Checkpointinhibitoren beim nichtkleinzelligen Lungenkarzinom

Zusammenfassung

Hintergrund

Die moderne Immuntherapie mit Checkpointinhibitoren hat unaufhaltsam Einzug in die Behandlung des nichtkleinzelligen Lungenkarzinoms (NSCLC) gehalten.

Fragestellung

Studien zu Checkpointinhibitoren beim fortgeschrittenen NSCLC wurden auf ihre Ergebnisse hinsichtlich Effektivität und Toxizität analysiert und bewertet.

Material und Methode

Phase-I-, Phase-II- und Phase-III-Studienergebnisse zu neuen Checkpointinhibitoren beim fortgeschrittenen NSCLC wurden aus der Literatur (Pubmed) und aus Beiträgen auf großen internationalen Kongressen (ASCO, ESMO, WCLC) zusammengestellt.

Ergebnisse

Für die beiden PD-1-Antikörper Nivolumab und Pembrolizumab existieren bereits große Phase-III-Studien beim fortgeschrittenen NSCLC in der Second- und First-Line-Therapie. Zulassungen sind für Nivolumab (ohne Markerbezug, Zweitlinie) und Pembrolizumab (bei PD-L1-Expression ≥ 1 % „tumor proportion score", ​TPS; Zweit- und Drittlinie) beim fortgeschrittenen NSCLC und für Pembrolizumab in der Erstlinie bei Hochexpression des Immunmarkers PD-L1 (≥50 % TPS) von der EMA (European Medicines Agency) ausgesprochen worden. Erste Ergebnisse von Phase-III-Studien mit PD-L1-Antikörpern sind für das Atezolizumab bereits berichtet worden (OAK-Studie) oder werden für das Durvalumab aktuell noch erwartet (MYSTIC-Studie). Für Kombinationen mit konventioneller Chemotherapie und Kombinationen mit anderen Checkpointinhibitoren wie CTLA4-Antikörpern fehlen noch die abschließenden Ergebnisse von großen Phase-II- bzw. Phase-III-Studien.

Schlussfolgerungen

Die moderne Immuntherapie mit einem PD-1-Antikörper hat sich als integrale Behandlungsoption beim fortgeschrittenen NSCLC klar etabliert. In Zukunft wird die Suche nach besseren prädiktiven Faktoren und Markern für einen eher selektiven Einsatz dieser hochwirksamen, aber spezifischen Medikamente essenziell werden.

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Efficacy and safety of ixekizumab for the treatment of moderate-to-severe plaque psoriasis: Results through 108 weeks of a randomized, controlled phase 3 clinical trial (UNCOVER-3)

Ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin 17A, is efficacious in treating moderate-to-severe plaque psoriasis through 60 weeks.

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A new evidence-based risk stratification system for cutaneous squamous cell carcinoma into low, intermediate, and high risk groups with implications for management

Most primary cutaneous squamous cell carcinomas are cured with surgery. A subset, however, may develop local and nodal metastasis that may eventuate in disease-specific; death. This subset has been variably termed high risk. Herein, we review; an emerging body of data on the risks of these outcomes and propose an evidence-based; risk stratification for low-, intermediate-, and high-risk tumors that takes into; account both tumor and patient characteristics. Finally, we discuss a framework for; management of these tumors on the basis of data, when available, and our; recommendations when data are sparse.

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Serious infections among a large cohort of subjects with systemically treated psoriasis

Biologic therapy is effective for treatment of moderate-to-severe psoriasis but may be associated with an increased risk for serious infection.

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Uncovering burden disparity: A comparative analysis of the impact of moderate-to-severe psoriasis and hidradenitis suppurativa

Psoriasis and hidradenitis suppurativa (HS) exhibit distinct clinical features, but no studies have directly compared the health-related quality of life (HRQoL) in patients with moderate-to-severe manifestations of these conditions.

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Early mobilization programme improves functional capacity after major abdominal cancer surgery: a randomized controlled trial

Abstract

Background: Major abdominal oncology surgery is associated with substantial postoperative loss of functional capacity, and exercise may be an effective intervention to improve outcomes. The aim of this study was to assess efficacy, feasibility and safety of a supervised postoperative exercise programme.Methods: We performed a single-blind, parallel-arm, randomized trial in patients who underwent major abdominal oncology surgery in a tertiary university hospital. Patients were randomized to an early mobilization postoperative programme based on supervised aerobic exercise, resistance and flexibility training or to standard rehabilitation care. The primary outcome was inability to walk without human assistance at postoperative day 5 or hospital discharge.Results: A total of 108 patients were enrolled, 54 into the early mobilization programme group and 54 into the standard rehabilitation care group. The incidence of the primary outcome was nine (16.7%) and 21 (38.9%), respectively (P=0.01), with an absolute risk reduction of 22.2% [95% confidence interval (CI) 5.9–38.6] and a number needed to treat of 5 (95% CI 3–17). All patients in the intervention group were able to follow at least partially the exercise programme, although the performance among them was rather heterogeneous. There were no differences between groups regarding clinical outcomes or complications related to the exercises.Conclusions: An early postoperative mobilization programme based on supervised exercises seems to be safe and feasible and improves functional capacity in patients undergoing major elective abdominal oncology surgery. However, its impact on clinical outcomes is still unclear.Clinical trial registration: NCT01693172.

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Racial and Insurer-Based Disparities of Care Exist Among Thyroid Cancer Patients in the United States

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 351-353.


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Large Retrospective Study Confirms the 2015 American Thyroid Association Guidelines for Classifying Small Thyroid Nodules on Ultrasound

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 344-347.


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Conflicting Occurrence of Thyroid-Stimulating or Blocking Antibodies Is Seen in 4 to 9% of Patients with Autoimmune Thyroid Disease

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 335-337.


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A Deiodinase 2 Polymorphism May Lower Serum T3 and Tissue T3 in Levothyroxine-Treated Patients

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 338-340.


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Hypothyroid Symptoms in Pregnant Women Fail to Predict Hypothyroid Status

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 332-334.


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Moderate-Risk versus High-Risk RET Mutation Does Not Impact Medullary Thyroid Cancer Outcomes in MEN2A Patients

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 348-350.


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Is There a Distinct Pattern of Mutations in Benign Adenomatous Nodules?

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 341-343.


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Does Empathy, a Central Element of the Art of Medicine, Proscribe Using “Good Cancer” Themes in Clinical Practice?

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 354-357.


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Age Range Error in Key Points, Abstract, Introduction, and Figure Caption

In the Original Investigation titled "Trends in Nationwide Herpes Zoster Emergency Department Utilization From 2006 to 2013," published online on June 21, 2017, there was an age range error repeated in the Key Points, Abstract, Introduction, and Figure 2 caption. The range given as "18 to 19" should have been "less than 20." This article was corrected online.

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Rectus Femoris Tear Presenting as a Cause of a Subcutaneous Mass

This case report describes a tear of the rectus femoris muscle presenting as subcutaneous mass.

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Topical Steroids in Chinese Cosmetics

This Viewpoint highlights the importance of eliminating topical steroids from Chinese cosmetic products.

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Psoriasis

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Selecting Patients With Thin Melanoma for Sentinel Lymph Node Biopsy

Thin (T1) melanomas, defined in the 8th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual for melanoma as any primary cutaneous melanoma of Breslow thickness 1.0 mm or thinner, account for more than 70% of newly diagnosed cutaneous melanoma in the United States. (The AJCC Cancer Staging Manual, 8th edition, staging system for melanoma mandates reporting of Breslow thickness measurements to the nearest 0.1 mm, not the nearest 0.01 mm, and this convention will be used in this editorial. The AJCC recommends measuring thin melanomas to the nearest 0.01 mm if practical but then reporting the thickness rounded to the nearest 0.1 mm. With this convention, T1 melanomas include those as thick as 1.04 mm, and T1b melanomas are those reported as 0.8 to 1.0 mm, regardless of mitotic count or ulceration. Melanomas 0.75 to 0.84 mm in thickness would all be reported as 0.8 mm and included in T1b.) It is estimated that in 2017, 87 110 individuals will be diagnosed as having invasive melanoma of any thickness, and it is quite possible this represents an underestimate owing to the many thin melanomas that are treated in dermatologists' offices and other settings where they would not be routinely reported to regional or national registries. Nevertheless, even assuming that this figure is correct, this represents more than 60 000 thin melanoma cases in 1 year alone, and virtually all of them present initially with clinically negative regional lymph nodes. While the average individual with a thin melanoma may have a very low chance of developing distant metastases and dying of their disease, owing to the large number of cases in aggregate 29% of melanoma deaths now come from the T1 patient population, more than from the T2, T3, or T4 melanoma categories.

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Diversity in the Selection of Dermatology Applicants

To the Editor We read with great interest the Viewpoint by Chen and Shinkai on rethinking the paradigm by which dermatology applicants are selected. Dermatology is considered one of the least diverse specialties, and to address this lack of diversity in our specialty, Chen and Shinkai offer 6 outstanding recommendations. However, we believe that 1 additional imperative consideration should have been addressed—the role of the research fellowship and its implications for dermatology resident selection.

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Association Between Age and Lymph Node Positivity in Thin Melanoma

This cohort study using data from the US National Cancer Database examines the association between age and regional lymph node positivity in patients with thin melanoma.

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An Average Face

The face is a source of much fascination to scientists and researchers because of the particularly well-developed ability of humans to process information from other's faces. In fact, humans have a nearly automatic tendency to categorize a person as attractive or unattractive, with the ability to differentiate within 100 milliseconds, showing that beauty can be assessed rapidly and from just small amounts of information.

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Nationwide Herpes Zoster Emergency Department Utilization

This population-based study examines the trends in the incidence of herpes zoster based on utilization of the emergency department for patients categorized by age.

http://ift.tt/2sqlsna

Nivolumab for Treatment-Related Vitiligo in Relapsed Metastatic Melanoma

This case report describes the use of nivolumab therapy for treatment-related vitiligo in a patient with relapsed metastatic melanoma.

http://ift.tt/2tIoXqQ

Diagnosis of Melanoma and Melanotic Macules of the Lip

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

http://ift.tt/2pIoouA

Human Papillomavirus Vaccination and Keratinocyte Carcinomas—Reply

In Reply We appreciate Dr Mayer's interest in our article as well as his comments highlighting the inherent limitations of a small case series. We reported 2 cases of immunocompetent patients with a history of multiple keratinocyte carcinomas (KCs) and observed a substantial reduction of both squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs) subsequent to the quadrivalent human papillomavirus (HPV) vaccine.

http://ift.tt/2t1ydUa

Association of Multiple Primary Skin Cancers With HIV Biomarkers

This cohort study of patients with at least 1 prior nonmelanoma skin cancer (NMSC) evaluates the association of subsequent NMSCs with HIV infection, CD4 count, and viral load.

http://ift.tt/2teAMAM

Significance of Efficacy Results in a Randomized Clinical Trial

To the Editor Dr Tzanetakou and colleagues reported on the results of a placebo-controlled clinical trial of anakinra in hidradenitis suppurativa. The primary efficacy end point was based on decreased disease activity scores from baseline to the end of treatment, and the 2 study arms were also compared regarding the Hidradenitis Suppurativa Clinical Response (HiSCR). The Fisher exact test was performed for both the primary analysis and the HiSCR analysis, as stated in the "Statistical Analysis" section. For the primary analysis, the disease activity score was decreased in 20% (2 of 10) of the placebo arm compared with 67% (6 of 9) of the anakinra arm. For the HiSCR analysis, response was achieved in 30% (3 of 10) of the placebo arm and 78% (7 of 9) of the anakinra arm. A P value of .04 was reported for both the primary analysis and the HiSCR analysis. However, our calculations show that the P value for both analyses should be .07. A χ² test would have resulted in a P value of P = .04 for both analyses. However, a χ² test is known to inflate the type I error rate when the sample size is small and is therefore not appropriate for these analyses (see eg, McDonald, pages 88-89).

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Follicular Skin Microbiome in Hidradenitis Suppurativa and Healthy Controls

This case-control study investigates the follicular skin microbiome in patients with hidradenitis suppurativa and healthy controls.

http://ift.tt/2qbZ0Pm

Orangeness—Peeling Back the Myths Behind Carotenemia

Orange skin, often attributed to carotenemia, features prominently in pop culture and media. Such appearances tend to fall into 2 categories: biomedically oriented approaches or ones indicating deeper symbolic meaning. The first approach emphasizes biological mechanisms, as seen in medical television shows such as House (season 1, episode 1) and Scrubs (season 6, episode 4). Patients present as orange after gorging on carrots (turning skin yellow) and either niacin or tomato juice (turning skin red). In a clear example on the children's show The Magic School Bus, Ms Frizzle takes her audience on a field trip to determine why Arnold has turned orange (season 4, episode 6). They discover that rapacious consumption of Sea Wheedies, Arnold's favorite snack, released massive amounts of beta-carotene, causing his skin change.

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Purpuric Drug Eruptions in Non–Small Cell Lung Cancer

This study characterizes purpuric skin eruptions caused by epidermal growth factor receptor inhibitors.

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Herpes—A Not So Simple(x) History

Centuries ago, the term herpes referred to a group of blistering diseases. The origin of the word is derived from the ancient Greek herpein, meaning "to creep" or "move slowly," characterizing the latent onset of the infection and the inconspicuous, recurrent spread of lesions on the skin. It was not until the late 19th century that this condition was categorized into specific subtypes—many of which are now known to infect humans. Of these, herpes simplex virus 1 and 2 are perhaps the most infamous viral dermatological conditions, known for their unsightly presentation on the genitals and lips (colloquially referred to as "cold sores").

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Correlation Among Cancer Mortality Rates and Internet Searches

This cross-sectional analysis of Google seach volume index data investigates whether internet search volumes are correlated with registry recorded incidences and mortalities of common cancers

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September 2017 Issue Highlights

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Effectiveness of European Regulation on Euxyl K400 Sensitization in Northeastern Italy From 1996 to 2012 and Occupation

No abstract available

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Fragrances Categorized According to Relative Human Skin Sensitization Potency

Background: The development of non-animal alternatives for skin sensitization potency prediction is dependent upon the availability of a sufficient dataset whose human potency is well characterized. Previously, establishment of basic categorization criteria for 6 defined potency categories, allowed 131 substances to be allocated into them entirely on the basis of human information. Objectives: To supplement the original dataset with an extended range of fragrance substances. Methods: A more fully described version of the original criteria was used to assess 89 fragrance chemicals, allowing their allocation into one of the 6 potency categories. Results: None of the fragrance substances were assigned to the most potent group, category 1, whereas 11 were category 2, 22 were category 3, 37 were category 4, and 19 were category 5. Although none were identified as non-sensitizing, note that substances in category 5 also do not pass the threshold for regulatory classification. Conclusions: The combined datasets of >200 substances placed into potency categories solely on the basis of human data provides an essential resource for the elaboration and evaluation of predictive non-animal methods.

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Self-Assessment

No abstract available

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Treatment of Multiple-Resistant and/or Recurrent Cutaneous Warts With Squaric Acid Dibutylester: A Randomized, Double-blind, Vehicle-controlled Clinical Trial

Background: Contact immunotherapy with squaric acid dibutylester (SADBE) for cutaneous warts has been reported to be effective, although no controlled studies are available so far. Objective: The aim of this study was to evaluate the efficacy of SADBE on cutaneous warts by a randomized, double-blind, vehicle-controlled, clinical trial. Methods: Thirty-six patients were randomly assigned to SADBE (18 cases) or vehicle (18 cases) group. At 8 weeks, subjects were clinically evaluated for number/size reduction rate and for Investigator Global Assessment. Those who showed improvement extended therapy up to 40 weeks, whereas those who showed unresponsiveness were either switched to SADBE application for up to 48 weeks (if in the vehicle group) or withdrawn from the study (if under SADBE). Results: At 8 weeks, a significant reduction in wart number (P = 0.020) and size (P = 0.010) in the SADBE group, with clearing rates of 41.2% versus 12.5% in the SADBE and vehicle groups, respectively, was observed. Nine remaining SADBE responders who underwent treatment extension up to 40 weeks achieved clearing versus 2 patients of the vehicle group who remained unresponsive. Clearing was obtained in 81.8% of patients who underwent previous ineffective vehicle treatment and had been switched to SADBE. Conclusions: Squaric acid dibutylester is an effective therapeutic option and is significantly more effective than vehicle.

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Measuring Sleep Disturbance in Atopic Dermatitis: Patient-Reported Versus Objective Outcomes

No abstract available

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Contact Allergy to Hydroperoxides of Linalool and D-Limonene in a US Population

Background: Linalool and D-limonene are common fragrance ingredients that readily oxidize on exposure to air. The resulting hydroperoxides of linalool and D-limonene have been shown to have high frequencies of positive patch test reactions in several European and international studies. Objective: The aim of the study was to investigate the prevalence of contact allergy to the hydroperoxides of linalool and D-limonene in a US population. Methods: In this retrospective study, 103 patients with suspected fragrance allergy were patch tested to linalool 10% petrolatum (pet), hydroperoxides of linalool 1% pet, D-limonene 10% pet, and/or the hydroperoxides of D-limonene 0.3% pet between July 9, 2014, and October 25, 2016. Conclusions: In this study, the frequency of positive patch test reactions to the hydroperoxides of linalool is 20% (19/96), and the frequency of positive reactions to the hydroperoxides of D-limonene is 8% (7/90). These high frequencies suggest that patch testing to the hydroperoxides of linalool and limonene should be performed in all patients with suspected fragrance allergy.

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Lichen Planus Pigmentosus Inversus Caused by Occupational Systemic Sensitization to Metals in a Semiconductor Factory Worker

No abstract available

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Allergenic Ingredients in Personal Hygiene Wet Wipes

Background: Wet wipes are a significant allergen source for anogenital allergic contact dermatitis. Objective: The aim of the study was to calculate the frequency of potentially allergenic ingredients in personal hygiene wet wipes. Methods: Ingredient lists from brand name and generic personal hygiene wet wipes from 4 large retailers were compiled. Results: In the 54 personal hygiene wet wipes evaluated, a total of 132 ingredients were identified (average of 11.9 ingredients per wipe). The most common ingredients were Aloe barbadensis (77.8%), citric acid (77.8%), fragrance (72.2%), sorbic acid derivatives (63.0%), tocopherol derivatives (63.0%), glycerin (59.3%), phenoxyethanol (55.6%), disodium cocoamphodiacetate (53.7%), disodium ethylenediaminetetraacetic acid (EDTA) (42.6%), propylene glycol (42.6%), iodopropynyl butylcarbamate (40.7%), chamomile extracts (38.9%), sodium benzoate (35.2%), bronopol (22.2%), sodium citrate (22.2%), lanolin derivatives (20.4%), parabens (20.4%), polyethylene glycol derivatives (18.5%), disodium phosphate (16.7%), dimethylol dimethyl hydantoin (DMDM) (14.8%), and cocamidopropyl propylene glycol (PG)–dimonium chloride phosphate (11.1%). Of note, methylisothiazolinone (5.6%) was uncommon; methylchloroisothiazolinone was not identified in the personal hygiene wet wipes examined. Conclusions: There are many potential allergens in personal hygiene wet wipes, especially fragrance and preservatives.

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Atopic Dermatitis and Sleep Disturbance in Adults

No abstract available

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Angioedema, Stomatitis, and Urticaria Caused by Contact Allergy to Invisalign

No abstract available

http://ift.tt/2vTGidX

Allergenic Ingredients in Hand Wet Wipes

No abstract available

http://ift.tt/2h0y1lT

Asymptomatic Radio-Opacity at the Floor of Nasal Cavity

Abstract

Asymptomatic pathologies are usually discovered incidentally on radiographs. Sometimes, the presentation is characteristic and diagnosis is easily arrived. For uncharacteristic presentations, numerous differential diagnosis can be made and multiple investigations may be required by the radiologist. The present manuscript discusses the differential diagnosis of a commonly presenting asymptomatic radio-opacity at the floor of the nasal cavity and an unusual outcome of the investigation.

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“Predatory” journals threatening the scientific medical press

Publication date: Available online 12 September 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): O. Laccourreye, F. Rubin, H. Maisonneuve
In this report, the authors analyze the revolutions (journal indexing, structuring of medical writing and reviewing, impact of information technology and transformation of the medical press's business model) that, in a very short space of time, have profoundly affected the world of medical writing, which has now come under the fire of "predatory" journals.



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Asymptomatic Radio-Opacity at the Floor of Nasal Cavity

Abstract

Asymptomatic pathologies are usually discovered incidentally on radiographs. Sometimes, the presentation is characteristic and diagnosis is easily arrived. For uncharacteristic presentations, numerous differential diagnosis can be made and multiple investigations may be required by the radiologist. The present manuscript discusses the differential diagnosis of a commonly presenting asymptomatic radio-opacity at the floor of the nasal cavity and an unusual outcome of the investigation.

http://ift.tt/2xzsE48

Correction to: Viral Immunol 2017;30:298–301. DOI: 10.1089/vim.2016.0152

Viral Immunology Sep 2017, Vol. 30, No. 7: 545-545.


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Arabic Validation of the Tinnitus Handicap Inventory and the Mini-Tinnitus Questionnaire on 100 Adult Patients

Abstract

Arabic formats of tinnitus questionnaires are needed to provide clinicians and researchers responsive and reliable tools to assess tinnitus.

Arabic versions of the Tinnitus Handicap Inventory and the Mini-Tinnitus Questionnaire are established.

Tinnitus Handicap Inventory and Mini-Tinnitus Questionnaire are reliable and valid tools for tinnitus assessment.

Tinnitus Handicap Inventory and Mini-Tinnitus Questionnaire are correlated.

Mini-Tinnitus Questionnaire is a quicker and more compact method of evaluating tinnitus compared to Tinnitus Handicap Inventory.

This article is protected by copyright. All rights reserved.

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Pachydermoperiostosis: The value of molecular diagnosis

Publication date: Available online 12 September 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): V. Seta, Y. Capri, M. Battistella, M. Bagot, E. Bourrat
BackgroundPachydermoperiostosis is a rare autosomal recessive genetic disorder characterized by the association of periostosis and pachydermia. To date, two genes involved in prostaglandin metabolism, HPGD and SLCO2A1, have been identified.Patients and methodsA 7-year-old girl presented digital clubbing of the hands and feet, curved nails, hyperhidrosis, and pachydermia, as well as eczema of the trunk and limbs. The diagnosis of pachydermoperiostosis was confirmed by the detection of a homozygous mutation in the HPGD gene. The second case concerned a 41-year-old male with acral and cephalic pachydermia (cutis verticis gyrata), and palmoplantar keratoderma. Bone X-rays showed changes in the distal ends of several bones. The diagnosis of pachydermoperiostosis was confirmed by the detection of a homozygous mutation in the SLCO2A1 gene.DiscussionThe genotype/phenotype correlation suggests that patients with SLCO2A1 mutations will develop the symptoms later in life, but that these will be more severe, with a greater likelihood of cutis verticis gyrata and joint involvement compared with patients presenting HPGD mutations. In addition, hereditary enteropathy has recently been described in patients with SLCO2A1 mutations, which could account for the gastrointestinal picture seen in the second patient. Finally, on account of cases involving myelofibrosis associated with mutations in the SLCO2A gene, these patients should have a hematologic follow-up.ConclusionGiven the genotype/phenotype correlations illustrated by these cases, it would appear useful to propose molecular diagnosis for patients presenting pachydermoperiostosis.



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A Study of Multiple Immunotherapy-Based Treatment Combinations in Patients With Locally Advanced Unresectable or Metastatic Gastric or Gastroesophageal Junction Cancer (G/GEJ)

Condition:   Gastric Adenocarcinoma or Gastroesophageal Junction Adenocarcinoma
Interventions:   Drug: 5-Fluorouracil (5-FU);   Drug: Leucovorin;   Drug: Oxaliplatin;   Biological: Atezolizumab;   Drug: Cobimetinib;   Biological: Ramucirumab;   Drug: Paclitaxel;   Biological: PEGylated recombinant human hyaluronidase (PEGPH20);   Drug: BL-8040;   Drug: Linagliptin;   Biological: Atezolizumab;   Drug: Cobimetinib
Sponsor:   Hoffmann-La Roche
Not yet recruiting - verified September 2017

http://ift.tt/2wpWnaQ

Transoral Robotic Surgery and Tailored Radiotherapy in Unknown Primary and Small Squamous Cell Head and Neck Cancer

Condition:   Head and Neck Squamous Cell Carcinoma
Intervention:   Other: da Vinci Surgical System Model IS4000
Sponsor:   University Health Network, Toronto
Recruiting - verified September 2017

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Improvement of Genetic Testing for Cutaneous Melanoma

This study evaluates the efficiency of using the "rule of 3" vs the widely accepted "rule of 2" for the detection of melanoma-prone mutations in France, a country with low to moderate melanoma incidence.

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Task Shifting in Dermatology

This evidence synopsis examines the use of task shifting to bridge treatment gaps by delegating elements of health care to available personnel in resource-limited settings.

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Addressing Minority Representation in Dermatology

This study uses course evaluation responses and anecdotal feedback to assess a pilot program that includes direct mentorship to encourage inner-city high school students from populations underrepresented in medicine to consider careers in dermatology.

http://ift.tt/2w8HmPl

Safety of Systemic Agents for the Treatment of Pediatric Psoriasis

This cohort study assesses patterns of use and relative risks of systemic agents for moderate to severe psoriasis in children.

http://ift.tt/2fi4alt

Generalized Net-Like Erythema and Stroke in a Young Female

A woman in her 40s with Raynaud syndrome and a medical history of stroke presented with erythema, ataxia, and left-sided hemidysesthesia. What is your diagnosis?

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Ultrawide field imaging and sonography of a radial buckle

Description

A 78-year-old male presented with blurring of vision in right eye (RE) since 2 months. He was diagnosed to have retinal detachment in RE 27 years ago, which had been successfully repaired with scleral buckling surgery. Retinal holes had been treated with laser prophylaxis in left eye (LE). On examination, visual acuity was 6/24 in RE and 6/9 in LE. Both eyes had posterior subcapsular cataract (RE>LE). The retina was attached in RE, while features of high myopia, like fundus tessellation and peripapillary crescent, were evident. Indent of a radial explant was noticeable in the inferior nasal quadrant along with indent of an encirclage band (figure 1). Lattice degeneration and adequately lasered retinal lesions were seen in both eyes. The posteriorly placed radial explant was noted as a raised and hyperechoic structure with corresponding acoustic shadow on ultrasound B scan of RE (figure 2)....

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Cranial fasciitis of childhood (CFC): an unusual clinical case of a rare disease.

Cranial fasciitis of childhood (CFC) is a very uncommon tumour of the scalp, which is almost exclusively observed in the first years of life. It is a benign proliferation of fibroblasts, but its rapid growth rate may resemble a malignant disease. This disease may be suspected from clinical and radiological features, but a definitive diagnosis may be achieved only by pathological examination. We report a case whose onset was in late childhood and whose clinical and radiological characteristics were atypical.

http://ift.tt/2wpIcT1

Proximal avulsion rupture of the flexor digitorum longus tendon associated with a medial malleolus ankle fracture

Description

A 37-year-old man presented to the emergency department with right lower limb pain after being hit by an excavator. His right ankle was swollen, but no open wounds were observed. Radiography and CT of the right ankle revealed a medial malleolus ankle fracture (figure 1A,B).

Figure 1

(A) Radiograph revealing a medial malleolus ankle fracture. (B) CT scan revealing a medial malleolus ankle fracture.

During his treatment with osteosynthesis, a proximal avulsion rupture of the flexor digitorum longus (FDL) tendon from the musculotendinous attachment was discovered (figure 2). The flexor hallucis longus (FHL) tendon and posterior tibial neurovascular bundle were intact. The ruptured FDL tendon was interlaced through the FHL tendon and immobilised in a below-knee cast for 6 weeks. He showed a good functional outcome and had returned to work at the 5-month follow-up.

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Lactobacillus: the not so friendly bacteria

We present a 65-year-old diabetic patient with a complex liver abscess and bacteraemia from Lactobacillus paracasei. The abscess resulted in a prolonged hospital stay due to ongoing sepsis despite ultrasound-guided drainage and broad-spectrum antibiotics. Furthermore, the patient developed several secondary complications including a right-sided pleural effusion, an inferior vena cava thrombus and septic lung emboli. The abscess was eventually managed successfully with a prolonged course of antibiotics and multiple ultrasound-guided drainage procedures.

To our knowledge, this is the first reported case of probiotic consumption, confirmed by strain identification, as the likely source of a liver abscess. Probiotic products have been widely used for many years and are advocated to the general public for their health benefits with no warning of side effects. Lactobacilli are one group of bacteria commonly used in these products. Although rare, complications have been reported. Susceptible patients, such as those who are immunocompromised, should be advised against excessive consumption.

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Predictive factors for oropharyngeal dysphagia after prolonged orotracheal intubation

Publication date: Available online 13 September 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Ana Carolina Martins de Oliveira, Amélia Augusta de Lima Friche, Marina Silva Salomão, Graziela Chamarelli Bougo, Laélia Cristina Caseiro Vicente
IntroductionLesions in the oral cavity, pharynx and larynx due to endotracheal intubation can cause a reduction in the local motility and sensitivity and impair the swallowing process, resulting in oropharyngeal dysphagia.ObjectiveTo verify the predictive factors for the development of oropharyngeal dysphagia and the risk of aspiration in patients with prolonged orotracheal intubation admitted to an intensive care unit.MethodsThis is an observational, analytical, cross-sectional and retrospective data collection study of 181 electronic medical records of patients submitted to prolonged orotracheal intubation. Data on age; gender; underlying disease; associated comorbidities; time and reason for orotracheal intubation; Glasgow scale on the day of the speech-language-audiology assessment; comprehension; vocal quality; presence and severity of dysphagia; risk of bronchoaspiration; and the suggested oral route were collected. The data were analyzed through logistic regression. The level of significance was set at 5%, with a 95% Confidence Interval.ResultsThe prevalence of dysphagia in this study was 35.9% and the risk of aspiration was 24.9%. As the age increased, the altered vocal quality and the degree of voice impairment increased the risk of the presence in dysphagia by 5-; 45.4- and 6.7-fold, respectively, and of aspiration by 6-; 36.4- and 4.8-fold. The increase in the time of orotracheal intubation increased the risk of aspiration by 5.5-fold.ConclusionPatients submitted to prolonged intubation who have risk factors associated with dysphagia and aspiration should be submitted to an early speech-language/audiology assessment and receive appropriate and timely treatment. The recognition of these predictive factors by the entire multidisciplinary team can minimize the possibility of clinical complications inherent to the risk of dysphagia and aspiration in extubated patients.



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Issue Information

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Administration of low-dose combination anti-CTLA4, anti-CD137, and anti-OX40 into murine tumor or proximal to the tumor draining lymph node induces systemic tumor regression

Abstract

The delivery of immunomodulators directly into the tumor potentially harnesses the existing antigen, tumor-specific infiltrating lymphocytes, and antigen presenting cells. This can confer specificity and generate a potent systemic anti-tumor immune response with lower doses and less toxicity compared to systemic administration, in effect an in situ vaccine. Here, we test this concept using the novel combination of immunomodulators anti-CTLA4, -CD137, and -OX40. The triple combination administered intratumorally at low doses to one tumor of a dual tumor mouse model had dramatic local and systemic anti-tumor efficacy in lymphoma (A20) and solid tumor (MC38) models, consistent with an abscopal effect. The minimal effective dose was 10 μg each. The effect was dependent on CD8 T-cells. Intratumoral administration resulted in superior local and distant tumor control compared to systemic routes, supporting the in situ vaccine concept. In a single tumor A20 model, injection close to the tDLN resulted in similar efficacy as intratumoral and significantly better than targeting a non-tDLN, supporting the role of the tDLN as a viable immunotherapy target in addition to the tumor itself. Distribution studies confirmed expected concentration of antibodies in tumor and tDLN, in keeping with the anti-tumor results. Overall intratumoral or peri-tDLN administration of the novel combination of anti-CTLA4, anti-CD137, and anti-OX40, all agents in the clinic or clinical trials, demonstrates potent systemic anti-tumor effects. This immunotherapeutic combination is promising for future clinical development via both these safe and highly efficacious routes of administration.

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Primary facial reanimation in head and neck cancer

Publication date: Available online 12 September 2017
Source:Oral Oncology
Author(s): Axel Sahovaler, David Yeh, John Yoo
Facial Paralysis (FP) profoundly impairs the life of individuals, both functionally and psychosocially. Surgical approaches to treat this condition are myriad, but the ultimate goal is to restore symmetry and movement. Ablative surgery for tumors of the head and neck region are amongst the most common etiologies causing FP and this group of patients represents unique challenges. Surgical defects may have multiple competing reconstructive requirements and addressing the FP must be considered in this context. Furthermore, extent of disease, patient age, duration of preceding paralysis, adjuvant treatment, as well as the various different type of facial nerve defects are factors that may influence the type of reconstructive technique selected to address the FP.The complexity of FP especially following head and neck ablation can lead to results that are inconsistent and humbling. FP defects can be broadly described as having the potential for facial muscle recovery versus irreversible paralysis. Literature that specifically focuses on primary facial reanimation procedures in the oncological setting is scarce. We present a comprehensive review of primary facial reanimation after ablative surgery including the descriptions of a wide array of surgical techniques such as reinnervation, dynamic muscle transposition, static suspension, and free tissue transfer. Understanding the advantages and limitations of the different options will enable the surgeon to offer treatment for the paralyzed face for most clinical scenarios.



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Neutralization of viral infectivity by zebrafish c-reactive protein isoforms

Publication date: November 2017
Source:Molecular Immunology, Volume 91
Author(s): Melissa Bello-Perez, Alberto Falco, Regla Medina-Gali, Patricia Pereiro, Jose Antonio Encinar, Beatriz Novoa, Luis Perez, Julio Coll
This work explores the unexpected in vivo and in vitro anti-viral functions of the seven c-reactive protein (crp1-7) genes of zebrafish (Danio rerio). First results showed heterogeneous crp1-7 transcript levels in healthy wild-type zebrafish tissues and organs and how those levels heterogeneously changed not only after bacterial but also after viral infections, including those in adaptive immunity-deficient rag1^−/− mutants. As shown by microarray hybridization and proteomic techniques, crp2/CRP2 and crp5/CRP5 transcripts/proteins were among the most modulated during in vivo viral infection situations including the highest responses in the absence of adaptive immunity. In contrast crp1/CRP1/and crp7/CRP7 very often remained unmodulated. All evidences suggested that zebrafish crp2-6/CRP2-6 may have in vivo anti-viral activities in addition to their well known anti-bacterial and/or physiological functions in mammalians. Confirming those expectations, in vitro neutralization and in vivo protection against spring viremia carp virus (SVCV) infections were demonstrated by crp2-6/CRP2-6 using crp1-7 transfected and/or CRP1-7-enriched supernatant-treated fish cells and crp2-5-injected one-cell stage embryo eggs, respectively. All these findings discovered a crp1-7/CRP1-7 primitive anti-viral functional diversity.These findings may help to study similar functions on the one-gene-coded human CRP, which is widely used as a clinical biomarker for bacterial infections, tissue inflammation and coronary heart diseases.



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Mast Cell Chymase Decreases The Severity Of Group B Streptococcus Infections

Publication date: Available online 12 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Claire Gendrin, Nicholas J. Shubin, Erica Boldenow, Sean Merillat, Morgan Clauson, Danny Power, Kelly S. Doran, Magnus Abrink, Gunnar Pejler, Lakshmi Rajagopal, Adrian M. Piliponsky
BackgroundGroup B Streptococcus (GBS) or Streptococcus agalactiae are ß-hemolytic, Gram-positive bacteria that colonize the lower genital tract of women and are frequently associated with infections during pregnancy. Innate immune defenses are critical for controlling GBS dissemination and systemic infection. Mast cells are resident sentinel cells that come into contact with pathogens early during colonization and infection.ObjectiveWe aimed to investigate the contribution of chymase to systemic GBS infection and rates of preterm birth.MethodsPharmacological and genetic approaches using mice deficient in mast cell protease (MCPT)4, the mouse functional homolog of human chymase, were employed.ResultsOur studies show that, in response to GBS, mast cells release a protease with chymotrypsin-like cleavage specificity. Additionally, increased GBS systemic infection and preterm births were observed in MCPT4-deficient mice vs. MCPT4 sufficient mice. We further observed that proteolytic cleavage of the host extracellular matrix protein fibronectin by peritoneal cell-derived mast cell (PCMC) lysates diminished GBS adherence. Consistent with this observation, the increase in GBS dissemination and preterm births observed in MCPT4-deficient mice was abolished when GBS were deficient in expression of the fibronectin binding protein, SfbA.ConclusionsTaken together, our results suggest that the protective effect of MCPT4 against GBS dissemination and preterm labor can in part be attributed to MCPT4-mediated proteolysis of fibronectin. Our studies reveal a novel role of mast cells in defense against bacterial infections.

Teaser

MCPT4-mediated downregulation of fibronectin via proteolytic cleavage contributes to reduced systemic GBS dissemination and preterm birth rates.


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Alveolar eosinophilia in current smokers with chronic obstructive pulmonary disease in the SPIROMICS cohort

Publication date: Available online 12 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Carlos H. Martinez, Sara X. Li, Andrew J. Hirzel, Valerie R. Stolberg, Neil E. Alexis, R. Graham Barr, Eugene R. Bleecker, Elizabeth E. Carretta, Stephanie A. Christenson, Christopher B. Cooper, David J. Couper, Claire M. Doerschuk, MeiLan K. Han, Nadia N. Hansel, Annette T. Hastie, Eric A. Hoffman, Robert J. Kaner, Fernando J. Martinez, Deborah A. Meyers, Wanda K. O'Neal, Robert Paine, Nirupama Putcha, Stephen I. Rennard, Prescott G. Woodruff, Michelle Zeidler, Jeffrey L. Curtis, Christine M. Freeman
Active smoking in stable COPD subjects significantly increased eosinophil accumulation in the distal airspaces, but not in sputum or peripheral blood. Our findings support the need to investigate this cell-type as a potential driver of COPD symptomatology and progression.



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Clinical, Immunological and Genetic Spectrum of 696 Patients with Combined Immunodeficiency

Publication date: Available online 12 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Hassan Abolhassani, Janet Chou, Wayne Bainter, Craig Platt, Mahmood Tavassoli, Toba Momen, Marzieh Tavakol, Mohammad Hossein Eslamian, Mohammad Gharagozlou, Masoud Movahedi, Mohsen Ghadami, Amir Ali Hamidieh, Gholamreza Azizi, Reza Yazdani, Mohsen Afarideh, Alireza Ghajar, Arash Havaei, Zahra Chavoushzadeh, Seyed Alireza Mahdaviani, Taher Cheraghi, Nasrin Behniafard, Reza Amin, Soheila Aleyasin, Reza Faridhosseini, Farahzad Jabbari-Azad, Mohammamd Nabavi, Mohammad Hassan Bemanian, Saba Arshi, Rasol Molatefi, Roya Sherkat, Mahboubeh Mansouri, Mehrnaz Mesdaghi, Delara Babaie, Iraj Mohammadzadeh, Javad Ghaffari, Alireza Shafiei, Najmeddin Kalantari, Hamid Ahanchian, Maryam Khoshkhui, Habib Soheili, Abbas Dabbaghzadeh, Afshin Shirkani, Rasoul Nasiri Kalmarzi, Seyed Hamidreza Mortazavi, Javad Tafaroji, Abbas Khalili, Javad Mohammadi, Babak Negahdari, Mohammad-Taghi Joghataei, Basel K. al-Ramadi, Capucine Picard, Nima Parvaneh, Nima Rezaei, Talal Chatila, Michel J. Massaad, Sevgi Keles, Lennart Hammarström, Raif S. Geha, Asghar Aghamohammadi
BackgroundCombined immunodeficiencies (CIDs) are diseases of defective adaptive immunity with diverse clinical phenotypes. Although CIDs are more prevalent in the Middle East than Western countries, the resources for genetic diagnosis are limited.ObjectivesThis study aims to characterize the categories of CID patients in Iran clinically and genetically.MethodsClinical and laboratory data were obtained from 696 patients with CIDs. Patients were subdivided into those with syndromic (344 patients) and non-syndromic CIDs (352 patients). Targeted DNA sequencing was performed on 243 patients (34.9%).ResultsThe overall diagnostic yield of the 243 sequenced patients was 77.8% (189 patients). The clinical diagnosis of HIES (p<0.001), onset of disease > 5y (p=0.02), and the absence of multiple affected family members (p=0.04), were significantly more frequent in the patients without a genetic diagnosis. An autosomal recessive disease was found in 62.9% of patients, reflecting the high rate of consanguinity in this cohort. Mutations impairing VDJ recombination and DNA repair were the most common underlying causes of CIDs. However, in patients with syndromic CIDs, autosomal recessive mutations in ATM, autosomal dominant mutations in STAT3 and microdeletions in 22q11.21 were the most commonly affected genomic loci. Patients with syndromic CIDs had a significantly lower five-year survival rate rather than those with non-syndromic CIDs.ConclusionsThis study provides proof of principle for the application of targeted next-generation sequencing panels in countries with limited diagnostic resources. The impact of genetic diagnosis on clinical care requires continued improvements in therapeutic resources for these patients.

Teaser

Capsule Summary: In this study of 696 patients with CID, molecular diagnosis was achieved in ∼78% of the patients.


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Mast cell exosomes can suppress allergic reactions by binding to IgE

Publication date: Available online 12 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Guogang Xie, Haiwei Yang, Xia Peng, Lihui Lin, Juan Wang, Kun Lin, Zelin Cui, Jia Li, Hui Xiao, Yuting Liang, Li Li

Teaser

Neutralizing free IgE would appear to be an important strategy for the treatment of allergic diseases. This article explores a novel anti-IgE agent.


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Role of the IL-12/IL-35 balance in Sjögren’s syndrome

Publication date: Available online 12 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Olivier Fogel, Elodie Rivière, Raphaèle Seror, Gaetane Nocturne, Saida Boudaoud, Bineta Ly, Jacques-Eric Gottenberg, Véronique Le Guern, Jean-Jacques Dubost, Joanne Nititham, Kimberly E. Taylor, Philippe Chanson, Philippe Dieudé, Lindsey A. Criswell, Bernd Jagla, Alice Thai, Michael Mingueneau, Xavier Mariette, Corinne Miceli-Richard
BackgroundAn interferon (IFN) signature is involved in the pathogenesis of primary Sjögren's syndrome (pSS), but whether the signature is type 1 or 2 remains controversial. Mouse models and genetic studies suggested the involvement of T helper 1 and type 2 IFN pathways. Likewise, polymorphisms of interleukin 12A gene (IL-12A), which encodes for IL-12p35, have been associated with pSS. IL-12p35 subunit is shared by 2 heterodimers, IL-12 and IL-35.ObjectiveTo confirm the genetic association of IL-12A polymorphism and pSS and elucidate the involvement of the IL-12/IL-35 balance in pSS by functional studies.MethodsThe genetic study involved 673 patients with pSS from 2 French pSS cohorts and 585 healthy French controls. Functional studies were performed on sorted monocytes, stimulated or not. IL-12A mRNA and IL-12 and IL-35 protein levels were assessed by qRT-PCR and by ELISA and a multiplex kit for IL-35 and IL-12, respectively.ResultsWe confirmed the association of the IL-12A rs485497 polymorphism and pSS and found an increased serum protein level of IL-12p70 in pSS patients carrying the risk allele (p=0.016). Serum level of IL-12p70 was greater in patients than controls (p=0.0001), especially patients with more active disease (p=0.05); conversely IL-35 level was decreased in patients (p=0.0001) especially in patients with a more active disease (p=0.05). In blood cellular subsets, both IL-12p35 and EBI-3 mRNAs were detected only in B cells with a trend toward a lower level among pSS patients.ConclusionOur findings emphasize the involvement of the IL-12/IL-35 balance in the pathogenesis of pSS. Serum IL-35 level was associated with low disease activity, in contrast to serum IL-12p70 level, which was rather associated with a more active disease.



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Reduced risk of peanut sensitization following exposure through breast-feeding and early peanut introduction

Publication date: Available online 12 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Tracy J. Pitt, Allan B. Becker, Moira Chan-Yeung, Edmond S. Chan, Wade T.A. Watson, Rishma Chooniedass, Meghan B. Azad
BackgroundRecent trials have shown that avoiding peanuts during infancy increases the risk of peanut allergy; however, these studies did not address maternal peanut consumption.ObjectiveWe sought to investigate the relationship between maternal peanut consumption while breast-feeding, timing of direct peanut introduction, and peanut sensitization at age 7 years.MethodsSecondary analysis of a nested cohort within the 1995 Canadian Asthma Primary Prevention Study intervention study was performed. Breast-feeding and maternal and infant peanut consumption were captured by repeated questionnaires during infancy. Skin prick testing for peanut sensitization was performed at age 7 years.ResultsOverall, 58.2% of mothers consumed peanuts while breast-feeding and 22.5% directly introduced peanuts to their infant by 12 months. At 7 years, 9.4% of children were sensitized to peanuts. The lowest incidence (1.7%) was observed among children whose mothers consumed peanuts while breast-feeding and directly introduced peanuts before 12 months. Incidence was significantly higher (P < .05) if mothers consumed peanuts while breast-feeding but delayed introducing peanuts to their infant beyond 12 months (15.1%), or if mothers avoided peanuts themselves but directly introduced peanuts by 12 months (17.6%). Interaction analyses controlling for study group and maternal atopy confirmed that maternal peanut consumption while breast-feeding and infant peanut consumption by 12 months were protective in combination, whereas either exposure in isolation was associated with an increased risk of sensitization (P interaction = .003).ConclusionsIn this secondary analysis, maternal peanut consumption while breast-feeding paired with direct introduction of peanuts in the first year of life was associated with the lowest risk of peanut sensitization, compared with all other combinations of maternal and infant peanut consumption.

Graphical abstract

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High Patient Satisfaction with Daylight-Activated Methyl Aminolevulinate Cream in the Treatment of Multiple Actinic Keratoses: Results of an Observational Study in Australia

Abstract

Introduction

Actinic keratoses (AK) are treated to reduce the risk of progression to squamous cell carcinoma and for symptomatic and cosmetic benefits. The objective of this observational study was to generate real-life data on the use of daylight photodynamic therapy with methyl aminolevulinate cream (MAL DL-PDT) in treating mild to moderate facial/scalp AK.

Methods

A multicenter, prospective, observational study was conducted in Australia in patients receiving a single treatment of MAL DL-PDT for mild to moderate AK. Efficacy was assessed 3 months after treatment by investigator-assessed improvement and patient- and physician-completed satisfaction questionnaires. Adverse events were recorded throughout the study.

Results

Overall, 81 patients were enrolled of mean age 62.7 years, mostly men (76.5%) with skin phototype I (64.2%) or II (35.8%) and a long history of AK (mean duration 16.8 years). Most had multiple lesions (82.7% had >10 lesions) of predominantly grade I (75.3%). At 3 months after treatment, almost half the patients (46.8%) required no further treatment. The proportions of patients and physicians satisfied to very satisfied with the MAL DL-PDT treatment were 79.7% and 83.3%, respectively. After receiving the treatment, 74.1% of patients indicated via the questionnaire that they were not bothered at all by the pain. Related AEs were reported in 48.1% of patients, mainly mild erythema (44.4%).

Conclusions

In clinical practice in Australia, the use of MAL DL-PDT in treating multiple mild to moderate non-hyperkeratotic AK of the face and/or scalp results in high levels of patient and physician satisfaction reflecting the good efficacy and tolerability of this almost painless, convenient procedure.

Trial Registration

ClinicalTrials.gov identifier, NCT02674048.

Funding

Galderma R&D.

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Paediatric anaesthesia for low-resource settings

1H022A033J02

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Teledermatoskopie mittels Smartphone

Zusammenfassung

Hintergrund

Die mobile Teledermatoskopie ist eine vielversprechende Technik zur Ergänzung oder Substitution einer dermatologischen Untersuchung.

Fragestellung

In dieser Pilotstudie wurde das Ergebnis teledermatoskopischer Konsultationen mit den Ergebnissen aus klinischen Konsultationen sowie histologischen Resultaten verglichen.

Methodik

Konventionelle und dermatoskopische Fotos von Einzelläsionen wurden mithilfe eines auf ein Mobiltelefon aufgesetzten Handyscopes bei 26 Patienten aufgenommen. Fünf Ärzte/innen führten die klassische klinische Untersuchung einschließlich Dermatoskopie durch, eine erfahrene Oberärztin beurteilte die teledermatologischen und teledermatoskopischen Bilder. Die Ergebnisse wurden bezüglich der gestellten Diagnose, der genannten Differenzialdiagnosen, des empfohlenen weiteren Vorgehens und der subjektiven und objektiven Diagnosesicherheit verglichen. Darüber hinaus wurden 23 % der Läsionen exzidiert und histologisch befundet.

Ergebnisse

Die am häufigsten gestellte Diagnose war „Nävuszellnävus", gefolgt von „subungualem Hämatom" und „Basalzellkarzinom". Die Ergebnisse der klinischen Konsultation und der Teledermatoskopie stimmten hinsichtlich der Diagnose in 92,3 % der Fälle überein. Die Therapieempfehlungen deckten sich zu 76,9 %. Von den 6 histologisch gestellten Diagnosen waren 66,7 % gleichermaßen mittels Teledermatoskopie bzw. konventionell klinisch-dermatoskopisch gestellt worden. Bezüglich der Diagnosesicherheit ergab sich kein Nachteil zulasten der Teledermatoskopie.

Schlussfolgerungen

Teledermatologische Aufnahmen von Einzelläsionen, die mit teledermatoskopischen Aufnahmen kombiniert werden, lassen sich gut und sicher beurteilen. Bei eingeschränktem Zugang zu fachärztlicher Beratung ist die mobile Dermatoskopie eine belastbare Alternative zur klassischen dermatologischen Konsultation.

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Second Branchial Anomalies: A Study of 94 Cases

Abstract

Ninety-four patients with second branchial anomalies were retrospectively analysed at a tertiary care centre from January 2006 to September 2016 to determine the demographical data and management. Branchial sinus and fistula presented earlier as compared to branchial cyst. The mean age at presentation in case of branchial sinuses, fistulae and cysts was 5.07, 5.79 and 7.31 years respectively. There was preponderance in males as compared to females, more so in bilateral cases. Male to female sex ratio was 2.91:1. The branchial fistulae were the most common type of lesions, followed by the branchial sinuses. The branchial anomalies were more on the right side (65.96%) probably due to right handedness of the population. Only eight patients (8.51%) had bilateral anomalies. Four patients had familial association, it was seen in bilateral cases and they presented earlier than unilateral cases. Early and complete surgical excision is the treatment of choice. Preoperative sinogram/fistulogram and intraoperative methylene blue dye injection is not mandatory for excision of a branchial sinus/fistula. Post-operative wound infection was the most common complication (4.25%).

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Pectoral nerve block1 versus modified pectoral nerve block2 for postoperative pain relief in patients undergoing modified radical mastectomy: a randomized clinical trial †

Abstract

Background. Pectoral nerve block1 (PEC1) given between pectoralis major and minor, and modified pectoral nerve block2 (mPEC2) performed between pectoralis minor and serratus anterior, can provide continuous analgesia after modified radical mastectomy (MRM) when catheters are placed before skin closure. This study was designed to compare PEC1 and mPEC2 block for providing postoperative pain relief after MRM.Methods. Sixty-two physically fit patients undergoing MRM were assigned into two groups (Group PEC1, n=31 and Group mPEC2, n=31). Before wound closure, epidural catheter was placed in the group designated muscle plane and 30ml of 0.25% bupivacaine was injected through the catheter after wound closure. Bupivacaine 15ml of 0.25% top up was given on patient's demand or whenever visual analogue scale (VAS) score was>4. Time for first analgesia (TFA), number of top ups and VAS was recorded at 0.5, 6, 12, 18, 24 h after surgery. Sensory blockade was assessed 30 min after extubation.Results. Analgesia was significantly prolonged in group mPEC2 [mean(SD)] 313.45(43.05) vs 258.87(34.71) min in group PEC1, P<0.001. Total pain experienced over 24 h was significantly less in group mPEC2 [mean(SD)] 9.77(6.93) than in group PEC1 24.19(10.81), P<0.0001. Consequently, top up requirements were significantly reduced in group mPEC2 than in group PEC1 [median(range)] 3(2-4) vs 4(3-5) respectively, P<0.001. Lateral pectoral (77.42% and 35.48%) and thoracodorsal nerves (93.55% and 48.39%) had higher incidence of sensory block in group mPEC2 than group PEC1, P<0.001.Conclusions. mPEC2 provides better postoperative analgesia than PEC1 when catheters are placed under direct vision after MRM.Clinical trial registration. CTRI/2017/02/007811 (REF/2015/11/010185).

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Beta-blockers in sepsis: time to reconsider current constraints?

New insights into the mechanisms of action of beta-blockers, and the potential consequences for clinical practice, are continually evolving. Originally, this class of drugs was targeted towards treatment or prevention of hypertension, arrhythmias and myocardial ischaemia. Their therapeutic potential then expanded towards the reduction of mortality after myocardial infarction and heart failure.¹ Although these indications are now widely accepted, they were not immediately apparent. So why may the use of beta-blockers be beneficial in patients already suffering from impaired myocardial contractility? Clinical observations suggested that the beneficial effect of beta-blockers was greater in patients with the worst cardiac performance.² Concurrent findings that chronic use of an oral beta-agonist was associated with increased mortality led to re-evaluation of the paradigm,³⁴ fuelled new research that unravelled the concept of maladaptive sympathetic overstimulation in heart failure,⁵ and changed clinical practice towards the use of beta-blockade.

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Contents

Sujana S. Chandrasekhar

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Improving Team Performance Through Simulation-Based Learning

American health care is facing an epidemic of medical errors. A major cause of these errors is poor teamwork. Crisis resource management (CRM) is a set of teamwork principles derived from the airline industry. Medical simulation is an educational tool that affords health care providers a means of improving teamwork by learning and practicing CRM. This article (1) discusses the case for teaching team training, (2) reviews the principles of medical simulation as they pertain to team training, (3) provides practical guidelines for using medical simulation in otolaryngology education, (4) discusses current evidence for the efficacy of medical simulation.

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Copyright

ELSEVIER

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The Economics of Surgical Simulation

There are massive hidden costs in the current paradigm of surgical training related to increased operative times for procedures with resident involvement and costs of medical errors. Shifting procedural training outside of the operating room through use of simulation has the potential to improve patient safety, minimize learning time to achieve competency, and increase operative efficiency. Investment in surgical simulation has the potential to reduce costs to health care systems through improved operating room efficiency and reduction of medical errors. This article explores the economic costs related to surgical training in otolaryngology and the value of investment in surgical simulation.

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Assessment of Surgical Skills and Competency

Evaluation of surgical skills and competency are important aspects of the medical education process. Measurable and reproducible methods of assessment with objective feedback are essential components of surgical training. Objective Structured Assessment of Technical Skills (OSATS) is widely used across the medical specialties and otolaryngology-specific tools have been developed and validated for sinus and mastoid surgery. Although assessment of surgical skills can be time-consuming and requires human and financial resources, new evaluation methods and emerging technology may alleviate these barriers while also improving data collection practices.

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CME Accreditation Page

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Contributors

SUJANA S. CHANDRASEKHAR, MD

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Simulation in Otolaryngology

OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA

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Forthcoming Issues

Allergy for the Otolaryngologist

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Sonographie in der Nachsorge bei Kopf- und Halskarzinomen

Zusammenfassung

In Deutschland ist die hochauflösende Sonographie mit Verwendung von Farbduplexverfahren neben der Computertomographie (CT) ein gängiges und bewährtes Verfahren im Rahmen der Therapiekontrolle („restaging") nach der Primärtherapie von Kopf-Hals-Karzinomen (HNSCC). Im internationalen Kontext existieren für HNSCC keine evidenzbasierten Leitlinien für das Re-Staging oder die Tumornachsorge. Entscheidungen für und wider eine „neck dissection" (ND) nach primärer Radiochemotherapie (RCT) werden in den Tumorkonferenzen häufig individuell getroffen und unterliegen damit einer Variabilität. Anders als in Großbritannien oder den USA besteht in Deutschland eine hohe Expertise in der Anwendung des Ultraschalls in Kombination mit der CT zum routinemäßigen Re-Staging von HNSCC nach RCT. Mittels der hochauflösenden Sonographie (B-Mode und Farbdoppler) sind morphologische Veränderungen von Halslymphknoten hervorragend darstellbar. Ein weiterer wichtiger Aspekt ist die genaue und standardisierte Dokumentation von Befunden und deren Dynamik im Verlauf. Zusammen mit der klinischen Präsentation ermöglicht die Sonographie eine konkrete Entscheidungsfindung und „Therapie aus einer Hand".

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Second Branchial Anomalies: A Study of 94 Cases

Abstract

Ninety-four patients with second branchial anomalies were retrospectively analysed at a tertiary care centre from January 2006 to September 2016 to determine the demographical data and management. Branchial sinus and fistula presented earlier as compared to branchial cyst. The mean age at presentation in case of branchial sinuses, fistulae and cysts was 5.07, 5.79 and 7.31 years respectively. There was preponderance in males as compared to females, more so in bilateral cases. Male to female sex ratio was 2.91:1. The branchial fistulae were the most common type of lesions, followed by the branchial sinuses. The branchial anomalies were more on the right side (65.96%) probably due to right handedness of the population. Only eight patients (8.51%) had bilateral anomalies. Four patients had familial association, it was seen in bilateral cases and they presented earlier than unilateral cases. Early and complete surgical excision is the treatment of choice. Preoperative sinogram/fistulogram and intraoperative methylene blue dye injection is not mandatory for excision of a branchial sinus/fistula. Post-operative wound infection was the most common complication (4.25%).

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Scrotoschisis: a case report

Scrotoschisis is a rare congenital anomaly of the scrotal wall with idiopathic etiology and unknown prevalence. This pathology is extremely rare. We report a new case and review the literature for relevant data.

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Food Rituals and their Social Significance in the Mid-Second Millennium BC in the Southern Levant: A View from Megiddo

Abstract

Ceremonies involving intentional burial of animals with humans are acknowledged to bear religious, social and political connotations, and we explored both the ritual activity and the social trajectory of these activities. To date, these ceremonies have rarely been examined within the context of nearby daily activities. We studied faunal remains associated with intramural burials with comparison to contemporaneous daily life in the mid-second millennium BC at Tel Megiddo, as well as comparison with concomitant extramural burials and locations of public feasts. Our study highlights the human interaction with animals that are not often treated as bearing social meaning or having interrelationships with human, the livestock animals. We demonstrate that livestock animals in the second millennium BC had a significant social role as well as economic value. The choice of animals consumed and sacrificed in these rituals is strongly related to the animal's symbolic potency, and is based on the desired social message that the population aims to convey. Finally, the form of luxury food that is found in the Megiddo funerary rituals supports the hypothesis regarding the intramural burials' role in creating and enhancing social family bonds.

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