a distinct entity with two subtypes: congenital IHG (CIHG) and acquired IHG (AIHG). However, due to the rarity of the disease and the lack of defining histological criteria, the concept of IHG is not widely accepted. We studied paraffin-embedded intestinal specimens from 79 patients diagnosed with Hirschsprung's disease (HD) (n = 49), CIHG (n = 25), and AIHG (n = 5) collected between January 1996 and December 2015. Histopathological diagnosis of HD, CIHG, and AIHG was confirmed by hematoxylin and eosin staining and immunohistochemical staining using Hu C/D and CD56. We evaluated (immuno)histopathological findings, counted the number of ganglion cells, and measured the size of Auerbach's plexus. Hu C/D labeled neuronal cell bodies, whereas CD56 was detected in all neuronal components. In HD, all ganglion cells in Auerbach's plexus in the normoganglionic segment (NGS) were immunoreactive for Hu C/D, whereas in the aganglionic segment (AGS), these were replaced by CD56-positive extrinsic nerve fibers and bundles. The number of ganglion cells in AIHG and CIHG was significantly lower than in the NGS of HD (p < 0.05). Auerbach's plexus was significantly smaller in CIHG (p < 0.05) but in AIHG equivalent to the NGS in HD. In summary, immunostaining for Hu C/D and CD56 is useful for definitive histopathological diagnosis of IHG.
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Is tumor cellularity in primary invasive breast carcinoma of prognostic significance?
Abstract
Many methods of analysis to predict survival of invasive mammary carcinoma in the post-neoadjuvant setting utilize tumor cellularity alone or in combination with other tumor features. The goal of this study was to evaluate the prognostic value of tumor cellularity in primary non-treated carcinoma. We used 366 cases of invasive breast carcinoma to determine invasive tumor cellularity (%) by reviewing a representative excisional tumor section and correlated this with breast cancer recurrence (BCR) and overall mortality (OM). Mean patient age was 58 years (range, 21–91) and median follow-up was 87 months (range, 0.7–165). Of the cases, 25% were Nottingham grades I, 41% grade II, and 32% grade III. The Nottingham Prognostic Index (NPI) ranged from 2.06 to 6.8 (mean 3.93). Estrogen receptor was positive in 66% and negative in 25% of cases. Cellularity ranged from 2 to 99% (mean 47.6%). The OM hazard ratio increased by 1.73 for every unit increase in NPI (P < 0.00005; 95% confidence interval 1.45–2.05) The BCR hazard ratio increased by 2.011 for every unit increase in NPI BCR (P < 0.00005; 95% confidence interval 1.62–2.50). Cellularity, unadjusted for other covariates, was not significantly associated with either OM or BCR. When adjusted for NPI, cellularity still showed no significant relation to OM or BCR. The same analysis performed on estrogen receptor-positive and estrogen receptor-negative subgroups continued to show no relation between cellularity and OM or BCR. In conclusion, despite its utility in the neoadjuvant setting, we were unable to show that cellularity is predictive of survival in primary breast carcinomas.
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Prediction of distant metastases from nasopharyngeal carcinoma: Improved diagnostic performance of MRI using nodal volume in N1 and N2 stage disease
Source:Oral Oncology, Volume 69
Author(s): Qi-Yong Ai, Ann D. King, Frankie K.F. Mo, Benjamin King Hong Law, Kunwar S. Bhatia, Brigette B. Ma, Darren M.C. Poon, Michael K.M. Kam
PurposeTo determine if the magnetic resonance imaging (MRI) of the head and neck can predict distant metastases (DM) from nasopharyngeal carcinoma (NPC).Methods and materialsMRI examinations of 763 NPC patients were assessed for primary tumour stage (T), nodal stage (N), primary tumour volume (PTV) and total nodal volume (NV). The association between MRI and clinical parameters were examined in DM+ and DM− patients using logistic regression and for distant metastases free survival (DMFS) using cox regression. Optimum thresholds were assessed by receiver-operating characteristics analysis, and positive predictive value (PPV) and odds ratio (OR) calculated.ResultsDistant metastases were present in 181/763 NPC patients (23.7%). Higher N stage and NV were the independent predictors of DM (p<0.001 and 0.018 respectively) and poor DMFS (p=0.001 and 0.030 respectively). Addition of NV (threshold≥32.8cm3) to the N stage improved the PPVs and ORs for DM in stage N1 (from 18.9% to 31.8% and 5.613 to 11.133 respectively) and stage N2 (from 40.4% to 60.8% and 16.189 to 36.979 respectively) but not in stage N3 (68.3% to 68.6% and 51.385 to 52.052 respectively).ConclusionMRI N stage and NV were independent predictors of DM and DMFS. The addition of NV in NPC patients with bulky N1 and N2 disease improved the ability of MRI to predict DM.
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CXCR6 gene characterization in two ethnically distinct South African populations and association with viraemic disease control in HIV-1-infected black South African individuals
Source:Clinical Immunology
Author(s): Anabela C.P. Picton, Maria Paximadis, Richard E. Chaisson, Neil A. Martinson, Caroline T. Tiemessen
CXCR6 genetic variation was described for HIV-1-uninfected black (n=41) and Caucasian (n=40) South Africans. We also investigated the CXCR6 rs2234358 and rs2234355 single nucleotide polymorphisms in HIV-1 disease control in 124 HIV-1-infected drug-naïve black individuals [elite controllers (n=11), viraemic controllers (VCs, n=30), high viral load long-term nonprogressors (HVL LTNPs, n=11) and progressors (n=72)] compared to healthy controls (HCs; n=232). The rs2234358-T allele was underrepresented in VCs (40.0%) compared to HCs (59%, P=0.006), HVL LTNPs (72.7%, P=0.012) and progressors (59%, P=0.014). The rs2234358-TT genotype was underrepresented in VCs (7%) compared to progressors (32%; OR=6.57, P=0.006) and HCs (35%; OR=7.18, P=0.001, Pbonferroni=0.034). The rs2234355-GA genotype was overrepresented in VCs (80%) compared to HCs (50.4%; OR=0.25, P=0.003) and progressors (29.17%; OR=0.10, P=3.8×10−5, Pbonferroni=0.001). The combination of rs2234355-GA in the absence of rs2234358-TT was overrepresented in VCs (80%) compared to HCs (32.6%, OR=0.12, P=1×10−6, Pbonferroni=3.4×10−5) and to progressors (16.7%; OR=0.05, P<1×10−8, Pbonferroni<1×10−7).
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Subclinical lower airways correlates of chronic allergic and non-allergic rhinitis
Summary
The upper and lower airways behave as a physiological and pathophysiological unit. Subclinical lower airways abnormalities have been described in patients with rhinitis without asthma. These are expressed as bronchial hyperreactivity, abnormalities in lung function and bronchial inflammation, likely as a result of the same phenomenon with systemic inflammatory impact that reaches both the nose and the lungs, which for unknown reasons does not always have a full clinical expression.
Patients with rhinitis are at increased risk of developing asthma; therefore most authors suggest a careful clinical evaluation and monitoring of these patients, especially if symptoms related to inflammation in the lower airways are observed.
Although current treatments, such as H1-antihistamines, intranasal steroids and allergen immunotherapy are quite effective for the management of rhinitis, it is difficult to prove their capacity to prevent asthma among subjects with rhinitis. Evidence showing that the treatment of rhinitis has a favorable impact on indicators of bronchial hyperreactivity and inflammation among subjects that have no symptoms of asthma, is more frequently described.
In this review we address the frequency and characteristics of lower airway abnormalities in subjects with rhinitis, both in pediatric and adult populations, their likely predictive value for the development of asthma and the possibilities for therapeutic intervention that could modify the risk of subjects with rhinitis towards presenting asthma.
This article is protected by copyright. All rights reserved.
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Evaluation of the Reliability of the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) and the Cutaneous Assessment Tool Binary Method (CAT-BM) in Juvenile Dermatomyositis Among Pediatric Dermatologists, Rheumatologists, and Neurologists
Abstract
Background
The Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) and Cutaneous Assessment Tool-Binary Method (CAT-BM) have been shown to be reliable and valid outcome measures to assess cutaneous disease in adult dermatomyositis (DM) and juvenile DM (JDM), respectively.
Objective
This study compared the CDASI and CAT-BM for use by pediatric dermatologists, pediatric rheumatologists, and pediatric neurologists in patients with JDM.
Methods
Five pediatric dermatologists, five pediatric rheumatologists, and five pediatric neurologists each evaluated 14 patients with JDM using the CDASI, CAT-BM, and skin Physician Global Assessment (PGA) scales. Inter-rater, intra-rater reliability, construct validity, and completion time were compared.
Results
Inter-rater reliability for CDASI activity and damage scores was good to moderate for pediatric dermatologists and rheumatologists, but poor for pediatric neurologists. The inter-rater reliability for CAT-BM activity scores was moderate for pediatric dermatologists and rheumatologists, but poor for pediatric neurologists and poor across all specialties for damage scores. Intra-rater reliability for the CDASI and CAT-BM activity and damage scores was moderate to excellent for pediatric dermatologists, rheumatologists, and neurologists. Strong associations were found between skin PGA activity and damage scores and CDASI or CAT-BM activity and damage scores, respectively (p<0.002). The CDASI had a mean completion time of 5.4 minutes versus the CAT-BM of 3.1 minutes.
Conclusions
Our data confirm the reliability of the CDASI activity and damage scores and the CAT-BM activity scores when used by pediatric dermatologists and rheumatologists in assessing JDM. Significant variation existed in the pediatric neurologists' scores.
This article is protected by copyright. All rights reserved.
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Analysis of an electrical impedance spectroscopy system in short-term digital dermoscopy imaging of melanocytic lesions
Abstract
Background
Electrical impedance spectroscopy (EIS) is a non-invasive diagnostic technique that measures tissue impedance.
Objectives
This prospective study, conducted at 2 centres in Australia, aimed to evaluate the effect of adding an EIS measurement at baseline to suspicious melanocytic lesions undergoing routine short-term sequential digital dermoscopy imaging (SDDI)
Methods
Patients presented with suspicious melanocytic lesions that were eligible for short-term SDDI (with no clear feature of melanoma on dermoscopy). The EIS measurement was performed at the first visit following the dermoscopic photography. Normally, an EIS score of ≥4 is considered positive whereas this protocol investigated a higher cut-off in combination with SDDI. When the EIS score was ≥7 the lesion was excised immediately due to the high risk of melanoma. Lesions with a score <7 were monitored with standard SDDI over a 3 month period.
Results
From a total of 160 lesions analysed, 128 of 154 benign lesions received an EIS score of 0-6, giving a specificity of the EIS method for the diagnosis of melanoma of 83.1% (95% CI:76.3-88.7). Five of the six melanomas found in this study had an EIS score ≥7, with a sensitivity for melanoma diagnosis of 83.3% (95% CI:35.9-99.6).
When EIS 0-6 lesions were subsequently followed up with SDDI, one additional melanoma was detected (EIS=6) giving the sensitivity for the diagnosis of melanoma overall of 100%: 95% CI:54.1-100 (6/6 MM excised) and the specificity 69.5%: 95% CI:61.5 to 76.6 (107/154 benign lesions not excised).
Conclusion
If utilizing a protocol where an EIS score ≤3 requires no SDDI and ≥7 requires immediate excision this reduced the need for SDDI by 46.9% (75/160): 95% CI:39.0-54.9.
This article is protected by copyright. All rights reserved.
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Fluorescence-Advanced-Videodermatoscopy (FAV): a new method for in-vivo skin evaluation
Abstract
Dermatoscopy is a non-invasive technique that allows a rapid and magnified in-vivo observation of the skin 1–3. Manual dermatoscopy uses optical systems that work by modifying the cutaneous air-tissue optical interference 1. Videodermatoscopy, on the other hand, is supported by digital systems allowing an image acquisition at higher magnification.
This article is protected by copyright. All rights reserved.
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Microbially managed organic growing media for greenhouse horticulture
The production of vegetables in growing media is an efficient way to produce vegetables in soilless culture systems. The management of the microbial community associated with growing media may serve as potential sustainable pathway to increase eco-efficiency. Consequently, it is important to find out how biotic and abiotic factors affect the composition and diversity of microbial communities associated with growing media. The aim of this PhD thesis was to study the ecology of the microbial community in soilless culture systems. First, the microbial community of a mineral and an organic growing medium was examined and it was found that both growing media have a distinct, microbial community structure. Second, key functionalities of growing media and their individual constituents were quantified. Particularly, the nitrogen dynamics were studied in relation to the microbial community associated with plant and growing medium. Third, the valorization of recycled nutrients as a high-value microalgae fertilizer and struvite was investigated. In addition, an adapted fertigation strategy in combination with organic fertilizers was developed to narrow the yield gap with a pure mineral growing medium when cultivating tomatoes. Afterwards, the microbial community structure of four contrasting soil and soilless tomato cultivating systems were studied. Finally, the effect of fertilizers and plant type on the microbial community structure of the rhizosphere and the bulk zone were investigated. Overall, organic growing media show a potential for developing novel cultivating systems fitting into a more sustainable horticulture.
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