High-risk cutaneous squamous cell carcinoma in a Japanese allogeneic bone marrow transplant recipient on long-term voriconazole

Abstract

Cutaneous squamous cell carcinomas arise as secondary cancers in hematopoietic stem cell transplant survivors. They have been documented primarily in Western cohorts and relatively little is known about their occurrence in Asian hematopoietic stem cell transplant recipients, with no reports of squamous cell carcinomas with high-risk features in Asian patients. We describe a case of a cutaneous squamous cell carcinoma with high-risk features on the scalp of a Japanese bone marrow transplant recipient approximately 6.5 years post-transplant, who was on long-term voriconazole. The history of a photodistributed erythema followed by the appearance of multiple actinic keratoses and solar lentigines, together with the rarity of cutaneous squamous cell carcinomas in Asian hematopoietic stem cell transplant cohorts revealed in our literature review, suggest that voriconazole use contributed to the development of high-risk squamous cell carcinoma in our patient.

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Phosphorylated signal transducer and activator of transcription 3 in the epidermis in adult-onset Still's disease

Abstract

Adult-onset Still's disease (AOSD) is characterized by multiple systemic inflammation of unknown etiology. Although the typical eruption of AOSD is salmon-pink rheumatoid rash on the trunk and extremities, persistent pruritic papules and plaques have also been reported. Correlations between serum cytokines, including interleukin-6 and -18, and disease activity in AOSD have been reported. Activated signal transducer and activator of transcription 3 (STAT3) is transported into the nucleus, where it functions as a transcription factor that regulates genes involved in cell survival and inflammation. To assess whether STAT3 was phosphorylated in skin samples from AOSD patients, we conducted immunohistochemical analysis of affected and unaffected lesions from four AOSD patients in comparison with 10 normal controls. Quantitative analysis was conducted by measuring the ratio of epidermal keratinocytes with phosphorylated STAT3 (p-STAT3)-positive nuclei to total epidermal keratinocytes. p-STAT3 was found to be more strongly expressed in the nuclei in the epidermis of AOSD than in normal controls. Quantification of the data revealed significant differences in staining for p-STAT3 between AOSD and normal skin. Our findings suggest that phosphorylation of STAT3 may be a potential therapeutic target for AOSD.

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Mycobacterium tuberculosis found at both skin lesions and Mantoux testing site in a patient with erythema induratum of Bazin

Abstract

Mycobacterium tuberculosis is very rarely found in erythema induratum of Bazin; recently, we found an unusual case with positive acid-fast bacilli and polymerase chain reaction for detecting M. tuberculosis in both skin lesions of the extremities and the site of Mantoux test.

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Food-dependent exercise-induced anaphylaxis due to shrimp associated with 43 kDa, a new antigen

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Gnathostomiasis caused by ingestion of raw Oncorhynchus masou ishikawae roe

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Case of reticulated acanthoma with sebaceous differentiation with clinicopathological surveillance

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Typical Chinese pedigree of autosomal dominant genetic disease: Neurofibromatosis type 1 with a novel frame-shift mutation

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Information for Readers

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5





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Table of Contents

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5





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Cost and health care utilization in patients with asthma and high oral corticosteroid use

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Michael S. Broder, Karina Raimundo, Ka Ming Ngai, Eunice Chang, Noelle M. Griffin, Liam G. Heaney




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Instructions for Authors

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5





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Editorial Board

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5





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Can we effectively use radiographic imaging and clinical parameters for making an earlier diagnosis of granulomatous interstitial lung disease in patients with common variable immunodeficiency?

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Terry Harville




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Allergenic extracts to diagnose and treat sensitivity to insect venoms and inhaled allergens

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Taruna Khurana, Jennifer L. Bridgewater, Ronald L. Rabin
ObjectiveTo review allergenic extracts used to diagnose or treat insect allergies, including how the extracts are manufactured and their measurements of potency or concentration.Data SourcesPeer-reviewed articles derived from searching PubMed (National Center for Biotechnology Information) about insect allergies and extract preparation. Encyclopedia of Life (http://www.eol.org/) and http://allergome.org/ were also referenced for background information on insects and associated allergens.Study SelectionsSearch terms used for the PubMed searches included insect allergens and allergies, Apidae, Vespidae, fire ants, cockroach allergies, insect allergen extract preparation, and standardization.ResultsHumans may be sensitized to insect allergens by inhalation or through stings. Cockroaches and moths are predominantly responsible for inhalation insect allergy and are a major indoor allergen in urban settings. Bees, fire ants, and wasps are responsible for sting allergy. In the United States, there are multiple insect allergen products commercially available that are regulated by the US Food and Drug Administration. Of those extracts, honeybee venom and insect venom proteins are standardized with measurements of potency. The remaining insect allergen extracts are nonstandardized products that do not have potency measurements.ConclusionSensitization to inhalational and stinging insect allergens is reported worldwide. Crude insect allergen extracts are used for diagnosis and specific immunotherapy. A variety of source materials are used by different manufacturers to prepare these extracts, which may result in qualitative differences that are not reflected in measurements of potency or protein concentration.



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Penicillin desensitization: Treatment of syphilis in pregnancy in penicillin-allergic patients

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Michele N. Pham, Hsi-en Ho, Mauli Desai




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Clinical characteristics of patients with chronic obstructive pulmonary disease overlapped with bronchial asthma

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Jing-bo Liang, Li-jin Liu, Qiu-hong Fang
BackgroundThe clinical characteristics of patients with chronic obstructive pulmonary disease overlapped with bronchial asthma (COPD-BA) have not been discussed thoroughly.ObjectiveTo reveal the clinical features of patients with COPD-BA, to evaluate the risk factors of COPD-BA, and to provide suggestions for COPD individualized therapy.MethodsA retrospective observational study was performed. A total of 182 patients with COPD (90 with COPD-BA and 92 with pure COPD) were recruited in the study. Information on the following items was collected: demographics, clinical manifestations, complications, laboratory findings, other histories, and inpatient treatments during exacerbation.ResultsA total of 182 patients were diagnosed with COPD, with 90 (49.45%) being classified as having COPD-BA. Patients with COPD-BA were more likely to be female (P = .004) and experienced more severe respiratory exacerbations (P = .04) despite being younger (P = .008). Those patients at onset of recurrent cough and sputum production were younger (P = .001). Significantly, a positive asthmatic family history (P = .03) was observed. Patients with COPD-BA usually had higher level of total serum IgE (although no differences were observed), had higher positive rates of the serum specific IgE (P = .004), and were more like to have an allergic history (P = .003). Allergic factor was the risk factor of COPD-BA (odds ratio, 4.477). During hospitalization, patients with COPD-BA tended to be treated with systemic corticosteroids (P = .008).ConclusionPatients with COPD-BA were characterized by persistent airflow limitation with unique clinical features. Allergic factor was associated with the presence of asthmatic characteristics in patients with COPD. When hospitalized for exacerbation, the individualized therapy for COPD-BA might include the use of corticosteroids systemically.



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How does autism spectrum disorder affect the risk and severity of childhood asthma?

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Urður Jónsdóttir, Jason E. Lang
BackgroundAutism spectrum disorder (ASD) and asthma are among the most common chronic disorders in childhood. Both are associated with altered immune regulation and share several risk factors. The effects of ASD on risk for later asthma and asthma severity remain unclear.ObjectiveTo determine whether ASD in children increases the risk of incident asthma and worsens asthma severity.MethodsWe performed 2 distinct analytic designs (case-control and retrospective longitudinal cohort) using a multistate electronic health records database to assess the odds of new asthma and asthma severity among children with ASD. In both designs, children with ASD were matched with children without ASD according to sex, age, race, ethnicity, location, and insurance status. Pulmonary function, controller medication prescriptions, asthma exacerbations, and asthma-related hospitalizations were collected. The effects of ASD on asthma risk and severity were assessed using multivariable linear and logistic regression.ResultsAmong children with asthma, ASD was associated with reduced exacerbations (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.54–0.92), better forced expiratory volume in 1 second/forced vital capacity ratio (0.876 vs 0.841, P < .001), and lower odds of airflow obstruction (OR, 0.53; 95% CI, 0.31–0.90) but had higher odds of asthma controller prescription (OR, 2.18; 95% CI, 1.62–2.93). In a longitudinal analysis of children without asthma, ASD was found to be protective for new asthma (OR, 0.44; 95% CI, 0.26–0.74).ConclusionAmong children with asthma, concomitant ASD is associated with better asthma-related outcomes but a higher controller treatment burden. In addition, our data did not support ASD as a risk factor for incident asthma.



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Associations between caesarean delivery and allergic outcomes

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Evelyn Xiu Ling Loo, Jordan Zheng Ting Sim, See Ling Loy, Anne Goh, Yiong Huak Chan, Kok Hian Tan, Fabian Yap, Peter D. Gluckman, Keith M. Godfrey, Hugo Van Bever, Bee Wah Lee, Yap Seng Chong, Lynette Pei-chi Shek, Mark Jean Aan Koh, Seng Bin Ang




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A case of atypical, complete DiGeorge syndrome without 22q11 mutation

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Cosby A. Stone, Mary Louise Markert, Roshini S. Abraham, Allison Norton




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Severe delayed-type hypersensitivity to chloramphenicol with systemic reactivation during intradermal testing

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Timothy J. Watts




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Use of a composite symptom score during challenge in patients with suspected aspirin-exacerbated respiratory disease

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Kevin A. Cook, Brian D. Modena, Nathan E. Wineinger, Katharine M. Woessner, Ronald A. Simon, Andrew A. White
BackgroundAspirin-exacerbated respiratory disease is characterized by asthma, chronic rhinosinusitis, nasal polyposis, and sensitivity to aspirin and other nonsteroidal anti-inflammatory drugs. Confirmation of the diagnosis requires provocation challenge with resulting upper and/or lower airways reactivity. Currently, determination of a positive challenge result is based solely on clinical judgment that synthesizes subjective symptoms and objective measures, as a concomitant increase in nasal or bronchial airways resistance is measured in only half of patients.ObjectiveTo describe a quantitative scoring system, based on symptoms typically reported during provocation challenge, used to identify a positive challenge result.MethodsA total of 115 patients were asked to record 10 symptoms, rated on a scale from 1 (mild) to 10 (most severe), at regular intervals during intranasal ketorolac with modified oral aspirin challenge performed in our office. Composite scores, a simple sum of all individual scores, were calculated at each time point and compared with baseline, prechallenge values.ResultsOne hundred of the 115 patients were determined to have a positive challenge result. A statistically significant difference in composite scores was observed in reactors vs nonreactors. All nonreactors recorded an increase in composite score of less than 5, whereas 69% of reactors recorded an increase of 5 or more.ConclusionOur 10-symptom composite score provides a quantitative and comparable measure of symptoms that typically present during a challenge with a positive result. Although an external validation is needed to confirm its diagnostic performance characteristics, a change in composite score of 5 or more appears to be specific to reactors.



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Atopic status and latex sensitization in a cohort of 1,628 students of health care faculties

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Anna Elena Wudy, Corrado Negro, Alessandro Adami, Francesca Larese Filon
BackgroundAtopic diseases have increased since the second half of the previous century. Atopic workers are at higher risk to be sensitized to latex, and the first years of exposure are supposed to be especially risky.ObjectiveTo assess atopic status and rate of latex sensitization in health care students starting their exposure to latex gloves.MethodsWe analyzed medical surveillance data from 1,628 health care students from 2010 to 2016. Students completed a questionnaire focused on their previous and current latex exposure and personal and family histories of allergic diseases; underwent skin prick testing with common allergens and latex extract (and/or total and latex-specific immunoglobulin E in serum); and underwent a medical examination.ResultsSkin prick test results for common inhalant allergens showed that 807 of 1,628 students (49.6%) had atopy. Atopy by skin prick testing was associated with male sex (odds ratio 1.49, 95% confidence interval 1.18–1.86), a personal history of oculorhinitis or asthma (odds ratio 10.22, 95% confidence interval 7.4–14.13), and atopic eczema (odds ratio 1.87, 95% confidence interval 1.05–3.36) at multivariate regression analysis. Eleven students (0.7% of total population) were found to be sensitized to latex and all had atopy.ConclusionDespite the high prevalence of atopy in health care students of Trieste, the latex sensitization rate is very low and comparable to general population. This is reasonably due to the low exposure to latex gloves at the time of the evaluation and to low latex release from the gloves currently used in our hospital.



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Comparison between skin prick test and serum immunoglobulin E by CAP system to inhalant allergens

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Young-Hee Nam, Soo-Keol Lee
BackgroundSkin prick tests (SPTs) and measurements of serum specific immunoglobulin E (sIgE) antibodies are the most commonly used diagnostic tools for confirming sensitization. However, disagreement between the tests has been observed.ObjectiveTo compare SPT and the CAP system for diagnosis of sensitization to common inhalant allergens.MethodsSubjects included 2,635 patients 10 to 90 years old who underwent analyses by SPT and CAP at the Dong-A University Hospital (Busan, Korea) from June 2011 through May 2016. The 2 test results were compared for 17 inhalant allergens.ResultsAgreement between the SPT and sIgE level was 75.3%. Overall agreement was moderate (κ = 0.59), with strong agreement for house dust mites and birch (κ > 0.7) and weak agreement for Tyrophagus putrescentiae and dog (κ < 0.3). When CAP was compared with SPT as the reference, the sensitivity was 75.8% and the specificity was 75.2%. Mean wheal size by SPT showed a positive correlation with sIgE levels (r = 0.59), which decreased with age.ConclusionThere was a discrepancy between SPT and CAP for diagnosing allergic sensitization among inhalant allergens. The allergic sensitization and correlation between the tests decreased with age. Cautious interpretation of the clinical relevance of allergen sensitization based on SPT and CAP results is required, especially in older patients.



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Physicians' experience and opinion on contraindications to allergen immunotherapy: The CONSIT survey

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Pablo Rodríguez del Rio, Constantinos Pitsios, Marina Tsoumani, Oliver Pfaar, Giannis Paraskevopoulos, Radoslaw Gawlik, Erkka Valovirta, Desirée Larenas-Linnemann, Pascal Demoly, Moises A. Calderón
BackgroundAllergen immunotherapy (AIT) is the only disease-modifying treatment in allergy but several contraindications limit its use.ObjectiveTo collect the outcome of using AIT in theoretically contraindicated situations in real patients in the Contraindications to Specific ImmunoTherapy (CONSIT) survey.MethodsThe CONSIT is an electronic European Academy of Allergy and Clinical Immunology survey conducted to gather the safety outcomes of patients undergoing subcutaneous, sublingual, or venom AIT and the opinions of physicians on each of 17 selected conditions: children younger than 5 years; starting AIT during pregnancy; controlled severe asthma; arrhythmias; coronary disease; cancer; autoimmune disease; bone marrow and solid organ transplantation; human immunodeficiency virus and acquired immunodeficiency syndrome; previous anaphylaxis during AIT; use of β-blockers, angiotensin-converting inhibitors, cyclosporine, and methotrexate; and inability to communicate. Safety using AIT was reported in a 3-point scale: 1, "no problems"; 2, "minor problems" (requiring only dose modifications); and 3, "major problems" (AIT not tolerated). Each physician was asked about the degree of contraindication that each condition should have: no contraindication (score 1), relative contraindication (score 2), or absolute contraindication (score 3).ResultsFive hundred twenty physicians (75% Europeans, 89% allergists) reported on approximately 45,000 patients undergoing AIT with any of these conditions. Major problems were infrequent, occurring more frequently in patients with asthma (9.9%) and with previous anaphylaxis from AIT (9.5%). Regarding opinions, experienced physicians scored a significantly lower mean for all conditions than non-experienced physicians for all routes.ConclusionMajor problems were infrequent and experienced physicians were less likely to be restrictive in the use of AIT.



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Early childhood allergy symptoms in relation to plasma selenium in pregnant mothers

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Daniela Podlecka, Iwona Stelmach, Joanna Jerzynska, Kinga Polanska, Beata Janasik, Jolanta Gromadzinska, Wojciech Wasowicz, Wojciech Hanke, Pawel Majak, Wlodzimierz Stelmach




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Vestibular syncope: A disorder associated with drop attack in Ménière’s disease

Experiments in humans and animals indicate that vestibular influx through vestibular sympathetic reflex is an important and vital part of the regulatory system of circulation. The otolith organ adjusts the circulatory responses through the vestibular sympathetic reflex during an upright stance and may trigger a vasovagal attack of syncope. The aim of the present study was to evaluate the prevalence and association of syncope attacks among patients with Ménière's disease (MD). Vestibular syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously in people with vestibular disorders and without localizing neurological deficit.

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Contact allergy in children with atopic dermatitis: a systematic review

Abstract

The importance of contact allergy in children with atopic dermatitis is frequently debated. Previously, patients with atopic dermatitis were believed to have a reduced ability to produce a type IV immunologic response. However, this belief has been challenged and authors have highlighted the risk of underestimating and overlooking allergic contact dermatitis in children with atopic dermatitis. Several studies have been published aiming to shed light on this important question but results are contradictory. To provide an overview of the existing knowledge, we systematically reviewed studies that report frequencies of positive patch test reactions in children with atopic dermatitis. We identified 436 manuscripts of which 31 met the inclusion criteria. Although the literature is conflicting, it is evident that contact allergy is a common problem in children with atopic dermatitis.

This article is protected by copyright. All rights reserved.

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Antibiotic Stewardship im Alltag – „Fragen Sie Ihren Arzt und Apotheker!“

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 274-286
DOI: 10.1055/s-0042-122109

Antibiotic Stewardship (ABS) lässt sich nicht alleine praktizieren. Ein gut etabliertes, interdisziplinäres ABS-Team mit Mandat und Deputat durch die Geschäftsführung kann den Anforderungen im Alltag und bei Ausnahmesituationen wie z. B. einem Ausbruch durch einen multiresistenten Erreger gerecht werden. Klinisch-infektiologische Kompetenz ist dabei für alle Teammitglieder grundlegend. Die Rollen des ABS-Teams bei einem Ausbruchsgeschehen wie dem hier beschriebenen durch einen 4MRGN A. baumannii sind vielfältig. Der rationale Einsatz von Reserveantibiotika und Dosisoptimierung von Antiinfektiva, z. B. durch therapeutisches Drug Monitoring (TDM), stehen dabei im Vordergrund. Durch restriktiven Einsatz von Antibiotika kann der antibiotische Selektionsdruck gesenkt und damit der Bildung weiterer Resistenzen entgegengewirkt werden. Der Einsatz von Reserveantibiotika im Rahmen eines Ausbruchsgeschehens führt zu erheblichen Kostensteigerungen bei gleichzeitig sinkenden Patientenzahlen. Interdisziplinarität zwischen der Hygiene, dem ABS-Team und den verschiedenen Kliniken sowie Unterstützung durch die Geschäftsführung sind wichtig für die Prävention und auch das Management von Ausbrüchen durch multiresistente Erreger.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Antibiotic Stewardship und Hygiene – 2 Seiten einer Medaille

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 248-259
DOI: 10.1055/s-0042-122129

In der öffentlichen Wahrnehmung werden hohe Raten von multiresistenten Erregern in medizinischen Einrichtungen vor allem mit zwei Begriffen assoziiert: erstens „Krankenhaus" und zweitens „Hygieneproblem". Wahrscheinlich mindestens ebenso wichtig oder sogar wichtiger ist jedoch der Antibiotikaeinsatz im ambulanten und stationären Bereich. Antibiotika selektionieren multiresistente Erreger (MRE). Durch die Mikrobiomforschung werden wir diese Zusammenhänge in der Zukunft besser verstehen. Wahrscheinlich bieten sich dadurch auch neue Ansatzpunkte für die Prävention der Ausbreitung von multiresistenten Erregern. Die vorliegenden Daten unterstreichen die Notwendigkeit der engen Interaktion zwischen Krankenhaushygiene und einer rationalen Antiinfektiva-Verordnung (Antibiotic Stewardship).
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Schnellübersicht der Anästhesie und Notfallmedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 245-245
DOI: 10.1055/s-0042-120975

Georg Thieme Verlag KG Stuttgart · New York

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Beatmung mit reinem Sauerstoff verbessert nicht Ergebnisse bei der Reanimation

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 238-239
DOI: 10.1055/s-0043-106424

Georg Thieme Verlag KG Stuttgart · New York

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Stets aktueller Klassiker

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 244-244
DOI: 10.1055/s-0042-106750

Georg Thieme Verlag KG Stuttgart · New York

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Intravenöse Eisengabe: keine signifikante Einsparung von Transfusionen

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 238-238
DOI: 10.1055/s-0043-106426

Georg Thieme Verlag KG Stuttgart · New York

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Subduralhämatom nach PDA häufiger als angenommen

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 239-240
DOI: 10.1055/s-0043-106425

Georg Thieme Verlag KG Stuttgart · New York

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Quiz intensiv – Stellen Sie die Diagnose!

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 298-302
DOI: 10.1055/s-0043-103259

Georg Thieme Verlag KG Stuttgart · New York

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Gabapentin – wenig analgetische Effekte in der Akutschmerztherapie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 240-241
DOI: 10.1055/s-0043-102203

Georg Thieme Verlag KG Stuttgart · New York

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Alle Aspekte der modernen Schmerzmedizin auf einen Blick

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 244-244
DOI: 10.1055/s-0042-120976

Georg Thieme Verlag KG Stuttgart · New York

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Patienten erinnern sich an schmerzhafte Maßnahmen auf der ITS

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 241-241
DOI: 10.1055/s-0042-122656

Georg Thieme Verlag KG Stuttgart · New York

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Antibiotic Stewardship: Es ist fünf vor zwölf!

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 246-247
DOI: 10.1055/s-0043-104571

Georg Thieme Verlag KG Stuttgart · New York

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Fit für die Prüfung „Spezielle Schmerztherapie“

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 243-243
DOI: 10.1055/s-0042-104433

Georg Thieme Verlag KG Stuttgart · New York

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Antibiotic Stewardship – From Bench to Bedside

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 260-273
DOI: 10.1055/s-0043-100499

Der Artikel erläutert die praktische Umsetzung eines Antibiotic Stewardship (ABS) in der Klinik. Bei steigender Prävalenz von resistenten Bakterien ist die Ärzteschaft aufgefordert, Antibiotikaverordnungen kritisch zu hinterfragen und zu reduzieren. ABS-Programme sollen dies unterstützen. Hierbei muss insbesondere das Engagement der Klinikleitungen im ABS besser werden. Das Problembewusstsein für den Antibiotikaverbrauch muss besser werden und die Daten darüber intern transparent kommuniziert werden. Jedoch auch in der Ärzteschaft gibt es Schulungsbedarf. Das pathophysiologische Verständnis sowie die akkurate Diagnostik von Infektionserkrankungen müssen verbessert werden. Ärzte brauchen den Mut, auf Antibiotika zu verzichten. Der Konsens innerhalb einer Abteilung und eines Krankenhauses zur Vorenthaltung von Antibiotika muss gestärkt werden. Dabei muss jedoch auch das Bewusstsein steigen, die Sepsis als Notfall zu behandeln und dabei primär die Fokussanierung anzustreben und nicht nur die schnelle Antibiotikatherapie. Die mikrobiologische Präanalytik ist von entscheidender Bedeutung. Hier müssen weniger Abstriche, sondern mehr aussagekräftige Analysemethoden wie Blutkulturen oder invasive Proben angestrebt werden. Schließlich kommt der Interaktionen zwischen Klinikern, Mikrobiologen und Krankenhaushygienikern ein hoher Stellenwert zu.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Ein praxisorientierter Survival-Guide für den Intensivalltag

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 243-244
DOI: 10.1055/s-0042-105826

Georg Thieme Verlag KG Stuttgart · New York

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Management des massiven intraoperativen Blutverlusts anhand eines Fallbeispiels

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 288-296
DOI: 10.1055/s-0042-102821

Der massive intraoperative Blutverlust stellt eine potenziell lebensbedrohliche Komplikation während eines operativen Eingriffs dar. Die letale Trias aus schockbedingter Azidose, Hypothermie und Koagulopathie verstärkt die Blutungsneigung zusätzlich. Um diesen circulus vitiosus zu vermeiden, erfordert das Management einer intraoperativen Massivblutung ein strukturiertes und standardisiertes Vorgehen. Vorrangige Behandlungsziele sind dabei die Aufrechterhaltung einer adäquaten Gewebeoxygenierung, die Wiederherstellung einer suffizienten Gerinnungsfunktion, sowie Normothermie und die Homöostase des Säure-Basen- und Elektrolythaushaltes. Der vorliegende Artikel veranschaulicht diese Therapieziele und ihre pathophysiologischen Hintergründe anhand eines Fallbeispiels.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Vermeidung von Feuer/Brand/Explosion im OP

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 303-309
DOI: 10.1055/s-0042-116688

Die offene Sauerstoffgabe bei Patienten unter Sedierung und die Anwendung von Elektrokoagulation führen die Hitliste im Risikoprofil von Feuer, Brand, oder gar einer Explosion (FBE) in der Nähe von Menschen im OP. Das wesentliche Risiko ist das Dreieck „Oxidation – Zündenergie – entzündbares Material" (OZE). Ein hohes Risiko haben Eingriffe innerhalb oder in der Nähe des Luftwegs bei Anwendung von Laserenergie. Insgesamt treffen diese Ereignisse selten, aber mit steigender Tendenz und meist vollkommen unerwartet ein. Die verheerenden Konsequenzen sowie – bei sachgerechter Durchführung – die mögliche Vermeidung unterstreichen die Frage, mit welchen Maßnahmen das Risiko reduziert oder das Ereignis gar verhindert werden kann.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Intubation fehlgeschlagen – und dann?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 237-238
DOI: 10.1055/s-0043-106427

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Cochlea-Implantation ab dem 70. Lebensjahr – Nutzen der bimodalen Versorgung mit Hörgerät und CI

Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-122343

Die bimodale Versorgung mit Cochlea Implantat (CI) und Hörgerät (HG) auf dem Gegenohr führt zu guten audiologischen Resultaten bei Erwachsenen und Kindern. Bei älteren Patienten ist noch wenig bekannt über den Nutzen der bimodalen Versorgung. Ziel der Studie war, den subjektiven und objektiven Nutzen der bimodalen Versorgung im hohen Alter zu untersuchen, und einen möglichen Zusammenhang mit dem Restgehör herzustellen. 22 postlingual höchstgradig schwerhörige bis ertaubte Patienten mit Alter≥70 Jahre wurden von 2002 bis 2014 mit einseitigem CI versorgt. 17 Patienten waren bimodal (CI und HG) versorgt. Mittels retrospektiver Datenanalyse und strukturierter Befragung wurde der audiologische und subjektive Nutzen beurteilt. Das Zeitintervall von Implantation bis zur letzten audiologischen Messung betrug 6 Monate–12 Jahre. Bimodal betrug die durchschnittliche Einsilberverständlichkeit 61% (in Ruhe bei 65db SPL, binaurale Messung mit CI und HG „best-aided"). Mit CI alleine betrug die durchschnittliche Einsilberverständlichkeit 53%. Der Unterschied von 8% war statistisch nicht signifikant (p=0.35). Das Restgehör auf dem HG-Ohr bei 250 Hz, 500 Hz und 1 kHz zeigte keine statistisch signifikante Korrelation mit dem bimodalen Nutzen. Wir konnten einen deutlichen subjektiven Nutzen der bimodalen Versorgung im hohen Alter bestätigen. In Ruhe und im Vergleich mit CI alleine erreichte die Mehrzahl der Patienten bimodal zwar nur eine gering verbesserte Einsilberverständlichkeit, alle trugen jedoch das HG ganztägig. Das Cochleaimplantat führt auch im hohen Alter bereits nach wenigen Monaten zu einer nutzbaren Sprachverständlichkeit, welche sich im Langzeitverlauf weiter verbessern kann. Bei vorhandenem Restgehör empfehlen wir die regelmässige Überprüfung der bestehenden HG-Versorgung.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Mikrolaryngoskopie: Eine populationsbezogene Analyse zu Outcome, Komplikationen und Operationsraten

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-100765

Obwohl die Mikrolaryngoskopie (MLS) ein integraler Bestandteil der operative HNO-Heilkunde ist, gibt es keine populationsbezogenen Untersuchungen zu den Operationsraten und der Effektivität der MLS in der klinischen Routine. Alle 616 Patienten, die 2011 in einer der 8 Thüringer HNO-Kliniken eine MLS erhielten, wurden hinsichtlich Patientencharakteristika, Therapie, Komplikationen und Nachuntersuchung analysiert. Die stationäre Aufnahme erfolge vorrangig wegen einer gutartigen Erkrankung des Larynx (60%) und bei 33% wegen eines Malignoms oder Verdacht auf ein Malignom. Bei Verdacht auf einen gutartigen Prozess wurde dies in 98% der Fälle bestätigt. Der Verdacht auf einen bösartigen Tumor bestätigte die MLS in 51% der Fälle bzw. wurde in 49% ausgeschlossen. Ein transientes Larynxödem (22%) und revisionspflichtige Blutung (1%) waren die häufigsten Komplikationen. Ein Zahnschaden trat in 2 Fällen auf (0,2%). Ein Rezidiv der ursprünglichen Erkrankung wurde in 14% beobachtet. Eine längere Operationszeit war ein unabhängiger Prädiktor für eine postoperative Blutung (p=0,05) oder ein Larynxödem (p=0,013). Eine Re-MLS (p<0,0001) und die endgültige Diagnose eines bösartigen Tumors (p=0,017) waren unabhängige Prädiktoren für ein Rezidiv. Die Operationsrate lag bei 22,98/100000 Einwohner. Die höchste Inzidenz lag beim Patientenalter von 50–59 Jahren mit 39,76/100000. Gutartige Tumoren waren die häufigste Indikation mit einer Rate von 19,33/100000. Diese populationsbezogene Analyse zeigt dass die MLS eine effektive chirurgische Maßnahme mit geringen Risiken im Alltag des HNO-Arztes ist.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Patienten-Instruktionsvideo mit synchroner Videoaufnahme von Gesichtsbewegungen bei Fazialisparese

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-101699

Um die Schwere einer Fazialisparese zu dokumentieren oder um die Schwere mit einem Grading System zu bewerten, werden Photografien und Videoaufnahmen benötigt. Für die Videoaufnahmen gibt es keinen internationalen Standard, was die Vergleichbarkeit von Patientengruppen behindert. Es wurde ein Instruktionsvideo entwickelt, in dem Patienten Gesichtsbewegungen vorgemacht werden mit der Aufforderung diese nachzumachen. Während die Instruktionen dem Patienten vorgespielt wurden, wurden die Patienten synchron beim Nachmachen der Gesichtsbewegungen mit handelsüblicher Hardware (Webcam, Bildschirm sowie LED-Beleuchtung) gefilmt. Die mimischen Bewegungsübungen wurden so ausgewählt, dass die Patientenaufnahmen anschließend mit verschiedenen Grading Systemen (House-Brackmann, Sunnybrook, Stennert, Yanagihara) oder auch (semi)automatisch ausgewertet werden konnten. Für die Qualitätskontrolle wurde ein Evaluationsbogen erstellt. Das Instruktionsvideo dauert 11 min und 05 s und gliedert sich in 3 Teile: 1) Erklärung des Ablaufs, 2) Vormachen und Nachmachen der mimischen Bewegungen, 3) Nachsprechen von Sätzen für die Analyse der Kommunikationsfähigkeit. Es wurden bisher 13 Probanden und 10 Patienten mit akuter als auch chronischer Fazialisparese gefilmt. Die so gewonnenen Patientenaufnahmen ließen sich nach den oben genannten Grading Systemen auswerten. Die Instruktionen wurden von den Probanden und Patienten als gut erklärt und einfach nachzuahmen bewertet. Es gibt nun ein Instruktionsvideo für die standardisierte Aufzeichnung von Gesichtsbewegungen; dieses sollte zur Bewertung von Fazialisparesen im klinischen Alltag und in Studien verwendet werden, um zukünftig Daten von Patienten innerhalb von internationalen Studien besser vergleichen zu können.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Authors' Reply: "Nonalcoholic fatty liver disease, portal vein thrombosis and coagulation: more questions than answers?.

No abstract available

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Kontroverse Rechtslage zur Kostenübernahme einer Liposuktion bei Lipödem

Zusammenfassung

Die rechtliche Frage, ob bzw. unter welchen Voraussetzungen die Kosten für eine Liposuktionsoperation bei der Fettverteilungsstörungskrankheit Lipödem von den Krankenkassen zu übernehmen ist, wird zwischen den Sozialgerichten und innerhalb der zuständigen Sozialgerichte der ersten und zweiten Instanz kontrovers beurteilt. Neben der richterlichen Entscheidungsfreiheit spielen dabei auch die Durchführungsart der Operation, die bisherigen medizinischen Erkenntnisse und die nach wie vor ausbleibende Entscheidung des Gemeinsamen Bundesausschusses zu dieser Thematik eine entscheidende Rolle. Dieser Beitrag befasst sich mit den unterschiedlichen Entscheidungsströmen durch Wiedergabe und Darstellung ausgewählter und prägnanter Urteile und schließt mit einem Ausblick und einigen Handlungsempfehlungen für die Betroffenen ab.

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Post-Traumatic Dizziness

Abstract

Purpose of Review

Traumatic brain injury (TBI) is a significant cause of morbidity and to a lesser extent mortality yearly. Dizziness remains a common complaint, presenting in up to 80% of patients post-head injury. This has obvious physical and psychological consequences not only to the individual but also a significant economic impact on society as a whole. Despite much being written in the field of TBI including concussion and sports-related head injury, the effects of trauma on the vestibular system have had relatively little study. Large-scale population studies addressing dizziness in the context of head injury do not exist in the literature. This article aims to provide an overview of dizziness post-TBI. The results from a large prospective database from the University Health Network (UHN) Workplace Insurance and Safety Board (WSIB) Neurotology are presented.

Recent Findings

The results of the UHN WSIB Neurotology database (n = 3438 head-injured workers) from the Canadian province of Ontario (1998–2014) either suggested or diagnosed BPPV in 23% post-head injured workers. One hundred and forty-nine workers (4.3%) were diagnosed with other distinct forms of peripheral vestibular dysfunction; the most common episodic type (35% of 149 workers) being a recurrent vestibulopathy (RV). The study did not find a causative link in the TBI patients studied to support a diagnosis for post-traumatic Meniere's as the incidence of the disease in this cohort was equal to that in the general population.

Summary

This article is intended to provide an overview of post-traumatic dizziness following TBI, to discuss generally recognized inner ear disorders post-head injury, the results from the UHN WSIB Neurotology database and to address some of the controversies in the field.

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Intratympanic (IT) Therapies for Menière’s Disease: Some Consensus Among the Confusion

Abstract

Purpose of Review

Aminoglycosides and corticosteroids are commonly used to treat Menière's disease. Intratympanic (IT) administration of these medications allows high inner ear concentrations without significant adverse systemic effects. As a direct result, IT therapy has grown in popularity. Recent studies have compared patient outcomes between IT aminoglycosides and corticosteroids. This review summarizes these findings.

Recent Findings

Trials comparing IT corticosteroids to IT placebo or oral therapy have had conflicting results. Most recently, Lambert et al. investigated the effect of IT dexamethasone in a sustained-release formulation compared to placebo. Their findings demonstrated improvement in some secondary measures of vertigo with the sustained-release formulation. IT gentamicin is known to be effective in controlling vertigo in Menière's disease. In a recent study from 2016, Patel et al. compared IT gentamicin and IT methylprednisolone in a double-blind, randomized controlled trial and identified no significant differences between the two in vertigo control.

Summary

IT injections of aminoglycosides and corticosteroids can improve vertigo control. Hearing and vestibular loss however may result with IT aminoglycosides. Corticosteroids demonstrate limited hearing loss but may not have the same efficacy in controlling vertigo. Further investigation in the etiology of Menière's disease is needed to tailor the proposed treatment to suit the disease mechanism.

http://ift.tt/2qtFQDX

Center for AIDS Research Receives $15.5 Million Grant from NIH

The Johns Hopkins Center for AIDS Research (CFAR) has received a five-year, $15.5 million grant from the National Institutes of Health (NIH) to continue its work supporting HIV research across the university.

http://ift.tt/2pIFlFc

Monetary Intelligence and Behavioral Economics: The Enron Effect—Love of Money, Corporate Ethical Values, Corruption Perceptions Index (CPI), and Dishonesty Across 31 Geopolitical Entities

http://ift.tt/2p6a7E5

Spirituality in Dermatology Practice

This Viewport discusses the challenges of helping patients find spiritual solace in the clinical setting amid periods of suffering and addressing their fears, hopes, and suffering

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Eruptive Keratoacanthomas Associated With Pembrolizumab Therapy

This case report describes 3 patients who developed eruptive keratoacanthomas in association with pembrolizumab treatment and their management.

http://ift.tt/2pIr631

Frequency of Syphilis Diagnoses by Dermatologists

This study examines frequency of syphilis diagnoses by dermatologists in Rhode Island compared with other clinicians in that state.

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Pembrolizumab-Induced Extensive Panniculitis and Nevus Regression

This case report describes a patient with pembrolizumab-induced extensive panniculitis and nevus regression.

http://ift.tt/2pIkFNG

Increasing Diversity in Dermatology Residencies

To the Editor We read the article by Chen and Shinkai with great interest. Diversity in dermatology is a key topic, and this work helps bring it into the spotlight that it truly deserves. However, 2 underrepresented ethnic groups in dermatology were neglected in the article. Native American/Alaska Natives represent 0.9% of the US population, but only 0.2% of dermatologists. Furthermore, Native Hawaiian/Pacific Islanders are also considered underrepresented in dermatology (representing 0.2% of the US population). It may be of value in the future to fully include all underrepresented racial groups in dermatology because these initiatives evolve to enhance the successes of these types of efforts. Not doing so may cause smaller underrepresented groups to feel as if their unique experiences are not being accounted for.

http://ift.tt/2p6mb86

Diagnosis of Melanoma and Melanotic Macules of the Lip

This case series study reports in vivo reflectance confocal microscopy (RCM) features of normal lips of different phototypes and attempts to identify features that assist in distinguishing melanoma from benign melanotic macules using dermoscopy and RCM.

http://ift.tt/2pIoouA

Increasing Diversity in Dermatology Residencies—Reply

In Reply We appreciate the thoughtful response to our article by Kailas and Rigel. We acknowledge that our article omitted key statistics, including those on Native American/Alaska Natives and Native Hawaiian/Pacific Islanders, and thank the authors for pointing these out. It was not our intention to exclude the many underrepresented groups within our specialty through lack of mention; indeed, we fully support ongoing efforts to better characterize our specialty with respect to race and ethnicity as well as other individual characteristics including and not limited to socioeconomic status, religion, gender, sexual orientation, disability, immigration status, and international medical graduate status. We share the conviction of Kailas and Rigel that improved understanding and continued recognition of these disparities in representation between underrepresented minority groups in dermatology and the general population will further strengthen the argument that a call to action is needed.

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Generic Drugs—Changes in Cost and Challenges in Practice

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Medicare Part D Payments for Topical Steroids

This cost analysis assesses Medicare and patient out-of-pocket costs for topical steroids and models potential savings that could result from substitution of the least expensive topical steroid from the corresponding potency class.

http://ift.tt/2p63Qby

Bilastine: a new H1-antihistamine with an optimal profile for updosing in urticaria

Abstract

This review set out to examine published papers detailing the efficacy of bilastine in skin models and urticaria to assess whether it meets the optimal profile for updosing in urticaria, i.e. strong clinical efficacy and freedom from unwanted side effects, particularly sedation. Bilastine is a highly effective H₁-antihistamine even when used at the basic dose of 20 mg daily. Its facilitated uptake after oral dosage gives it a rapid onset and long duration of action. In both wheal and flare studies and in urticaria updosing four fold showed increased effectiveness. With respect to somnolence, bilastine is a substrate for P-glycoprotein, a membrane pump which prevents it crossing the blood–brain barrier. Consequently, bilastine is a practically 'non-sedating' H₁-antihistamine. In conclusion, the excellent profile of bilastine in both efficacy and safety make it the ideal H₁-antihistamine for updosing the daily dose fourfold in difficult-to-treat urticaria as recommended by the EAACI/GALEN/EDF/WAO guideline for the management of urticaria.

This article is protected by copyright. All rights reserved.

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Is endoscopic endonasal transsphenoidal surgery increases the susceptibility to rhinosinusitis

Abstract

The aim of the study was to analyze whether the measurement of changes in the anatomical position and volume of middle concha, the volume changes in the area between the middle concha and lamina papyracea, the evaluation of opacification in major paranasal sinuses, and osteomeatal complex occlusion in cases with middle concha by out-fracture technique during endoscopic endonasal transsphenoidal approach is a minimally invasive surgery, and also to find out whether these changes lead to the development of tendency to rhinosinusitis. It was a retrospective clinical study. Forty-five cases, between 2013 and 2015, planned for endoscopic endonasal transsphenoidal surgery due to hypophyseal pathology at the Neurosurgery Departments of Marmara University Hospital were evaluated retrospectively. The patients were evaluated for the changes in the anatomy of the middle concha and the effects of these changes to paranasal sinuses by paranasal computed tomographies were studied at the preoperative second week and postoperative 12 month. The Lund–Mackay scoring system was used for the evaluation of opacification in the five major paranasal sinuses and occlusion of the osteomeatal complex in the pre- and postoperative period. The Lund–Mackay scoring system was used to analyze the paranasal computed tomography of the patients at the preoperative 2 weeks and postoperative first year. According to the Lund–Mackay scoring system, no significant difference was detected between the preoperative and postoperative opacification of paranasal sinuses (p > 0.05). Besides, there was also no significant difference between the preoperative and postoperative osteomeatal complex occlusion (p > 0.05). Considering the distance between middle concha and lamina papyracea following the out-fracture of the middle concha, a significant lateralization of 0.5 mm between the preoperative and postoperative period was observed (p < 0.05). In addition, a significant change was also detected in the volume of middle concha (p < 0.05). The volume of the area between the middle concha and lamina papyracea was decreased with a statistical significance (p < 0.05). The endoscopic endonasal transsphenoidal surgery causes some variations in the structures of the middle concha, paranasal sinuses, and OMC, but these changes do not lead to significant rhinologic pathologies.

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Traditie als scenario. Over het werk van Ilja Leonard Pfeijffer

http://ift.tt/2qFuwAP

Media Advisory: Online Mendelian Inheritance In Man (OMIM) Hosts Symposium Celebrating 50 Years

Johns Hopkins' Online Mendelian Inheritance in Man (OMIM) is celebrating its 50th anniversary on May 4, 2017.

OMIM is a comprehensive database of human genes and genetic disorders authored and updated daily by the McKusick-Nathans Institute of Genetic Medicine at Johns Hopkins Medicine. In the early 1960s, Dr. Victor A. McKusick pioneered this catalog entitled Mendelian Inheritance in Man (MIM) allowing physicians and medical professionals around the world to diagnose genetic conditions before genetic testing became readily available. OMIM, the online version, was launched in 1985 and became readily available on the internet in 1987. Fifty years later, OMIM is still a fundamental source of information in the scientific community.

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Food Allergy in South Africa

Abstract

Purpose of the Review

Whilst food allergy seems to have increased significantly in many developed countries in the past few decades, quality data on the burden of food allergy in many developing countries is scanty. Until recently, South Africa had a dearth of robustly designed food allergy studies. This article summarizes some of the recent research and observations regarding food allergy from the South African setting.

Recent Findings

South Africa has recently seen two important food allergy prevalence studies in selected and unselected populations. Both show allergy rates in keeping with those in several westernized countries. The major difference between sensitization and allergy rates in these studies emphasizes the vital role of the food challenge in differentiating true food allergy from asymptomatic sensitisation in equivocal cases. Eczema, young age and living in an urban population are important risk factors for food allergy in South Africa. Egg and peanut allergy are the most common food allergies in both selected and unselected populations in South Africa. In peanut allergy, Ara h 2 is the most useful component in differentiating true allergy from tolerance in peanut-sensitized patients. Use of internationally derived 95% positive predictive values for peanut and egg allergy produced many false positives in South African studies. Studies in South Africa show a trend towards more conservative introduction of peanut in eczema patients, which needs to be addressed in the light of recent studies showing a protective effect of earlier introduction of peanut. "Novel" allergies such as galactose-alpha-1,3-galactose allergy, food protein-induced enterocolitis syndrome and eosinophilic oesophagitis are being described with increasing frequency in South Africa.

Summary

The surprisingly high prevalence of food allergy in South Africa points towards possible involvement of South Africa in the so-called "food allergy epidemic". This has major implications on the planning of health services in the allergy sector. Food challenges will form a vital role in allergy services. Ninety-five percent positive predictive values for peanut and egg allergy may need revision to be more applicable to the local population.

http://ift.tt/2oXiDdd

A longitudinal study of repair strategies in Primary Progressive Aphasia using Conversation Analysis

BACKGROUND. A systematic review on spontaneous speech, conversation and interaction in primary progressive aphasia (PPA) was conducted until October 2015. While it was possible to distinguish PPA subtypes based on spontaneous speech characteristics, differentiation between subtypes for conversation and interaction was impossible due to scarcity of publications on the subject. These findings were used as basis for a preliminary longitudinal study, the aim of which was to provide a description of the evolution in repair strategies used by patients with PPA during the first two years of diseaseprogression. METHOD. Video recordings of natural occurring patient-therapist conversations were systematically transcribed for two participants: MJG (progressive nonfluent aphasia, PNFA) and RG (logopenic progressive aphasia, LPA). These transcriptions were analysed both quantitatively and qualitatively using a conversation analytic method. RESULTS. Differences in repair strategies between MJG and RG were found in the relative importance of the repair trajectories and the context in which they were used throughout the disease progression. CONCLUSION. These findings demonstrate the evolution in the use of repair strategies throughout the progression of PPA. Though not generalisable, there are clear indications for differences between the PPA subtypes. Further research within this subject is required for a clearer and more universally applicable view on repair sequences in PPA patients.

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De prevalentie van Vocal Tract Discomfort binnen de Vlaamse populatie: een prospectieve studie van gezonde 65-plussers.

ACHTERGROND Patiënten met stemstoornissen ervaren geregeld oncomfortabele sensaties in en rond het spraakkanaal, i.e. Vocal Tract Discomfort of VTD. Deze veroorzaken ongegronde angst voor ernstigere onderliggende pathologieën. Deze studie verzamelde VTD-prevalentiecijfers bij gezonde Vlaamse 65-plussers en identificeerde relaties tussen VTD-symptomen en stembelasting en correlaties tussen de VTD-schaal en andere perceptuele en self-assessment schalen. METHODE Bij 271 deelnemers (116 mannen en 155 vrouwen) met een gemiddelde leeftijd van 74,77 jaar (SD 6,51 jaar; range [64,67 – 94,25]) werden vragenlijsten die peilden naar demografische, beroepsgebonden en stembelastende factoren, de VTD-schaal, de Corporal Pain Scale en de Voice Handicap Index afgenomen. De stemkwaliteit werd perceptueel beoordeeld a.d.h.v. de GRBASIschaal. RESULTATEN Van alle deelnemers rapporteerde 62% (168/271) minstens één VTD-symptoom, waarvan een kriebelend, een droog en een globusgevoel de meest frequente en meest ernstige waren. Hoe vaker men VTD ervaart, hoe ernstiger. Stembelastend gedrag vertoonde een significante relatie tot branderige, kriebelende en droge sensaties. Gepensioneerde leerkrachten meldden hierbinnen een beduidend groter aantal symptomen. Rokers en niet-rokers, verschillende leeftijdscategorieën en personen met en zonder (klein)kinderen vertoonden geen significante verschillen. CONCLUSIE Zelfs gezonde ouderen kunnen VTD-symptomen ervaren. Deze niet eigen zijn aan ernstige pathologieën.

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Cancer Is to Embryology as Mutation Is to Genetics: Hypothesis of the Cancer as Embryological Phenomenon

Despite numerous advances in cell biology, genetics, and developmental biology, cancer origin has been attributed to genetic mechanisms primarily involving mutations. Embryologists have expressed timidly cancer embryological origin with little success in leveraging the discussion that cancer could involve a set of conventional cellular processes used to build the embryo during morphogenesis. Thus, this "cancer process" allows the harmonious and coherent construction of the embryo structural base, and its implementation as the embryonic process involves joint regulation of differentiation, proliferation, cell invasion, and migration, enabling the human being recreation of every generation. On the other hand, "cancer disease" is the representation of an abnormal state of the cell that might happen in the stem cells of an adult person, in which the mechanism for joint gene regulating of differentiation, proliferation, cell invasion, and migration could be reactivated in an entirely inappropriate context.

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A Prospective Multi-center Observational Study in Patients With Mucosal Melanoma of Head and Neck

Condition:   Mucosal Melanoma
Intervention:  
Sponsors:   Sun Yat-sen University;   First Affiliated Hospital, Sun Yat-Sen University;   Zhejiang Cancer Hospital
Recruiting - verified May 2017

http://ift.tt/2qF0gGg

A Study of the Effectiveness in Patients With Gastric or Gastroesophageal Junction Cancer With Nivolumab by Itself or in Combination With Ipilimumab and in Patients With Esophageal Cancer With Combination of Nivolumab and Ipilimumab.

Condition:   Various Advanced Cancer
Interventions:   Drug: Nivolumab monotherapy;   Drug: Nivolumab + Ipilimumab followed by Nivolumab monotherapy;   Drug: Nivolumab + Ipilimumab
Sponsors:   Bristol-Myers Squibb;   Ono Pharmaceutical Co. Ltd
Not yet recruiting - verified May 2017

http://ift.tt/2pYosXT

Prevalence of Liver Fibrosis and Cirrhosis in Patients With Squamous Cell Carcinoma of the Head and Neck

Conditions:   Liver Fibroses;   Liver Cirrhoses;   Squamous Cell Carcinoma of the Head and Neck
Intervention:   Other: Evaluation of the hepatic fibrosis stage by a hepatological assessment (Clinical, biological and imaging)
Sponsor:   Centre Hospitalier Universitaire, Amiens
Not yet recruiting - verified May 2017

http://ift.tt/2qEZLft

A Window of Opportunity Study to Assess the Modulation of Biomarkers in Head and Neck Squamous Cell Cancer (HNSCC) By Preoperative Treatment With BYL719

Condition:   Head and Neck Squamous Cell Cancer
Intervention:   Drug: BYL719
Sponsor:   Lawson Health Research Institute
Not yet recruiting - verified April 2017

http://ift.tt/2pYksH4

Role of Imaging to Predict the Deep Surgical Margin in Gingivobuccal Complex Tumors

Conditions:   Buccal Mucosa Cancer;   Gingival Cancer
Interventions:   Procedure: Clinical Evaluation;   Diagnostic Test: Radiological Imaging
Sponsor:   HealthCare Global Enterprise Ltd.
Recruiting - verified April 2017

http://ift.tt/2qF9W3U

Risk of developing psoriasis in patients with schizophrenia: a nationwide retrospective cohort study

Abstract

Background

Schizophrenia is a complex disease proceeds from an interaction between genetic background and environmental factors. Recent studies showed T helper 17 (Th17) signaling, which is the main downstream immune response of psoriasis, is activated in schizophrenia.

Objective

To investigate if patients with schizophrenia have higher risk of psoriasis.

Methods

In this nationwide retrospective cohort study, we analyzed the 1-million-enroll cohort from Taiwan's National Health Insurance Research Database. Psoriasis and schizophrenia were ascertained by International Classification of Diseases, 9th revision, Clinical Modification coding. The study cohort was comprised of enrollees diagnosed with schizophrenia during the period from January 1, 1996 through December 31, 2010, while the comparison population consisted of enrollees who had not been diagnosed with schizophrenia during the study period. Hazard ratio (HR) and 95% confidence interval (CI) were calculated for the risk of psoriasis associated with schizophrenia using Cox proportional hazards regression.

Results

The adjusted HR of psoriasis associated with schizophrenia was 2.32(95% CI = 1.81-2.98). After 15 years, the cumulative incidence of psoriasis in patients with schizophrenia and comparison population was 2.82% and 1.17%, respectively. The Kaplan-Meier curves for the cumulative incidence of psoriasis in individuals with and without schizophrenia differed significantly(P<0.0001, log-rank test).

Conclusions

Patients with schizophrenia have higher risk of psoriasis, which may be due to common genetic susceptibilities and/or immunologic mechanisms in both diseases. Th17 signaling and pro-inflammatory cytokines may act as a link between these two diseases and are potential therapeutic targets for schizophrenia.

This article is protected by copyright. All rights reserved.

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Expression of G protein-coupled estrogen receptor, GPER in melanoma and in pregnancy-associated melanoma

Abstract

Background

The hormone sensitivity of melanoma and the role of 'classical' estrogen receptor (ER) α and β in tumor progression have been intensively studied with rather contradictory results. The presence of 'non-classical' G protein-coupled estrogen receptor (GPER) has not been investigated on human melanoma tissues.

Objective

To analyze the expression of GPER, ERα and ERβ in pregnancy-associated (PAM) and in non-pregnancy associated (NPAM) melanomas in correlation with traditional prognostic markers and disease-free survival (DFS).

Methods

Receptor protein levels were tested using immunohistochemistry in 81 formalin-fixed paraffin-embedded melanoma tissues. PAMs (n=38) were compared with age- and Breslow thickness-matched cases (n=43) including non-pregnant women (NPAM-W) (n=22) and men (NPAM-M) (n=21). The association between receptor expression and DFS was analyzed by uni- and multivariate Cox proportional hazards regression.

Results

GPER was detected both in PAMs and NPAMs. In 39 of the 41 (95.1%) GPER positive melanomas GPER and ERβ were co-expressed. GPER/ERβ positive melanomas were significantly more common in PAM compared to NPAM (p=0.0001) with no significant difference between genders (p=0.4383). In PAMs the distribution of GPER and ERβ was similar (78.4% versus 81.6%; p=0.8504), while in NPAM ERβ was the representative ER (60.5% versus 27.9%; p=0.0010) without gender difference (59.1% versus 61.9%). GPER/ERβ positive melanomas were associated with lower Breslow thickness, lower mitotic rate and higher presence of peritumoral lymphocyte infiltration (PLI) compared to GPER/ERβ negative cases (p=0.0156, p=0.0036 and p=0.0001) predicting a better DFS (HR=0.785, 95% CI 0.582-1.058). Despite the significantly higher frequency of GPER and ERβ expression in PAM, no significant difference was found in DFS between PAM and NPAM. All but one case failed to show ERα expression.

Conclusions

The presence of GPER and its simultaneous expression with ERβ can serve as a new prognostic indicator in a significant subpopulation of melanoma patients.

This article is protected by copyright. All rights reserved.

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A newly identified novel variant in the CSF2RA gene in a child with pulmonary alveolar proteinosis: a case report

The congenital form of pulmonary alveolar proteinosis due to colony stimulating factor 2 receptor alpha gene mutations is a rare disease with only a few cases reported worldwide. In this study we report a new ...

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Quantification of volatile organic compounds in ten cities across three continents

Volatile organic compounds (VOCs) are emitted from both biogenic and anthropogenic sources. Biogenic compounds dominate VOCs emissions worldwide while the anthropogenic VOCs prevail in urban areas. Apart from undesired and direct human health effects, VOCs can affect the physical-chemical behaviour of the atmosphere in several ways. In addition to influencing local, regional and even global photochemistry, some of these compounds have a potential impact on climate (e.g. due to their ability to form aerosol particles). Despite these facts, few studies have focused on urban environments of developing countries where VOCs levels are expected to be high because of rapid industrialization and lenient regulations. People spend up to 80-90% of their time indoors (houses, offices, bars etc.) and a significant amount of time (5%) in traffic while commuting to and from work. However, air quality (e.g. exposure assessment) concerning a diversity of airborne VOCs for those micro-environments are hardly documented, even in the developed world. Given these considerations, quantitative data on VOCs levels in urban environments are of crucial importance in order to (i) enable comparison of pollution levels and exposure, and (ii) estimate their undesired effects (in particular, ozone formation potential and cancer risk assessment). In this thesis, VOCs have been measured in ten cities across five countries (i.e. Belgium, Vietnam, the Philippines, Bangladesh, and Ethiopia) in Europe, Asia, and Africa. All air sampling has been done in an active way using sorbent tubes filled with Tenax TA. The analysis has been excecuted by thermal desorption-gas chromatography-mass spectrometry (TD-GC-MS) using internal standard calibration. The quantification resulted in a unique dataset of concentration levels of up to 84 VOCs in 450 samples from urban air regions or micro-environments where hardly data on VOCs exist today. This dataset has been used to make a first estimation of ozone formation potential and cancer risk via inhalation.

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Radiofrequency exposure near an attocell as part of an ultra-high density access network

In the future, wireless radiofrequency (RF) telecommunications networks will provide users with gigabit-per-second data rates. Therefore, these networks are evolving toward hybrid networks, which will include commonly used macro- and microcells in combination with local ultra-high density access networks consisting of so-called attocells. The use of attocells requires a proper compliance assessment of exposure to RF electromagnetic radiation. This paper presents, for the first time, such a compliance assessment of an attocell operating at 3.5GHz with an input power of 1mW, based on both root-mean-squared electric field strength (E-rms) and peak 10g-averaged specific absorption rate (SAR(10g)) values. The E-rms values near the attocell were determined using finite-difference time-domain (FDTD) simulations and measurements by a tri-axial probe. They were compared to the International Commission on Non-Ionizing Radiation Protection's (ICNIRP) reference levels. All measured and simulated E-rms values above the attocell were below 5.9V/m and lower than reference levels. The SAR(10g) values were measured in a homogeneous phantom, which resulted in an SAR(10g) of 9.7mW/kg, and used FDTD simulations, which resulted in an SAR(10g) of 7.2mW/kg. FDTD simulations of realistic exposure situations were executed using a heterogeneous phantom, which yielded SAR(10g) values lower than 2.8mW/kg. The studied dosimetric quantities were in compliance with ICNIRP guidelines when the attocell was fed an input power <1mW. The deployment of attocells is thus a feasible solution for providing broadband data transmission without drastically increasing personal RF exposure. (C) 2017 Wiley Periodicals, Inc.

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Measurements of intermediate-frequency electric and magnetic fields in households

Historically, assessment of human exposure to electric and magnetic fields has focused on the extremely-low frequency (ELF) and radiofrequency (RF) ranges. However, research on the typically emitted fields in the intermediate-frequency (IF) range (300 Hz to 1 MHz) as well as potential effects of IF fields on the human body remains limited, although the range of household appliances with electrical components working in the IF range has grown significantly (e.g., induction cookers and compact fluorescent lighting). In this study, an extensive measurement survey was performed on the levels of electric and magnetic fields in the IF range typically present in residences as well as emitted by a wide range of household appliances under real-life circumstances. Using spot measurements, residential IF field levels were found to be generally low, while the use of certain appliances at close distance (20 cm) may result in a relatively high exposure. Overall, appliance emissions contained either harmonic signals, with fundamental frequencies between 6 kHz and 300 kHz, which were sometimes accompanied by regions in the IF spectrum of rather noisy, elevated field strengths, or much more capricious spectra, dominated by 50 Hz harmonics emanating far in the IF domain. The maximum peak field strengths recorded at 20 cm were 41.5 V/m and 2.7 A/m, both from induction cookers. Finally, none of the appliance emissions in the IF range exceeded the exposure summation rules recommended by the International Commission on Non-Ionizing Radiation Protection guidelines and the International Electrotechnical Commission (IEC 62233) standard at 20 cm and beyond (maximum exposure quotients EQ(E) 1.0 and (E)Q(H) 0.13).

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Can body-worn devices be used for measuring personal exposure to mm waves?

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Reference intervals for biochemical blood variables, packed cell volume, and body temperature in pet rats (Rattus norvegicus) using point-of-care testing

Background: Rats (Rattus norvegicus) are increasingly kept as pets, thus more and more requiring veterinary care. Important differences exist between pet and laboratory rats, but little information is available on pet rats. Diagnosis and treatment of pet rat diseases would benefit from RIs specific for this animal population. Objectives: The aim was to establish RIs for biochemical blood variables, PCV, and body temperature in pet rats. Additionally, influences of sex and feed rationing method (ad libitum, restricted) on these variables were determined. Methods: American Society for Veterinary Clinical Pathology (ASVCP) recommendations were followed. Biochemical variables were measured using an automated chemistry analyzer, the VetScan VS2. Nonparametric statistical methods were used to determine RIs and effects of sex and feed rationing method. Results: Reference intervals were established using values of 123 clinically healthy pet rats (except for globulins and albumin/globulin ratio, n = 120) and were: glucose 6.6-13.7 mmol/L, total proteins 66-88 g/L, albumin 38 g/L, globulins 12-35 g/L, albumin/globulin ratio 1.0-4.7, urea nitrogen 2.5-6.6 mmol/L, creatinine 53 mol/L, total bilirubin 4-7 mol/L, ALP 40-442 IU/L, ALT 22-137 IU/L, amylase 502-1113 IU/L, sodium 133-144 mmol/L, potassium 3.6-5.3 mmol/L, calcium 9.5-10.9 mg/dL, phosphorus 2.3-7.0 mg/dL, PCV 40-50%, and body temperature 35.8-39.3 degrees C. Sex significantly affected 10 variables. No significant influence was found with feed limitation Conclusions: Reference intervals reported in this study will be useful for interpretation of biochemistry analysis in pet rats and therefore improve pet rat medicine.

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Adult-onset Sydenham’s chorea or drug-induced movement disorder? A case report

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A 'clickable' MTX-reagent as a practical tool for profiling small molecule-intracellular target interactions via MASPIT

We present a scalable synthesis of a versatile MTX reagent with an azide ligation handle that allows rapid -selective conjugation to yield MTX fusion compounds (MFCs) appropriate for MASPIT, a three-hybrid system that enables the identification of mammalian cytosolic proteins that interact with a small molecule of interest. We selected three structurally diverse pharmacologically active compounds (tamoxifen, reversine, and FK506) as model baits. After acetylene functionalization of these baits, MFCs were synthesized via a CuAAC reaction, demonstrating the general applicability of the MTX reagent. In analytical mode, MASPIT was able to give concentration-dependent reporter signals for the established target proteins. Furthermore, we demonstrate that the sensitivity obtained with the new MTX reagent was significantly stronger than that of a previously used non-regiomeric conjugate mixture. Finally, the FK506 MFC was explored in a cellular array screen for targets of FK506. Out of a pilot collection of nearly 2000 full-length human ORF preys, FKBP12, the established target of FK506, emerged as the prey protein that gave the highest increase in luciferase activity. This indicates that our newly developed synthetic strategy for the straightforward generation of MFCs is a promising asset to uncover new intracellular targets using MASPIT cellular array screening.

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Discovery of an acyclic nucleoside phosphonate that inhibits Mycobacterium tuberculosis ThyX based on the binding mode of a 5-alkynyl substrate analogue

The urgent need for new antibiotics poses a challenge to target un(der)exploited vital cellular processes. Thymidylate biosynthesis is one such process due to its crucial role in DNA replication and repair. Thymidylate synthases (TS) catalyze a crucial step in the biosynthesis of thymidine 5-triphosphate (TTP), an elementary building block required for DNA synthesis and repair. To date, TS inhibitors have only been successfully applied in anticancer therapy due to their lack of specificity for antimicrobial versus human enzymes. However, the discovery of a new family of TS enzymes (ThyX) in a range of pathogenic bacteria that is structurally and biochemically different from the "classic" TS (ThyA) has opened the possibility to develop selective ThyX inhibitors as potent antimicrobial drugs. Here, the interaction of the known inhibitor 5-(3-octanamidoprop-1-yn-1yl)-2'-deoxyuridine-5'-monophosphate (1) with Mycobacterium tuberculosis ThyX enzyme is explored using molecular modeling starting from published crystal structures, with further confirmation through NMR experiments. While the deoxyuridylate (dUMP) moiety of compound 1 occupies the cavity of the natural substrate in ThyX, the rest of the ligand (the "5-alkynyl tail") extends to the outside of the enzyme between two of its four subunits. The hydrophobic pocket that accommodates the alkyl part of the tail is formed by displacement of Tyr 44. C, Tyr 108. A and Lys 165. A. Changes to the resonance of the Lys 165 NH3 group upon ligand binding were monitored in a titration experiment by 2D HISQC NMR. Guided by the results of the modeling and NMR studies, and inspired by the success of acyclic antiviral nucleosides, compounds where a 5-alkynyl uracyl moiety is coupled to an acyclic nucleoside phosphonate (ANP) were synthesized and evaluated. Of the compounds evaluated, sodium (6-(5-(3-octanamidoprop-1-yn-1-yl)-2,4-dioxo-3,4-dihydropyrimidin-1(2H)-yl) hexyl) phosphonate (3e) exhibited 43% of inhibitory effect on ThyX at 50 mm. While only modest activity was achieved, this is the first example of an ANP inhibiting ThyX, and these results can be used to further guide structural modifications to this class to develop more potent compounds with potential application as antibacterial agents acting through a novel mechanism of action.

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The synthesis and in vivo evaluation of 2',2'-difluoro KRN7000

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Synthesis and in vitro evaluation of α-GalCer epimers

alpha-GalCer (also known as KRN7000) is an immunomodulatory glycolipid that is known to potently activate invariant natural killer T (NKT) cells upon CD1d-mediated stimulation. Because Th1 and Th2 cytokines, which are released after alpha-GalCer presentation, antagonize each other's effects, a-GalCer analogues-that induce a biased Th1/Th2 response are highly awaited. In this context, we report the synthesis and in vitro evaluation of alpha-Gal-D-Xylo-Cer and two alpha-Gal-L-lyxo-Cer analogues, one with the natural acyl chain, the other with a truncated chain.

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Synthesis and biological evaluation of bicyclic nucleosides as inhibitors of M-tuberculosis thymidylate kinase

Herein we describe the synthesis and conformational analysis of a series of bicyclic thymidine derivatives and their evaluation as inhibitors of thymidine monophosphate kinase from Mycobacterium tuberculosis (TMPKmt), based on previously discovered bicyclic sugar nucleosides. With a K(i) value of 2.3 mu m, 1-[3-aminomethyl-3,5-dideoxy-2-O,6-N-(thiocorbonyl)-beta-D-ribofuranosyl]thymine emerged as the most potent TMPK inhibitor of this series. Moreover, this promising compound displays inhibitory potency against Mycobacteria cultures with an IC(99) value of 100 mu g mL(-1), thus promoting TMPKmt for the first time as a validated target for further inhibitory design. Attempts to rationalise the observed structure-activity relationship (SAR) involving molecular modelling and conformational analysis are described.

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Innovative 3D Model of the Human Middle Ear in High Resolution with a Histological Microgrinding Method: A Feasibility Study and Comparison with CT

Conclusion. The development of a histological 3D model of the tympanic cavity visualizes the exact microanatomy of the sound conduction organ and is therefore essential for finite elements simulations and surgical training. Objectives. So far, no accurate histological 3D model of the sound conduction system existed in literature. For 3D reconstruction of the very fine structures inside and outside the auditory ossicles, a method based on histological slices allows a more differential analysis of both hard and soft tissues and could thus be superior to μCT. Method. A complete temporal bone was embedded in epoxy resin and microground in distances of about 34 μm. After photodocumentation of every plane, a 3D reconstruction was performed by using the Computer Aided Design (CAD) program Rhinoceros 5®. For comparison, a μCT of the same specimen resulted in a 3D model of the calcified structures in the middle ear. Results. The histological 3D model gives an excellent overview to all anatomical soft and bony tissues of the human auditory ossicles. Specifically the fine blood vessel system and the exact dimension of cartilage areas inside the ossicles can be illustrated much more precisely than with μCT data. The present technique also allows the evaluation of the fine connecting ligaments inside the tympanic cavity.

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Arterial stiffening, insulin resistance and acanthosis nigricans in a community sample of adolescents with obesity

Hudson, LD; Kinra, S; Wong, ICK; Viner, RM; Arterial stiffening, insulin resistance and acanthosis nigricans in a community sample of adolescents with obesity. International Journal of Obesity (In press).

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Long-term impacts of parental migration on Chinese children’s psychosocial well-being: mitigating and exacerbating factors

Zhao, C; Wang, F; Li, L; Zhou, X; Hesketh, T; (2017) Long-term impacts of parental migration on Chinese children's psychosocial well-being: mitigating and exacerbating factors. Social Psychiatry and Psychiatric Epidemiology 10.1007/s00127-017-1386-9 . (In press). Green open access

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Network Stack Specialization for Performance

Marinos, I; Watson, RNM; Handley, M; (2014) Network Stack Specialization for Performance. In: Bustamante, FE and Hu, YC and Krishnamurthy, A and Ratnasamy, S, (eds.) SIGCOMM '14: Proceedings of the 2014 ACM conference on SIGCOMM. (pp. pp. 175-186). Association for Computer Machinery: New York, USA. Green open access

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Bags, batteries and boxes: A qualitative interview study to understand how syringe drivers are adapted and used by healthcare staff

Vincent, CJ; Blandford, A; (2017) Bags, batteries and boxes: A qualitative interview study to understand how syringe drivers are adapted and used by healthcare staff. Applied Ergonomics , 63 (C) pp. 115-122. 10.1016/j.apergo.2017.04.012 .

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The Synthesis of Single Tetragonal Phase Zirconia by SolGel Route

Zhang, P; Choy, KL; (2015) The Synthesis of Single Tetragonal Phase Zirconia by SolGel Route. International Journal of Engineering Research & Science (IJOER) , 1 (7) pp. 18-24.

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Chapter 30 – Functional eye movement disorders

Kaski, D; Bronstein, AM; (2016) Chapter 30 – Functional eye movement disorders. In: Handbook of Clinical Neurology. (pp. 343-351). Elsevier

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Limiting Thymic Precursor Supply Increases the Risk of Lymphoid Malignancy in Murine X-Linked Severe Combined Immunodeficiency

Ginn, SL; Hallwirth, CV; Liao, SHY; Teber, ET; Arthur, JW; Wu, J; Lee, HC; Ginn, SL; Hallwirth, CV; Liao, SHY; Teber, ET; Arthur, JW; Wu, J; Lee, HC; Tay, SS; Hu, M; Reddel, RR; McCormack, MP; Thrasher, AJ; Cavazzana, M; Alexander, SI; Alexander, IE; - view fewer (2017) Limiting Thymic Precursor Supply Increases the Risk of Lymphoid Malignancy in Murine X-Linked Severe Combined Immunodeficiency. Molecular Therapy - Nucleic Acids , 6 pp. 1-14. 10.1016/j.omtn.2016.11.011 . Green open access

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Exploiting the Cracks: Wedge Issues in Multiparty Competition

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Impact of venous outflow tract on survival of osteocutaneous free fibula flaps for mandibular reconstruction: A 14-year review

Abstract

Background

The principle reconstructive modality for segmental mandibulectomy defects is the osteocutaneous free fibula flap. Preoperative CT angiography has been recommended to assess the quality of arterial inflow to the flap and donor limb. However, the impact of the venous system on flap viability has not been explored.

Methods

A retrospective review of all patients undergoing free fibula flap mandible reconstruction was performed at a single tertiary cancer center from 2002 to 2015. Overall complications, including operative reexploration and total flap losses, were evaluated.

Results

One hundred seven patients underwent free fibula flap reconstruction of the mandible. Nine patients underwent multiple free flaps and were excluded from this study. Of the remaining 98 patients, 8 patients required operative exploration for microvascular compromise. All patients were found to have venous thrombosis. There were 3 total flaps losses with a salvage rate of 62.5% and overall flap survival of 96.9%. The size of the vena comitantes in the compromised flaps were significantly larger than those of the remaining patients (4.4 mm vs 3.1 mm; P < .0001). Although the total operative times were similar between the 2 groups (585.2 minutes vs 563.3 minutes), the ischemia time was significantly shorter in those cases that required operative takeback (76.5 minutes vs 104.0 minutes; P < .04).

Conclusion

Venous thrombosis of free fibula flaps is more common than arterial thrombosis. Venous stasis in larger vena comitantes may be a contributing factor to microvascular compromise. Anticoagulation and/or handsewn anastomosis may be beneficial if the veins are larger than 4.0 mm in size.

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Structural alterations in tumor-draining lymph nodes before papillary thyroid carcinoma metastasis

Abstract

Background

The purpose of this study was to define and characterize the thyroid tumor-draining lymph nodes in genetically engineered mice harboring thyroid-specific expression of oncogenic Braf^V600E with and without Pten insufficiency.

Methods

After intratumoral injection of methylene blue, the lymphatic drainage of the thyroid gland was visualized in real time. The thyroid gland/tumor was resected en bloc with the respiratory system for histological analysis.

Results

Although mice harboring Braf^V600E mutations were smaller in body size compared with their wild-type (WT) littermates, the size of their thyroid glands and deep cervical lymph nodes were significantly larger. Additionally, the tumor-draining lymph nodes showed increased and enlarged lymphatic sinuses that were distributed throughout the cortex and medulla. Tumor-reactive lymphadenopathy and histiocytosis, but no frank metastases, were observed in all mice harboring Braf^V600E mutations.

Conclusions

The tumor-draining lymph nodes undergo significant structural alterations in immunocompetent mice, and this may represent a primer for papillary thyroid carcinoma (PTC) metastasis.

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Radiotherapy for juvenile ossifying fibroma of the maxillary sinus: Case report and literature review

Abstract

Background

Juvenile ossifying fibroma (JOF) is a benign fibro-osseous lesion that can be locally aggressive. It is typically treated with surgical excision. A few cases using adjuvant radiotherapy have been reported in the literature.

Methods

We report a case of JOF treated with surgical excision and adjuvant radiotherapy to minimize the risk of local recurrence. We also review the literature.

Results

Our patient tolerated radiotherapy without complication and had not experienced a local recurrence at the time of writing this manuscript.

Conclusions

This is one of the first reports of adjuvant radiotherapy after surgical excision to improve local control in patients with JOF. Radiotherapy should be considered in patients for whom reexcision after a recurrence would result in unacceptable morbidity.

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Intraoperative nerve monitoring during parathyroid surgery: The Fort Worth experience

Abstract

Background

Avoidance of recurrent laryngeal nerve (RLN) injury during parathyroid surgery is of paramount important. The purpose of this study was to determine if intraoperative nerve monitoring allowed for decreased rates of RLN injury during parathyroid surgery.

Method

Between 1997 and 2016, 213 patients undergoing parathyroidectomy were retrospectively analyzed to determine postoperative recurrent nerve injury. Eighty-seven patients did not have intraoperative nerve monitoring, whereas 126 patients did.

Results

Based on the number of patients presenting with nerve injury during the postoperative period operated on with and without nerve monitoring, it was found that the difference in the 2 modalities was not statistically significant (P > .05).

Conclusion

Routine use of intraoperative nerve monitoring during parathyroid surgery may not yield any additional benefit in preventing injury to the RLN.

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Helistroke Service: Flying the Physician to the Stroke Patient Works

Flying a stroke specialist by helicopter to a nearby stroke patient for emergency care is feasible, saves money and, most importantly, gets critical care to patients faster than transporting the patient to a hospital first, according to a single-patient, proof-of-concept study by a Johns Hopkins Medicine research team.

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Expanding the Interactome of TES by Exploiting TES Modules with Different Subcellular Localizations

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Evaluation of direct Etest for antimicrobial susceptibility testing of bacteria isolated from synovial fluid of horses using enrichment bottles

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Reverse electrodialysis - reverse osmosis hybrid for seawater desalination using secondary treated waste water effluent: optimal pre-treatment strategy

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Van grote kuis naar open huis? De evolutie van etnocentrisme in België tussen 1981 en 2009

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Basisindicatoren HRRF: ECOOM-UGent databank 2009

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Phenobarbital or potassium bromide as an add-on antiepileptic drug for the management of canine idiopathic epilepsy refractory to imepitoin

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Methodological considerations on graph theoretical analysis of structural brain networks

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Use of Chlorothiazide in the Management of Central Diabetes Insipidus in Early Infancy

Management of central diabetes insipidus in infancy is challenging. The various forms of desmopressin, oral, subcutaneous, and intranasal, have variability in the duration of action. Infants consume most of their calories as liquids which with desmopressin puts them at risk for hyponatremia and seizures. There are few cases reporting chlorothiazide as a temporizing measure for central diabetes insipidus in infancy. A male infant presented on day of life 30 with holoprosencephaly, cleft lip and palate, and poor weight gain to endocrine clinic. Biochemical tests and urine output were consistent with central diabetes insipidus. The patient required approximately 2.5 times the normal fluid intake to keep up with the urine output. Patient was started on low renal solute load formula and oral chlorothiazide. There were normalization of serum sodium, decrease in fluid intake close to 1.3 times the normal, and improved urine output. There were no episodes of hyponatremia/hypernatremia inpatient. The patient had 2 episodes of hypernatremia in the first year of life resolving with few hours of hydration. Oral chlorothiazide is a potential bridging agent for treatment of central DI along with low renal solute load formula in early infancy. It can help achieve adequate control of DI without wide serum sodium fluctuations.

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Trans-Oral Robotic Surgery (TORS) for a Ewing's sarcoma of tongue in pediatric patient: a case report

Publication date: Available online 2 May 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Frank Rikki Canevari, Filippo Montevecchi, Stefania Galla, Raffaele Sorrentino, Claudio Vicini, Federico Sireci




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The multicultural evolution of beauty in facial surgery

Publication date: Available online 2 May 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Eric W. Cerrati, J. Regan Thomas




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How media multitasking reduces advertising irritation : the moderating role of the Facebook wall

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Sociaal Werk zal politiek zijn of niet zijn. Vermarkting legt hypotheek op politiserend werken.

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Transition models for turbomachinery boundary layer flows : a review

Current models for transition in turbomachinery boundary layer flows are reviewed. The basic physical mechanisms of transition processes and the way these processes are expressed by model ingredients are discussed. The fundamentals of models are described as far as possible, with a common structure of the equations and with emphasis on the similarities between the models. Tests of models reported in the literature are summarized and our own test is added. A conclusion on the performance of models is formulated.

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The endocardial endothelium: function and electrophysiology

Basic electrophysiological properties of cultured endocardial endothelial (EE) cells from the porcine right ventricle were studied by the conventional whole-cell patch-clamp technique. In isotonic conditions, the major membrane current in resting EE cells was an inwardly rectifying K-current (I-K) responsible for the negative value of the resting potential (-50 to -70mV). Outwardly directed currents at positive clamp potentials were small. In hypotonic conditions (hypertonic pipette solution), cells depolarized and an outwardly rectifying Cl-current was activated. The volume-activated current was inactivated by returning to isotonic conditions and was inhibited by DIDS (4,4'-diisothiocyanostilbene-2,2' disulfonic acid, 100-300 mu M) or flufenamic acid 50-100 mu M. A possible role of the Cl-current in EE cells is discussed.

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pH aspects of the effect of ammonium chloride on conduction velocity in isolated atrial fibers

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Path planning of the hybrid parallel robot for ankle rehabilitation

Rakhodaei, H; Saadat, M; Rastegarpanah, A; Abdullah, CZ; (2016) Path planning of the hybrid parallel robot for ankle rehabilitation. Robotica , 34 (01) pp. 173-184. 10.1017/S0263574714001210 .

http://ift.tt/2qEhVhs

Contribution of Collaborative Work to Teacher Reflection and the Transformation of Pedagogical Practices of School and University Science Teachers // Contribución del trabajo colaborativo en la reflexión docente y en la transformación de las prácticas pedagógicas de profesores de ciencia escolares y universitarios

González-Weil, C; Gómez Waring, M; Ahumada Albalay, G; Bravo González, P; Salinas Tapia, E; Avilés Cisternas, D; Pérez, JL; González-Weil, C; Gómez Waring, M; Ahumada Albalay, G; Bravo González, P; Salinas Tapia, E; Avilés Cisternas, D; Pérez, JL; Santana Valenzuela, J; - view fewer (2014) Contribution of Collaborative Work to Teacher Reflection and the Transformation of Pedagogical Practices of School and University Science Teachers // Contribución del trabajo colaborativo en la reflexión docente y en la transformación de las prácticas pedagógicas de profesores de ciencia escolares y universitarios. Pensamiento Educativo: Revista de Investigación Educacional Latinoamericana , 51 (2) pp. 75-85. 10.7764/PEL.51.2.2014.6 . Green open access

http://ift.tt/2pXsRdD

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

Aabakken, L; Karlsen, TH; Albert, J; Arvanitakis, M; Chazouilleres, O; Dumonceau, J-M; Färkkilä, M; Aabakken, L; Karlsen, TH; Albert, J; Arvanitakis, M; Chazouilleres, O; Dumonceau, J-M; Färkkilä, M; Fickert, P; Hirschfield, GM; Laghi, A; Marzioni, M; Fernandez, M; Pereira, SP; Pohl, J; Poley, J-W; Ponsioen, CY; Schramm, C; Swahn, F; Tringali, A; Hassan, C; - view fewer (2017) Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline. Journal of Hepatology 10.1016/j.jhep.2017.02.013 . (In press).

http://ift.tt/2qE4n5q

Nine Translations from Baudelaire (1959)

Townsend Warner, Sylvia; (2017) Nine Translations from Baudelaire (1959). The Journal of the Sylvia Townsend Warner Society , 2017 pp. 20-34. 10.14324/111.444.stw.2017.03 . Green open access

http://ift.tt/2pXFTI9

Man's Moral Law

Townsend Warner, Sylvia; (2017) Man's Moral Law. The Journal of the Sylvia Townsend Warner Society , 2017 pp. 9-19. 10.14324/111.444.stw.2017.02 . Green open access

http://ift.tt/2qEfMSS

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline.

Aabakken, L; Karlsen, TH; Albert, J; Arvanitakis, M; Chazouilleres, O; Dumonceau, J-M; Färkkilä, M; Aabakken, L; Karlsen, TH; Albert, J; Arvanitakis, M; Chazouilleres, O; Dumonceau, J-M; Färkkilä, M; Fickert, P; Hirschfield, GM; Laghi, A; Marzioni, M; Fernandez, M; Pereira, SP; Pohl, J; Poley, J-W; Ponsioen, CY; Schramm, C; Swahn, F; Tringali, A; Hassan, C; - view fewer (2017) Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline. Endoscopy 10.1055/s-0043-107029 . (In press).

http://ift.tt/2pXo0JE

Some Notes on George Moir and Flora Warner

Harman, Claire; (2017) Some Notes on George Moir and Flora Warner. The Journal of the Sylvia Townsend Warner Society , 2017 pp. 1-8. 10.14324/111.444.stw.2017.01 . Green open access

http://ift.tt/2qExrd6

Sylvia Townsend Warner’s Letters: Where Are They Now?

Tolhurst, Peter; (2017) Sylvia Townsend Warner's Letters: Where Are They Now? The Journal of the Sylvia Townsend Warner Society , 2017 pp. 65-76. 10.14324/111.444.stw.2017.05 . Green open access

http://ift.tt/2pXQhjp

A Recurrent Modulation: Religious Themes in the Poetry of Sylvia Townsend Warner

Matarasso, Pauline; (2017) A Recurrent Modulation: Religious Themes in the Poetry of Sylvia Townsend Warner. The Journal of the Sylvia Townsend Warner Society , 2017 pp. 35-64. 10.14324/111.444.stw.2017.04 . Green open access

http://ift.tt/2qEhq6Z

Real-time imaging of single neuronal cell apoptosis in patients with glaucoma.

Cordeiro, MF; Normando, EM; Cardoso, MJ; Miodragovic, S; Jeylani, S; Davis, BM; Guo, L; Cordeiro, MF; Normando, EM; Cardoso, MJ; Miodragovic, S; Jeylani, S; Davis, BM; Guo, L; Ourselin, S; A'Hern, R; Bloom, PA; - view fewer (2017) Real-time imaging of single neuronal cell apoptosis in patients with glaucoma. Brain 10.1093/brain/awx088 . (In press). Green open access

http://ift.tt/2pXHU78

A qualitative investigation into patients’ views on visual field testing for glaucoma monitoring

Glen, FC; Baker, H; Crabb, DP; (2014) A qualitative investigation into patients' views on visual field testing for glaucoma monitoring. BMJ Open , 4 (1) , Article e003996. 10.1136/bmjopen-2013-003996 . Green open access

http://ift.tt/2qEuIQO

Teachers’ Perceptions about the Use of Background Music in Preschool Free Play Time

Lee, Y; Welch, GF; (2017) Teachers' Perceptions about the Use of Background Music in Preschool Free Play Time. Asia-Pacific Journal of Research in Early Childhood Education , 11 (2) pp. 85-106. 10.17206/apjrece.2017.11.2.85 .

http://ift.tt/2pXuyYA

A discrete electromechanical model for human cardiac tissue: effects of stretch-activated currents and stretch conditions on restitution properties and spiral wave dynamics

We introduce an electromechanical model for human cardiac tissue which couples a biophysical model of cardiac excitation (Tusscher, Noble, Noble, Panfilov, 2006) and tension development (adjusted Niederer, Hunter, Smith, 2006 model) with a discrete elastic mass-lattice model. The equations for the excitation processes are solved with a finite difference approach, and the equations of the mass-lattice model are solved using Verlet integration. This allows the coupled problem to be solved with high numerical resolution. Passive mechanical properties of the mass-lattice model are described by a generalized Hooke's law for finite deformations (Seth material). Active mechanical contraction is initiated by changes of the intracellular calcium concentration, which is a variable of the electrical model. Mechanical deformation feeds back on the electrophysiology via stretch-activated ion channels whose conductivity is controlled by the local stretch of the medium. We apply the model to study how stretch-activated currents affect the action potential shape, restitution properties, and dynamics of spiral waves, under constant stretch, and dynamic stretch caused by active mechanical contraction. We find that stretch conditions substantially affect these properties via stretch-activated currents. In constantly stretched medium, we observe a substantial decrease in conduction velocity, and an increase of action potential duration; whereas, with dynamic stretch, action potential duration is increased only slightly, and the conduction velocity restitution curve becomes biphasic. Moreover, in constantly stretched medium, we find an increase of the core size and period of a spiral wave, but no change in rotation dynamics; in contrast, in the dynamically stretching medium, we observe spiral drift. Our results may be important to understand how altered stretch conditions affect the heart's functioning.

http://ift.tt/2pw39M6

A detailed phenotypic assessment of individuals affected by MFRP-related oculopathy

Purpose: To determine the spectrum of mutations and phenotypic variability within patients with mutations in membrane-type frizzled related protein gene (MFRP). Methods: Individuals were initially ascertained based on a phenotype similar to that previously published in association with MFRP mutations. Affected patients underwent a full ophthalmic examination (best-corrected visual acuity, slit-lamp examination, applanation tonometry, and fundoscopy), color fundus photography, optical coherence tomography, autofluorescence imaging, and electrophysiology. MFRP was identified by a genome-wide scan in the fourth-largest autozygous region in one consanguineous family. Sanger sequencing of all the exons and intron-exon boundaries of MFRP was undertaken in the affected individuals. Results: Seven affected individuals from four families were identified as having mutations in MFRP. Patients from two families were homozygous for mutations already previously described (c. 1143_1144 insC and c. 492 delC), while those from the other two were compound heterozygous for mutations (c. 201G>A and c. 491_492 insT, and c. 492 delC, and c. 1622_1625 delTCTG), three of which were novel. There was considerable phenotypic variability within and among families. Autofluorescence imaging revealed the central macula to be relatively well preserved. Foveal cysts and optic nerve head drusen were present in two of the four families. Electrophysiology results showed rod-cone dystrophy with mild to moderate reduction in macular function in all affected members. Conclusions: We report three novel MFRP mutations and expand the phenotypic data available on patients with MFRP mutations.

http://ift.tt/2qxRfjm