Soft-diet feeding impairs neural transmission between mitral cells and interneurons in the mouse olfactory bulb

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Tomohiro Noguchi, Chizuru Utsugi, Makoto Kashiwayanagi
(Objective) The subventricular zone in mice generates a lot of neuroblasts even during adulthood. These neuroblasts migrate to the olfactory bulb and differentiate into inhibitory interneurons such as granule cells and periglomerular cells. Olfactory sensory neurons receive information from various odorants and transmit it to the olfactory bulb. Our previous study showed that soft-diet feeding impairs neurogenesis in the subventricular zone, in turn leading to the reduction of odor-induced behaviors and Fos-immunoreactivities, the latter of which are markers of neural activity, at the olfactory bulb after exposure to odors. Release of GABA from inhibitory interneurons at the olfactory bulb induces inhibitory currents at the mitral cells, which are output neurons from the olfactory bulb. (Design) In the present study, we measured spontaneous inhibitory postsynaptic currents (sIPSCs) at the mitral cells of mice fed a soft diet in order to explore the effects of changes in texture of diets on neural function at the olfactory bulb. (Results) The soft-diet feeding extended the intervals between sIPSCs and reduced their peak amplitudes. (Conclusions) The present results suggest that soft-diet feeding in mice attenuates the neural functions of inhibitory interneurons at the olfactory bulb.

Graphical abstract

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Treatment of Patients With Hepatitis C Virus infection (Genotype 4) With Ledipasvir-Sofosbuvir in the Liver Transplant Setting.

Background: Hepatitis C virus infection is a major cause of liver cirrhosis and hepatocellular carcinoma and the leading indication for liver transplantation. In the Middle East, genotype 4 HCV infection is the most common genotype. However, limited data exists on the treatment of genotype-4 in the liver transplant setting. We evaluated the safety and efficacy of ledipasvir-sofosbuvir (LDV/SOF) in treating HCV genotype-4 infected patients with cirrhosis or postliver transplantation. Methods: This prospective, single-arm, observational study includes cohort of patients with cirrhosis before liver transplantation (Cohort A) and a cohort of postliver transplantation patients (Cohort B). Patients received LDV/SOF (90 mg-400 mg) once daily for 12-24 weeks with or without ribavirin (RBV). Patients with creatinine clearance below 30 were excluded. Results: A total of 111 patients (61 cirrhotic; 50 postliver transplants) with HCV genotype 4 were treated in KFSH&RC; 55% cohort A and 44% cohort B received ribavirin. Sustained virological response SVR12 was 91.8% and 86% of cohorts A and B, respectively. There were no treatment-related mortality or serious adverse effects. RBV dose reduction occurred in 25% without any treatment discontinuation. SVR12 rates in cohort A were significantly higher in patients with a viral load below 800 000 (100% vs 83.9%, p value=0.022). Viral load did not impact SVR rates in cohort B. The use of RBV did not increase SVR12 and was associated with anemia. Conclusions: Ledipasvir-sofosbuvir without ribavirin is an effective and safe treatment option for patients with HCV genotype 4 infection in pre and postliver transplant setting. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Ocular surface lubricants.

Purpose of review: The purpose of this article is to provide an overview of the ocular lubricants currently available, consider the components of the various formulations and highlight the status of preservative use in the treatment of anterior ocular surface diseases. Recent findings: The primary components of ocular surface lubrication have been, in the past, based on various cellulose formulations that increase hydration. Advances in lubrication have come from areas of the human body requiring lubrication such as the skeletal joints as well as examining the use of natural components of the tear fluid. These have resulted in novel modifications of existing tear components, for example, thiolated carboxymethyl hyaluronic acid which creates crosslinking to mechanically increase retention time for ocular surface hydration. Other proteoglycans such as lubricin, having one of the lowest coefficients of friction in nature, to a lipopolysaccharide derivative of tamarind seed, may provide a unique delivery system for lubricants and medications. Summary: The present state of ocular surface lubrication is slowly advancing from the routine use of cellulose-based solutions and gels to more advanced replacement with natural tear components. The advances that are occurring on other lubricating surfaces of the musculoskeletal system are also providing some insights into potential use on the ocular surface. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Hymenoptera-induced anaphylaxis: is it a mast cell driven hematological disorder?.

Purpose of review: Hymenoptera-induced allergy (HVA) is a common cause of anaphylaxis and may be fatal. It is associated with systemic mastocytosis in about 7% of adult patients. Systemic mastocytosis is a proliferative disorder of hematopoietic mast cell progenitors. There is recent data on the association between systemic mastocytosis and HVA. Recent findings: Hymenoptera venoms are the most common immunoglobulin E-mediated elicitors of anaphylaxis in patients with mastocytosis. Some patients with systemic mastocytosis do not have cutaneous involvement and have only been identified because of HVA. These patients do have distinct demographic, clinical, and laboratory features as compared with patients with mastocytosis with skin lesions. They show a male predominance, more severe (cardiovascular) as compared to skin symptoms, lower baseline serum tryptase, less bone marrow mast cell aggregates, and KIT mutations restricted to mast cell lineage. Summary: Although hymenoptera-induced anaphylaxis is not primarily a mast cell-driven hematological disorder, the latter is present in a significant proportion of patients and has to be excluded by basal serum tryptase determination, skin inspection as well as exclusion of systemic mastocytosis by D816V mutation analysis in peripheral blood and/or bone marrow examination in selected patients. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Climate changes and Hymenoptera venom allergy: are there some connections?.

Purpose of review: This review aims to update the world status of the main allergenic stinging Hymenoptera. Recent findings: In this review, we consider the problems that social Hymenoptera (bees, wasps and ants) could represent in the nearest future for human health in different parts of the world. Summary: Distribution and consistency of allergenic species including venomous insects are interested by accelerated dynamics caused by climate changes and globalization. Owing to the expansion of ranges of native species and colonization of invasive ones, even in the uncertainty of present available models, new challenges presented by stinging Hymenoptera should be expected in the future. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Organoid culture systems to study host–pathogen interactions

Devanjali Dutta | Hans Clevers

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Pulmonary function in patients with eosinophilic chronic rhinosinusitis

Publication date: Available online 10 August 2017
Source:Auris Nasus Larynx
Author(s): Kensuke Uraguchi, Shin Kariya, Seiichiro Makihara, Mitsuhiro Okano, Takenori Haruna, Aiko Oka, Rumi Fujiwara, Yohei Noda, Kazunori Nishizaki
ObjectiveThere is a close relationship between upper and lower respiratory tract diseases. Chronic rhinosinusitis patients frequently have lung diseases including asthma and chronic obstructive pulmonary disease. Eosinophilic chronic rhinosinusitis is considered a refractory and intractable subtype of chronic rhinosinusitis. However, there has been no report on pulmonary function in patients with eosinophilic chronic rhinosinusitis. The purpose of this study is to examine the pulmonary function in eosinophilic chronic rhinosinusitis patients and non-eosinophilic chronic rhinosinusitis patients, and evaluate clinical factors associated with the pulmonary function of these patients.MethodsPulmonary function was measured in 53 patients with eosinophilic chronic rhinosinusitis with asthma, 58 patients with eosinophilic chronic rhinosinusitis without asthma, and 30 patients with non-eosinophilic chronic rhinosinusitis. The diagnosis of chronic rhinosinusitis was based on the definition in the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2012. Eosinophilic chronic rhinosinusitis was diagnosed based on the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) scoring system. The relationship between pulmonary function and clinical parameters was assessed. These parameters included radiographic severity of chronic rhinosinusitis, peripheral blood eosinophil percentage, serum total immunoglobulin E level, and eosinophilic infiltration in nasal polyps.ResultsThe pulmonary function of the patients with eosinophilic chronic rhinosinusitis was significantly affected. The eosinophilic chronic rhinosinusitis patients had more peripheral airway obstruction as compared to the patients with non-eosinophilic chronic rhinosinusitis.ConclusionOur findings indicated latent obstructive lung function changes in the eosinophilic chronic rhinosinusitis patients. The patients with eosinophilic chronic rhinosinusitis should be carefully monitored in order to detect lung diseases.



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Variations in the labyrinthine segment of facial nerve canal revealed by high-resolution computed tomography

Publication date: Available online 10 August 2017
Source:Auris Nasus Larynx
Author(s): Aiyan Jin, Peng Xu, Fengqin Qu
ObjectiveTo study variations in the labyrinthine segment of fallopian canal and the associated middle and inner ear malformations.MethodThe high-resolution computed tomography (HRCT) images of the temporal bone in 24 patients with congenital variations in the labyrinthine segment of fallopian canal were analyzed retrospectively. The length of labyrinthine segment of the facial nerve and angle of the first genu of 10 normal subjects were also measured. Based on the original axial images, multi-planar reformation (MPR) and curved-planar reformation (CPR) images of bilateral ossicular chains, inner ear structure and fallopian canal were reconstructed. HRCT features of congenital variations in the labyrinthine segment of the facial nerve were analyzed, including its beginning site, dehiscence, length, angle of the first genu and the associated middle and inner ear malformations.ResultsAmong the normal subjects, the length of labyrinthine segment of the facial nerve was 3.56±0.41mm, and angle of the first genu was 71.87±8.09°. Five types of variations in the labyrinthine segment of the facial nerve were found in 45 ears of 24 cases, including dehiscence in geniculate fossa in 25 ears, anteromedial displacement at the beginning site in 27 ears (widening of Bill's bar in 7 cases), enlargement of the angle of the first genu in 30 ears with an average value of 107.2° (96.0–126.0°), increase of length in 30 ears with an average length of 6.8mm (5.2–8.3mm) and bifurcation in one ear. Associated middle ear malformation in 6 ears and inner ear malformation in 36 ears were also found.ConclusionA variety of congenital variations may occur in the labyrinthine segment of the facial nerve and they are often associated with middle or inner ear malformations, which can be clearly displayed by HRCT with MPR or CPR images.



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Antibody Affinity Against 2009 A/H1N1 Influenza and Pandemrix Vaccine Nucleoproteins Differs Between Childhood Narcolepsy Patients and Controls

Viral Immunology , Vol. 0, No. 0.


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Pulmonary function in patients with eosinophilic chronic rhinosinusitis

There is a close relationship between upper and lower respiratory tract diseases. Chronic rhinosinusitis patients frequently have lung diseases including asthma and chronic obstructive pulmonary disease. Eosinophilic chronic rhinosinusitis is considered a refractory and intractable subtype of chronic rhinosinusitis. However, there has been no report on pulmonary function in patients with eosinophilic chronic rhinosinusitis. The purpose of this study is to examine the pulmonary function in eosinophilic chronic rhinosinusitis patients and non-eosinophilic chronic rhinosinusitis patients, and evaluate clinical factors associated with the pulmonary function of these patients.

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When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council

Although most patients with atopic dermatitis (AD) are effectively managed with topical medication, a significant minority require systemic therapy. Guidelines for decision making about advancement to systemic therapy are lacking.

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Photodynamic therapy is more effective than imiquimod for actinic keratosis in organ transplant recipients – a randomized intra-individual controlled trial

Abstract

Background

Actinic keratoses (AKs) in solid organ transplant recipients (OTRs) are difficult-to-treat pre-malignancies and comparison of topical therapies is therefore warranted.

Objectives

In an intra-individual study to compare efficacy and safety of field treatment with methyl aminolevulinate photodynamic therapy (MAL-PDT) and imiquimod (IMIQ) for AKs in OTRs.

Materials and methods

OTRs (n=35) with 572 AKs (grade I-III) in two similar areas in the face, scalp, dorsal hands or forearms were included. All patients received one MAL-PDT and one IMIQ session (3 weekly applications for 4 weeks) in each study area according to randomization. Treatments were repeated after 2 months (IMIQ) and 3 months (PDT) in skin with incomplete AK-response. Outcome measures were complete lesion response (CR), skin reactions, laboratory results and treatment preference.

Results

The majority of study areas received two treatment sessions (PDT n=25, IMIQ n=29 patients). At 3 months after two treatments, PDT-treated skin achieved higher CR (AK I-III, median 78%, range 50-100%) compared to IMIQ-treated skin areas (median 61%, range 33-100%, p <0.001). Fewer emergent AKs were seen in PDT- vs. IMIQ-treated skin (0.7 vs. 1.5 AK, p=0.04). Patients developed more intense inflammatory skin reactions following PDT (PDT 2.8, IMIQ 1.7, p<0.01) that resolved faster compared to IMIQ (median 10 vs. 18 days, p<0.01). Patient preference (p= 0.47) and cosmesis (p>0.30) were similar for PDT and IMIQ. No significant changes in laboratory results were observed.

Conclusion

Compared to IMIQ, PDT-treatment obtained higher AK clearance at 3-month follow-up and shorter-lasting, but more intense short-term skin reactions.

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Are vitiligo treatments cost-effective? A systematic review

Abstract

Vitiligo is characterised by well demarcated, cutaneous, macular depigmentation, with worldwide prevalence estimated to be between 0.2-1.8% [1]. Vitiligo treatments aim to encourage re-pigmentation and include topical corticosteroids, calcineurin inhibitors and NB-UVB phototherapy. Camouflage can also be prescribed to help mask the appearance of vitiligo, although this is frequently only prescribed for the face.

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Sirolimus effects on Kasabach-Merritt phenomenon coagulopathy

Abstract

Kasabach-Merritt phenomenon (KMP) is a very rare life-threatening condition that combines a vascular tumor belonging to the kaposiform hemangioendothelioma (KHE) spectrum lesions, and thrombocytopenia.^1,2 Thrombocytopenia results from platelet trapping within the tumor. Platelet activation leads to various degrees of decreased fibrinogen and elevated D-dimer levels. This coagulopathy is frequently protracted after thrombocytopenia resolution. Several treatments have been proposed with variable efficiency.

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Solar urticaria developing in patients with Erythropoietic Protoporphyria: a clue to the pathogenesis of Solar Urticaria?

Abstract

We describe three cases of solar urticaria (SU) developing in patients with a diagnosis of Erythropoietic Protoporphyria (EPP). We suggest that this may imply that the endothelium may be the location of a chromophore in SU.

Patient 1 was a 42-year-old female. She had EPP characterised lifelong by three day long bouts of burning pain and swelling on the backs of hands and face induced by 10 minutes of exposure to spring or summer sun, and an increased red cell free protoporphyrin IX concentration (36micromol/L (normal range <0.2micromol/L)).

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The Immune Reconstitution of the Skin Following Sex Mismatched Allogeneic Hematopoietic Stem Cell Transplant: A prospective case series utilizing fluorescent in situ hybridization and immunohistochemistry

Abstract

Graft versus host disease (GVHD) is a common, morbid, and potentially fatal complication of allogeneic hematopoietic stem cell transplantation (aHSCT).^1-3 The exact timing of the arrival of donor-derived immune cells and their profile in the skin have not been well described in humans.^4-6 Fluorescent in situ hybridization (FISH) is a technique that has been used to distinguish host versus donor-derived immune cells in patients who have undergone sex-mismatched aHSCT.⁷

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Acquired anhidrosis associated with systemic sarcoidosis: Quantification of nerve fibers around eccrine glands by confocal microscopy

Abstract

Neurological disorders can cause hypohidrosis and/or anhidrosis by disturbing either the central or the peripheral nervous systems.^1-3 Although a syringotropic variant of cutaneous sarcoidosis causes dysfunction of sweating, systemic sarcoidosis rarely causes hypohidrosis or anhidrosis.^4,5 Here we present a novel case of an acquired anhidrosis in a patient with systemic sarcoidosis. Furthermore, we developed a novel methodology to quantify nerve fibers around eccrine glands using confocal microscopy and found that nerve fibers around eccrine glands in anhidrotic areas are significantly decreased compared to hidrotic areas.

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Osteocondroma del seno maxilar, una localización infrecuente

Publication date: Available online 10 August 2017
Source:Acta Otorrinolaringológica Española
Author(s): Ana Belén Gil Guerra, Esther Gómez San Martín, María Isabel Jiménez Cuenca




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Protective barrier properties of Rhinosectan® spray (containing xyloglucan) on an organotypic 3D airway tissue model (MucilAir): results of an in vitro study

To evaluate barrier protective properties of Rhinosectan® spray, a medical device containing xyloglucan, on nasal epithelial cells (MucilAir).

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American Thyroid Association Announces 2017 Research Grant Awards

ATA Awards Research Grant to Marco Medici, MD, PhD, MSc, Erasmus Medical Center

ATA Awards Research Grant to Lawrence A. Shirley, MD, MS, FACS, Ohio State University Wexner Medical Center

ATA Awards Research Grant to Jason E. Coleman, PhD, University of Florida

ATA Awards ThyCa Research Grant to Vicki Emma Smith, PhD, University of Birmingham, UK

ATA Awards ThyCa Research Grant to Jens Lohr, MD, PhD, Dana Farber Cancer Institute

ATA Awards ThyCa Research Grant to Glenn J. Hanna, M.D., Dana-Farber Cancer Institute's Center for Head and Neck Oncology

ATA Awards Bite Me Cancer Research Grant to Brian P. Danysh, PhD, University of Texas MD Anderson Cancer Center

The post American Thyroid Association Announces 2017 Research Grant Awards appeared first on American Thyroid Association.

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Role of CDKN2A/p16 expression in the prognostication of oral squamous cell carcinoma

Publication date: October 2017
Source:Oral Oncology, Volume 73
Author(s): Swati Shree Padhi, Souvick Roy, Madhabananda Kar, Arka Saha, Shomereeta Roy, Amit Adhya, Manas Baisakh, Birendranath Banerjee
ObjectiveCDKN2A/p16 is a known tumor suppressor gene with a homologous deletion in Oral Squamous cell carcinoma. CDKN2A/p16 is found to be inactivated in a broad spectrum of solid tumors and in more than 80% of OSCC. Molecular alteration of CDKN2A/p16 in progression of OSCC can pose an important tool for the prognosis of squamous cell carcinoma.Material and methodSystematic network analysis was carried out to obtain involvement of CDKN2A/p16 in oral cancer by polysearch and FunDO. In the present study we have screened 104 OSCC patients from eastern region of India for CDKN2A/p16 expression in recurrent and non-recurrent OSCC. The observation was validated by Comparative Genomic Hybridisation and Next generation sequencing in recurrent cases.ResultSystematic analysis revealed direct involvement of CDKN2A/p16 in oral cancer. There was a consistent downregulated expression of CDKN2A/p16 in the recurrent cases. The gene expression study confirmed a >5-fold downregulation of CDKN2A/p16 in recurrent tumors as compared to non-recurrent ones. Array CGH analysis revealed a copy number deletion in the recurrent case. Furthermore, next generation sequencing validated deletion of CDKN2A/p16 and reported it asa common variant with a nonsense mutation having stop /loss of function of the gene in recurrent cases. Recurrent cases with deleted CDKN2A/p16 expression had poor prognosis and low survival rate.ConclusionCDKN2A/p16 frequently alters in oral cancer progression with a deletion/loss of function in the recurrent cases displaying its role in aiding several molecular events for the malignant transformations occurring throughout disease progression.



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Strategy for the treatment and follow-up of sinonasal solitary extramedullary plasmacytoma: a case series

Extramedullary plasmacytoma is a rare neoplasm characterized by monoclonal proliferation of plasma cells outside bone marrow. It accounts for 4% of all non-epithelial sinonasal tumors. According to the literat...

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Recommendations for the Management of Comorbidity in Hidradenitis Suppurativa

Abstract

Background

The association between hidradenitis suppurativa (HS) and some diseases is becoming relevant in recent years. Providing appropriate management of HS from an early stage requires to include prompt diagnosis and treatment of concomitant diseases and to prevent any potential comorbidity. This approach should consider the adverse events of the drugs used to treat HS potentially related to the onset of a comorbidity.

Objective

To provide the dermatologist with an accurate, easily used tool that will inform the diagnosis of HS comorbidity, and to facilitate decision-making regarding the referral and treatment of patient with HS-associated comorbidity.

Methods

These recommendations have been developed by a working group composed of seven experts (three dermatologists, a cardiovascular specialist internist, a rheumatologist expert in spondyloarthritis, a gastroenterologist and a psychiatrist) and a team of three methodologist researchers. The expert group selected the HS comorbidities considered in these recommendations through a literature review. The recommendations on diagnostic criteria are based on the relevant clinical practice guidelines for each of the comorbidities and on the recommendations of the experts. The information regarding the repercussion of HS medical treatments on associated comorbid diseases was obtained from the summary of product characteristics of each drug.

Results

The comorbidities considered in this guide are: cardiovascular risk factors (diabetes, dyslipidemia, obesity, hypertension, and metabolic syndrome), inflammatory bowel disease, inflammatory joint disorders, and psychological disorders (anxiety and depression). In addition, the association between HS and the consumption of alcohol and tobacco is included. The tables and figures are a precise, easy-to-use tool to systematize the diagnosis of comorbidity in patients with HS and facilitate the decision-making process regarding referral and treatment of patients with an associated disease.

Conclusion

The application of these recommendations will facilitate the dermatologist practice, and benefit HS patients' health and quality of life.

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Patients with psoriasis have different preferences for topical therapy, highlighting the importance of individualized treatment approaches: Randomized Phase IIIb PSO-INSIGHTFUL study

Abstract

Background

Poor adherence to topical therapy in psoriasis remains an issue; it is associated with poor clinical outcomes, reduced quality of life, and increased costs. Treatment-related factors leading to poor adherence include lack of efficacy, excessive time applying medication, and poor cosmetic characteristics (e.g. slow absorption, greasiness).

Objective

To assess the topical treatment attributes that influence patient preference for fixed combination calcipotriol 50 μg/g (Cal) and betamethasone 0.5 mg/g as dipropionate (BD) foam versus gel, as well as in comparison with the latest topical treatment (LTT) a patient received.

Methods

PSO-INSIGHTFUL was a Phase IIIb, prospective, multicentre (Canada/Germany), open-label, randomized, two-arm crossover study in patients aged ≥18 years with mild-to-severe psoriasis (NCT02310646). Following a washout period of up to 4 weeks, patients were randomized 1:1 to once-daily Cal/BD foam for 1 week, followed by Cal/BD gel for 1 week, or vice-versa. Patients completed six questionnaires evaluating patient preferences.

Results

213 patients were randomized; 118 had received a topical treatment in the previous 3 months. Based on the Subject's Preference Assessment, 50% of patients preferred Cal/BD foam and 50% preferred Cal/BD gel. Based on the Topical Product Usability Questionnaire (TPUQ), overall mean scores were high for both Cal/BD foam and gel, and were often significantly in favour of both products compared with LTT. Greater differences between Cal/BD foam and gel versus LTT occurred when the previous treatment was an ointment or cream. Cal/BD foam was generally preferred by younger patients (aged 18–39 years), whereas Cal/BD gel tended to be preferred by older patients (aged ≥40 years). Results from other questionnaires were aligned with the TPUQ.

Conclusions

Patients with psoriasis have diverse needs and different preferences for topical treatment. This knowledge may help prescribers to choose the right formulation for the right patient, potentially leading to improved adherence and better treatment outcomes.

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Clearance in vulvar lichen sclerosus: a realistic treatment endpoint or a chimera?

Abstract

Background

according to the current guidelines, the aim of vulvar lichen sclerosus (VLS) treatment is to improve symptoms and signs, not to cure.

Objective

to assess i) the rate of VLS patients who achieved complete clearance of symptoms or objective features, or both, with a 12-week pharmacological treatment and ii) the predictive value of therapeutic response of the demographic and clinical features.

Methods

we retrospectively included VLS patients who had undergone any topical treatment for 12 weeks; demographics, history, VLS-related symptoms and objective features recorded at baseline and on completion of treatment were collected and elaborated. The primary study endpoint was to assess the rate of patients achieving complete clearance of global subjective score (GSS), or in global objective score (GOS), and in both scores.

Results

196 patients were included; 24 (12.2%) were asymptomatic at baseline, 9 (4.6%) dropped out. After treatment 78 patients (47.3%) achieved GSS = 0, 40 (21.4%) achieved GOS = 0, and 23 (13.9%) achieved complete clearance of both symptoms and signs. Lower symptom scores at baseline and shorter disease duration were associated with the achievement of symptom clearance at the end of the treatment. Earlier disease onset, diagnosis and beginning of study treatment as well as lower baseline GOS were significantly associated with complete recovery of VLS signs and clearance of both symptoms and signs.

Conclusion

a relevant part of patients who undergo a 12-week topical treatment is not completely cured of VLS. It may be hypothesized that these patients, in spite of a significant improvement, may still have substantial residual disease and, as a result, its effect on their quality of life.

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Epithelial-to-mesenchymal transition contributes to invasion in squamous cell carcinomas originated from actinic keratosis through the differentiated pathway whereas proliferation plays a more significant role in the classical pathway

Abstract

Background

Every actinic keratosis (AK) starts with atypia at the basal layers of the epidermis (AK I). Progression into invasive squamous cell carcinoma (iSCC) may occur following two main pathways, classical and differentiated. In the former, iSCC only occurs after involvement of the upper epidermal layers by atypical cells (AK III), while in the latter iSCC develops directly from AK I. In the anogenital mucosa, these two pathways are associated with differential expression of p53 and p16.

Objective

To explore differences between both pathways in the pathogenesis of AK, focusing on Ki67, p53, p16 and molecules that reveal epithelial mesenchymal transition.

Methods

Tissue microarrays representative of superficial and deep portions of 80 consecutive iSCCs (53 DP/27CP) were studied immunohistochemically using antibodies against Ki67, p53, p16, vimentin, E-cadherin, β-catenin and D2-40. The evaluation was performed by three researchers and the results compared for consensus.

Results

iSCCs originated through the differentiated pathway exhibited significantly lower proliferative activity (Ki67) (30% vs 46%, P=0.003) and significantly lower expression of vimentin (P<0.001), E-cadherin (P<0.001) and membranous β-catenin (P<0.001) than iSCCs developed through the classical pathway. The expression of E-cadherin and membranous β-catenin was significantly correlated (Pearson's r =0.386, Spearman's Rho<0.001). There were no significant differences regarding the expressions of p53, p16 and D2-40.

Conclusion

Epithelial mesenchymal transition participates in transformation from AK I into iSCC (differentiated pathway), whereas a higher proliferative capacity facilitates intraepidermal extension in the classical pathway. Podoplanin, which is also involved in tumour invasion, does not seem to play a differential role in either pathway. Finally, the absence of differences in p53 and p16 expressions is at variance with other epithelia where the classical pathway is associated with human papillomavirus infection, and can be explained by the fact that both AK pathways share identical mechanisms of actinic oncogenesis.

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Fragrance contact allergens in 5,588 cosmetic products identified through a novel smartphone application

Summary

Background

More than 25% of the adult European population suffers from contact allergy, with fragrance substances recognized as one of the main causes. Since 2005, 26 fragrance contact allergens have been mandatory to label in cosmetic products within the EU if present at 10 ppm or above in leave-on and 100 ppm or above in wash-off cosmetics.

Objective

To examine exposure, based on ingredient labelling, to the 26 fragrances in a sample of 5,588 fragranced cosmetic products.

Methods

The investigated products were identified through a novel, non-profit smartphone application (app), designed to provide information to consumers about chemical substances in cosmetic products. Products registered through the app between December 2015 and October 2016 were label checked according to International Nomenclature of Cosmetic Ingredients (INCI) for the presence of the 26 fragrance substances or the wording "fragrance/parfum/aroma".

Results

The largest product categories investigated were "cream, lotion and oil" (n=1192), "shampoo and conditioner" (n=968) and "deodorants" (n=632). Among cosmetic products labelled to contain at least one of the 26 fragrances, 85.5% and 73.9% contained at least two and at least three of the 26 fragrances, respectively. Linalool (49.5%) and limonene (48.5%) were labelled most often among all investigated products. Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC/Lyral^®) was found in 13.5% of deodorants. Six of the 26 fragrance substances were labelled on less than one percent of all products, including the natural extracts Evernia furfuracea (tree moss) and Evernia prunastri (oak moss). 329 (5.9%) products had one or more of the 26 fragrance substances labelled, but did not have "parfum/fragrance/aroma" listed on the label.

Conclusions

Consumers are widely exposed to, often multiple, well-established fragrance contact allergens through various cosmetic products intended for daily use. Several fragrance substances that are common causes of contact allergy were rarely labelled in this large sample of cosmetic products.

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Actinic keratoses show variable histological basal growth patterns – a proposed classification adjustment

Abstract

Background

Common histological classification schemes of actinic keratoses (AK) do not evaluate growth patterns at basal epidermal aspects of AK. Until now, the importance of basal epidermal growth patterns of AK has not been studied.

Objective

To investigate the extent of atypical keratinocytes throughout the epidermis and variation in basal growth patterns of AK.

Methods

AK lesions occurring on the head/face from patients seen in routine practice were assessed histologically. We determined histological grade (AK I-III), basal growth patterns of atypical keratinocytes (crowding, budding, papillary sprouting) and accompanying parameters.

Results

Of the 246 lesions included, 28.0% were histologically classified as AK I, 46.7% as AK II, and 25.2% as AK III. 26.4% of the basal growth patterns were classified as crowding (pro I), 49.6% as budding (pro II), 17.9% as papillary sprouting (pro III) and 6.1% without basal directed growth. No significant correlation of the histological AK I-III grading and underlying growth patterns was observed (P= 0.4666). However, adnexal structure involvement (OR= 2.37; 95%CI 1.21-4.65), infiltration (OR= 2.53; 95%CI 1.31-4.90) and increased number of vessels (OR= 2.56; 95%CI 1.42-4.65) were independent positive predictive markers for pro II and pro III basal growth patterns.

Conclusions

Basal growth patterns (pro I-III) in AK do not correlate with the established AK I-III histological grading system. Besides the degree of upward extension, varying degrees of downward extension exist. Histological classification should consider both, upwards and downward growth patterns when assessing AK.

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Factors predicting the self-evaluated health of hidradenitis suppurativa patients recruited from an outpatient clinic

Abstract

Objectives

In recent years, Hidradenitis suppurativa has received increased attention, but still lack well-defined, robust patient reported outcome measures. Such measures are likely to be influenced by contextual factors. We therefore aim to describe the association of biological and other factors with HS patient's self-evaluated health as reflected by the EQ5D VAS score.

Methods

This cross-sectional study measured basic information, Dermatology Life Quality Index, Major Depression Inventory, and Euro-QoL-5D. Information obtained through questionnaires was used to create a model showing the relation between biologic factors, questionnaire results and self-evaluated health using the stepwise method for linear regression.

HS patients (n=805) registered at our department were invited to participate. 503 (62.5%) patients replied to this survey. There was no difference in basic demographics between responders and non-responders.

Results

Possible predictors for this study were DLQI, MDI, BMI, smoking, gender. A final model for correlation with self-evaluated health was obtained.

Significant predictors for the model was DLQI (P < 0.05), BMI points above 25 and active smoking (both: P < 0.01) and MDI (P < 0.001).

Conclusion

As this is a cross-sectional study, reveals several clinically relevant correlations. Smoking appears to correlate with the highest change in VAS score, but an MDI of 10 (lower than study average) or a BMI of 40 influences the results more. This study provides an assessment of how much BMI and smoking, in relation to other factors, correlate to the self-evaluated health state of HS patients. These may therefore be relevant contextual factors to the construction and interpretation of specific patient reported outcome measures.

To improve QoL, we advocate smoking cessation and weight loss, and advice active screening for depression as over 10% of our patients qualify for a depressive diagnosis according to ICD-10.

This article is protected by copyright. All rights reserved.

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Mucosa-associated invariant T cells infiltrate hepatic metastases in patients with colorectal carcinoma but are rendered dysfunctional within and adjacent to tumor microenvironment

Abstract

Mucosa-associated invariant T (MAIT) cells are innate-like T lymphocytes that are unusually abundant in the human liver, a common site of colorectal carcinoma (CRC) metastasis. However, whether they contribute to immune surveillance against colorectal liver metastasis (CRLM) is essentially unexplored. In addition, whether MAIT cell functions can be impacted by chemotherapy is unclear. These are important questions given MAIT cells' potent immunomodulatory and inflammatory properties. Herein, we examined the frequencies and functions of peripheral blood, healthy liver tissue, tumor-margin and tumor-infiltrating MAIT cells in 21 CRLM patients who received no chemotherapy, FOLFOX, or a combination of FOLFOX and Avastin before they underwent liver resection. We found that MAIT cells, defined as CD3ε⁺Vα7.2⁺CD161⁺⁺ or CD3ε⁺MR1 tetramer⁺ cells, were present within both healthy and tumor-afflicted hepatic tissues. Paired and grouped analyses of samples revealed the physical proximity of MAIT cells to metastatic lesions to drastically influence their functional competence. Accordingly, unlike those residing in the healthy liver compartment, tumor-infiltrating MAIT cells failed to produce IFN-γ in response to a panel of TCR and cytokine receptor ligands, and tumor-margin MAIT cells were only partially active. Furthermore, chemotherapy did not account for intratumoral MAIT cell insufficiencies. Our findings demonstrate for the first time that CRLM-penetrating MAIT cells exhibit wide-ranging functional impairments, which are dictated by their physical location but not by preoperative chemotherapy. Therefore, we propose that MAIT cells may provide an attractive therapeutic target in CRC and that their ligands may be combined with chemotherapeutic agents to treat CRLM.

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The Economic Impact of Adult Hearing Loss

This systematic review evaluates available data on all relevant costs associated with hearing loss among adults.

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Implementing Quality Improvement and Patient Safety in Residency Education

This Viewpoint discusses practical strategies for implementing successful resident-led patient safety and quality improvement initiatives in otolaryngology–head and neck surgery residency education.

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Neutrophil Extracellular Traps and Fibrin in Otitis Media

This study examines the relationship between neutrophil extracellular traps, fibrin, and bacteria in experimentally induced otitis media in chinchillas and in human temporal bones with acute onset and recurrent otitis media.

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Schon deutlich besser und Ansporn für die Zukunft

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Rezepturen mit Fertigarzneimitteln

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Tisotumab Vedotin Continued Treatment in Patients With Solid Tumors.

Conditions:   Ovary Cancer;   Cervix Cancer;   Endometrium Cancer;   Bladder Cancer;   Prostate Cancer;   Esophagus Cancer;   Lung Cancer, Nonsmall Cell;   Squamous Cell Carcinoma of the Head and Neck
Intervention:   Drug: Tisotumab Vedotin
Sponsor:   Genmab
Recruiting - verified August 2017

http://ift.tt/2vS7sps

Pembrolizumab in Combination With Anti-platelet Therapy for Patients With Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck

Condition:   Head and Neck Cancer
Interventions:   Drug: Pembrolizumab;   Drug: Clopidogrel;   Drug: acetylsalicylic acid
Sponsor:   Medical University of South Carolina
Not yet recruiting - verified July 2017

http://ift.tt/2wLnVrR

Effectiveness of Lay Navigators in Meeting Cancer Patients' Non-Clinical Needs: A Pilot Study

Conditions:   Breast Cancer;   Gynecologic Cancer;   Neck Cancer;   Head Cancer;   Gastrointestinal Cancer;   Thoracic Cancer;   Cutaneous Tumor
Intervention:   Other: Lay Navigation
Sponsor:   Stanford University
Recruiting - verified August 2017

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Prevention of graying: Is KROX20 the solution?

http://ift.tt/2usNKfB

Methotrexate for treatment of vitiligo

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Topical cetirizine 1% for treatment of androgenetic alopecia

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Rate of serious infection in patients who are prescribed systemic biologic or nonbiologic agents for psoriasis: A large, single center, retrospective, observational cohort study

Abstract

Background

Systemic biologic and nonbiologic agents used to treat psoriasis may or may not contribute to serious infection (SI) risk. Safety data, particularly for biologic agents, and associated risk for SI, are scarce. The study's aim was to explore the risk for SI in psoriasis patients exposed to systemic biologic or nonbiologic agents.

Methods

A large, single-center electronic medical record repository was searched between January 2010 and December 2014. Records for patients prescribed a systemic agent for psoriasis (SAP) with psoriasis or psoriatic arthritis diagnoses were included (ICD-9 codes 696.1 and 696.0, respectively). SIs were those who required hospitalization, and/or injectable antibacterial, antiviral or antifungal therapy. SIs occurring within 120 days after exposure to a SAP, were included for study.

Results

A total of 1,346 patients were exposed to a SAP between January 2010 and December 2014; 27 (2%) had a SI. Comparing biologic and nonbiologic agent exposure, no statistically significant difference for risk of SI was detectable (p = .83).

Conclusion

In this population, the SI rate for biologic and nonbiologic systemic agents was clinically indistinguishable, thereby supporting consideration of the entire spectrum of available systemic therapeutic agents, both biologic and nonbiologic agents, for management of moderate to severe psoriasis.

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A novel topical agent in the treatment of seborrheic keratoses: A proof of concept study by clinical and dermoscopic evaluation

Abstract

In this proof of concept study, 50 lesions from 15 patients with multiple seborrheic keratoses (SKs) were treated with a novel aqueous solution containing nitric acid, zinc and copper salts, and organic acids (acetic, lactic, and oxalic acid). Treatment consisted in the application of an amount of the solution sufficient to obtain a whitening/yellowish reaction. Application of the nitric–zinc solution was performed every other week until clinical and dermoscopic clearance or crust formation, for a maximum of 4 applications. Efficacy evaluation was performed at 8 weeks (T1) and 6 months (T2). All subjects, who reported no or minimal discomfort during and after the application of the solution, completed the study. At T1, a complete clinical and dermoscopic resolution was observed in 37 lesions after an average of 3 applications/lesion (range 2–4). A partial response, with minimal persistent residual spots, was detected in the remaining 13 lesions. All patients with complete clearance showed no relapses at a 6-month follow-up (T2). The positive preliminary results indicate that this novel solution may represent a promising alternative option for SKs especially in patients not keen or eligible to undergo invasive tissue-destructive procedures.

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Irradiación de Cabeza & Cuello en la Infancia

The post Irradiación de Cabeza & Cuello en la Infancia appeared first on American Thyroid Association.

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Expression and purification of norovirus virus like particles in Escherichia coli and their immunogenicity in mice

Publication date: Available online 9 August 2017
Source:Molecular Immunology
Author(s): Yuqi Huo, Xin Wan, Tong Ling, Jie Wu, Wenhui Wang, Shuo Shen
Norovirus (NoV) virus like particles (VLPs) produced in Spodoptera frugiperda (Sf9) cells have been tested in human volunteers as vaccine candidate and were shown to be protective against NoV induced acute gastroenteritis. In this study, prevailing Sydney-2012-like NoV major capsid protein gene with or without N-terminal deletions (N26 and N38, 26 and 38 amino acids deleted from N terminus，respectively) were sub-cloned into prokaryotic expression vector, pCold III and pCold IV. Soluble and insoluble proteins were detected for both vectors after induction and higher levels of protein expression were observed for constructs pCold III-N26 and pCold III-N38. Electron microscopy observation of unpurified and purified lysates indicated in vivo assembly of VLPs with two sizes in accordance with those observed in Sf9 cells. In vitro salivary HBGA-VLP binding assay demonstrated that VLPs assembled in Escherichia coli (E. coli) exhibited the same binding pattern as that of VLPs assembled in Sf9 cells. Immunization of mice with purified VLPs derived from pCold III-N38 demonstrated higher IgG antibody titers and blocking antibody titers when compared with full-length capsid protein assembled VLPs from recombinant baculovirus expression system. In conclusion, NoV VLPs produced in E. coli using pCold expression vector might be used for the development of NoV vaccine.



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Hereditary angioedema with a mutation in the plasminogen gene

Abstract

Background

Hereditary angioedema (HAE) with normal C1-INH (HAEnCI) may be linked to specific mutations in the coagulation factor 12 (FXII) gene (HAE-FXII) or functional mutations in other genes that are still unknown. We sought to identify and characterize a hitherto unknown type of HAE with normal C1-INH and without mutation in the F12 gene.

Methods

The study comprised analysis of whole exome sequencing, Sanger sequencing, and clinical data of patients.

Results

We detected a mutation in the plasminogen gene in patients with HAEnCI. The mutation c.9886A>G was located in exon 9 leading to the missense mutation p.Lys330Glu (K330E) in the kringle 3 domain of the plasminogen protein. The mutation was identified by next generation sequencing in 14 patients with HAEnCI belonging to 4 of 7 families. Family studies revealed that this type of HAE was transmitted as an autosomal dominant trait. The plasminogen gene mutation was present in all studied symptomatic patients and was also found in 9 out of 38 index patients from 38 further families with HAEnCI. Most patients had swelling of face/lips (78.3%) and tongue (78.3%). 331 out of all 3.795 tongue swellings (8.7%) were associated with dyspnea, voice changes and imminent asphyxiation. Two women died by asphyxiation due to a tongue swelling.

Conclusions

HAE with a mutation in the plasminogen gene is a novel type of HAE. It is associated with a high risk of tongue swellings.

This article is protected by copyright. All rights reserved.

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Case 24-2017: An 8-Month-Old Girl with Fever and an Abdominal Mass

Presentation of Case. Dr. Rajitha Venkatesh (Pediatrics): An 8-month-old girl was admitted to this hospital because of fever and an abdominal mass. The patient had been in her usual good health until approximately 6 days before admission, when she passed a large stool surrounded by clotted blood.…

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Ganglioneuroma of the External Auditory Canal and Middle Ear

Objective. We report an extremely rare case of ganglioneuroma involving the external auditory canal and middle ear. Case Report. Ganglioneuromas are rare benign mature tumors thought to originate from sympathetic ganglions, with the highest incidence in the retroperitoneum, adrenal medulla, and posterior mediastinum. We present a case of ganglioneuroma of the external auditory canal and middle ear. At the age of 12 months, the patient was diagnosed with neuroblastoma stage IV with metastasis to the squamous temporal bone, bone marrow, and skull base. He received a high-risk protocol regimen resulting in complete remission. The patient later presented with recurrent right ear discharge at the age of six years and was diagnosed with ganglioneuroma of external auditory canal and middle ear after appropriate investigations. We report in this article the clinical presentation, investigations, surgical intervention, and follow-up. Conclusion. After the literature review and to our knowledge, this is the first reported case of its kind. Ganglioneuroma maturing from neuroblastoma is one of the theories describing pathophysiology of the disease. Ganglioneuroma should be considered in the differential diagnosis of patients presenting with recurrent ear discharge and decreased hearing in treated cases of neuroblastoma with metastases to temporal bone.

http://ift.tt/2wKrCOf

Diagnostic dilemma: ALPS versus Evans syndrome

Publication date: Available online 9 August 2017
Source:Clinical Immunology
Author(s): Evan Li, Amanda B. Grimes, Nicholas L. Rider, Donald H. Mahoney, Thomas A. Fleisher, William T. Shearer




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Diffuse cerebral oedema from sickle cell vaso-occlusive crisis

Description

A middle-aged African-American male with homozygous sickle cell disease presented with vaso-occlusive crisis and suffered a generalised tonic-clonic seizure while in the emergency department. He had been seizure-free for more than a decade, thus was not taking antiepileptic medications. CT head revealed diffuse cerebral oedema, effacement of the fourth ventricle and obstructive hydrocephalus (figure 1). An external ventricular drain was placed with improvement of hydrocephalus, and a repeat CT head revealed right parietal hypodensity (figure 1). MRI brain and conventional cerebral angiogram showed right parietal cerebral oedema, a large arteriovenous malformation, right internal carotid artery occlusion, moyamoya disease and basilar artery aneurysm (figure 2). The patient's cerebral oedema and neurological examination initially improved after exchange transfusion; however, he developed acute subarachnoid haemorrhage from basilar artery aneurysm rupture and brainstem strokes causing coma. He underwent palliative extubation after discussion with family and is now deceased.

...

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Persisting fatigue and myalgia as the presenting features in a case of hypokalaemic periodic paralysis

We report a case of a 9-year-old boy who developed hypokalaemic periodic paralysis (HypoPP) following a prodrome of persistent fatigue and muscle aches associated with mildly elevated creatine kinase (CK) levels.

HypoPP is usually associated with a sudden onset of weakness and hypokalaemia at presentation. A review of published cases failed to identify any other reports of individuals with a similar onset of symptoms and elevated CK levels prior to the development of frank HypoPP.

In the case described above, the association of these symptoms with elevated levels of CK may have been related to the underlying mutation in the skeletal muscle calcium channels that was subsequently identified.

In cases of persisting fatigue and myalgia associated with elevated CK levels it may be helpful to consider HypoPP in the differential diagnosis.

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Regadenoson cardiac stress test-induced stress cardiomyopathy

Takotsubo cardiomyopathy, also described as apical ballooning syndrome/stress-induced cardiomyopathy, imitates acute coronary syndrome and is usually related to a massive physiological or emotional stressor. We describe perhaps the first reported case to the best of our knowledge of a 55-year-old Caucasian woman who presented with congestive heart failure after having a regadenoson cardiac stress test a few hours prior to presentation to the hospital. Transthoracic echocardiogram revealed reduced heart function. She had normal coronaries on cardiac catheterisation, and left ventriculography confirmed apical ballooning syndrome. She underwent guideline-directed therapy, and heart function improved in the repeat echocardiogram along with clinical resolution of symptoms.

http://ift.tt/2ftSLBY

A rare urological presentation of appendicitis

A 17-year-old boy with no medical comorbidities, but a significant family history of malignancy, presented to Accident and Emergency following 3 days of increasing rectal pain, symptoms of bladder outflow obstruction (poor flow, intermittent stream and hesitancy) and dysuria. Notably he had no abdominal pain. Digital rectal examination revealed a tender, enlarged prostate. Inflammatory markers were significantly raised (white cell count 17.7, C reactive protein 191). He was diagnosed clinically as prostatitis and commenced on intravenous antibiotics. Despite this his pain and inflammatory markers deteriorated, necessitating a CT of his abdomen and pelvis. This demonstrated multiloculated large thick-walled abscesses in the pelvis closely related to the rectum, prostate and seminal vesicles with some bowel wall thickening. Laparoscopy demonstrated a large colonic mass adherent to surrounding structures. The procedure was converted to laparotomy to enable resection of the mass via a limited right haemicolectomy. He recovered well and was discharged. Histopathological analysis of the specimen revealed appendicitis.

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Sight preserving orbital decompression: a novel multidisciplinary approach to managing severe proptosis in neurofibromatosis type 2

We describe the importance of collaboration between multiple surgical specialties in managing a complex case of sight-threatening severe proptosis in a young woman with type 2 neurofibromatosis (NF2) complicated by pre-existing contralateral blindness. Trans-nasal and lateral orbital surgical approaches were aided by stereotactic navigation to debulk a large frontal/sphenoid wing meningioma, which had been exerting pressure onto the right globe and optic nerve. The patient made an excellent postoperative recovery along with preserved residual visual acuity, normal neurology and a good aesthetic outcome.

http://ift.tt/2fv5Drs

Bimaxillary concomitant hypohyperdontia in a 10-year-old child

Numerical anomalies, either addition or deletion, are quite a common findings in human dentition. However, it is extremely rare to find both hypodontia and hyperdontia simultaneously in the same individual. This condition is referred as concomitant hypohyperdontia (CHH). Aetiology of this condition is still obscure. The prevalence of CHH has been reported to be between 0.002% and 3.1%. This case report highlights a rare occurrence of bimaxillary CHH represented by the absence of both mandibular central incisors and presence of two supernumerary teeth in the maxillary anterior segment. The rarity of such condition of mixed hypodontia as well as hyperdontia in single human dentition prompted the author to report the case.

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Extramedullary haematopoiesis presenting with cardiac tamponade in a patient with polycythaemia vera

A 71-year-old man with a history of polycythaemia vera, diagnosed 4 years ago, presented to the emergency room with shortness of breath. A bedside echocardiogram revealed a large pericardial effusion with features concerning for pericardial tamponade. A left anterior thoracotomy and a pericardial window were emergently performed in the operating room and relieved the patient's symptoms. Histology evaluation of the pericardial fragments and pericardial fluid revealed the presence of trilineage haematopoietic elements without any increase in the blasts. A bone marrow core biopsy revealed an increase in reticulin fibre and increase in the number of blasts of 5%–10%, whereas peripheral blood testing was positive for JAK2 V617F mutation. This case report reviews the literature for cases of extramedullary haematopoiesis associated with myeloproliferative neoplasms.

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Atypical haemolytic uremic syndrome (aHUS) and membranoproliferative glomerulonephritis (MPGN), different diseases or a spectrum of complement-mediated glomerular diseases?

Historically, patients with kidney diseases caused by genetic or acquired dysregulation of the complement alternative pathway have been grouped into clinical syndromes, C3 glomerulopathy (C3GN/DDD) and thrombotic microangiopathy (TMA), specifically atypical haemolytic uremic syndrome (aHUS). Recent data suggested that these diseases share a common pathophysiology and that patients can transition between glomerulopathies in this spectrum. Histopathologically, the main difference cited is the immunofluorescence (IF) findings, with C3 predominance in C3 glomerulopathy (compared with immunoglobulins and complements in immune complex-mediated membranoproliferative glomerulonephritis (MPGN)) and negative IF in TMA. We report a case in which a patient presented with hypertension, seizures, proteinuria, renal impairment and immune complex-mediated MPGN on kidney biopsy. Months later, she presented with classical TMA. She failed to respond to steroids and plasma exchange therapy but subsequently made a remarkable haematological and renal recovery after eculizumab treatment, thus supporting an underlying complement dysregulation and a diagnosis of aHUS.

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Tetraparesia: an unusual presentation of disseminated tuberculosis

A 48-year-old man with a 4 months history of asthenia, anorexia, 10 kg weight loss and 1 month of hematuria and dysuria was admitted to another hospital for sudden muscular weakness. He was found to have areflexic tetraparesis and was referred to our hospital.

On admission, he was bradycardic, tachypneic, with flaccid tetraplegia. Laboratory results showed metabolic acidemia, severe hyperkalemia and hyponatremia, acute renal dysfunction and sterile pyuria. After hyperkalemia correction, the neurological symptoms resolved.

On the second day, he became febrile and chest radiograph and CT images showed a pulmonary bilateral reticulomicronodular pattern, left hydronephrosis and diffuse bladder wall thickening. Disseminated tuberculosis was considered as diagnosis by the coexistence of this imagiologic alterations and sterile pyuria. Acid-fast test for Mycobacteriumtuberculosis was negative, but the urine culture became positive after 2 weeks.

Antituberculosis treatment was started. One year later, he was asymptomatic and the structural urinary lesions had disappeared.

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Giant hydronephrosis in a case of ureterocele with duplex system: an entity yet not reported

Ureterocele, which is a cystic dilatation of the terminal ureter, is usually associated with the upper moiety in a case of the duplex system. Giant hydronephrosis, a rare entity, is usually due to pelviureteric junction obstruction and is usually diagnosed in infants and children. We report a unique case of a unilateral complete duplex system with ureterocele with giant hydronephrosis of the upper moiety in an adult woman presenting as an abdominal lump. To the best of our knowledge, this is the first case of giant hydronephrosis associated with ureterocele in an adult patient.

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Issue Information - TOC

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Editorial Board

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100





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Endoscopic Thyroid Surgery Through Trans-oral Vestibular Approach (TOVA): A Case Series and Review of Literature

Abstract

Endoscopic surgery is now standard of care for different Endocrine Disorders; the endoscopic thyroid surgery is becoming more popular and different approaches has been practice by many thyroid surgeon worldwide. Trans-orovestibular approach, based on the principle of natural orifice transluminal surgery is truly scar free thyroid surgery and has minimal dissection. We are presenting here three cases of benign solitary thyroid nodule operated endoscopically through trans-oro-vestibular approach in one male and two female patients. Described about the approach, challenges during surgery and outcome. These surgeries documented very few in literatures in live human patients. Transoral endoscopic thyroid surgery through vestibular approach is shortest and direct remote access approach. The need of limited dissection in this approach provides less complication and excellent cosmetic outcome in strictly selected patients.

http://ift.tt/2vlCCUL

Endoscopic Thyroid Surgery Through Trans-oral Vestibular Approach (TOVA): A Case Series and Review of Literature

Abstract

Endoscopic surgery is now standard of care for different Endocrine Disorders; the endoscopic thyroid surgery is becoming more popular and different approaches has been practice by many thyroid surgeon worldwide. Trans-orovestibular approach, based on the principle of natural orifice transluminal surgery is truly scar free thyroid surgery and has minimal dissection. We are presenting here three cases of benign solitary thyroid nodule operated endoscopically through trans-oro-vestibular approach in one male and two female patients. Described about the approach, challenges during surgery and outcome. These surgeries documented very few in literatures in live human patients. Transoral endoscopic thyroid surgery through vestibular approach is shortest and direct remote access approach. The need of limited dissection in this approach provides less complication and excellent cosmetic outcome in strictly selected patients.

http://ift.tt/2vlCCUL

Discharges with surgical procedures performed less often than once per month per hospital account for two-thirds of hospital costs of inpatient surgery

Most surgical discharges (54%) at the average hospital are for procedures performed no more often than once per month at that hospital. We hypothesized that such uncommon procedures would be associated with an even greater percentage of the total cost of performing all surgical procedures at that hospital.

http://ift.tt/2vQBB7Q

Submental intubation — Practical alternative airway in maxillofacial surgeries

Airway management of maxillofacial patients is very crucial for both anesthetists and maxillofacial surgeons, as the former need to maintain a patent airway for adequate ventilation while the latter require adequate room for surgical procedures. In most maxillofacial surgeries where dental occlusion needs to be assessed intra operatively, nasotracheal intubation is always the preferred route. However, this route of intubation is not always possible and orotracheal intubation is not practical as it hinders the achievement of dental occlusion.

http://ift.tt/2urRBcP

Is gabapentin effective and safe in open hysterectomy? A PRISMA compliant meta-analysis of randomized controlled trials

Pain management after open hysterectomy has been investigated for years. Owing to the effect of significant analgesic, gabapentin was often administrated for pre-emptive analgesia. However, the relationship between gabapentin and postoperative pain after open hysterectomy is still controversial. This meta-analysis was applied to assess the efficacy of pre-emptive use of gabapentin in open hysterectomy.

http://ift.tt/2vQINk5

Sugammadex efficacy for reversal of rocuronium- and vecuronium-induced neuromuscular blockade: A pooled analysis of 26 studies

To summarize and compare efficacy of sugammadex with neostigmine or placebo for reversal of rocuronium- or vecuronium-induced neuromuscular blockade (NMB), and to demonstrate consistency of sugammadex results across various patient populations.

http://ift.tt/2urCrnX

Modified open-access scheduling for new patient evaluations at an academic chronic pain clinic increased patient access to care, but did not materially reduce their mean cancellation rate: A retrospective, observational study

To determine if open-access scheduling would reduce the cancellation rate for new patient evaluations in a chronic pain clinic by at least 50%.

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Clinical efficacy of a supraglottic airway device with a pressure gauge for robot-assisted surgery

The number of robot-assisted surgeries has increased in the recent years. During a robot-assisted surgery, it is difficult to manage a change in airway pressure due to a pneumoperitoneum and a change of the position in the perioperative position. Inadequate airway pressure management may increase the incidence of sore throats [1,2]. The LMAR Protector™ Airway (Teleflex Medical Japan, Tokyo, Protector) is the newest type of most second-generation airway. The Protector has an integrated cuff pressure indicator that allows for continuous cuff pressure monitoring at-a-glance (Fig.

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The combination of sugammadex and desflurane may increase the risk of bronchospasm during general anesthesia

Since our hospital began carrying sugammadex, a period of three months, our Anesthesiology department had three cases of bronchospasm. All three occurred immediately after sugammadex administration during general anesthesia with desflurane maintenance. Two of these cases occurred during routine orthopedic surgery and the other during an uncomplicated hernia repair at a southern VA hospital in the United States.

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Lumbar vertebra surgery performed with a bilateral posterior quadratus lumborum block

The methods for perioperative pain management have remained limited for lumbar vertebrae surgery. Several type of quadratus lumborum (QL) block has been reported to be an effective analgesic in not only trunk surgery but also lower limbs surgery [1,2,3]. Of these QL block, a posterior QL block, injects local anesthetic at the posterior aspect of the QL, may be effective analgesic in lumbar vertebrae surgery because local anesthetic may flow to the transverse process and block posterior branched of lumbar spinal nerve (Fig.

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Ultrasound-guided transversus thoracic muscle plane block: Complication in 299 consecutive cases

It has been reported that a transversus thoracic muscle plane (TTP) block can block multiple anterior branches of the intercostal nerves (Th2 to 6), which dominate the internal mammary region [1,2,3,4,5]. Some complications such as hematoma, infection, and pneumothorax may occur after a TTP block. In the present study, we reported the incidence of these complications in patients who received an ultrasound-guided TTP block. This study was approved by the Showa University Hospital Institutional Review Board (approval number 2234) and was registered at the University Hospital Medical Information Network (UMIN ID number UMIN000026296).

http://ift.tt/2vQpVSu

Nebulized ketamine for successful management of difficult airway

Awake fiberoptic intubation (FOI) is the gold standard of airway management when a difficult airway is expected. It is essential to sufficiently anaesthetize the upper airway and suppress the gag, swallow and cough reflexes prior to awake FOI and thus ensure patient comfort [1]. Topical application of local anaesthetics by nebulization is one of the techniques used to anaesthetize the airway. To the best of our knowledge, this is the first report on the advantage of a nebulized administration route of ketamine in securing the airway.

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Biological evidence of the impact of burnout on the health of anesthesiologists

Our group presented a study on burnout many years ago and the initial reaction by other researchers in the anesthesia community was to dismiss the importance of our findings [1]. I remember that a prominent anesthesiologist in particular said "In my time, we just told people to toughen up." It was not until surgeons started to present and support national studies regarding burnout that we decided to pay closer attention and greater value to the issue [2].

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Uncommon combinations of ICD10-PCS or ICD-9-CM operative procedure codes account for most inpatient surgery at half of Texas hospitals

Recently, there has been interest in activity-based cost accounting for inpatient surgical procedures to facilitate "value based" analyses. Research 10–20years ago, performed using data from 3 large teaching hospitals, found that activity-based cost accounting was practical and useful for modeling surgeons and subspecialties, but inaccurate for individual procedures. We hypothesized that these older results would apply to hundreds of hospitals, currently evaluable using administrative databases.

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Perioperative use of 5% dextrose to decrease postoperative nausea and vomiting

In a randomized clinical trial comparing the incidence of postoperative nausea and vomiting (PONV) during perioperative administration of 5% dextrose and normal saline in patients undergoing laparoscopic cholecystectomy, Mishra et al. [1] show that perioperative administration of 5% dextrose can reduce PONV significantly and even if PONV occurs, the quantity of rescue antiemetics to combat PONV is also reduced significantly. Many things of this study were well done. The authors used a consistent operation (elective laparoscopic cholecystectomy) and had tried to control most of known factors affecting PONV, such as age, female gender, non-smoking status, Apfel score, durations of anesthesia and operation, intraoperative fluid volumes, etc.

http://ift.tt/2us3orC

Laparoscopic cholecystectomy under neuraxial anesthesia compared with general anesthesia: Systematic review and meta-analyses

Pneumoperitoneum during laparoscopic cholecystectomy (LC) can cause hypercapnia, hypoxemia, hemodynamic changes and shoulder pain. General anesthesia (GA) enables the control of intraoperative pain and ventilation. The need for GA has been questioned by studies suggesting that neuraxial anesthesia (NA) is adequate for LC.

http://ift.tt/2vQBx86

Application of a skin traction method to facilitate ultrasound-guided brachial plexus block in obese patient with short neck

Ultrasound-guided brachial plexus block is difficult to perform in patients who are obese and have a short neck, as a thick subdermal adipose layer makes stable ultrasound probe placement impossible [1]. A skin traction method is reportedly helpful for central venous catheter placement in pediatric cases [2]. Here, we propose the use of the skin traction method to perform brachial plexus block in obese patients.

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Another quest for the holy grail of abolishing post operative nausea and vomiting

Postoperative nausea and vomiting (PONV) continues to have an incidence of approximately 30% in the general population, up to 70% in high-risk individuals, and also consistently ranks amongst the most undesirable side-effects of anesthesia that patients encounter post-operatively [1,2]. PONV remains one of the most common causes of prolonged post-operative care unit (PACU) stay as well as unexpected hospital admission for same-day surgery patients, both of which can have profound significance and implications that reach well beyond the PACU as well as potentially have a negative impact on the patient's satisfaction and increase overall health care costs.

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Cervical interfascial plane (CIP) block and multifidus cervicis plane (MCP) block: Similarities and tips

We read with interest the Correspondence by Drs. Ueshima and Otake regarding cervical interfascial plane (CIP) block [1]. They described that CIP block was administered with local anesthetic injection between the multifidus and longissimus muscles at the level of C5, achieving C2-6 analgesic effect observed by pinprick test. We would like to express our concerns about this technique.

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PECS2 blocks for breast surgery: A case for multimodal anesthesia

Breast surgery is associated with moderate to severe postoperative pain, and high incidence of postoperative nausea and vomiting (PONV). If left untreated, it can lead to increased patients' suffering, a prolongation of hospital stay and related costs [1]. Failure to provide good postoperative analgesia is also associated with poor recovery and increased risk of developing chronic post-surgical pain (CPSP) [2]. The incidence of CPSP after breast surgery can be as high as 60% in some cases and acute postoperative pain is, in itself, an independent predictor of CPSP after breast surgery at 4 and 9months [2,3].

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A novel treatment for herpes zoster pain using an electrical stimulating catheter with a steering guidewire

Herpes zoster is caused by reactivation of latent varicella-zoster virus in the trigeminal or dorsal root ganglion. Reactivation of the virus results in inflammation, a local immune response, and destruction of affected central and peripheral nerves [1]. Severe zoster pain can cause physical disability and emotional distress. The severity of acute zoster pain is a risk factor for postherpetic neuralgia [2]. Therefore, effective treatment of zoster pain is important to prevent negative sequelae. By delivering therapeutic agents directly into targeted spinal segment, accurate epidural drug delivery can maximize the desired effects while minimizing adverse systemic effects.

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Labor analgesia: We need to better understand and educate our obstetric patients

Nitrous oxide has long been an option for labor analgesia in the United Kingdom. It has only been over the last few years, however, that it has become available on some Labor and Delivery units in the United States with many others now considering whether to offer it as another analgesic choice for laboring women. Limited data are available regarding the efficacy of nitrous oxide labor analgesia. In this issue of the Journal of Clinical Anesthesia, Sutton, et al. provide useful information that may assist anesthesiologists and obstetricians who are adopting its use on their units.

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Validation of the modified 4-tiered categorization system through comparison with the 5-tiered categorization system of the 2015 American Thyroid Association guidelines for classifying small thyroid nodules on ultrasound

Abstract

Background

The purpose of this study was to validate the modified 4-tiered categorization system and to compare stratification of malignancy risk in small thyroid nodules with the 2015 American Thyroid Association (ATA) management guidelines.

Methods

From January 2015 to December 2015, 737 thyroid nodules measured ≥ 1 cm and <2 cm were included in this study. Each nodule was assigned a category with the ultrasonographic patterns described by the 2015 ATA guidelines.

Results

On univariate analysis, there was no difference of malignancy risk between low suspicion and very low suspicion nodules (P = .584). Therefore, we suggested a modified 4-tiered categorization, which combines very low suspicion and low suspicion nodules into the "revised low suspicion" category. Specificity, positive predictive value (PPV) and accuracy were higher with the modified 4-tiered categorization system (P < .001 for all).

Conclusion

The modified 4-tiered categorization system allows more efficient management with better diagnostic performance than the 2015 ATA categorization system in small thyroid nodules.

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