Cholecystokinin receptor antagonist alters pancreatic cancer microenvironment and increases efficacy of immune checkpoint antibody therapy in mice

Abstract

Advanced pancreatic ductal adenocarcinoma (PDAC) has typically been resistant to chemotherapy and immunotherapy; therefore, novel strategies are needed to enhance therapeutic response. Cholecystokinin (CCK) has been shown to stimulate growth of pancreatic cancer. CCK receptors (CCKRs) are present on pancreatic cancer cells, fibroblasts, and lymphocytes. We hypothesized that CCKR blockade would improve response to immune checkpoint antibodies by promoting influx of tumor-infiltrating lymphocytes (TILs) and reducing fibrosis. We examined the effects of CCKR antagonists or immune checkpoint blockade antibodies alone or in combination in murine models of PDAC. Monotherapy with CCKR blockade significantly decreased tumor size and metastases in SCID mice with orthotopic PDAC, and in C57BL/6 mice, it reduced fibrosis and induced the influx of TILs. Immune-competent mice bearing syngeneic pancreatic cancer (Panc02 and mT3-2D) that were treated with the combination of CCK receptor antagonists and immune checkpoint blockade antibodies survived significantly longer with smaller tumors. Tumor immunohistochemical staining and flow cytometry demonstrated that the tumors of mice treated with the combination regimen had a significant reduction in Foxp3+ T-regulatory cells and an increase in CD4+ and CD8+ lymphocytes. Masson's trichrome stain analysis revealed 50% less fibrosis in the tumors of mice treated with CCKR antagonist compared to controls and compared to checkpoint antibody therapy. CCKR antagonists given with immune checkpoint antibody therapy represent a novel approach for improving survival of PDAC. The mechanism by which this combination therapy improves the survival of PDAC may be related to the decreased fibrosis and immune cells of the tumor microenvironment.

http://ift.tt/2zu72UO

Eosinophils and Eosinophil-Associated Diseases: an Update

Publication date: Available online 16 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jeremy A. O'Sullivan, Bruce S. Bochner
The goal of this series is to offer a survey of the latest literature for clinicians and scientists alike, providing a list of important recent advances relevant to the broad field of allergy and immunology. This particular assignment was to cover the topic of eosinophils. In an attempt to highlight major ideas, themes, trends and advances relevant to basic and clinical aspects of eosinophil biology, a search of papers published since 2015 in JACI and other high impact journals was performed. Manuscripts were then reviewed and organized, and then key findings were summarized. Given space limitations, many outstanding papers could not be included, but the hope is that what follows provides a succinct overview of recently published work that has significantly added to our knowledge of eosinophils and eosinophil-associated diseases.



http://ift.tt/2yqXrxI

Fibrinogen-cleavage products and TLR4 promote the generation of programmed cell death 1 ligand 2(PD-L2)+ dendritic cells in allergic asthma

Publication date: Available online 14 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Minkyoung Cho, Jeong-Eun Lee, Hoyong Lim, Hyun-Woo Shin, Roza Khalmuratova, Garam Choi, Hyuk Soon Kim, Wahn Soo Choi, Young-Jun Park, Inbo Shim, Byung-Seok Kim, Chang-Yuil Kang, Jae-Ouk Kim, Shinya Tanaka, Masato Kubo, Yeonseok Chung
BackgroundInhaled protease allergens preferentially trigger Th2-mediated inflammation in allergic asthma. The role of dendritic cells (DCs) on the induction of Th2 cell responses in allergic asthma has been well documented; however, the mechanism by which protease allergens induce Th2-favorable DCs in the airway remains unclear.ObjectiveWe sought to determine a subset of DCs responsible for Th2 cell responses in allergic asthma and the mechanism by which protease allergens induce the DC subset in the airway.MethodsMice were intranasally challenged with protease allergens or fibrinogen-cleavage product (FCP) to induce allergic airway inflammation. DCs isolated from the mediastinal lymph nodes were analyzed for surface phenotype and T cell stimulatory function. Anti-Thy1.2 and Mas-TRECK mice were used to deplete innate lymphoid cells and mast cells, respectively. Adoptive cell transfer, bone marrow DC culture, anti-IL-13, and TLR4-deficient mice were used for further mechanistic studies.ResultsProtease allergens induced a remarkable accumulation of Th2-favorable PD-L2⁺ DCs in the mediastinal lymph nodes, which was significantly abolished in mice depleted of mast cells and, to a lesser extent, innate lymphoid cells. Mechanistically, FCP generated by protease allergens triggered IL-13 production from wild-type mast cells but not from TLR4-deficient mast cells, which resulted in the increase of PD-L2⁺ DCs. Intranasal administration of FCP induced an increase of PD-L2⁺ DCs in the airway, which was significantly abolished in TLR4- and mast cell-deficient mice. Injection of IL-13 restored PD-L2⁺ DC population in mice lacking mast cells.ConclusionOur findings unveil the 'protease-FCP-TLR4-mast cell-IL-13' axis as a molecular mechanism for the generation of Th2-favorable PD-L2⁺ DCs in allergic asthma, and suggest that targeting PD-L2⁺ DC pathway might be effective in suppressing allergic T cell responses in the airway.

Graphical abstract

http://ift.tt/2ysVKjp

Clinical relevance of sensitization to hydrolyzed wheat protein in wheat-sensitized individuals

Publication date: Available online 13 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Morten J. Christensen, Per Stahl Skov, Lars K. Poulsen, Carsten Bindslev-Jensen, Charlotte G. Mortz




http://ift.tt/2ysVBMT

Interaction of DJ-1 with Lyn is essential for IgE-mediated stimulation of human mast cells

Publication date: Available online 13 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Do-Kyun Kim, Michael A. Beaven, Dean D. Metcalfe, Ana Olivera
BackgroundDJ-1 is a redox-sensitive protein with multiple roles in cell homeostasis whose levels are altered in mast cell (MC)-related disorders. However, whether DJ-1 can regulate human MC function is unknown.ObjectiveWe sought to investigate the potential role of DJ-1 in the responses of human MCs to antigen stimulation.MethodsDJ-1 was silenced in human CD34⁺-derived and LAD2 MCs using lentiviral sh-RNA constructs. Release of β-hexosaminidase, PGD2 and GM-CSF and changes in reactive oxygen species (ROS) levels were measured after FcεRI engagement. Enzymatic assays, sucrose density gradient centrifugation, immunoprecipitations, dot and Western blots, and confocal imaging were performed for signaling, cellular localization and co-association studies.ResultsDJ-1 knockdown substantially reduced mediator release as well as Lyn and Syk kinase activation and signaling by mechanisms which appeared largely unrelated to DJ-1 antioxidant activity. Upon FcεRI activation, non-oxidized rather than oxidized DJ-1 translocated to lipid rafts where it associated with Lyn, an interaction that appeared critical for maximal Lyn activation and initiation of signaling. Using purified recombinant proteins, we demonstrated that DJ-1 bound to Lyn directly but no other Src kinases, and this interaction was specific for human but not mouse proteins. In addition, DJ-1 reduced SHP-2 phosphatase activity by scavenging ROS thus preventing Syk dephosphoryation and perpetuating MC signaling.ConclusionWe demonstrate a novel role for DJ-1 in the early activation of Lyn by FcεRI that is essential for human MC responses and which provides the basis for an alternative target in allergic diseases therapy.

Graphical abstract

Teaser

We demonstrate a previously unrecognized interaction between DJ-1 and the Src kinase Lyn in antigen-activated human mast cells that is essential for maximal Lyn activation and the release of bioactive allergic and inflammatory mediators.


http://ift.tt/2x05sZ5

Transcriptional determinants of individualized inflammatory responses at anatomically separate sites

Publication date: Available online 13 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Lam C. Tsoi, Jingjing Yang, Yun Liang, Mrinal K. Sarkar, Xianying Xing, Maria A. Beamer, Abhishek Aphale, Kalpana Raja, Jeffrey H. Kozlow, Spiro Getsios, John J. Voorhees, J. Michelle Kahlenberg, James T. Elder, Johann E. Gudjonsson




http://ift.tt/2x1jHwK

LAIR-1 limits neutrophil extracellular trap formation in viral bronchiolitis

Publication date: Available online 16 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Ruben J. Geerdink, Marije P. Hennus, Geertje H.A. Westerlaken, Alferso C. Abrahams, Kim I. Albers, Jona Walk, Esther Wesselink, Riny Janssen, Louis Bont, Linde Meyaard




http://ift.tt/2yr69MD

Advances in mechanisms of allergic disease in 2016

Publication date: Available online 13 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Marc E. Rothenberg, Hirohisa Saito, R. Stokes Peebles
This review highlights advances in mechanisms of allergic disease, particularly type 2 innate lymphoid cells; TH2 lymphocytes; eicosanoid regulation of inflammation; extracellular vesicles in allergic responses; IL-33; microbiome properties, especially as they relate to mucosal barrier function; and a series of findings concerning the allergic inflammatory cells eosinophils, basophils, and mast cells. During the last year, mechanistic advances occurred in understanding type 2 innate lymphoid cells, particularly related to their response to ozone, involvement with experimental food allergy responses, and regulation by IL-33. Novel ways of regulating TH2 cells through epigenetic regulation of GATA-3 through sirtuin-1, a class III histone deacetylase, were published. The understanding of eicosanoid regulation of inflammation increased and focused on additional properties of phospholipase A2 and the role of prostaglandin D2 and its receptors and inhibitory prostaglandin E2 pathways. Mechanisms through which extracellular vesicles are released and contribute to allergic responses were reported. There was a deeper appreciation of mucosal barrier function, the epithelial alarmin IL-33, and the microbiome. Finally, there were advances concerning allergic inflammatory cells (mast cells, basophils, and eosinophils) that will undoubtedly have an effect on disease understanding and new therapeutic strategies.



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Lower Airway Microbiota and Mycobiota in Children with Severe Asthma

Publication date: Available online 13 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): David L. Goldman, Zigui Chen, Viswanathan Shankar, Michael Tyberg, Alfin Vicencio, Robert Burk




http://ift.tt/2yr63Vh

The interferon gene signature is increased in early treatment-naïve rheumatoid arthritis and predicts a poorer response to initial therapy

Publication date: Available online 5 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Faye AH. Cooles, Amy E. Anderson, Dennis W. Lendrem, Julie Norris, Arthur G. Pratt, Catharien Hilkens, John D. Isaacs

Teaser

The interferon gene signature in early, disease modifying drug naïve rheumatoid arthritis predicts clinical outcomes at 6 months after therapy initiation. We suggest type 1 interferons may be a future therapeutic target in early RA.


http://ift.tt/2x27sjH

Aclaración sobre la evaluación de la obstrucción nasal mediante rinomanometría y escalas subjetivas y medición del éxito terapéutico médico y quirúrgico

Publication date: Available online 14 October 2017
Source:Acta Otorrinolaringológica Española
Author(s): Francisco Larrosa, Isam Alobid




http://ift.tt/2ih6LjZ

Migración digestiva y expulsión espontánea de un tubo de derivación salivar de Montgomery

Publication date: Available online 14 October 2017
Source:Acta Otorrinolaringológica Española
Author(s): Pablo Torrico Román




http://ift.tt/2gKBp1f

Myopericytoma of the tongue base: A case report

Publication date: Available online 16 October 2017
Source:Acta Otorrinolaringológica Española
Author(s): Stefano Rubino, Rita De Berardinis, Daniele Colombo, Alessandro De Padova




http://ift.tt/2ih6BZV

Diagnóstico y tratamiento de la otitis media secretora infantil: recomendaciones CODEPEH

Publication date: Available online 13 October 2017
Source:Acta Otorrinolaringológica Española
Author(s): Faustino Núñez-Batalla, Carmen Jáudenes-Casaubón, Jose Miguel Sequí-Canet, Ana Vivanco-Allende, Jose Zubicaray-Ugarteche
La incidencia y prevalencia de la otitis media secretora infantil (OMS) son elevadas, sin embargo, existen evidencias de que solo una minoría de profesionales sigue las recomendaciones de las guías para su manejo clínico. Con objeto de mejorar el diagnóstico y el tratamiento de la OMS, para prevenir y/o reducir sus consecuencias sobre el desarrollo del niño, la Comisión para la Detección Precoz de la Hipoacusia (CODEPEH) ha realizado una amplia revisión de la literatura científica sobre la materia y ha elaborado un documento de recomendaciones para una correcta actitud clínica ante la OMS, abordando métodos diagnósticos y tratamiento médico y quirúrgico. Entre otros, no usar ninguna medicación, especialmente corticoides y antibióticos, siendo la espera vigilada la primera medida a tomar durante 3 meses. Si persiste la OMS, el otorrinolaringólogo valorará el tratamiento quirúrgico. En niños que presentan comorbilidades de diversa entidad, el impacto de la OMS es superior por lo que hay que actuar de forma inmediata, sin espera vigilada.The incidence and the prevalence rates of otitis media with effusion (OME) are high. However, there is evidence that only a minority of professionals follow the recommendations provided in clinical practice guidelines. For the purpose of improving diagnosis and treatment of OME in children to prevent and/or reduce its impact on children's development, the Commission for the Early Detection of Deafness (CODEPEH) has deeply reviewed the scientific literature on this field and has drafted a document of recommendations for a correct clinical reaction to of OME, including diagnosis and medical and surgical treatment methodology. Among others, medication, in particular antibiotics and corticoids, should not be prescribed and 3 months of watchful waiting should be the first adopted measure. If OME persists, an ENT doctor should assess the possibility of sugical treatment. The impact of OME in cases of children with a comorbidity is higher, so it requires immediate reaction, without watchful waiting.



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Epidermal nevus syndromes: New insights into whorls and swirls

Abstract

Knowledge of the molecular underpinnings of many epidermal nevi and epidermal nevus syndrome has expanded rapidly in recent years. In this review and update on epidermal nevus syndrome, we will cover recent genetic discoveries involving epidermal nevi, including nevus sebaceus, keratinocytic epidermal nevus, nevus comedonicus, congenital hemidysplasia with ichthyosiform nevus and limb defects syndrome, phakomatosis pigmentokeratotica, Becker's nevus, porokeratotic adnexal ostial nevus, inflammatory linear verrucous epidermal nevi, and cutaneous-skeletal hypophosphatemia syndrome. We will discuss how newly defined mutations relate to the biology reflected in the cutaneous patterns seen in these mosaic disorders and how new molecular data has informed our understanding of these diseases and shaped management decisions.

http://ift.tt/2ifOIKY

Alopecic and aseptic nodule of the scalp in a girl

Abstract

Alopecic and aseptic nodule of the scalp is a rare entity characterized by the presence of nodules or cysts with sterile punctured material and negative cultures accompanied by nonscarring alopecia in the scalp of young men. We describe a case in which an 11-year-old girl presented with a nodular, fluctuant, round lesion on the vertex with localized alopecia. High-resolution ultrasound showed a hypoechoic lesion with increased flow on Doppler imaging and culture of the citrine-yellowish material obtained by puncture was negative. The patient showed complete clinical response to treatment with topical indomethacin.

http://ift.tt/2gKnyIz

Hermansky-Pudlak syndrome: Report of two patients with updated genetic classification and management recommendations

Abstract

Hermansky-Pudlak syndrome (HPS) is a rare autosomal recessive disorder caused by mutations in one of nine genes involved in the packaging and formation of specialized lysosomes, including melanosomes and platelet-dense granules. The cardinal features are pigmentary dilution, bleeding diathesis, and accumulation of ceroid-like material in reticuloendothelial cells. Pulmonary fibrosis induced by tissue damage is seen in the most severe forms, and one subtype is characterized by immunodeficiency. We describe two patients with HPS type 1 and review the updated gene-based classification, clinical features, and recommendations for evaluation and follow-up.

http://ift.tt/2xKniPd

Correction to: Thyroid 2016;26:1343–1421. DOI: 10.1089/thy.2016.0229

Thyroid , Vol. 0, No. 0.


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The Role of Chemokines in Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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CD4+ T Memory Stem Cells Correlate with Disease Progression in Chronically HIV-1-Infected Patients

Viral Immunology , Vol. 0, No. 0.


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Psychological and lifestyle risk factors for asthma exacerbations and morbidity in children

Asthma is the most common childhood illness and disproportionately affects low-income, minority children who live in urban areas. A range of risk factors are associated with asthma morbidity and mortality, suc...

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Effectiveness of a Smartphone Application for the Management of Metabolic Syndrome Components Focusing on Weight Loss: A Preliminary Study

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


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Is There a Link between Defects of Thyroid Hormonogenesis and Morphogenesis?

Clinical Thyroidology Oct 2017, Vol. 29, No. 10: 389-391.


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Most Low-Risk Papillary Thyroid Cancers Remain Stable During Active Surveillance

Clinical Thyroidology Oct 2017, Vol. 29, No. 10: 368-370.


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Ultrasound Has a Role in Predicting Tumor Invasiveness in Follicular Variant of Papillary Thyroid Carcinoma

Clinical Thyroidology Oct 2017, Vol. 29, No. 10: 371-374.


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Hypothyroidism in the Differential Diagnosis of Hyponatremia — A Clinical Pearl in Peril

Clinical Thyroidology Oct 2017, Vol. 29, No. 10: 395-397.


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A 10-Gene Classifier Can Accurately Diagnose Malignant Versus Benign Cytologically Indeterminate Thyroid Nodules

Clinical Thyroidology Oct 2017, Vol. 29, No. 10: 375-377.


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Mortality May Be Higher in Older Patients Whose Levels of TSH and Free T4 Are More Variable

Clinical Thyroidology Oct 2017, Vol. 29, No. 10: 385-388.


http://ift.tt/2ig4zZT

Tumor-Volume–Doubling Time of Pulmonary Metastases in Follicular-Cell–Derived Thyroid Carcinoma May Allow More Appropriate Selection of Patients for Multikinase Inhibitor Therapy

Clinical Thyroidology Oct 2017, Vol. 29, No. 10: 378-381.


http://ift.tt/2gLRtjD

Exposure to Flame Retardants Is Inconsistently Associated with Papillary Thyroid Cancer

Clinical Thyroidology Oct 2017, Vol. 29, No. 10: 392-394.


http://ift.tt/2igmM9w

Subclinical Hyperthyroidism with Serum TSH

Clinical Thyroidology Oct 2017, Vol. 29, No. 10: 382-384.


http://ift.tt/2gJttgL

Thyroid Cancer Tumor Board: To Surveil or Not to Surveil? That Is the Question

Clinical Thyroidology Oct 2017, Vol. 29, No. 10: 398-400.


http://ift.tt/2ieSFiX

The American Thyroid Association’s Professional Journals: New Editor-in-Chief for VideoEndocrinology™

October 16, 2017—Three highly regarded professional journals are published by the American Thyroid Association (ATA): Thyroid, Clinical Thyroidology, and VideoEndocrinology™. Each is under the leadership of an editor-in-chief (EIC) with specialized qualifications.  The ATA is proud to announce that William B. Inabnet, III, MD, will take over the helm of the video-journal at the beginning of 2018.

The incoming EIC of VideoEndocrinology, William B. Inabnet, III, MD, is Chair of the Department of Surgery at Mount Sinai Beth Israel (New York) and the Eugene W. Friedman, MD, Professor of Surgery and Surgical Director of the Diabetes, Obesity, and Metabolism Institute at the Icahn School of Medicine at Mount Sinai. He is also the inaugural Director of Endocrine Surgery Quality for the Mount Sinai Health System.

Dr. Inabnet received his MD from the University of North Carolina at Chapel Hill, NC, and completed his residency in general surgery at Rush Medical College and Rush-Presbyterian-St Luke's Medical Center in Chicago. He completed a fellowship in endocrine surgery at Cochin Hospital in Paris, where he trained under Professor Yves Chapuis, a world leader in the field of endocrine surgery and targeted parathyroidectomy.

An international authority in the field of minimally invasive endocrine surgery, Dr. Inabnet has pioneered new techniques in minimal-access endocrine neck surgery as well as adrenal and pancreatic surgery. In 1998, he helped perform the first endoscopic thyroid resection in the United States (second in the world), and has since helped advance the field of video-endoscopic neck surgery. Dr. Inabnet was among the first surgeons in the United States to introduce remote access thyroid surgery and is one of the few surgeons in the world who performs transaxillary, bilateral axillo-breast approach (BABA) and transoral endoscopic thyroid surgery.

Dr. Inabnet is also a leader in the field of minimally invasive metabolic surgery with an interest in disorders of the endocrine system in obese patients, especially type 2 diabetes and malignancy. He has participated in national and international clinical trials evaluating the role of gastrointestinal surgery in treating diabetes. He holds numerous leadership positions in the American Association of Endocrine Surgeons, the American Association of Metabolic and Bariatric Surgery, the American College of Surgeons, and the ATA.

He has authored more than 180 peer-reviewed articles and book chapters, as well as five textbooks. He lectures throughout the world and is a member of the Southern Surgical Association, the American Surgical Association, the French National Academy of Surgery, and the French Academy of Medicine.

"Dr. Inabnet was selected as Editor-in-Chief by an ATA search committee from a pool of very strong candidates because of his experience with audiovisual production and presentation, his vision, and his prominent position in the field of endocrine surgery. The interest of this outstanding field of candidates in the position speaks to the importance of VideoEndocrinology™, especially to surgeons performing thyroid, parathyroid, and adrenal procedures," says John C. Morris, III, MD, President of the ATA and Professor of Medicine, Mayo Clinic, Rochester, MN. "With Barry's leadership, we look forward to the continued growth and stature of this groundbreaking video-journal, continuing the trajectory established by its inaugural Editor-in-Chief, Dr. Gerard Doherty."

Gerard M. Doherty, MD, Surgeon-in-Chief, Brigham and Women's Hospital, Harvard University, has provided strong leadership for VideoEndocrinology since its inception in 2014. The ATA is very grateful for his invaluable work and guidance in founding the first broad-based video-journal in endocrinology.

Peter A. Kopp, MD, is Editor-in-Chief of the ATA's flagship journal Thyroid and Professor of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago. Thyroid is a monthly, peer-reviewed forum for topics ranging from the molecular biology of the thyroid gland to clinical management of thyroid disorders. The journal Thyroid also publishes quarterly Chinese editions.

Jerome M. Hershman, MD, MS, MACP, is Editor-in-Chief of the ATA's online journal Clinical Thyroidology, which provides a broad-ranging look at the clinical thyroid literature. Dr. Hershman is Distinguished Professor of Medicine Emeritus at the David Geffen School of Medicine at UCLA and Director of the Endocrine Clinic at the West Los Angeles VA Medical Center. He was the Editor of Thyroid from 1991­‒2000.

###

 The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 94^th anniversary, the ATA continues to deliver its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health.  These efforts are carried out via several key endeavors:

 The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology

• Annual scientific meetings
• Biennial clinical and research symposia
• Research grant programs for young investigators
• Support of online professional, public, and patient educational programs
• Development of guidelines for clinical management of thyroid disease and thyroid cancer

The ATA promotes thyroid awareness and information online through Clinical Thyroidology for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).

The post The American Thyroid Association's Professional Journals: New Editor-in-Chief for VideoEndocrinology™ appeared first on American Thyroid Association.

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American Thyroid Association: Presentations at 87th Annual Meeting Regarding Medications and Their Effects ATA Abstracts

October 13, 2017—The American Thyroid Association (ATA) will hold its 87^th Annual Meeting on October 18‒22, 2017, in Victoria, British Columbia. In addition to the major talks and awards, a variety of scientific and clinical presentations will be accessible to attendees in the form of posters and oral abstracts. One group of these concerns thyroid medications and their effects.

1. Priyanka Iyer of the Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, will present a poster titled: "Pembrolizumab added to Kinase Inhibitor (KI) therapy in Anaplastic Thyroid Carcinoma (ATC): A Single Cancer Center's " Iyer and others from numerous departments at the Anderson Cancer Center participated in this study.
   
   ATC has a 1-year mortality of 80% with a median overall survival of only 5 months. Targeted therapy with KI in ATC has provided substantial clinical benefit but eventually patients develop resistance. Pembroluzimab is an anti-programmed cell-death protein immunotherapy agent approved for several other types of cancers. The objective of this study was to explore the benefit of combining these therapies for ATC patients.
   
   The extended survival time seen in the study patients was "remarkable." A prospective clinical trial exploring KI therapy plus immunotherapy is now underway.
   
2. A poster presented by Douglas Bauer of the University of California at San Francisco (UCSF) examines the value of thyroid hormone therapy in older adults with subclinical hypothyroidism. This study, known as the TRUST Randomized Trial, was a placebo-controlled randomized trial of thyroid hormone replacement among 737 older adults with persistent subclinical hypothyroidism conducted at the University of Bern (Switzerland), University College Cork (Ireland), University of Glasgow (Scotland), and Leiden University Medical Center and Leyden Academy on Vitality and Ageing (The Netherlands).
   
   The study concluded that levothyroxine replacement did not improve either hypothyroid symptoms or tiredness in older adults with subclinical hypothyroidism, even for those with higher symptom scores at the beginning of the study.
   

1. Fereidoun Azizi of the Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, will present a clinical oral abstract discussing the "Higher remission rate after long-term methimazole therapy in patients with Graves' disease: a randomized clinical trial." Additional researchers from the same institute contributed to the trial, which was undertaken in response to the suggestion in other studies that long-term antithyroid drug treatment may induce high remission rates in patients with Graves' hyperthyroidism. The researchers compared the rates of and the variables associated with remission of hyperthyroidism in patients with long-term vs. short-term methimazole (MMI) therapy.
   
   The study concluded that long-term, low-dose MMI treatment for 60-120 months is a safe and effective method for treatment of Graves' hyperthyroidism; however, it is accompanied by much higher remission rates than the conventional treatment for 18-24 months.
   
2. In a highlighted oral abstract, George J. Kahaly of Johannes Gutenberg University Medical Center in Mainz, Germany, will report on a trial by the European Thyroid Association/ European Group on Graves' Orbitopathy (EUGOGO) entitled, "Combined mycophenolate with intravenous methylprednisolone therapy is more effective than intravenous methylprednisolone alone in active and moderate-to-severe Graves' orbitopathy: a randomized, observer-blind, multicenter trial." The trial was undertaken because the first-line treatment that EUGOGO had recommended—intravenous methylprednisolone (P)—may encounter either a lack of response or relapse after discontinuation of treatment. This study compared the efficacy and the safety of combining intravenous P and mycophenolate sodium (a lymphocyte-proliferation inhibiting agent) therapy to P alone.
   
   Conclusion: The addition of mycophenolate significantly improves the efficacy of methylprednisolone therapy alone in patients with active, moderate-to-severe Graves' orbitopathy.
   

1. Robert Smallridge of the Mayo Clinic in Jacksonville, Florida, will present a poster comparing the incidence of "Cardiovascular Event Rates Between Generic and Brand L-Thyroxine for Treatment of Hypothyroidism," a population-based, cohort study. Additional researchers from the Mayo Clinic in Rochester, Minnesota, also participated.
   
   Hypothyroidism increases cardiovascular risk. Thyroid hormone may reverse these changes, but overtreatment may increase the risk of cardiovascular events. Cardiovascular events may vary by T4 preparation. This was a retrospective analysis using a large administrative claims database including 87,902 patients. The study strengths include: a large, diverse real-world population, a wide range of ages, pharmacy claims documenting continued refills, and propensity score matching. Its limitations include: coding and billing variations, unmeasured residual confounding, and lack of TSH and T4 values.
   
   The study concluded that, in patients with predominantly benign thyroid disease and newly treated hypothyroidism, the short/intermediate term cardiovascular events rates were similar for generic and brand T4
   
2. In a poster, Yevgeniya Kushchayeva of the NIDDK/NIH in Bethesda, Maryland, will present the results of a study investigating the antitumor activity and mechanism in thyroid cancer of Nelfinavir (NFV), using in vitro and in vivo (mouse) models. Participants in the study included researchers from additional branches of the NIH (NCI, NICHD, and NINDS), from Uniformed Services University in Bethesda, and from the Radiology Department of Mercy Catholic Medical Center, Philadelphia.
   
   Treatment of radioiodine-refractory metastatic thyroid cancer is challenging, with limited options. NFV is a protease inhibitor that is safe, well-tolerated, and an FDA-approved treatment for HIV. Repurposing NFV for cancer therapy as generated significant interest.
   
   The study showed that NFV has significant and diverse anticancer activity in thyroid cancer cells, both in vitro and in vivo. The anticancer activity is cell-line specific; analysis of dysregulated pathways in patient tumors can help determine the likelihood of NFV-treatment response.
   

The ATA looks forward to authors from over 40 countries coming to Victoria to present their unpublished thyroid research during the 87^th Annual Meeting of the American Thyroid Association. 2017 had a record breaking number of abstract submissions (up 10% from 2016). Forty-five oral abstracts and 457 posters will be presented from Thursday, October 19 through Saturday, October 21.

We are pleased to announce that over 228 of the abstracts submitted were from thyroid trainees (students, residents, and fellows). The top three rated trainee posters have been invited to present during the Highlighted Trainee Abstracts Short Oral session on Saturday, October 21 in addition to their poster display.  An additional 30 of top rated posters have been selected to participate in the 5^th Annual Trainee Poster Contest.

New this we will have iPosters for the oral abstracts. iPosters are large interactive posters displayed on high definition touch-screen monitors that will be displayed onsite. Attendees will be able to scroll through select abstracts at their leisure, click on images to enlarge them, and watch and listen to video and audio files. Additionally, iPosters will be available in an electronic poster gallery online after the meeting to increase the visibility of thyroid research.

###

 The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 94^th anniversary, the ATA continues to deliver its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health.  These efforts are carried out via several key endeavors:

 The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology

• Annual scientific meetings
• Biennial clinical and research symposia
• Research grant programs for young investigators
• Support of online professional, public, and patient educational programs
• Development of guidelines for clinical management of thyroid disease and thyroid cancer

The ATA promotes thyroid awareness and information online through Clinical Thyroidology for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).

 

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American Thyroid Association: Presentations at 87th Annual Meeting Regarding Surgical and Alternative Treatments ATA Abstracts

October 13, 2017—The American Thyroid Association (ATA) will hold its 87^th Annual Meeting on October 18‒22, 2017, in Victoria, British Columbia. In addition to the major speeches and awards, a variety of smaller presentations will be accessible to attendees in the form of posters and oral abstracts. One group of these concerns thyroid surgical and alternative treatments.

1. Mingbo Zhang of General Hospital of Chinese PLA in Beijing will present a clinical oral abstract entitled "Ultrasound-guided radiofrequency ablation of low-risk papillary thyroid microcarcinoma (PTMC): a prospective study on 421 " Y. Luo also participated in this study, which questioned whether surgery to such low-risk cancers might be overtreatment. However, rather than relying solely on active surveillance, minimally invasive treatment could be used to eliminate PTMC and reduce the tumor-related risk of growth and metastasis. The objective of this study was to evaluate the efficacy and safety of ultrasound-guided radiofrequency ablation (RFA) of low-risk PTMC on a large scale of patients with over 1-year follow-up. The ablation area exceeded the tumor edge to prevent marginal residue and recurrence.
   
   The result of the study was that RFA can indeed effectively eliminate low risk PTMC with a very small complication rate. Very low recurrent PTMC and cervical lymph nodes were detected, which could be treated by second RFA. RFA may be an alternative strategy for the treatment of low-risk PTMC, especially in patients with heavy mental burden. No distant metastasis was detected in the study patients and no major complications were encountered.
   
2. Raquel Villavicencio of the Indiana University School of Medicine in Indianapolis will present a poster describing the "Effects of Hypothyroidism on Surgical Outcomes." Cary N. Mariash of the same medical school also participated. They began with the hypothesis that, between hypothyroid surgery patients in the United States and other surgical patients, no differences would appear in lengths of hospital stay, deaths, or postoperative cardiac complications. They queried surgical databases for patients who underwent an operative procedure between January 1, 2010, and December 31, 2015.
   
   In contrast to the initial hypothesis, hypothyroidism is associated with a markedly increased length of hospital stay (14.4 versus 6.6 days). However, absolute incidence of hypotension, bradycardia, and hyponatremia did not significantly differ. The study was not sufficiently powered to discern differences in mortality or postoperative cardiac complications but does show that, even with modern techniques and anesthesia, a significant increased risk remains when operating on a hypothyroid patient.
   
3. Tanaz Vaghaiwalla of the Department of Surgery, University of Miami, will present a poster showing the influence of various socioeconomic and demographic factors on the decision to surgically manage patients with Graves' disease (GD). The study hypothesized that, while disease acuity and presentation ultimately determine management, demographic and socioeconomic factors may also affect access to treatment and influence the decision for surgical management. Vaghaiwalla examined the association of sociodemographic factors to emergency hospitalizations and the use of thyroidectomies for GD. She performed a cross-sectional analysis using the Nationwide Inpatient Sample (2006‒2011) to identify hospitalizations for GD, and univariate and logistic regression analyses to evaluate factors associated with the use of thyroidectomies during emergency and elective hospitalizations for GD.
   
   The conclusion of this study was that race, sex, income, and insurance status affect the rate of emergent hospitalizations for GD, and such factors may influence the use of Increased access to definitive care for GD may improve outcomes and reduce emergency healthcare utilization.
   
4. Megan Saucke of the University of Wisconsin in Madison will present a poster examining providers' views on active surveillance (AS) as an alternative to surgery for patients with papillary thyroid microcarcinomas (PTMC). Additional researchers from the same university worked on this study, entitled "Barriers and Facilitators of Active Surveillance: Informational and Emotional." Because data were lacking on attitudes and beliefs about the acceptability of this nonsurgical option, the researchers performed a mixed-methods study using semi-structured interviews and a survey of 12 endocrinologists and 12 surgeons who treat patients with They analyzed interview transcripts using content analysis.
   
   Providers' primary barriers to favoring AS as a management option included: worry about metastasis, fear of worse outcomes, the instinct to remove cancer, and reassurance provided by surgical removal. Providers believed these barriers were also significant to patients. Other barriers included the assumption that patients do not want AS, lack of resources to perform AS, ultrasound reliability, skepticism about data on AS, fear of patients not following up, expectation of surgery, and patients getting surgery elsewhere.
   
   Providers also described facilitators of patients' consideration of AS, including: physician recommendation, patients' fear of surgery, life circumstances, and desire to avoid thyroid hormone replacement.
   
   The study concluded that barriers to AS include practice limitations, but also patients' and providers' reactions to a cancer diagnosis and uncertainty about outcomes. Findings suggest that reassurance by providers and/or utilization of a decision-support tool may facilitate patients' consideration of AS.
   

The ATA will welcome authors from over 40 countries coming to present their unpublished thyroid research at the 87^th Annual Meeting of the American Thyroid Association in Victoria, BC, Canada. 2017 had a record breaking number of abstract submissions (up 10% from 2016). Forty-five oral abstracts and 457 posters will be presented from Thursday, October 19 through Saturday, October 21.

Over 228 of the abstracts submitted were from thyroid trainees (students, residents, and fellows). The top three rated trainee posters have been invited to present during the Highlighted Trainee Abstracts Short Oral session on Saturday, October 21 in addition to their poster display.  An additional 30 of top rated posters have been selected to participate in the 5^th Annual Trainee Poster Contest.

For the first time at an ATA Annual Meeting, the abstracts accepted for oral presentation will also be presented as iPosters. iPosters are large interactive posters displayed on high definition touch-screen monitors that will be displayed onsite. Attendees will be able to scroll through select abstracts, click on images to enlarge them, and watch and listen to video and audio files. For those unable to attend, iPosters will be available in an electronic poster gallery online after the meeting to increase the visibility of thyroid research and bring the wealth of science to those around the world.

###

The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 94^th anniversary, the ATA continues to deliver its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health.  These efforts are carried out via several key endeavors:

 The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology

• Annual scientific meetings
• Biennial clinical and research symposia
• Research grant programs for young investigators
• Support of online professional, public, and patient educational programs
• Development of guidelines for clinical management of thyroid disease and thyroid cancer

The ATA promotes thyroid awareness and information online through Clinical Thyroidology for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).

 

The post American Thyroid Association: Presentations at 87th Annual Meeting Regarding Surgical and Alternative Treatments ATA Abstracts appeared first on American Thyroid Association.

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Characterization of disease burden, comorbidities and treatment use in a large US based cohort: Results from the Corrona Psoriasis Registry

Psoriasis is an immunodysregulatory inflammatory disease associated with comorbidities impacting quality of life. With the advent of new treatments, there is growing need to assess the long term safety and efficacy of treatments in a real-world setting.

http://ift.tt/2ifHXc1

Ultrasound Detection of Arteria Comitans: A Novel Technique to Locate the Sciatic Nerve.

In the gluteal and thigh region, the arteria comitans accompanies the sciatic nerve for a short distance, then penetrates the nerve and runs to the lower part of the thigh. There is no study that recognizes this artery as a guide to the location of the sciatic nerve. In this report, we describe a series of 6 knee arthroplasty patients in whom ultrasound-guided sciatic nerve block was successfully performed using color Doppler and pulsed wave Doppler to visualize the arteria comitans as a guide to the location of the sciatic nerve. We have found that detecting the arteria comitans as a landmark is novel and may offer an additional tool with the existing methods for sciatic nerve block. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

http://ift.tt/2kUBOCP

Early Postoperative Fever in Pediatric Patients undergoing Cochlear Implant Surgery

Abstract

Early Post-Operative Fever after cochlear Implant surgery is not uncommon.

We assessed all pediatric patients undergoing cochlear implants and addressed the patients with post-operative fever.

A hundred and thirty surgeries were performed; of all patients 25 developed early postoperative fever.

The workup did not identify the cause of fever in any of the patients. Fever resolved without any additional Intervention.

There was no difference in fever or infection rate in patients that received prophylactic antibiotic, whether prolonged (one week) versus or only perioperative treatment (one day).

This article is protected by copyright. All rights reserved.

http://ift.tt/2xJzf84

Barbed Expansion Sphincter Pharyngoplasty for the Treatment of Oropharyngeal Collapse in OSAS: a Retrospective Study on 17 patients

Abstract

Expansion Sphincter Pharyngoplasty (ESP) was introduced in 2007 and represents a promising surgical technique to treat patients with oropharyngeal walls collapse with reduced morbidity and high success rates.

Between December 2012 and January 2015 17 patients underwent ESP at the department of Otorhinolaryngology of the University of Brescia (Italy), using barbed knotless sutures to improve the biomechanical effect of sutures on tissue collapse (BESP).

Patients with moderate to severe OSAS and BMI < 30 kg/m², who did not tolerate or refused ventilation therapy, were selected for BESP based on the presence of oropharyngeal collapse, as determined by upper airway examination and drug-induced sleep endoscopy.

Overall success of BESP was 94,1%. Postoperative oxygen desaturation index (ODI) showed significant improvement (P<0.01). Likewise, Epworth Sleepiness Scale score was significantly reduced (P<0.05). No patient complained of uncontrolled pain after the procedure and/or reported unsatisfactory analgesia at follow-up visits.

Albeit limited by the sample size and duration of follow-up, our experience confirms the validity of BESP in this selected patient population.

This article is protected by copyright. All rights reserved.

http://ift.tt/2ysAFHi

The Triangular rotation advancement flap for congenital longitudinal earlobe cleft

Abstract

The Earlobe is an essential part of the facial aesthetics. Almost all cultures of the world use the earlobe for improving their appearances. Deformities or absence of the earlobe is a cause of distress to many individuals.

This article is protected by copyright. All rights reserved.

http://ift.tt/2xJrXAT

Transnasal Endoscopic Optic Nerve Decompression in Post Traumatic Optic Neuropathy

Abstract

To quantify the successful outcome in patients following optic nerve decompression in post traumatic unilateral optic neuropathy in form of improvement in visual acuity. A prospective study was carried out over a period of 5 years (January 2011 to June 2016) at civil hospital Ahmedabad. Total 20 patients were selected with optic neuropathy including patients with direct and indirect trauma to unilateral optic nerve, not responding to conservative management, leading to optic neuropathy and subsequent impairment in vision and blindness. Decompression was done via Transnasal-Ethmo-sphenoidal route and outcome was assessed in form of post-operative visual acuity improvement at 1 month, 6 months and 1 year follow up. After surgical decompression complete recovery of visual acuity was achieved in 16 (80%) patients and partial recovery in 4 (20%). Endoscopic transnasal approach is beneficial in traumatic optic neuropathy not responding to steroid therapy and can prevent permanent disability if earlier intervention is done prior to irreversible damage to the nerve. Endoscopic optic nerve surgery can decompress the traumatic and oedematous optic nerve with proper exposure of orbital apex and optic canal without any major intracranial, intraorbital and transnasal complications.

http://ift.tt/2zsCCSC

Sialendoscopic Approach in Management of Juvenile Recurrent Parotitis

Abstract

To assess the role of sialendoscopy as a diagnostic and therapeutic modality in juvenile recurrent parotitis. Juvenile recurrent parotitis (JRP) is the second most frequent salivary gland disease in childhood and is characterized by recurrent non suppurative and non obstructive parotid inflammation. These attacks influence the quality of life and can even lead to gland destruction, and there are no definitive treatment to avoid them. Sialendoscopic dilatation is emerging as the new treatment modality in this aspect. Study design: retrospective study. Study setting: Department of Otorhinolaryngology in tertiary care hospital. 17 cases of juvenile recurrent parotitis (i.e. children of age group 3–11 years presenting with complaints of recurrent parotid region swelling and pain, sometimes associated with fever) were included in the study during October 2012–September 2015. All cases underwent sialendoscopy under general anaesthesia. Diagnostic (classifying the ductal lesion) and interventional sialendoscopic procedure (dilatation with instillation of steroid) were carried out in single sitting. Follow up was done for a minimum of 6 months (range 6–36 months). 17 patients with mean age of 5.6 years and gender distribution of 47:53 (boys:girls) underwent sialendoscopy for JRP. 8 patients presented with unilateral parotitis and 9 with bilateral. The mean number of attacks in previous 1 year were 9.2. Average time for procedure was 20 min. All cases had ductal stenosis and ductal mucosa was pale in 15 cases on endoscopy. 1 patient underwent repeat endoscopy after 2 years. 50% had complete resolution of symptoms and 6 patients had one mild (swelling not associated with fever which subsided on its own) attack after treatment. Follow up period ranged from 6 months to 3 years. No complications were observed. Sialendoscopy has emerged as a viable option for assessment and treatment of JRP. Dilatation of the parotid duct and steroid instillation has significantly reduced the morbidity of this condition.

http://ift.tt/2zcQ4sY

Transnasal Endoscopic Optic Nerve Decompression in Post Traumatic Optic Neuropathy

Abstract

To quantify the successful outcome in patients following optic nerve decompression in post traumatic unilateral optic neuropathy in form of improvement in visual acuity. A prospective study was carried out over a period of 5 years (January 2011 to June 2016) at civil hospital Ahmedabad. Total 20 patients were selected with optic neuropathy including patients with direct and indirect trauma to unilateral optic nerve, not responding to conservative management, leading to optic neuropathy and subsequent impairment in vision and blindness. Decompression was done via Transnasal-Ethmo-sphenoidal route and outcome was assessed in form of post-operative visual acuity improvement at 1 month, 6 months and 1 year follow up. After surgical decompression complete recovery of visual acuity was achieved in 16 (80%) patients and partial recovery in 4 (20%). Endoscopic transnasal approach is beneficial in traumatic optic neuropathy not responding to steroid therapy and can prevent permanent disability if earlier intervention is done prior to irreversible damage to the nerve. Endoscopic optic nerve surgery can decompress the traumatic and oedematous optic nerve with proper exposure of orbital apex and optic canal without any major intracranial, intraorbital and transnasal complications.

http://ift.tt/2zsCCSC

Sialendoscopic Approach in Management of Juvenile Recurrent Parotitis

Abstract

To assess the role of sialendoscopy as a diagnostic and therapeutic modality in juvenile recurrent parotitis. Juvenile recurrent parotitis (JRP) is the second most frequent salivary gland disease in childhood and is characterized by recurrent non suppurative and non obstructive parotid inflammation. These attacks influence the quality of life and can even lead to gland destruction, and there are no definitive treatment to avoid them. Sialendoscopic dilatation is emerging as the new treatment modality in this aspect. Study design: retrospective study. Study setting: Department of Otorhinolaryngology in tertiary care hospital. 17 cases of juvenile recurrent parotitis (i.e. children of age group 3–11 years presenting with complaints of recurrent parotid region swelling and pain, sometimes associated with fever) were included in the study during October 2012–September 2015. All cases underwent sialendoscopy under general anaesthesia. Diagnostic (classifying the ductal lesion) and interventional sialendoscopic procedure (dilatation with instillation of steroid) were carried out in single sitting. Follow up was done for a minimum of 6 months (range 6–36 months). 17 patients with mean age of 5.6 years and gender distribution of 47:53 (boys:girls) underwent sialendoscopy for JRP. 8 patients presented with unilateral parotitis and 9 with bilateral. The mean number of attacks in previous 1 year were 9.2. Average time for procedure was 20 min. All cases had ductal stenosis and ductal mucosa was pale in 15 cases on endoscopy. 1 patient underwent repeat endoscopy after 2 years. 50% had complete resolution of symptoms and 6 patients had one mild (swelling not associated with fever which subsided on its own) attack after treatment. Follow up period ranged from 6 months to 3 years. No complications were observed. Sialendoscopy has emerged as a viable option for assessment and treatment of JRP. Dilatation of the parotid duct and steroid instillation has significantly reduced the morbidity of this condition.

http://ift.tt/2zcQ4sY

Attenuation of high-frequency (30–200 Hz) thalamocortical EEG rhythms as correlate of anaesthetic action: evidence from dexmedetomidine

Abstract

Background

Gamma (30–80 Hz) and high-gamma (80–200 Hz) thalamocortical EEG rhythms are involved in conscious processes and are attenuated by isoflurane and propofol. To explore the hypothesis that this attenuation is a correlate of anaesthetic action, we characterized the effect dexmedetomidine, a selective adrenergic α-2 agonist with lesser hypnotic potency, on these rhythms.

Methods

We recorded local field potentials from barrel cortex and ventroposteromedial thalamic nucleus in ten previously instrumented rats to measure spectral power (30–50 Hz, 51–75 Hz, 76–125 Hz, 126–200 Hz bands) during baseline, at four dexmedetomidine plasma concentrations obtained by i.v. target-controlled infusion (1.86, 3.75, 5.63 and 7.50 ng ml⁻¹), and during recovery. Thalamocortical coherence over 0.3–200 Hz was also measured.

Results

Loss of righting reflex (LORR) occurred with 5.63 ng ml⁻¹. Dexmedetomidine produced a linear concentration-dependent attenuation of cortical (P<0.04) and thalamic (P ≤ 0.0051) log power in all bands. Slopes for cortex and thalamus were similar. The slope for dexmedetomidine on thalamic power in the 76–200 Hz range was less than half that of the other agents (P<0.003). LORR was associated with an increase in delta band (0.3–4.0 Hz) thalamocortical coherence (P<0.001). Increased low-frequency coherence also occurred with propofol and isoflurane.

Conclusions

Dexmedetomidine attenuates high-frequency thalamocortical rhythms, but to a lesser degree than isoflurane and propofol. The main differences between dexmedetomidine and the other anaesthetics involved thalamic rhythms, further substantiating the link between impaired thalamic function and anaesthesia. Increased delta coherence likely reflects cyclic hyperpolarization of thalamocortical networks and may be a marker for loss of consciousness.

http://ift.tt/2gepHva

Individualized positive end-expiratory pressure in obese patients during general anaesthesia: a randomized controlled clinical trial using electrical impedance tomography

Abstract

Background

General anaesthesia leads to atelectasis, reduced end-expiratory lung volume (EELV), and diminished arterial oxygenation in obese patients. We hypothesized that a combination of a recruitment manoeuvre (RM) and individualized positive end-expiratory pressure (PEEP) can avoid these effects.

Methods

Patients with a BMI ≥35 kg m⁻² undergoing elective laparoscopic surgery were randomly allocated to mechanical ventilation with a tidal volume of 8 ml kg⁻¹ predicted body weight and (i) an RM followed by individualized PEEP titrated using electrical impedance tomography (PEEP_IND) or (ii) no RM and PEEP of 5 cm H₂O (PEEP₅). Gas exchange, regional ventilation distribution, and EELV (multiple breath nitrogen washout method) were determined before, during, and after anaesthesia. The primary end point was the ratio of arterial partial pressure of oxygen to inspiratory oxygen fraction (PaO₂/FiO₂).

Results

For PEEP_IND (n=25) and PEEP₅ (n=25) arms together, PaO₂/FiO₂ and EELV decreased by 15 kPa [95% confidence interval (CI) 11–20 kPa, P<0.001] and 1.2 litres (95% CI 0.9–1.6 litres, P<0.001), respectively, after intubation. Mean (sd) PEEP_IND was 18.5 (5.6) cm H₂O. In the PEEP_IND arm, PaO₂/FiO₂ before extubation was 23 kPa higher (95% CI 16–29 kPa; P<0.001), EELV was 1.8 litres larger (95% CI 1.5–2.2 litres; P<0.001), driving pressure was 6.7 cm H₂O lower (95% CI 5.4–7.9 cm H₂O; P<0.001), and regional ventilation was more equally distributed than for PEEP₅. After extubation, however, these differences between the arms vanished.

Conclusions

In obese patients, an RM and higher PEEP_IND restored EELV, regional ventilation distribution, and oxygenation during anaesthesia, but these differences did not persist after extubation. Therefore, lung protection strategies should include the postoperative period.

Clinical trial registration

German clinical trials register DRKS00004199, http://ift.tt/2gfFcmy.

http://ift.tt/2ylRrsL

The role of Journal of Anesthesia as a flagship anesthesia journal in Asia

http://ift.tt/2gKzHgF

DNA recombination defects in Kuwait: Clinical, immunologic and genetic profile

Publication date: Available online 16 October 2017
Source:Clinical Immunology
Author(s): Waleed Al-Herz, Michel J. Massaad, Janet Chou, Luigi D. Notarangelo, Raif S. Geha
Defects in DNA Recombination due to mutations in RAG1/2 or DCLRE1C result in combined immunodeficiency (CID) with a range of disease severity. We present the clinical, immunologic and molecular characteristics of 21 patients with defects in RAG1, RAG2 or DCLRE1C, who accounted for 24% of combined immune deficiency cases in the Kuwait National Primary Immunodeficiency Disorders Registry. The distribution of the patients was as follow: 8 with RAG1 deficiency, 6 with RAG2 deficiency and 7 with DCLRE1C deficiency. Nine patients presented with SCID, 6 with OS, 2 with leaky SCID and 4 with CID and granuloma and/or autoimmunity (CID-G/AI). Eight patients [(7 SCID and 1 OS) (38%)] received hematopoietic stem cell transplant (HSCT). The median age of HSCT was 11.5months and the median time from diagnosis to HSCT was 6months. Fifty percent of the transplanted patients are alive while only 23% of the untransplanted ones are alive.



http://ift.tt/2hJlTm5

The maternal microbiome during pregnancy and allergic disease in the offspring

Abstract

There is substantial epidemiological and mechanistic evidence that the increase in allergic disease and asthma in many parts of the world in part relates to changes in microbial exposures and diet acting via the composition and metabolic products of the intestinal microbiome. The majority of research in this field has focused on the gut microbiome during infancy, but it is increasingly clear that the maternal microbiome during pregnancy also has a key role in preventing an allergy-prone immune phenotype in the offspring. The mechanisms by which the maternal microbiome influences the developing fetal immune system include alignment between the maternal and infant regulatory immune status and transplacental passage of microbial metabolites and IgG. Interplay between microbial stimulatory factors such as lipopolysaccharides and regulatory factors such as short-chain fatty acids may also influence on fetal immune development. However, our understanding of these pathways is at an early stage and further mechanistic studies are needed. There are also no data from human studies relating the composition and metabolic activity of the maternal microbiome during pregnancy to the offspring's immune status at birth and risk of allergic disease. Improved knowledge of these pathways may inform novel strategies for tackling the increase in allergic disorders in the modern world.

http://ift.tt/2gICpD8

Nicotinamide for prevention of nonmelanoma skin cancers: a change in practice?

http://ift.tt/2yoAz1O

Management of the lateral neck compartment in patients with sporadic medullary thyroid cancer

Abstract

Background

The purpose of this retrospective analysis was to evaluate the benefits of an elective lateral neck dissection (ELND) in patients with medullary thyroid cancer (MTC) without radiographically apparent lateral neck metastases.

Methods

Patients with sporadic MTC without radiographic evidence of lateral neck metastasis who underwent definitive surgery were divided into 2 groups based on surgical approach: no ELND (the observation group) and ipsilateral or bilateral ELND (the ELND group). Primary outcomes were biochemical cure, locoregional recurrence, distant metastasis, and overall survival (OS).

Results

Sixty-six patients met inclusion criteria: 44 patients (67%) in the observation group and 22 patients (33%) in the ELND group. Two of 44 patients (5%) in the observation group developed subsequent (ipsilateral) lateral neck disease. At last follow-up, locoregional disease control rates among the observation and ELND groups were 98% and 100% (P > .999), respectively, whereas biochemical cure rates were 82% and 85% (P > .999), respectively, and 5-year OSs were 84% and 100% (P = .156), respectively.

Conclusion

Patients with MTC without lateral neck metastasis have similar biochemical cure rates with observation or elective dissection of lateral neck compartments.

http://ift.tt/2yMwuYh

Local control in sinonasal malignant melanoma: Comparing conventional to hypofractionated radiotherapy

Abstract

Background

The purpose of this study was to analyze the effect of fractionation schedule on local control in postoperative radiotherapy (RT) for sinonasal malignant melanoma.

Methods

Sixty-three patients who were treated with surgery and postoperative RT in 4 accredited head and neck cancer centers in the Netherlands between 1998 and 2013 were retrospectively studied. Outcomes with conventional fractionation (2-2.4 Gy per fraction; n = 27) were compared to hypofractionation (4-6 Gy per fraction; n = 36). The primary endpoint was local control and the secondary endpoint was toxicity.

Results

Comparable local control rates were found after 2 and 5 years (63% vs 64% and 47% vs 53%; P = .73 for, respectively, conventional fractionation vs hypofractionation). Local recurrences were predominantly present ipsilateral (92%) and within the irradiated volume (88%). Late toxicity grade ≥ 3 was observed in 2 of 63 patients, 1 patient in both groups.

Conclusion

Radiotherapy fractionation schedule did not influence the local control rate or the incidence of late toxicity in patients treated with surgery and RT for sinonasal malignant melanoma in this retrospective analysis. Due to this retrospective nature and the limited number of patients, strong recommendations cannot be made. Expected toxicity, patient convenience, and workload may be taken into account for the choice of fractionation schedule until conclusive evidence becomes available.

http://ift.tt/2hIEbnC

Efficacy and safety of vinorelbine plus cisplatin chemotherapy for patients with recurrent and/or metastatic salivary gland cancer of the head and neck

Abstract

Background

The purpose of this study was to investigate the efficacy and safety of vinorelbine plus cisplatin chemotherapy in patients with recurrent and/or metastatic salivary gland cancer of the head and neck.

Methods

In this single-arm phase II study, patients with recurrent and/or metastatic salivary gland cancer were treated with i.v. vinorelbine (25 mg/m²) on days 1 and 8 plus cisplatin (80 mg/m²) on day 1 every 3 weeks for 4 or 6 cycles. The primary endpoint was the objective response rate. Progression-free survival (PFS), overall survival (OS), and adverse events were also assessed.

Results

Between September 2008 and November 2014, 40 patients with recurrent and/or metastatic salivary gland cancer received vinorelbine plus cisplatin chemotherapy. The objective response rate was 35.0%, including 1 complete response. Median PFS and OS rates were 6.3 months and 16.9 months, respectively. No treatment-related deaths occurred.

Conclusion

Administering vinorelbine plus cisplatin chemotherapy to patients with recurrent and/or metastatic salivary gland cancers is safe and effective.

http://ift.tt/2yNryCu

AHNS Series: Do you know your guidelines? Perioperative antithrombotic management in head and neck surgery

Abstract

Head and neck surgeons are commonly faced with surgical patients who have underlying medical problems requiring antithrombotic therapy. It is difficult to achieve a balance between minimizing the risk of thromboembolism and hemorrhage in the perioperative period. Data from randomized, controlled trials are limited, and procedure-specific bleed rates are also difficult to pinpoint. The decision is made more difficult when patients with moderate-to-high risk for thromboembolic events undergo procedures that are high risk for bleeding. This is true for many head and neck oncologic surgeries. Furthermore, although elective procedures may be delayed for optimization of antithrombotic medication, emergent procedures cannot. Head and neck surgery often represents the most challenging of all these circumstances, given the potential risk of airway compromise from bleeding after head and neck surgery.

http://ift.tt/2hIE77m

The roles and applications of autoantibodies in progression, diagnosis, treatment and prognosis of human malignant tumours

Publication date: Available online 16 October 2017
Source:Autoimmunity Reviews
Author(s): Jing Wu, Xiaobo Li, Wuqi Song, Yong Fang, Li Yu, Siyuan Liu, Leonid P. Churilov, Fengmin Zhang
The existence of autoantibodies towards an individual's own proteins or nucleic acids has been established for more than 100years, and for a long period, these autoantibodies have been believed to be closely associated with autoimmune diseases. However, in recent years, researchers have become more interested in the role and application of autoantibodies in progression, diagnosis, treatment and prognosis of human malignant tumours. Over the past few decades, numerous epidemiological studies have shown that the risk of certain cancers is significantly altered (increased or decreased) in patients with autoimmune diseases, which suggests that autoantibodies may play either promoting or suppressing roles in cancer progression. The idea that autoantibodies are directly involved in tumour progression gains special support by the findings that some antibodies secreted by a variety of cancer cells can promote their proliferation and metastasis. Because the cancer cells generate cell antigenic changes (neoantigens), which trigger the immune system to produce autoantibodies, serum autoantibodies against tumour-associated antigens have been established as a novel type of cancer biomarkers and have been extensively studied in different types of cancer. The autoantibodies as biomarkers in cancer diagnosis are not only more sensitive and specific than antigens, but also could appear before clinical evidences of the tumours, thus disclosing them. The observations that cancer risk is lower in patients with some autoimmune diseases suggest that certain autoantibodies may be protective from certain cancers. Moreover, the presence of autoantibodies in healthy individuals implies that it could be safe to employ autoantibodies to treat cancer. Of note, an autoantibodies derived from lupus murine model received much attention due to their selective cytotoxicity for malignant tumour cell without harming normal ones. These studies showed the therapeutic value of autoantibodies in cancer. In this review, we revisited the pathological or protective role of autoantibodies in cancer progression, summarize the application of autoantibodies in cancer diagnosis and prognosis, and discuss the value of autoantibodies in cancer therapy. The studies established to date suggest that autoantibodies not only regulate cancer progression but also promise to be valuable instruments in oncological diagnosis and therapy.



http://ift.tt/2x0a0if

Three cases of implantation of a SureScan ® system and MRI for investigating causes of pain

Abstract

We report three cases of implantation of the SureScan^® system and magnetic resonance imaging (MRI) for investigating causes of pain. Although there were metal-induced artifacts on the MR images of 2 patients, the artifacts did not affect the images of structures that needed to be assessed to make the diagnosis. The SureScan^® system enabled patients implanted with spinal cord stimulation devices to undergo MRI.

http://ift.tt/2xJzRPy

Prevalence, antibiotic resistance, and MLST typing of Helicobacter pylori in Algiers, Algeria

Abstract

Background

Helicobacter pylori infection is common in Algeria, but there are few data on the characterization of isolated strains. The aim of this study was to update data on the prevalence of H. pylori in patients submitted to endoscopy, antibiotic resistance, and phylogeography of H. pylori strains isolated in Algiers.

Materials and Methods

This is a prospective study carried out between November 2015 and August 2016. The culture of H. pylori was performed on antral and fundic gastric biopsies of adult patients from 3 hospitals. A real-time PCR using the fluorescence resonance energy transfer (FRET) principle for the detection of H. pylori followed by a melting curve analysis for the detection of mutations associated with resistance to clarithromycin was applied. Differentiation between antral and fundic isolates of the same patient was also determined by RAPD, and an MLST typing was performed for characterization of the phylogeographic group of H. pylori.

Results

By real-time PCR, the prevalence of H. pylori infection among the 147 patients included was 57%. Culture was positive in only 29% of the cases. Twenty-seven percent of patients had received H. pylori eradication treatment. The primary and secondary resistance rates to clarithromycin were 23% and 36%, respectively, and to metronidazole, 45% and 71%, respectively. Only one isolate was resistant to levofloxacin, and no resistance to amoxicillin, tetracycline, and rifampicin was detected. A double population was present in 14 patients. The MLST analysis classified the 42 H. pylori strains from 38 patients in 2 haplotypes: hpEurope (33) and hpNEAfrica (9).

Conclusion

The prevalence of H. pylori remains high in Algeria but appears to be decreasing in recent years. High resistance to clarithromycin requires increased monitoring of the evolution of antibiotic resistance and adaptation of eradication therapy.

http://ift.tt/2xJoAiq

Reduction of bone mineral density in native Chinese female idiopathic benign paroxysmal positional vertigo patients

Publication date: Available online 5 October 2017
Source:American Journal of Otolaryngology
Author(s): Yunqin Wu, Chengyao Gu, Weiwei Han, Xiaoxiong Lu, Caijing Chen, Zhenyi Fan
ObjectiveThis study aimed to investigate the clinical association between idiopathic benign paroxysmal positional vertigo (BPPV) and reduction of bone mineral density (BMD).MethodsBMD was measured in 78 native Chinese female de novo idiopathic BPPV patients and 126 healthy controls using dual-energy X-ray absorptiometry. We compared the mean T-scores and abnormal BMD prevalence between the two groups.ResultsThe mean T-scores were significantly lower in idiopathic BPPV patients than in healthy controls. The prevalence of osteopenia and osteoporosis were significantly higher in idiopathic BPPV patients than in healthy controls (65.4% vs 48.4%, p=0.013).ConclusionBMD reduction may be associated with idiopathic BPPV occurrence.



http://ift.tt/2ykOxUT

Immunological Profile of Solid Tumors Sample

Condition:   Solid Cancer
Intervention:   Other: immunohistochemistry assay
Sponsors:   Assistance Publique Hopitaux De Marseille;   Innate Pharma
Recruiting

http://ift.tt/2gdNhIy

Macintosh Laryngoscope Assisted Fiberoptic Intubation

Condition:   Difficult Intubation
Interventions:   Device: fiberoptic, airway;   Device: fiberoptic, Machintosh
Sponsor:   Mansoura University
Recruiting

http://ift.tt/2ykOisX

Prebiotics for the prevention of allergies: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background

Prevalence of allergic diseases in infants is approximately 10% reaching 20 to 30% in those with an allergic first-degree relative. Prebiotics are selectively fermented food ingredients that allow specific changes in composition/activity of the gastrointestinal microflora. They modulate immune responses and their supplementation has been proposed as an intervention to prevent allergies.

Objective

To assess in pregnant women, breastfeeding mothers, and infants (populations) the effect of supplementing prebiotics (intervention) versus no prebiotics (comparison) on the development of allergic diseases and to inform the World Allergy Organization guidelines.

Methods

We performed a systematic review of studies assessing the effects of prebiotic supplementation with an intention to prevent the development of allergies.

Results

Of 446 unique records published until November 2016 in Cochrane, MEDLINE, and Embase, 22 studies fulfilled a priori specified criteria. We did not find any studies of prebiotics given to pregnant women or breastfeeding mothers. Prebiotic supplementation in infants, compared to placebo, had the following effects: risk of developing eczema (RR: 0.68, 95% CI: 0.40 to 1.15), wheezing/asthma (RR, 0.37; 95% CI: 0.17 to 0.80), and food allergy (RR: 0.28, 95% CI: 0.08 to 1.00). There was no evidence of an increased risk of any adverse effects (RR: 1.01, 95% CI: 0.92 to 1.10). Prebiotic supplementation had little influence growth rate (MD: 0.92 g/day faster with prebiotics, 95% CI: 0 to 1.84), and the final infant weight (MD: 0.10 kg higher with prebiotics, (95% CI: -0.09 to 0.29). The certainty of these estimates is very low due to risk of bias and imprecision of the results.

Conclusions

Currently available evidence on prebiotic supplementation to reduce the risk of developing allergies is very uncertain.

This article is protected by copyright. All rights reserved.

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Stigma as a Barrier to Global Health Care

By Nathan Douthit

"People who are excluded…are not 'just like' the rest of the poor, only poorer. They are also disadvantaged by who they are or where they live, and as a result, are locked out of the benefits of development."^[1]

In 'HIV-associated dementia in the Dominican Republic: a consequence of stigma, domestic abuse and limited health literacy,' Santoso et al describe the case of a woman living with uncontrolled HIV for 14 years. She did not report it for fear of abuse and stigmatization in society. She also was found to have significant psychiatric disease, but when referred to a specialist, "She insisted that she was not 'crazy'."

Stigma can be a major factor in the progression of disease and the decision to seek care. The authors of this case describe the barriers to HIV care,

"People living with HIV/AIDS in the Dominican Republic experience social devaluing as their illness is commonly associated with marginalised groups such as sex workers, the lesbian, gay, bisexual, and transgender (LGBT) community and drug users. Additionally, they are subjected to institutionalised discrimination, including denial of medical services or jobs. Fear of discrimination likely played a significant role in this patient's avoidance of treatment."

And the reluctance to receive treatment for her psychiatric problems with,

"Although the patient voiced suicidal intent, she was reluctant to see the psychologist for fear of being labelled as a 'loca' (crazy person). Locas are rejected in Dominican society for being perceived as being out-of-control, unpredictable and unable to fulfill expected gender roles."

Stigma from mental health can have, "significant social and economic deprivation…as a consequence."^[2] This problem is not only neglected but, in some ways, exacerbated by the global health community. While the burden of depression exceeds malaria in low-income countries, the amount of awareness, fundraising and innovative treatments for the latter far exceed the former. It has been shown that physicians educated in low-income countries may worsen stigma by attributing mental illness to supernatural forces; a problem that persists even after psychiatric training.^[3]

Stigma from HIV is well described by the authors above. In many countries, there is legislation in place that enforces stigma and economic deprivation for those infected by HIV. The social stigma in place also effects the livelihood of patients.^[4]

Global health professionals engaged in the care of individual patients must work to ensure that discrimination and stigma are eliminated as barriers to care. This can be done by intentionally working with high-risk or stigmatised groups, education of local communities and advocacy for change in harmful policies. All stake-holders must realize that disease stigma causes increased morbidity and mortality and has no place in society.

In light of this, BMJ Case Reports invites authors to publish cases regarding stigma in global health and methods used to overcome this barrier. Global health case reports can emphasize:

-the devastating effects of stigma worsening disease

-diseases that are uniquely stigmatised in individual cultures

-innovative methods to overcome stigma

-the stigma created and perpetuated by the healthcare system

Manuscripts may be submitted by students, physicians, nurses or other medical professionals to BMJ Case Reports. For more information, review the blog on how to write a global health case report.

Read more about stigma and disease at BMJCR:

–Stigma kills! The psychological effects of emotional abuse and discrimination towards a patient with HIV in Uganda

–Factors affecting illness in the developing world: chronic disease, mental health and traditional medicine cures

–Myxoedema in a patient with achondroplasia in rural area of Guatemala

Read more about stigma and disease from other sources:

-World Health Organization. Mental health and development: targeting people with mental health conditions as a vulnerable group. World Health Organization; 2010.

-Ngui EM, Khasakhala L, Ndetei D, Roberts LW. Mental disorders, health inequalities and ethics: a global perspective. International Review of Psychiatry. 2010 Jun 1;22(3):235-44.

-Joint United Nations Programme on HIV/AIDS. Global AIDS update 2016. Geneva: UNAIDS. 2016.

References:

^[1] Reducing poverty by tackling social exclusion: a DFID policy paper. United Kingdom, Department for International Development, September 2005 (http://www.d http://ift.tt/2kWkZaX social-exclusion.pdf, accessed 29 December 2009).

^[2] World Health Organization. Mental health and development: targeting people with mental health conditions as a vulnerable group. World Health Organization; 2010.

^[3] Ngui EM, Khasakhala L, Ndetei D, Roberts LW. Mental disorders, health inequalities and ethics: a global perspective. International Review of Psychiatry. 2010 Jun 1;22(3):235-44.

^[4] Joint United Nations Programme on HIV/AIDS. Global AIDS update 2016. Geneva: UNAIDS. 2016.

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Successful treatment of SAPHO syndrome with apremilast

Abstract

Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome is a rare disease with inflammatory osteoarticular and skin involvement. The pathogenesis of SAPHO syndrome remains unclear, but evidence suggests it may be an autoinflammatory disease triggered upon exposure to infectious agents in genetically predisposed individuals. Induction of the IL-23/Th17 axis as well as neutrophil activation seem to play a key role, and therapies targeting these immunological pathways, including TNF-inhibitors, ustekinumab, secukinumab and the IL-1 inhibitor anakinra are potential treatment options that need further investigation. Here we report a case of a 24-year-old woman suffering from SAPHO syndrome who presented at our clinic with palmoplantar pustulosis and sternoclavicular joint involvement. Previous treatments with topical steroids and keratolytics combined with NSAIDs, intravenous methylprednisolone, methotrexate and salazopyrin had all failed to improve symptoms. Therapy with etanercept was not tolerated, and due to a previous demyelinating peripheral neuropathy, further treatment with TNF inhibitors was avoided. We initiated ustekinumab 45mg, which improved skin manifestations but not joint pain. Dose escalation to 90mg initially improved joint pain, but the dose had to be reduced to 45mg again due to increased infections. During subsequent 45mg ustekinumab treatment joint pain exacerbated so we switched to secukinumab, which improved skin and joint symptoms significantly but was associated with a pustular hypersensitivity reaction. Finally, we began treatment with apremilast, a pan-cytokine approach, resulting in stabilization of the skin and joint symptoms without side effects. To our knowledge, this is the first case report of apremilast as a treatment for SAPHO syndrome.

This article is protected by copyright. All rights reserved.

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Psychological effects of Helicobacter pylori-associated atrophic gastritis in patients under 50 years: A cross-sectional study

Abstract

Background

While gastrointestinal function is known to be closely related to psychological status, the influence of Helicobacter pylori-associated atrophic gastritis is currently unknown. We aimed to determine whether atrophic gastritis status or H. pylori infection is associated with psychological distress or depressed mood.

Materials and Methods

We performed a cross-sectional, observational study involving 975 Japanese individuals (503 females; mean age, 44 ± 8 years) who underwent a health checkup. Psychological distress was defined as a Kessler-6 Scale score ≥13 and depressive mood as a Center for Epidemiological Studies Depression Scale score ≥ 16. The odds ratios with 95% confidence intervals assessing the risk of psychological distress or depressive mood associated with H. pylori infection (H. pylori-specific immunoglobulin G levels >10 U/mL) and atrophic gastritis status (pepsinogen I levels < 70 μg/L and pepsinogen I/II ratio < 3) were calculated using multiple logistic analysis adjusting for several covariates.

Results

Individuals with atrophic gastritis had a significantly higher risk of experiencing psychological distress, with younger females (<50 years) displaying the highest risk for psychological distress and depressive mood regardless of H. pylori infection status. Among females aged <50 years, H. pylori-seropositive participants with atrophic gastritis (HP+AG+) showed the highest risk of psychological distress (OR, 16.4; 95% CI, 3.45-94.9) and depression (OR, 2.86; 95% CI, 1.31-6.05), using HP−AG− status as the reference.

Conclusions

Our findings support the results of previous animal studies regarding the psychological response to gastritis in humans. Further studies are needed to elucidate whether H. pylori eradication provides psychological benefits.

http://ift.tt/2xIsfZ6

Tageslicht-photodynamische Therapie

http://ift.tt/2zdl8bY

Pityriasis amiantacea und Folliculitis decalvans

Zusammenfassung

Wir berichten über eine 21-jährige Patientin mit seit 3 Jahren bestehenden Krusten und Erosionen an der Kopfhaut, die nach Therapiebeginn mit Adalimumab wegen Morbus Crohn auftraten. Mittels klinikopathologischer Korrelation wurde die Diagnose Pityriasis amiantacea bei Folliculitis decalvans gestellt. Topische und antibiotische systemische Therapie zeigten ein rasches Ansprechen. Das Auftreten von Pityriasis amiantacea und Folliculitis decalvans bei Anti-TNF (Tumor-Nekrose-Faktor)-α-Therapie ist bemerkenswert und unterstreicht die ambivalente Rolle von TNF-α bei Erkrankungen mit immunologischen Fehlfunktionen und Infektionen.

http://ift.tt/2ztJDCS

New and Emerging Biological Medications for Asthma, Allergic Rhinitis and Chronic Rhinosinusitis: a Concise Review

Abstract

Purpose of Review

The purpose of the study is to survey the current literature describing the use of biologic agents in the treatment of asthma, allergic rhinitis, and chronic rhinosinusitis.

Recent Findings

The Food and Drug Administration (FDA) has approved three biologic agents for asthma and four sublingual immunotherapy (SLIT) products for allergic rhinitis (AR). While no agents are specifically approved for chronic rhinosinusitis (CRS), the overlap between asthma, AR, and CRS potentially affords FDA-approved treatment options for CRS patients. In addition to currently approved products for these conditions, other agents are currently under investigation. Biologic agents have the potential to improve quality of life and reduce exacerbations and steroid use for patients with asthma. SLIT is a convenient method of administering immunotherapy to patients with AR. The current literature does not adequately compare the effectiveness of SLIT to subcutaneous immunotherapy (SCIT), but results are favorable to placebo for both. While not FDA approved as a treatment for CRS, biologic agents have resulted in benefits in subjective quality of life and objective nasal outcomes in clinical studies of patients with CRS and eosinophilia.

Summary

Mechanisms and clinical outcomes of new and upcoming biologic agents for asthma, AR, and CRS are described. It is expected that in the next decade, there will be more of these agents approved for use in these conditions.

http://ift.tt/2xIuqf5

Choanal Atresia: Birth Without Breath

Abstract

Bilateral Choanal atresia is a medical emergency. Corrective surgery is the mainstay of the treatment. Hegar's dilator was used in all cases to break the bony/membranous atretic plate. The 22 cases of choanal atresia all operated by the first author were included in this study. Eight cases were 1–5 year old with bilateral choanal atresia and all required immediate surgery as they had repeated attacks of respiratory distress and cycle of cyanosis. Eight cases were of CHARGE Syndrome. All the cases were operated under general anaesthesia. Hegar's dilators were used and nasal stents were placed in all cases. Although complete nasal patency was achieved by surgery, in 8 cases, neonates could not survive due to the CHARGE Syndrome. The mortality was unrelated to the surgery. The 14 cases which were not related to CHARGE Syndroma had a good postoperative recovery. 3 cases were above 15 years old with unilateral complete bony/membranous choanal atresia and they presented with continuos nasal discharge. Hegar's dilators are a safe and simple method of surgery for choanal atresia. Nasal stenting is mandatory to prevent restenosis.

http://ift.tt/2yl4IBF

Choanal Atresia: Birth Without Breath

Abstract

Bilateral Choanal atresia is a medical emergency. Corrective surgery is the mainstay of the treatment. Hegar's dilator was used in all cases to break the bony/membranous atretic plate. The 22 cases of choanal atresia all operated by the first author were included in this study. Eight cases were 1–5 year old with bilateral choanal atresia and all required immediate surgery as they had repeated attacks of respiratory distress and cycle of cyanosis. Eight cases were of CHARGE Syndrome. All the cases were operated under general anaesthesia. Hegar's dilators were used and nasal stents were placed in all cases. Although complete nasal patency was achieved by surgery, in 8 cases, neonates could not survive due to the CHARGE Syndrome. The mortality was unrelated to the surgery. The 14 cases which were not related to CHARGE Syndroma had a good postoperative recovery. 3 cases were above 15 years old with unilateral complete bony/membranous choanal atresia and they presented with continuos nasal discharge. Hegar's dilators are a safe and simple method of surgery for choanal atresia. Nasal stenting is mandatory to prevent restenosis.

http://ift.tt/2yl4IBF

Screening for Sturge-Weber syndrome: A state-of-the-art review

Abstract

Infants with a high-risk distribution of port-wine stains are commonly screened for Sturge-Weber syndrome using brain magnetic resonance imaging. There is no consensus about which port-wine stain phenotypes to screen, optimal timing, screening sensitivity, or whether presymptomatic diagnosis improves neurodevelopmental outcomes. This state-of-the-art review examines the evidence in favor of screening for Sturge-Weber syndrome, based on its effect on neurodevelopmental outcomes, against the risks and limitations of screening magnetic resonance imaging and electroencephalography. A literature search of PubMed/MEDLINE was conducted between January 2005 and May 2017 using key search terms. Relevant articles published in English were reviewed; 34 articles meeting the search criteria were analyzed according to the following outcome measures: neurodevelopmental outcome benefit of screening, diagnostic yield, financial costs, procedural risks, and limitations of screening magnetic resonance imaging and electroencephalography. There is no evidence that a presymptomatic Sturge-Weber syndrome diagnosis with magnetic resonance imaging results in better neurodevelopmental outcomes. The utility of electroencephalographic screening is also unestablished. In Sturge-Weber syndrome, neurodevelopmental outcomes depend on prompt recognition of neurologic red flags and early seizure control. Small numbers and a lack of prospective randomized controlled trials limit these findings. For infants with port-wine stain involving skin derived from the frontonasal placode (forehead and hemifacial phenotypes), we recommend early referral to a pediatric neurologist for parental education, counselling, and monitoring for neurologic red flags and seizures and consideration of electroencephalography regardless of whether magnetic resonance imaging is performed or its findings.

http://ift.tt/2yonaH7

Analysis of Treatment Goal Alignment between Japanese Psoriasis Patients and their paired Treating Physicians

Abstract

Background

Appropriate goal-oriented treatment strategies are important for optimal treatment outcomes and may prevent under-treatment. As treatment goals vary by patient, a study to examine treatment goals is more meaningful when patients and their physicians are paired. There has not been any study that examines alignment between paired psoriasis patients and physicians in real-world clinical practice using skin clearance as a treatment goal indicator.

Objectives

To evaluate treatment goal alignment between psoriasis patients and their paired physicians, and to quantitatively identify factors associated with goal misalignment.

Methods

The study was a nationwide multicenter cross-sectional observational study. Subjects were physician-reported moderate to severe psoriasis patients with a history of systemic treatments, directly paired with their treating physicians. Subjects completed surveys independently. Treatment goals included seven categories and patient-physician pairs were grouped as "aligned" or "misaligned" when the answers were the same or different, respectively.

Results

A total of 425 pairs (mean response rate, 94.7%) of responses were collected from 54 sites (64.8% General Practitioners or clinics; 35.2% university or large hospitals). Treatment goal misalignment was found in 67.9% of the patient-physician pairs. The misalignment was mainly "patient predominant" (60.9%) indicating that patients had higher goals ("complete clearance") than physicians. In the multivariate logistic regression analyses, patients' treatment expectation for "complete clearance" (odds ratio [OR]: 1.927; 95% confidential interval [CI]: 1.232 to 3.016) and physician rating of "level of understanding on treatment options" being low (OR: 1.552, 95% CI; 1.082 to 2.227) were significant factors for treatment goal misalignment.

Conclusions

The majority of treatment goal misalignment was found between paired psoriasis patients and their treating physicians in Japan. The most important contributing factors to misalignment were patients' treatment expectation for "complete clearance" and physicians' rating of their patients' "level of understanding on treatment options" being low.

This article is protected by copyright. All rights reserved.

http://ift.tt/2ymUFtj

Caecal volvulus with intestinal malrotation: need for caecopexy?

Description

Caecal volvulus accounts for 30% of all colonic volvulus.1 It occurs due to torsion or hyperflexion of an enlarged, poorly fixed hypermobile caecum. It manifests in two forms: axial rotation of the caecum and the ileum around the mesentery and the less common caecal bascule, where the bowel folds up on itself.2 Intestinal malrotation occurs due to incomplete or faulty rotation and fixation of the gut during the 5th to 11th week of fetal life. A combination of both is rare.

A 10-year-old boy presented with the complaints of right lower quadrant pain, bilious vomiting and non-passage of stools since 2 days. On examination, the child was dehydrated, had tachycardia, had low-volume pulse, had blood pressure of 86/60 mm Hg and had a grossly distended abdomen with no well-defined lump or signs of peritonism. His per rectal examination revealed an empty collapsed rectum. X-ray abdomen was...

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Effect of autologous adipose-derived mesenchymal stem cell therapy in the treatment of a post-traumatic chondral defect of the knee

Isolated chondral defects have a limited capacity to heal and predispose to the development of osteoarthritis. Current surgical management can be unpredictable in outcome. Improved understanding of the action of mesenchymal stem cells (MSCs) has seen renewed interest in their role in cartilage repair. A 26-year-old athlete presented with a post-traumatic, isolated patella chondral defect. The patient underwent an arthroscopy with removal of a chondral loose body. After failure to symptomatically improve 12 months following surgery, the patient received intra-articular autologous adipose-derived mesenchymal stem cell (ADMSC) therapy.

http://ift.tt/2gmv3Zf