Peri-operative factors predisposing to pharyngocutaneous fistula after total laryngectomy: analysis of a large multi-institutional patient cohort

Pharyngocutaneous fistula (PCF) is a problematic complication following total laryngectomy. Disagreement remains regarding predisposing factors. This study examines perioperative factors predicting PCF followi...

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Constructing a patient-specific computer model of the upper airway in sleep apnea patients

Objective

The use of computer simulation to develop a high-fidelity model has been proposed as a novel and cost-effective alternative to help guide therapeutic intervention in sleep apnea surgery. We describe a computer model based on patient-specific anatomy of obstructive sleep apnea (OSA) subjects wherein the percentage and sites of upper airway collapse are compared to findings on drug-induced sleep endoscopy (DISE).

Study Design

Basic science computer model generation.

Methods

Three-dimensional finite element techniques were undertaken for model development in a pilot study of four OSA patients. Magnetic resonance imaging was used to capture patient anatomy and software employed to outline critical anatomical structures. A finite-element mesh was applied to the volume enclosed by each structure. Linear and hyperelastic soft-tissue properties for various subsites (tonsils, uvula, soft palate, and tongue base) were derived using an inverse finite-element technique from surgical specimens. Each model underwent computer simulation to determine the degree of displacement on various structures within the upper airway, and these findings were compared to DISE exams performed on the four study patients.

Results

Computer simulation predictions for percentage of airway collapse and site of maximal collapse show agreement with observed results seen on endoscopic visualization.

Conclusion

Modeling the upper airway in OSA patients is feasible and holds promise in aiding patient-specific surgical treatment.

Level of Evidence

NA. Laryngoscope, 2017

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Efficacy and rebound rates in propranolol-treated subglottic hemangioma: A literature review

Objective

Propranolol has recently become the treatment of choice for management of subglottic and airway hemangiomas. This literature review aimed to determine the success rate of propranolol for managing these lesions as well as the rate of rebound growth following propranolol treatment cessation.

Study Design

Literature search involving MEDLINE and Scopus to identify English-language articles.

Methods

Studies were identified using hemangioma, subglottic or airway, and propranolol for search terms. Studies were eligible for inclusion if they reported the treatment used, individual deidentified patient data, and contained patients without medical or surgical treatment prior to propranolol therapy

Results

Initial review included 107 abstracts. Twenty-four articles including case reports and case series met inclusion criteria and were included in the qualitative analysis. Forty-nine patients were included. Twenty-eight (57%) were treated with propranolol alone, and 20 (41%) were treated with a combination of propranolol and a corticosteroid. Thirty-seven (76%) of patients were treated with a dose of 2 mg/kg/d of propranolol. The initial treatment was successful in 43 (88%) of patients. Rebound growth occurred in four (9%) patients. Overall, six (12%) patients underwent surgical resection.

Conclusions

Propranolol is efficacious for treating subglottic hemangiomas. Rebound growth does occur in a small subset of patients during the propranolol wean. Close observation for children during weaning of propranolol therapy for subglottic hemangioma is essential. Adjunctive management strategies need to be used in patients with rebound growth. Laryngoscope, 2017

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Cutaneous metastasis: experience from a tertiary healthcare institution in Singapore

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Dermoscopy of borderline tuberculoid leprosy

Abstract

Introduction

Leprosy is a chronic granulomatous condition caused by Mycobacterium leprae, and borderline tuberculoid (BT) leprosy is the most common type of leprosy and presents with large, well- to ill-defined hypopigmented patches. It is known for atypical presentations. Dermoscopy of granulomatous conditions is well documented. However, there is no description of dermoscopy of BT leprosy in the literature. Authors evaluated the dermoscopic patterns of BT leprosy.

Case report

Patients with BT leprosy were studied for dermoscopic patterns. A total of 12 patients (8 male, 4 female) with a median age of 25 years were present. Mean duration of disease was 6 months. The most frequent pattern was white areas (100%) followed by decreased density of hairs. Yellow globules were observed in 8 (66.66%) patients. Decreased white dots (represent sweat duct openings) and branching vessels were noted in 6 (50%) and 4 (33.33%) patients, respectively.

Conclusion

This is the first report of dermoscopy of BT leprosy in the literature, and new dermoscopic observations were made by the authors. Dermoscopy of BT leprosy shows characteristic patterns, thus it adds valuable information for the diagnosis of BT leprosy.

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A case of Netherton syndrome with intestinal atresia, a novel SPINK5 mutation, and a fatal course

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Peristomal skin complications: what dermatologists need to know

Abstract

A stoma is an artificial opening to the skin formed when a part of the gastrointestinal tract is resected and opened to the skin in order to divert the bowel content to the skin surface. The incidence of stomal and peristomal complication varies from 30 to 67% with a significant negative impact on patient quality of life. Despite their prevalence, care providers tend to show insufficient awareness of peristomal skin complications, and research-based evidence related to peristomal skin complication and management options particularly in dermatology literature is sparse. This article will present a comprehensive review of peristomal skin complications in classification, clinical presentation, causes, prevention, and management aiming at increasing knowledge about this topic.

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Never surprise a patient with scurvy

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What's new in dermoscopy of Bowen's disease: two new dermoscopic signs and its differential diagnosis

Abstract

Background

Clinical and dermoscopic features of Bowen's disease (BD) show great diversity. Some lesions of BD are often difficult to be differentiated from seborrheic keratosis, actinic keratosis, lichen planus-like keratosis, etc. It is necessary to fully describe the dermoscopic features of the disease, considering differential diagnosis.

Objective

To describe the dermoscopic feautres of Bowen's disease and summarize the dermoscopic differential diagnosis of the disease.

Patients and methods

Altogether 146 lesions with a histopathological diagnosis of Bowen's disease were consecutively included in this study. All the lesions were imaged with dermoscopy and analyzed for dermoscopic features.

Results

A total of 146 lesions were analyzed. The dermoscopic features most frequently observed in our series of lesions were scales (78.8%), glomerular vessels (69.2%), yellow crusts (56.8%), focal hemorrhage (55.5%), focal/multifocal hypopigmentation (44.5%), and linear irregular vessels (42.5%). Besides, we found two new dermoscopic signs in BD: the double-edge sign (30.1%) and the clusters of brown structureless areas (38.4%).

Conclusion

Bowen's disease presents a variety of dermoscopic features. The recognition of two new dermoscopic signs of BD and fully understanding its dermoscopic features will help us in differential diagnosis.

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The Impact of Waiting List Bmi Changes on the Short-Term Outcomes of Lung Transplantation.

Background: Obesity and underweight are associated with a higher postlung transplantation (LTx) mortality. This study aims to assess the impact of the changes in BMI during the waiting period for LTx on early postoperative outcomes. Methods: Medical records of 502 consecutive cases of LTx performed at our institution between 1999 and 2015 were reviewed. Patients were stratified per change in BMI category between pre-LTx assessment (candidate BMI) and transplant BMI as follows: A-Candidate BMI=30 and Transplant BMI18.5-29.9 and E-Candidate BMI>=30 or 18.5-29.9 and Transplant BMI>=30. Our primary outcome was in-hospital (H) mortality and secondary outcomes were length of mechanical ventilation (MV), intensive care unit (ICU) length of stay (LOS), H LOS and postoperative complications. Results: BMI variation during the waiting time was common, as 1/3 of patients experienced a change in BMI category. Length of MV (21 vs. 9 d; p=0.018), ICU LOS (26 vs. 15 d; p=0.035) and rates of surgical complications (76 vs. 44%; p=0.018) were significantly worse in patients of group E vs. D. Obese candidates who failed to decrease BMI

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Protective efficacy of a hydroxy fatty acid against gastric Helicobacter infections

Abstract

Background

We have previously revealed that omega-3 polyunsaturated fatty acids can prevent Helicobacter pylori infection by blocking the futalosine pathway, an alternative route for menaquinone (MK) biosynthesis.

Materials and Methods

1, Different H. pylori strains were grown in liquid media supplemented with linoleic acid, an omega-6 fatty acid, or its 10-hydroxy derivative, 10-hydroxy-cis-12-octadecenoic acid (HYA), in the presence or absence of MK. The bacterial numbers in the media were estimated by plating; 2, C57BL/6NCrl mice received drinking water supplemented with different fatty acids starting from 1 week before infection with H. pylori or Helicobacter suis until the end of the experiment. The gastric colonization levels of H. pylori or H. suis were determined 2 weeks after infection by plating or quantitative PCR, respectively; 3, Mice were given HYA, starting 1 week before infection with H. suis and continuing until 6 months after infection, for analysis of the gastric conditions.

Results

1, A low concentration (20 μmol/L) of HYA in culture broth suppressed the growth of H. pylori, and this inhibition was reduced by MK supplementation; 2, HYA treatment protected mice against H. pylori or H. suis infection; 3, HYA treatment suppressed the formation of lymphoid follicles in the gastric mucus layer after H. suis infection.

Conclusions

HYA prevents gastric Helicobacter infections by blocking their futalosine pathways. Daily HYA supplementation is effective for the prevention of gastric mucosa-associated lymphoid tissue lymphoma induced by persistent infection with H. suis.

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Efficacy of three-in-one capsule bismuth quadruple therapy for Helicobacter pylori eradication in clinical practice in a multinational patient population

Abstract

Background

Bismuth quadruple therapy (BQT) has been proven superior to standard triple therapy for Helicobacter pylori eradication in randomized clinical trials; however, little is known about the efficacy of BQT in daily routine practice.

Methods

In a single-center cohort study, we analyzed consecutive H. pylori-positive patients in whom three-in-one capsule BQT (Pylera^® + omeprazole) has been prescribed. All patients were instructed in a standardized fashion, and a prospective follow-up was planned. PCR on gastric biospies for clarithromycin and levofloxacin resistance was performed before treatment in a subgroup of patients. Treatment outcome was assessed by 13C urea breath test or by histology not earlier than 4 weeks after end of treatment.

Results

Three-in-one capsule BQT has been prescribed in 322 patients. Approximately 70.2% of patients had a migrational background. PCR results were available in 163 patients and identified resistance to clarithromycin and levofloxacin in 29 (17.8%) and 20 (12.3%) of cases, respectively. BQT was prescribed as first-line, second-line, and salvage treatments in 74%, 17%, and 9% of cases, respectively. Five patients discontinued treatment due to side effects (1.8%). By modified intention-to-treat and per-protocol analyzes, the overall H. pylori eradication rates were 95.0% (95% CI 94.92%-95.08%) and 96.7% (95% CI 94.6%-98.8%), respectively. The low number of treatment failures (n = 9) did not allow to identify risk factors for failure.

Conclusion

Three-in-one capsule bismuth quadruple therapy is effective and safe for treatment of H. pylori infection in routine practice, irrespective of the patient's migrational background or the number of previous treatment failures.

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Abstracts

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Local allergic rhinitis is an independent rhinitis phenotype: The results of a 10-years follow-up study

Abstract

Background

The knowledge about the natural history of local allergic rhinitis (LAR) is limited. One unmeet question is to demonstrate whether LAR should be considered the first step in the development of allergic rhinitis (AR) or an independent phenotype. The aim of this study was to prospectively evaluate the natural history of a population with LAR, the potential conversion to AR with systemic atopy, and the development of asthma during 10 years.

Methods

This is the second phase of a 10 year follow-up study of a cohort of 176 patients with LAR of recent onset and 115 age- and sex-matched healthy controls prospectively evaluated from 2005 to 2016. Clinical-demographic questionnaire, spirometry, skin prick-test, and specific-IgE were evaluated yearly. Nasal allergen provocation tests (NAPT) with D. pteronyssinus, Alternaria alternata, Olea europaea, and grass pollen were performed at baseline, and after 5 and 10 years.

Results

After 10 years LAR patients experienced a significant and clinically relevant worsening of the rhinitis, with increase of emergency assistance, development of asthma, loss of allergen tolerance, and impairment of the quality of life. This worsening became significant after 5 years and progressed throughout 10 years.

A similar rate of development of AR with systemic atopy was detected in patients and controls (9.7% vs 7.8%, Log-rank p=0.623). In 5 patients conversion to systemic atopy occurred >10 years (3%).

Conclusions

LAR is a well-differentiated clinical entity with a low rate of development of systemic atopy, a natural evolution towards worsening and a risk factor for suffering asthma.

This article is protected by copyright. All rights reserved.

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Infective dermatitis associated with human T-lymphotropic virus type 1 infection in Adelaide, South Australia

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Peri-operative factors predisposing to pharyngocutaneous fistula after total laryngectomy: analysis of a large multi-institutional patient cohort

Abstract

Background

Pharyngocutaneous fistula (PCF) is a problematic complication following total laryngectomy. Disagreement remains regarding predisposing factors. This study examines perioperative factors predicting PCF following total laryngectomy using a large multicenter data registry.

Methods

Retrospective cohort analysis was performed using patients undergoing total laryngectomy in the ACS-NSQIP database for 2006–2014. Sub-analysis was performed based on reconstruction type. Outcome of interest was PCF development within 30 days.

Results

Multivariate analysis of 971 patients was performed. Three variables showed statistical significance in predicting PCF: wound classification of 3 and 4 vs. 1–2 (OR 6.42 P < 0.0004 and OR 8.87, P < 0.0042), pre-operative transfusion of > 4 units of packed red blood cells (OR 6.28, P = 0.043), and free flap versus no flap reconstruction (OR 2.81, P = 0.008).

Conclusions

This study identifies important risk factors for development of PCF following total laryngectomy in a large, multi-institutional cohort of patients, thereby identifying a subset of patients at increased risk.

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Severe Ocular Myositis After Ipilimumab Treatment for Melanoma: A Report of 2 Cases

Ipilimumab binds and blocks cytotoxic T-lymphocyte-associated antigen-4, causing enhanced T-cell reaction, antitumor response, and significant improvement of the overall survival of patients with metastatic melanoma. Patients treated with ipilimumab can develop immune-related adverse effects, primarily dermatitis, colitis, hepatitis, and hypophysitis. Although, in phase I–III studies, 64.2% of all patients suffered from immune-related adverse effects, ocular adverse effects occurred in 1.3% only. In the cases reported below, 2 patients with metastatic melanoma developed severe ocular myositis after treatment with ipilimumab. These are the first 2 reports of successful treatment of this condition by use of a combination of methylprednisolone and mycophenolate mofetil, and, in 1 of the cases, additional medication with intravenous immunoglobulin.

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NK Cell–derived Exosomes From NK Cells Previously Exposed to Neuroblastoma Cells Augment the Antitumor Activity of Cytokine-activated NK Cells

Immune cell–derived exosomes can increase immunity against tumors. In contrast, tumor-derived exosomes can reduce the immunity and can change the tumor microenvironment to further develop and provide metastasis. These effects take place by an alteration in the innate and adaptive immune cell functions. In this experiment, we studied the natural killer (NK) cells' effectiveness on tumor cells after expansion and thereafter incubated it with exosomes. The exosomes were derived from 2 populations of NK cells: (1) naive NK cells and, (2) NK cells previously exposed to neuroblastoma (NB) cells. Moreover, we have studied the NB-derived exosomes on NK cell function. The molecular load of the characterized exosomes (by means of nanoparticle-tracking analysis, flow cytometry, scanning electron microscopy, and western blot) from NK cells exposed to the NB cell revealed their expression of natural killer cell receptors in addition to CD56, NKG2D, and KIR2DL2 receptors. These exosomes were used to treat NK cells and thereafter administered to NB tumor cells both in vitro and in vivo. Our results showed some kind of NK cells' education by the exosomes. This education from NK cells previously exposed to NB cell–derived exosomes caused efficient and greater cytotoxicity against NB tumors, but NB-derived exosomes act as tumor promoters by providing a tumor supporting niche. Hence, this method of preparing the exosomes has a dramatic effect on activation of anti-NK cells against NB cells.

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Ex Vivo Induction of Multiple Myeloma-specific Immune Responses by Monocyte-derived Dendritic Cells Following Stimulation by Whole-tumor Antigen of Autologous Myeloma Cells

The introduction of novel agents has significantly expanded treatment options for multiple myeloma (MM), albeit long-term disease control cannot be achieved in the majority of patients. Vaccination with MM antigen-loaded dendritic cells (DCs) represents an alternative strategy that is currently being explored. The aim of this study was to assess the immunogenic potential of ex vivo–generated monocyte-derived DCs (moDCs), following stimulation with the whole-antigen array of autologous myeloma cells (AMC). MoDCs were loaded with antigens of myeloma cells by 2 different methods: phagocytosis of apoptotic bodies from γ-irradiated AMC, or transfection with AMC total RNA by square-wave electroporation. Twenty patients with MM were enrolled in the study. Following stimulation and maturation, moDCs were tested for their capacity to induce T-helper 1 and cytotoxic T lymphocyte responses in vitro. Both strategies were effective in the induction of myeloma-specific cytotoxic T lymphocyte and T-helper 1 cells, as demonstrated by cytotoxicity and ELISpot assays. On the whole, T-cell responses were observed in 18 cases by either method of DC pulsing. We conclude that both whole-tumor antigen approaches are efficient in priming autologous antimyeloma T-cell responses and warrant further study aiming at the development of individualized DC vaccines for MM patients.

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Immune Checkpoint Inhibitors in Organ Transplant Patients

Modulation of T-cell activity through blockade of coinhibitory molecules has revolutionized the treatment of various malignancies. Several immune checkpoint inhibitors are currently Food and Drug Administration approved which target various coinhibitory pathways including cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed death 1 receptor (PD-1), and programmed cell death ligand-1. Clinical trials that lead to the Food and Drug Administration approval of these agents often excluded patients with an organ transplant. Excluding these patients was deliberate due to concern that immune checkpoint inhibitor therapy could lead to graft rejection. The PD-1 and CTLA-4 pathways are essential to downregulate our immune system in the setting of T-cell activation to prevent autoimmunity. Furthermore, both pathways are implicated in transplanted organ tolerance and modulation of the pathways may inadvertently lead to peripheral transplant rejection. Currently, there are no guidelines for the treatment of patients with immune checkpoint inhibitors in the setting of a prior organ transplant. Thus far, there are only 10 reported cases of patients in the literature who were treated in this setting. Two additional cases are reported herein, including 1 patient with a prior cardiac transplant receiving nivolumab for non–small cell lung cancer. Of the 12 cases, 4 patients experienced organ rejection. From these observations, the authors hypothesize factors that affect safety and of this treatment modality in this patient population. These factors include the integral role of the PD-1 pathway compared with the CTLA-4 pathway in organ acceptance, sequential implementation of different immune checkpoint inhibitor classes, length of time with a transplant before therapy, strength of immunosuppressive agents to prevent organ transplant rejection, and immunogenicity of the particular organ grafted. Although limited cases have been reported, there are circumstances in which immune checkpoint inhibitors have been used in the setting of organ transplantation without resulting in organ rejection. A thorough discussion with the patient of the potential risks, including graft rejection, and benefits of this therapy is necessary before beginning this treatment. More research is needed to explore the safety and efficacy of immune checkpoint inhibitors in the setting of organ transplantation.

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Immune-related Neurological Symptoms in an Adolescent Patient Receiving the Checkpoint Inhibitor Nivolumab

Immune checkpoint inhibitors are a novel group of immunotherapeutic agents for the treatment of cancer. Immune-related adverse events, including neurological symptoms, have been associated with these agents. We present the case of an adolescent with refractory Hodgkin lymphoma treated with nivolumab, a PD1 inhibitor, who developed Hashimoto thyroiditis, posterior reversible encephalopathy syndrome causing seizures, as well as urinary retention, truncal/appendicular spasticity, dysphagia, and a progressive encephalopathy that was clinically consistent with a diagnosis of progressive encephalopathy with rigidity and myoclonus, a stiff-person-syndrome spectrum disorder. He showed response and ultimately full recovery to a combination of intravenous steroids, intravenous immunoglobulin, and plasma exchange. To our knowledge, this is the first documented report of an immune-related neurological reaction to nivolumab in an adolescent patient and expands the spectrum of known nivolumab-associated toxicities.

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Is voice therapy effective for the treatment of dysphonic patients with benign vocal fold lesions?

To update our knowledge regarding the effectiveness of voice therapy for the treatment of vocal disturbance associated with benign vocal fold lesions, including vocal polyps, nodules and cysts, and for determining the utility of voice therapy in treating organic voice disorders, while highlighting problems for the future development of this clinical field.

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Risk factors for the occurrence of epistaxis: Prospective study

Analyse and compare the characteristics of patients with epistaxis admitted to the otolaryngology emergency department with those provided by a control group. Establish a model to identify epistaxis predictive factors.

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A case of ectopic salivary gland of the larynx

A 46-year-old man presented with sore throat. Laryngoscopic findings revealed a smooth yellow mass occupying the anterior portion of the false vocal fold on the left side. The authors performed biopsy under general anesthesia. The histopathological diagnosis was ectopic salivary gland. Because salivary glands are usually not found under the false vocal fold mucosa, ectopic salivary gland of the larynx was diagnosed.It is necessary to consider the possibility of ectopic salivary gland for mass lesions if swelling of the provisional vocal cord is found.

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Oral Antibacterial Therapy for Acne Vulgaris

What is the evidence for the efficacy of oral antibiotics for acne? This review examines different antibiotic classes and regimens and compares their potential side effects and long-term impact.
American Journal of Clinical Dermatology

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Endoscopically-assisted transmastoid approach to the geniculate ganglion and labyrinthine facial nerve

Endoscopic transcanal approaches to the facial nerve allow excellent exposure of the tympanic facial nerve. This approach becomes limited when access is required to the more proximal geniculate ganglion and la...

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Metabolic Syndrome in Hispanic Youth: Results from the Hispanic Community Children's Health Study/Study of Latino Youth

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


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Distinct Predictors and Comorbidities in Early Onset Type 2 Diabetes Mellitus Among Asian Indians

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


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Endoscopically-assisted transmastoid approach to the geniculate ganglion and labyrinthine facial nerve

Abstract

Background

Endoscopic transcanal approaches to the facial nerve allow excellent exposure of the tympanic facial nerve. This approach becomes limited when access is required to the more proximal geniculate ganglion and labyrinthine portion of the facial nerve. The aim of this report was to determine the feasibility of a transmastoid endoscopically assisted approach to the geniculate ganglion and labyrinthine facial nerve. This is an endoscopic cadaveric dissection and video review at a university anatomical laboratory.

Methods

A total of 12 endoscopic cadaveric dissections were performed. A cortical mastoidectomy and perilabyrinthine air cell removal was performed using an operating microscope. Beyond this, dissection was performed with an endoscope.

Results

In all dissections, an endoscopically assisted transmastoid approach allowed complete access to the geniculate ganglion, and at least 1.5 mm of the distal labyrinthine facial nerve. Further transcrusal drilling through the anterior crus of the superior semicircular canal allowed access to the entire labyrinthine facial nerve.

Conclusions

The entire geniculate ganglion and labyrinthine facial nerve is difficult to access with microscopic techniques. Adding endoscopic visualization allows for complete visualization of the geniculate ganglion. Clinical reports will further strengthen these preliminary cadaveric results.

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WHO-Klassifikation und klinisches Spektrum der kutanen Lymphome

Zusammenfassung

Hintergrund

Kutane Lymphome sind seltene Hauttumoren, die ein breites klinisches Spektrum aufweisen.

Ziel der Arbeit

Die Arbeit soll eine Übersicht über die aktuell gültige Klassifikation und über das klinische Spektrum der kutanen Lymphome geben.

Material und Methoden

Es erfolgen die Auswertung und Zusammenfassung der aktuellen Literatur zu den einzelnen Entitäten kutaner Lymphome unter Berücksichtigung der aktuell gültigen Klassifikation.

Ergebnisse

Nach der revidierten Fassung der WHO (World Health Organization)-Klassifikation 2016 ergeben sich kleinere Modifikationen in der Nomenklatur kutaner Lymphome. In den letzten Jahren wurden neue Typen der lymphomatoiden Papulose beschrieben. Zudem konnten in der Gruppe der follikulotropen Mycosis fungoides 2 prognostisch unterschiedliche Gruppen abgegrenzt werden. Die CD4-positive klein/mittel-großzellige T‑Zell-lymphoproliferative Erkrankung wird nicht mehr als Lymphom bezeichnet. Als neue Entitäten wurden das EBV (Epstein-Barr-Virus)-positive mukokutane Ulkus, das EBV-assoziierte diffus großzellige B‑Zell-Lymphom (nicht weiter spezifiziert) und das primär kutane akrale CD8⁺-T-Zell-Lymphom (provisorische Entität) mit aufgenommen.

Schlussfolgerung

Zur Klassifikation kutaner Lymphome soll die revidierte Fassung der WHO-Klassifikation Anwendung finden. Die klinisch-pathologische Korrelation bleibt ein elementarer Baustein zur korrekten Einordung.

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Construction and Immunogenicity Analysis of Whole-Gene Mutation DNA Vaccine of Aleutian Mink Virus Isolated Virulent Strain

Viral Immunology , Vol. 0, No. 0.


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An unusual cause of genu valgum and persistent instability

Abstract

We present the case of a professional adolescent footballer who attended our clinic with ongoing instability symptoms and valgus knee deformity after conservative management of an medial collateral ligament injury. The patient was found to have sustained a contra-coup Salter Harris Type V injury to his lateral distal femur physis resulting in premature growth arrest and deformity. Salter Harris Type V injuries are rare, and often not diagnosed until growth has arrest has occurred due to lack of identifiable features on initial plain radiographs. The patient was successfully treated with opening wedge femoral osteotomy and plication of the medial collateral ligament. This case reinforces the need for awareness of such injuries to avoid delayed diagnosis and describes options for management.

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Closed posterior ankle dislocation without associated fractures: a case report

Abstract

Ankle dislocation without associated fractures, also known as pure ankle dislocation is a rare injury. It is usually the result of high energy trauma. It could be a combination of predisposing anatomical factors plus certain ankle position at time of injury that produce this peculiar injury. In most cases it is managed conservatively with urgent reduction, 6–9 weeks of immobilization followed with intense physiotherapy. The outcome after these injuries is generally good where most of the patients in reported cases managed to return to the preinjury level of activity.

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Free flap transfer reconstruction in managing tongue carcinoma during pregnancy

Abstract

Malignant oral cancers do not commonly occur in pregnant women. But when they do, the presence of a foetus and maternal physiological changes complicate and limit the treatment options. Risk benefit assessment and balancing of them are always important. A 33-year-old woman, who was 25 weeks pregnant, presented with a squamous cell carcinoma on her tongue. She was clinically staged II (T2, N0 and M0). Discussions between the patient, surgical teams and obstetricians agreed to continue her pregnancy while managing the tumour. Hemi-glossectomy and ipsilateral neck dissection was performed. Free antero-lateral thigh flap was transferred to reconstruct the tongue defect, successfully. The patient gave birth to a healthy baby afterward. She is tumour free for 6 years. Free flap reconstruction can be an option, even if the patient is pregnant.

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Gastrointestinal adenocarcinoma metastasizing to the vulva: a case report

Metastatic vulval adenocarcinoma is a rare occurrence with only a few cases reported to date. They can arise from the breast, gastrointestinal system, or endometrium.

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Association between AKI and all-cause mortality after EVAR

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Important role of calcium chloride in preventing carbon monoxide generation during desflurane degradation with alkali hydroxide-free carbon dioxide absorbents

Abstract

We investigated whether calcium chloride (CaCl₂), a supplementary additive in carbon dioxide (CO₂) absorbents, could affect carbon monoxide (CO) production caused by desflurane degradation, using a Japanese alkali-free CO₂ absorbent Yabashi Lime^®-f (YL-f), its CaCl₂-free and 1% CaCl₂-added derivatives, and other commercially available alkali-free absorbents with or without CaCl₂. The reaction between 1 L of desflurane gas (3–10%) and 20 g of desiccated specimen was performed in an artificial closed-circuit anesthesia system for 3 min at 20 or 40 °C. The CO concentration was measured using a gas chromatograph equipped with a semiconductor sensor detector. The systems were validated by detecting dose-dependent CO production with an alkali hydroxide-containing CO₂ absorbent, Sodasorb^®. Compared with YL-f, the CaCl₂-free derivative caused the production of significantly more CO, while the 1% CaCl₂-added derivative caused the production of a comparable amount of CO. These phenomena were confirmed using commercially available absorbents AMSORB^® PLUS, an alkali-free absorbent with CaCl₂, and LoFloSorb™, an alkali-free absorbent without CaCl₂. These results suggest that CaCl₂ plays an important role in preventing CO generation caused by desflurane degradation with alkali hydroxide-free CO₂ absorbents like YL-f.

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Primary adrenal lymphoma with initial presentation concerning for bilateral adrenal pheochromocytomas

Primary adrenal non-Hodgkin's lymphoma is rarely encountered. Clinical presentation is non-specific with fatigue, abdominal pain and B-symptoms being more commonly reported. We report a case of primary bilateral adrenal lymphoma who initially presented with clinical features suspicious for pheochromocytoma. The patient was recently diagnosed with hypertension and had a family history of early ischaemic heart disease. Plasma free metanephrines were also elevated. Pheochromocytoma was deemed unlikely following multiple investigations and the diagnosis of lymphoma was made following adrenal biopsy. Partial response was noted on positron emission tomography CT scan following four cycles of chemotherapy but failed to remit after six cycles of chemotherapy. Subsequently, he received 20 fractions of radiation to his adrenal glands and is now awaiting further imaging. The presentation of primary adrenal lymphoma can be variable and given that the diagnosis is obtained through tissue sampling, pheochromocytoma should be excluded due to risk of a potentially fatal adrenergic crisis.

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Large atrial mass in a patient with Crohns disease: organised thrombus mimicking a myxoma

Description

A right atrial mass was incidentally discovered on a CT in a 30-year-old female patient with an 11-year history of Crohn's disease. Medical treatment included infliximab and azathioprine. She denied chest pain, palpitations, orthopnoea or dyspnoea. Transoesophageal echocardiography showed a large, 2.9x2.2 cm, non-obstructive, mobile mass attached by a broad stalk to the lateral wall of the right atrium (online  and figure 1). An atrial myxoma was suspected, and the tumour was completely extirpated. No other mass was found inside the atrium, and the cava veins were patent and free. Surprisingly, histological examination revealed an organised thrombus with no evidence of myxoma. The patient was discharged with long-term warfarin and had an uneventful recovery and no further episodes of thrombosis (2-year follow-up).

Figure 1

Transoesophageal echocardiogram showing a 2.2x2.9 cm mass in the right atrium.

The most frequent causes of thrombus formation...

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Isolated tricuspid valve Libman-Sacks endocarditis in a patient with antiphospholipid antibody syndrome

Description

A 30 year-old woman presented with an episode of transient ischaemic attack (TIA). She had a history of four consecutive first trimester abortions over the past 5 years and had no live issues. A physical examination revealed livedo reticularis on her palms and feet (figure 1). On cardiac auscultation, a pansystolic murmur was heard in the tricuspid area. The remainder of the physical examination was unremarkable. The patient denied any history of dyspnoea, palpitations or swelling of the feet. She had leucopenia and thrombocytopenia with a platelet count of 80 x10⁹/L. Rheumatological evaluation yielded a positive lupus anticoagulant and elevated IgG anticardiolipin antibody levels (>300 U/mL). However, testing for antinuclear antibody and antibodies against IgM anticardiolipin and beta-2-glycoprotein 1 yielded negative results. Screening for secondary causes of positive antiphospholipid antibodies was unremarkable including a negative work-up for systemic lupus erythematosus (SLE). Brain imaging was also normal. Echocardiography was done that revealed mildly thickened...

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Optic disc coloboma with pit treated as glaucoma: diagnostic utility of ultrasound and swept source optical coherence tomography

Description

A 6-year-old boy presented as a known case of developmental glaucoma and was using topical travoprost in the right eye (RE) since 1 year. Highest recorded intraocular pressure (IOP) was 24 mm Hg in RE, whereas central corneal thickness was 540 µm. Visual acuity was 6/6 in both eyes. On examination, the anterior segment of both eyes was unremarkable. IOP was 16 mm Hg in RE and 20 mm Hg in the left eye. Fundus examination of RE revealed a large and pale optic disc, with a nearly absent inferior neuroretinal rim. The origin of the inferior vascular bundle could not be deciphered, and there was a small atrophic patch inferior to the optic disc (figure 1). A suspicious cavity-like macular lesion was noted adjoining the nasal border of fovea. The fellow eye had a type 3 choroidal coloboma sparing the macula (Ida Mann classification system). Standard automated perimetry showed a large superior arcuate scotoma (

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TSH and PRL, side-effect markers in aripiprazole treatment: adjunctive aripiprazole-induced thyrotropin oversuppression in a young man with schizophrenia

A 26-year-old Japanese man was admitted to our unit with exacerbated paranoid schizophrenia. Prior to his admission, daily administration of olanzapine had been sufficient to maintain a partial remission of his schizophrenia, but due to an exacerbation of his delusions, he had then also been prescribed aripiprazole, which had been followed by no improvement in symptoms and a gradual further exacerbation of auditory delusions. Physical examinations, brain MRI and neurophysiological assessment were unremarkable. Blood analysis, however, revealed extremely low thyroid-stimulating hormone (TSH) and prolactin-releasing hormone (PRL) concentration. Interestingly, after aripiprazole discontinuation, he returned to partial remission with an increase in plasma TSH and PRL concentration.

http://ift.tt/2x8P0WI

Rose thorn injury

Description

A 71-year-old man, with a history of arterial hypertension, presented with a 4-month history of four painful progressively enlarging nodules on the dorsal aspect of the right hand. The patient reported that he had been pricked by a rose on the fourth finger approximately 3 weeks before the appearance of the first lesion on the site of the injury. On physical examination, we observed four erythematous nodules, 10–15 mm in diameter, in linear distribution extending from the hand proximally (figure 1). Two nodules presented superficial erosions with purulent secretion. No systemic symptoms were detected. Histopathology revealed epidermal hyperkeratosis and suppurative small granulomas with polymorphous dermal infiltrate and periodic acid-Schiff staining identified rare fungal spores (figure 2). Culture from the biopsy specimen was negative. Clinical presentation and histology were consistent with sporotrichosis, so the patient was given itraconazole 200 mg daily. After 3 months of treatment,...

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Mycoplasma pneumoniae-induced rash and mucositis: a recently described entity

Mycoplasmapneumoniae is a common cause of respiratory infections. Although most cases are mild, some patients have extrapulmonary complications including mucocutaneous eruptions including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and erythemamultiforme (EM). Recently, a new entity, called M. pneumoniae-induced rash and mucositis (MIRM) was described. The authors present a clinical case difficult to classify attending to the classical classification of epidermolytic syndromes that meets the criteria proposed for the diagnosis of MIRM. The mucocutaneous disease associated with M. pneumoniae presents predominant mucositis, with scarce or absent cutaneous involvement. Because of the distinct morphology, pathophysiology and benign clinical course, MIRM should be considered as a new entity, distinct from SJS/TEN and EM.

http://ift.tt/2x8GJlL

Zoster vaccine-associated primary varicella infection in an immunocompetent host

A 64-year-old immunocompetent man developed a widespread pruritic and vesicular rash 2 weeks after receiving the zoster vaccine (Zostavax). He had fever, bandaemia with normal total white blood cell count and mild transaminitis. PCR testing of serum and skin was positive for varicella zoster virus (VZV), while serum VZV IgG was negative. The analysis of single nucleotide polymorphism by PCR and sequencing from the skin swab was consistent with the vaccine strain. The patient received 1 week of intravenous acyclovir and was discharged after all lesions had crusted. He continues to do well on follow-up with no significant complications.

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Primary gastric Burkitt lymphoma: a rare cause of life-threatening haematemesis

Lymphomas are the second most common gastric malignancy following gastric adenocarcinoma. The majority of gastric lymphomas are either mucosa-associated lymphoid tissue lymphomas or diffuse large B-cell lymphomas. Primary gastric Burkitt lymphoma is a subtype of non-Hodgkin's lymphoma and represents an aggressive and rare malignancy with only a small number of cases reported worldwide. Clinical and radiological presentation is non-specific and mimics other gastric lymphomas. Diagnosis is established with pathological evaluation. Due to the paucity of cases, treatment of this condition is not well studied and is extrapolated from paediatric and adult literature of Burkitt lymphoma not isolated to the stomach. We present the case of a male patient with primary gastric Burkitt lymphoma who initially presented with life-threatening haematemesis, later achieving complete remission with treatment. We discuss the epidemiology, presentation and management of gastric Burkitt lymphoma.

http://ift.tt/2x8Sfxw

Drug rash with eosinophilia and systemic symptoms (DRESS) caused by phenytoin

Drug rash with eosinophilia and systemic symptoms (DRESS) is a rare but potentially life-threatening condition with high mortality. Diagnosis is challenging due to variable clinical presentation and a protracted latency period following initiation of the offending drug. DRESS is a complex interplay that starts by introduction of the offending drug, reactivation of viruses and activation of the immune system. Herpes virus reactivation is considered a diagnostic marker and indicator of illness severity. Prompt recognition and the removal of offending agent remain the key to successful treatment. In cases of severe organ involvement, corticosteroids, immunoglobulins, antiviral and specialist consultation may be helpful. Here we present a case of a 36-year-old African-American male who presented with symptoms mimicking sepsis with an associated skin eruption that was diagnosed as DRESS.

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Patient with Niemann-Pick disease type C: over 20 years' follow-up

We report a 37-year-old woman with Niemann-Pick disease type C (NPC) 1. At the age of 8 years, she presented slow running followed by both fingers dystonia at the age of 10 years. At the age of 16 years, she developed declined scholastic achievement. On her first visit at the age of 17 years, she showed dystonia, ataxic gait and vertical supranuclear gaze palsy. We suspected it was NPC. She presented atrophies in the frontal lobes, brainstem and cerebellum in a brain MRI. She presented hepatomegalies and splenomegalies in an abdominal CT. At the age of 26 years, she undertook perpetually tracheal fistula because of recurrent aspiration pneumonia. Diagnosis of NPC1 was made by filipin staining and existence of foamy cells in the bone marrow and NPC1 gene analysis. We obtained informed consent of genetic analysis. Miglustat therapy was started at the age of 32 years. Improvements in swallowing capacity and in muscle tonus were seen.

http://ift.tt/2x8KHLn

Macrophages induce EMT to promote invasion of lung cancer cells through the IL-6-mediated COX-2/PGE2/β-catenin signalling pathway

Publication date: October 2017
Source:Molecular Immunology, Volume 90
Author(s): Dehai Che, Shuai Zhang, Zihan Jing, Lihua Shang, Shi Jin, Fang Liu, Jing Shen, Yue Li, Jing Hu, Qingwei Meng, Yan Yu
Infiltration of macrophages plays a critical role in the connection between inflammation and cancer invasion; however, the molecular mechanism that enables this crosstalk remains unclear. This paper investigates a molecular link between infiltration of macrophages and metastasis of lung cancer cells.In this study, the macrophage density and cyclooxygenase-2 (COX-2) protein were examined in surgical specimens by immunohistochemistry (IHC), and the prostaglandin E2 (PGE2) levels were determined in the blood of 30 non-small cell lung cancer (NSCLC) patients using enzyme-linked immunosorbent assay (ELISA). We demonstrated that macrophage infiltration was significantly associated with elevated tumour COX-2 expression and serum PGE2 levels in NSCLC patients. Interestingly, the COX-2 and PGE2 levels as well as macrophages were poor predictors of NSCLC patient survival. THP-1-derived macrophages were co-cultured in vitro with A549 and H1299 lung cancer cells. In the co-culture process, interleukin-6 (IL-6) induced the COX-2/PGE2 pathway in lung cancer cells, which subsequently promoted β-catenin translocation from the cytoplasm to the nucleus, resulting in epithelial-mesenchymal transition (EMT) and lung cancer cell invasion.Our findings show that the IL-6-dependent COX-2/PGE2 pathway induces EMT to promote invasion of tumour cells through β-catenin activation during the interaction between macrophages and lung cancer cells, which suggests that inhibition of COX-2/PGE2 or macrophages has the potential to suppress metastasis of lung cancer cells.



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Utomilumab and ISA101b Vaccination in Patients With HPV-16-Positive Incurable Oropharyngeal Cancer

Conditions:   Malignant Neoplasms of Ill-defined Secondary and Unspecified Sites;   Malignant Neoplasms of Lip Oral Cavity and Pharynx;   Oropharyngeal Cancer
Interventions:   Drug: Utomilumab;   Biological: ISA101b
Sponsors:   M.D. Anderson Cancer Center;   ISA Pharmaceuticals B.V.;   Pfizer
Not yet recruiting - verified August 2017

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Percutaneous Ethanol Injection for Benign Cystic Thyroid Nodules

Condition:   Thyroid Nodule
Intervention:   Drug: ethanol injection
Sponsor:   hassan harby
Recruiting - verified August 2017

http://ift.tt/2v22rdV

Diagnosis of Allergy to Mammals and Fish: Cross-Reactive vs. Specific Markers

Abstract

Purpose of Review

Allergen extracts are still widely used in allergy diagnosis as they are regarded as sensitive screening tools despite the fact that they may lack some minor allergens. Another drawback of extracts is their low specificity, which is due to the presence of cross-reactive allergens. Progress in allergen identification has disclosed a number of allergenic molecules of homologous sequence and structure which are present in different animal species. This review summarizes recent advances in mammalian and fish allergen identification and focuses on their clinical relevance.

Recent Findings

Serum albumins and parvalbumins are well-known animal panallergens. More recently several members of the lipocalin family were found to be cross-reactive between furry animals whereas in fish, additional allergens, enolase, aldolase and collagen, were found to be important and cross-reactive allergens. New epidemiological studies have analysed the prevalence and clinical relevance of mammalian and fish components.

Summary

Primary sensitization can be distinguished from cross-sensitization by using marker allergens. Although substantial progress has been made in allergen identification, only few markers are commercially available for routine clinical practice.

http://ift.tt/2vUdVib

The skin microbiome: impact of modern environments on skin ecology, barrier integrity, and systemic immune programming

Skin barrier structure and function is essential to human health. Hitherto unrecognized functions of epidermal keratinocytes show that the skin plays an important role in adapting whole-body physiology to chan...

http://ift.tt/2vURv0z

Diagnosis of Allergy to Mammals and Fish: Cross-Reactive vs. Specific Markers

Abstract

Purpose of Review

Allergen extracts are still widely used in allergy diagnosis as they are regarded as sensitive screening tools despite the fact that they may lack some minor allergens. Another drawback of extracts is their low specificity, which is due to the presence of cross-reactive allergens. Progress in allergen identification has disclosed a number of allergenic molecules of homologous sequence and structure which are present in different animal species. This review summarizes recent advances in mammalian and fish allergen identification and focuses on their clinical relevance.

Recent Findings

Serum albumins and parvalbumins are well-known animal panallergens. More recently several members of the lipocalin family were found to be cross-reactive between furry animals whereas in fish, additional allergens, enolase, aldolase and collagen, were found to be important and cross-reactive allergens. New epidemiological studies have analysed the prevalence and clinical relevance of mammalian and fish components.

Summary

Primary sensitization can be distinguished from cross-sensitization by using marker allergens. Although substantial progress has been made in allergen identification, only few markers are commercially available for routine clinical practice.

http://ift.tt/2vUdVib

Emerging Role of Three-Dimensional Printing in Simulation in Otolaryngology

Simulation is rapidly expanding across medicine as a valuable component of trainee education. For procedural simulation, development of low-cost simulators that allow a realistic, haptic experience for learners to practice maneuvers while appreciating anatomy has become highly valuable. Otolaryngology has seen significant advancements in development of improved, specialty-specific simulators with the expansion of three-dimensional (3D) printing. This article highlights the fundamental components of 3D printing and the multitude of subspecialty simulators that have been developed with the assistance of 3D printing. It briefly discusses important considerations such as cost, fidelity, and validation where available in the literature.

http://ift.tt/2v1NjNu

Scabies in babies

Abstract

The clinical manifestations of scabies infestation vary according to age, making the diagnosis challenging, particularly for primary care providers and dermatologists who do not routinely care for young children. We present seven cases of newborns and infants who developed inflammatory burrows and nodules early in the course, which is not typical of the eruption seen in older children and adults. We review the cutaneous features, differential diagnosis, and treatment recommendations for scabies in different age groups.

http://ift.tt/2vU7Dz3

Versorgungsrealität der molekularen Diagnostik maligner Erkrankungen

Zusammenfassung

Hintergrund

In den letzten Jahren wurden bei verschiedenen Krebsentitäten zahlreiche onkogene Treibermutationen entdeckt oder Prädiktoren für zielgerichtete immunologische Therapien entwickelt. Eine optimale Therapieentscheidung erfordert zunehmend eine komplexe molekulare Diagnostik. Dabei besteht in Deutschland derzeit noch ein Versorgungsdefizit bei der flächendeckenden Umsetzung der umfassenden genomischen Testung.

Ziel

Es werden die Versorgungsrealität der molekularen Diagnostik maligner Erkrankungen mit dem Fokus auf die Relevanz des Multiplex-Testverfahrens sowie Versorgungsqualität und Finanzierung dargestellt.

Material und Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der PubMed Datenbank, den eigenen Erfahrungsberichten am Beispiel vom Netzwerk Genomische Medizin (NGM) inklusive einer Zusammenfassung der aktuell geltenden Rechtslage und Richtlinien zur Kostenerstattung der molekularen Diagnostik.

Ergebnisse

Am Beispiel vom Lungenkrebs, der unverändert häufigsten Krebstodesursache in Deutschland, wurde die entscheidende Rolle einer umfassenden qualitätsgesicherten Multiplex-Diagnostik zur optimalen Therapieselektion dargestellt. Aufgrund der dynamischen Entwicklung von zielgerichteten Therapien in Abhängigkeit von den Ergebnissen der Primär- und Rezidivtestung muss die molekularpathologische Diagnostik jedem betroffenen Patienten in Deutschland zugängig sein.

Diskussion

Für eine flächendeckende Umsetzung der Next-Generation-Sequencing(NGS)-Diagnostik müssen aber auch abgestimmten Qualitätskriterien implementiert werden, um die Ergebnisvalidität für jeden Patienten fortlaufend sichern zu können. Die aktuellen Refinanzierungsmängel (v. a. im stationären Sektor) haben einen negativen Einfluss auf die bundesweiten Testraten. Das deutsche Abrechnungssystem ist weiterhin relativ unflexibel im Umgang mit den medizinischen Innovationen. Die Zukunft der personalisierten Krebstherapien liegt in den interdisziplinären und intersektoralen Netzwerken.

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Black peel in facial dermatoses

Summary

Background

Melasma (facial dermatoses) is an acquired chronic disorder of hyperpigmentation over sun exposed parts and continues to be a therapeutic challenge due to the presence of melanin at varying depths in the epidermis and dermis, and many researchers are working hard to find a solution. The main culprit to remain is direct sun exposure, with other factors like drugs, genetic predisposition, thyroid abnormalities, pregnancy, phototoxic and photoallergic cosmetics. Melasma continues to have a remarkable impact on the well-being of affected patients causing deep psychological and social anguish, and with the expansion of cosmetic dermatology globally, treatments that are successful against skin diseases and boost beauty without prolonged recovery periods, or exposing patients to the risks of surgery, are increasingly recognised and acknowledged. Many clinicians have used various peeling in facial acne, scarring, and hyperpigmentations, and there have been no well-controlled studies comparing them with other conventional agents. Case presentation: a unique case of facial hyperpigmentation in a black female who presented seeking help which can be attributed to increased aesthetic awareness among people nowadays. A single session of black peel several passes was performed and the lady noted a lightening effect in the following weeks.

Objective

The aim of this paper is to improve, advance and expand our understanding and the knowledge beyond what is already known to wider colleagues, to impact society at large and to disseminate the findings to wider audiences. Also, the objective of the present paper is to examine the different effect of black peel in the treatment of facial dermatoses, and it gives realistic tips on performing black peeling safely and effectively in ethnic skin groups. This is meant to shed light on some ways for clinical handling and improving our understanding scientifically and educationally. It is the first original case report of interest in the existing literature for the best of my knowledge that had a positive impact for my female patient.

Method

A single pass of black peel was applied on the lady's face.

Results

A pleasing brightening effect was examined and boosted the lady confidence.

Conclusion

The patient had a positive pleasing experience that she had noticed from a single session application of the black peel.

http://ift.tt/2vUzCPr

Preliminary audiologic and peri-operative outcomes of the Sophono™ transcutaneous bone conduction device: A systematic review

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Aren Bezdjian, Hanneke Bruijnzeel, Sam J. Daniel, Wilko Grolman, Hans G.X.M. Thomeer
ObjectiveTo delineate the auditory functional improvement and peri-operative outcomes of the Sophono™ transcutaneous bone conduction device.MethodsEligible articles presenting patients implanted with the Sophono™ were identified through a comprehensive search of PubMed and Embase electronic databases. All relevant articles were reviewed to justify inclusion independently by 2 authors. Studies that successfully passed critical appraisal for directness of evidence and risk of bias were included.ResultsFrom a total of 125 articles, 8 studies encompassing 86 patients using 99 implants were selected. Most patients (79.1%) were children. Ear atresia (67.5%) was the most frequently reported indication for Sophono™ implantation. Overall pure tone average auditory improvement was 31.10 (±8.29) decibel. During a mean follow-up time of 12.48 months, 25 patients (29%) presented with post-operative complications from which 3 were deemed as serious implant-related adverse events (3.5%).ConclusionsThe Sophono™ transcutaneous bone conduction device shows promising functional improvement, no intra-operative complications and minor post-operative skin related complications. If suitable, the device could be a proposed solution for the rehabilitation of hearing in children meeting eligibility criteria. A wearing schedule must be implemented in order to reduce magnet-related skin complications.



http://ift.tt/2vZeEgx

A case of congenital lipomatous overgrowth, vascular malformations, epidermal nevi, spinal/skeletal anomalies and/or scoliosis syndrome with lipoatrophy as an important clinical manifestation

Abstract

Congenital lipomatous overgrowth, vascular malformations, epidermal nevi, spinal/skeletal anomalies and/or scoliosis syndrome is a PIK3CA-related overgrowth spectrum presenting with congenital, asymmetric, disproportionate overgrowth associated with dysregulated adipose tissue, enlarged bony structures, and mixed primarily truncal vascular malformations. We present this case to raise awareness that very thin body habitus (lipoatrophy) contrasting with areas of overgrowth can be an important clinical feature of this syndrome and, if not recognized, can lead to unnecessary investigations.

http://ift.tt/2wzbMt5

Chronic Airway Fibrosis in Orthotopic Mouse Lung Transplantation Models - An Experimental Reappraisal.

Background: Several mouse lung transplantation (Tx) models have been proposed for the study of chronic airway fibrosis (CAF), the most prevalent complication seen in human lung transplant recipients, termed chronic lung allograft dysfunction (CLAD). Alternatively, it has been called for to establish an experimental animal model for restrictive allograft syndrome (RAS), another phenotype of CLAD. However, these mouse transplant models exhibit significant heterogeneity in consistency and reproducibility. We therefore aimed at reevaluating current available models. Methods: 4 different Tx combinations were employed that manifest CAF: 2 minor antigen-mismatched Tx combinations (MINOR, donor: C57BL/10, recipient: C57BL/6J); or MINOR-N using recipient C57BL/6N, major histocompatibility antigen-mismatched immunosuppressed Tx (MAJOR, donor: BALB/c, recipient: C57BL/6J) and syngeneic Tx (SYN, donor and recipient: C57BL/6J) as control. The recipients were harvested and analyzed at week 8. Oxygenation, histology, reverse transcription polymerase chain reaction (RT-PCR), and magnetic resonance imaging were performed to analyze outcome of those models. Results: The most prominent manifestation of CAF, thickest subepithelial fibrotic changes, worst oxygenation and the most severe acute rejection were detected in the MAJOR group, compared to all other (p

http://ift.tt/2vZ59hf

Features of asthma which provide meaningful insights for understanding the disease heterogeneity

Abstract

Background

Data-driven methods such as hierarchical clustering (HC) and principal component analysis (PCA) have been used to identify asthma subtypes, with inconsistent results.

Objective

To develop a framework for the discovery of stable and clinically meaningful asthma subtypes.

Methods

We performed HC in a rich dataset from 613 asthmatic children, using 45 clinical variables (Model 1), and after PCA dimensionality reduction (Model 2). Clinical experts then identified a set of asthma features/domains which informed clusters in the two analyses. In Model 3, we re-clustered the data using these features to ascertain whether this improved the discovery process.

Results

Cluster stability was poor in Models 1 and 2. Clinical experts highlighted four asthma features/domains which differentiated the clusters in two models: age of onset, allergic sensitization, severity, and recent exacerbations. In Model 3 (HC using these four features), cluster stability improved substantially. The cluster assignment changed, providing more clinically interpretable results. In a 5-cluster model, we labelled the clusters as: "Difficult asthma" (n=132); "Early-onset mild atopic" (n=210); "Early-onset mild non-atopic: (n=153); "Late-onset" (n=105); and "Exacerbation-prone asthma" (n=13). Multinomial regression demonstrated that lung function was significantly diminished among children with "Difficult asthma"; blood eosinophilia was a significant feature of "Difficult", "Early-onset mild atopic", and "Late-onset asthma". Children with moderate-severe asthma were present in each cluster.

Conclusions and clinical relevance

An integrative approach of blending the data with clinical expert domain knowledge identified four features, which may be informative for ascertaining asthma endotypes. These findings suggests that variables which are key determinants of asthma presence, severity or control, may not be the most informative for determining asthma subtypes. Our results indicate that exacerbation-prone asthma may be a separate asthma endotype, and that severe asthma is not a single entity, but an extreme end of the spectrum of several different asthma endotypes.

This article is protected by copyright. All rights reserved.

http://ift.tt/2wtdJIt

Corticosteroid and Long-Acting ß-Agonist Therapy Reduces Epithelial Goblet Cell Metaplasia

Abstract

Background

Bronchial epithelial goblet cell metaplasia (GCM) with hyperplasia is a prominent feature of asthma, but the effects of treatment with corticosteroids, alone or in combination with a long-acting β₂-adrenergic receptor agonist (LABA) on GCM in the bronchial epithelium are unknown.

Objectives

To determine if corticosteroid alone or in combination with a LABA alter protein and gene expression pathways associated with IL-13-induced goblet cell metaplasia.

Results

We evaluated the effects of Fluticasone Propionate (FP) and of Salmeterol (SM), on the response of well-differentiated cultured bronchial epithelial cells to interleukin-13 (IL-13). Outcome measures included gene expression of SPDEF/FOXa2, gene expression and protein production of MUC5AC/MUC5B, and morphologic appearance of cultured epithelial cell sheets. We additionally analyzed expression of these genes in bronchial epithelial brushings from healthy, steroid-naïve asthmatic, and steroid-treated asthmatic subjects. In cultured airway epithelial cells, FP treatment inhibited IL-13-induced suppression of FOXa2 gene expression and upregulation of SPDEF, alterations in gene and protein measures of MUC5AC and MUC5B, and induction of GCM. The addition of SM synergistically modified the effects of FP modestly—only for gel-forming mucin MUC5AC. In bronchial epithelial cells recovered from asthmatic vs. healthy human subjects, we found FOXa2 and MUC5B gene expression to be reduced and SPEDF and MUC5AC gene expression to be increased; these alterations were not observed in bronchial epithelial cells recovered after treatment with inhaled corticosteroids.

Conclusion and Clinical Relevance

Corticosteroid treatment inhibits IL-13-induced GCM of the airways in asthma, possibly through its effects on SPDEF and FOXa2 regulation of mucin gene expression. These effects are modestly augmented by the addition of a long-acting ß-agonist. As we found evidence for drug treatment counter-acting the effects of IL-13 on the epithelium, we conclude that further exploration into the mechanisms by which corticosteroids and long-acting β₂-adrenergic agonists confer protection against pathologic airway changes is warranted.

This article is protected by copyright. All rights reserved.

http://ift.tt/2xmObsS

Quality and Safety in Anesthesia and Perioperative Care.

No abstract available

http://ift.tt/2wzl7Bg