A predictive model to distinguish malignant and benign thyroid nodules based on age, gender and ultrasonographic features

Publication date: Available online 4 November 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Fábio Muradás Girardi, Laura Mezzomo da Silva, Cecilia Dias Flores
IntroductionA discussion in literature about a standardized decision support tool for the management of thyroid nodules remains.ObjectiveThe purpose of this study was to create a statistical prediction model for thyroid nodules management.MethodsTwo hundred and four benign and 57 malignant thyroid nodules were selected for a retrospective study. The variables age, gender and ultrasonographic features were examined using univariate and multivariate models. A statistical formula was used to calculate the risk of cancer of each case.ResultsIn multivariate analysis, irregular shape, absence of halo, lower mean age, homogeneous echotexture, microcalcifications and solid content were associated with cancer. After applying the formula, 20 cases (7.6%) with a calculated risk for malignancy ≤3.0% were found, all of them benign. Setting the calculated risk in ≥80%, 21 (8.0%) cases were selected, and in 85.7% of them cancer was confirmed in histopathology. Internal accuracy of the prediction formula was 92.5%.ConclusionsThe prediction formula reached high accuracy and may be an alternative to other decision support tools for thyroid nodule management.



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Metastatic non-small cell lung carcinoma a mimic of primary breast carcinoma—case series and literature review

Abstract

Metastatic tumors to the breast are rare but constitute a major diagnostic dilemma. Of these, non-mammary carcinomatous metastases to the breast are particularly challenging and, without a clinical history, may be extremely difficult to distinguish from primary breast carcinoma (PBC). We specifically studied metastatic tumors of pulmonary origin, as the lung is one of the major primary sites for carcinomatous metastasis to breast. Sixteen metastatic lung tumors to the breast were identified in our archives between 1996 and 2017 including 12 non-small cell lung carcinomas (NSCLC), one large-cell neuroendocrine, one atypical carcinoid, and two small-cell carcinomas. Adenocarcinoma was the most frequent amongst the NSCLCs (11/14). We retrieved the clinical information of these cases and reviewed the pathological characteristics to provide practical tools for pathologists to aid in their identification. Even in the absence of a clinical history of lung cancer, metastatic pulmonary adenocarcinoma to the breast should be considered in at least one of the following scenarios: (1) single or multiple well-circumscribed lesions of the breast that lack an in situ component and that are accompanied by distant metastases but negative axillary lymph nodes, (2) breast tumors that are triple negative yet not high-grade, or (3) breast tumors presenting as stage 4 disease and/or having an unusually aggressive clinical course on standard breast therapy. Accurate and timely diagnosis of these tumors is mandatory because of treatment and prognostic implications.

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Negative selection, epitope mimicry and autoimmunity

Noel R Rose

http://ift.tt/2hG1W0r

Extreme Violence and the Invisibility of Women Who Murder: The Intersectionality of Gender, Race, Ethnicity, Sexual Orientation, and Gender Identity Equals Silence

Violence and Gender , Vol. 0, No. 0.


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Debates in allergy, regarding the symposium on: “Position Statements and Therapeutic Guidelines”

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): P. Rodríguez del Río, A. Cisteró-Bahima, R. van Ree




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Predictive biomarkers in allergen specific immunotherapy

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): D. Barber, M.M. Escribese




http://ift.tt/2hcKvHJ

Biologics in the treatment of severe asthma

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): S. Quirce, E. Phillips-Angles, J. Domínguez-Ortega, P. Barranco
Severe asthma is defined as asthma which requires treatment with high dose inhaled corticosteroids and with a second controller drug to prevent it from becoming uncontrolled or which remains uncontrolled despite this therapy. Patients with uncontrolled severe asthma require additional treatment options as add-on therapy, including biologics. Biologic therapies in asthma are designed to block key immune regulators, such as IgE, or certain pro-inflammatory cytokines, e.g. interleukin (IL)-5, IL-4, IL-13 or IL-17. Patients with severe asthma and eosinophilic phenotype may benefit from biologic therapies aimed at reducing blood and tissue eosinophils, such as mepolizumab, reslizumab and benralizumab. Patients with Th2-high phenotype may also benefit from therapy with anti-IL-4/anti-IL-13 monoclonal antibodies (dupilumab). The main limitations of asthma treatment with biologic agents are the crossover and overlap of the different pathways in the pathogenesis of asthma which may cause lack of complete success of these therapies, in addition of high costs, which make pharmacoeconomic studies necessary to identify the ideal target patient population to receive these biologic drugs.



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New insight into cancer immunotherapy

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): M.M. Escribese, D. Barber
A key point for maintenance of the immune system homeostasis is the balance between the capacity to recognize and fight exogenous molecules and the capacity to avoid auto reactivity. The disruption of this balance induces the progression of several immune diseases such as autoimmune diseases, allergies, infections or cancer.A promising therapeutic approach to treat these diseases is immunotherapy. In cancer, both active and passive immunotherapies have been tested with promising results, such as the blocking of immunological checkpoints like CTLA-4 and PD-1. These treatments, in the market since a few years ago, aim to redirect the patient's immunological response by inhibiting the induction of regulatory T cells, both in the priming and effector phases.This strategy sheds light on the immunological mechanisms that control the regulatory response mediated by T cells and opens new lines of research into other immunological diseases such as allergy, in which the induction of a regulatory response is necessary to avoid allergic progression and which is the main objective of allergen-specific immunotherapies available today.



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Biologics in chronic urticaria

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): M. Ferrer, R. Madamba




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Worldwide allergen immunotherapy guidelines: Evidence and experience-based

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): D.E.S. Larenas-Linnemann




http://ift.tt/2hdLXK5

Proposals for harmonization of allergens regulation in the European Union

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): M. Timón
Allergen medicinal products in the European Union are regulated differently across the different Member States. Thus, whereas in some countries strict quality, safety and efficacy requirements are in place, in others, most allergens are on the market as Named Patient Products, without any regulatory oversight. This situation results on European allergic patients being exposed to totally different standards depending on where they live. Initiatives to correct this situation are needed.



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Non-allergenic immunotherapy

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): E. Ibáñez Echevarría, J. Bartra Tomás, D. Hernández Fernández de Rojas




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Epicutaneous immunotherapy

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): S. Scheurer, M. Toda




http://ift.tt/2zg138w

Diagnostic dilemmas in chronic inflammatory bowel disease

Abstract

Histopathological assessment of biopsy and resection specimens of chronic inflammatory bowel disease (CIBD), or possible CIBD, forms a significant component of the routine workload in most tissue pathology laboratories. In this review, we have chosen selected areas of particular diagnostic difficulty in CIBD pathology, providing key advice for pathology reporting. Those mimics of CIBD which have the greatest potential for misdiagnosis are discussed, particularly the wide range of infectious colitides which represent possible diagnostic pitfalls. The most important distinguishing features between the two main forms of CIBD, ulcerative colitis and Crohn's disease, are addressed, first in relation to resection specimens, and then with emphasis on features which may also be diagnostically useful in endoscopic biopsy material. The importance of assessment of the index endoscopic specimen is stressed, before treatment has been instigated, along with careful correlation with clinical and endoscopic features. Problems in the assessment of post-surgical CIBD specimens are described and then the role of upper gastrointestinal pathology specimens in diagnosing both Crohn's disease and ulcerative colitis, with increased recognition of upper gastrointestinal tract involvement in the latter condition. Finally, with recent developments in endoscopic surveillance techniques and local excision options, modern approaches to reporting and managing neoplasia complicating CIBD are reviewed.

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Isolated right ventricular thrombus in an adult patient with nephrotic syndrome: a case report

Venous thrombosis in nephrotic syndrome is a well-described phenomenon. We report a case of an adult patient with an isolated thrombus in the right ventricle due to nephrotic syndrome, which was initially susp...

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SOCS-1 ameliorates smoke inhalation-induced acute lung injury through inhibition of ASK-1 activity and DISC formation

Publication date: Available online 3 November 2017
Source:Clinical Immunology
Author(s): Leifang Zhang, Kairei Zhu, Yating Ma, Chenming Xu, Qiwen Shi, Xiaoming Chen, Weike Su, Hang Zhao
Smoke inhalation leads to acute lung injury (ALI), a devastating clinical problem associated with high mortality. Suppressor of cytokine signaling-1 (SOCS-1) is a negative regulator of apoptosis and pro-inflammatory cytokine signaling, two major contributors to the pathogenesis of ALI. We have found that SOCS-1 protects lung epithelial cells from smoke-induced apoptosis through two mechanisms. One is that SOCS-1 enhances degradation of ASK-1 and diminishes cleavage of pro-caspase-3 to repress smoke-triggered apoptosis in lung epithelial cells. The other is that SOCS-1 represses smoke-triggered DISC formation through altering TRADD-caspase-8 interaction rather than TNFR-1-TRADD interaction or TNFR-1-TRAF-2 interaction. In conclusion, SOCS-1 relieves smoke inhalation-induced lung injury by repressing ASK-1 and DISC-mediated epithelium apoptosis.



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Targeting interferons and their pathways in Systemic Lupus Erythematosus

Publication date: Available online 4 November 2017
Source:Autoimmunity Reviews
Author(s): François Chasset, Laurent Arnaud
Significant advances in the understanding of the molecular basis of innate immunity have led to the identification of interferons (IFNs), particularly IFN-α, as central mediators in the pathogenesis of Systemic Lupus Erythematosus. Therefore, targeting of IFNs and of their downstream pathways has emerged as important developments for novel drug research in SLE. Based on this, several specific interferon blocking strategies using anti-IFN-α antibodies, anti-type I interferon receptor antibodies, Interferon-α-kinoid, or anti-IFN-γ antibodies have all been assessed in recent clinical trials. Alternative strategies targeting the plasmacytoid dendritic cells (pDCs), Toll-Like Receptors (TLRs)-7/9 or their downstream pathways such as the myeloid differentiation primary-response protein 88 (MYD88), spleen tyrosine kinase (Syk), Janus-kinases (JAKs), interleukin-1 receptor-associated kinase 4 (IRAK4), or the Tyrosine Kinase 2 (TYK2) are also investigated actively in SLE, at more preliminary clinical development stages, except for JAK inhibitors which have reached phase 2 studies. In a near future, in-depth and personalized functional characterization of IFN pathways may provide further guidance for the selection of the most relevant therapeutic strategy in SLE, tailored at the patient-level.



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Vitamin D and systemic lupus erythematosus - the hype and the hope

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Yehuda Shoenfeld, Roberto Giacomelli, Shir Azrielant, Onorina Berardicurti, John A. Reynolds, Ian N. Bruce
Over the past 20years, much has been written about the potential role of vitamin D in on adverse health outcomes. In recent years, evidence has accumulated regarding the effect of vitamin D on the immune system, and its different cells. Some studies have noted lower vitamin D concentrations in patients with SLE. These epidemiological data still not answer the question: is vitamin D deficiency the cause or the effect? To answer this, we will discuss the association between vitamin D deficiency and SLE and review the evidence from interventional studies.



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Cocaine and ANCA associated vasculitis-like syndromes – A case series

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Sujith Subesinghe, Sander van Leuven, Leena Yalakki, Shirish Sangle, David D'Cruz
ObjectivesWe analysed the spectrum of clinical manifestations of cocaine associated pseudovasculitis.MethodsClinical, serological, radiological and histological features of 14 patients with cocaine pseudovasculitis syndromes were included.ResultsTwelve patients had significant sinus thickening or erosive disease. Other multi-system manifestations included vasculitic rashes, pulmonary lesions and peripheral neuropathy. All patients had positive ANCA titres at presentation. All patients were managed with corticosteroids +/− methotrexate and co-trimoxazole, 2 patients received cyclophosphamide.ConclusionsAdvanced erosive nasal septal defects and atypical ANCA patterns are suggestive of cocaine induced pseudovasculitis. Complete drug cessation may negate the need for exposure to potent immunosuppressive agents.



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Physical activity and autoimmune diseases: Get moving and manage the disease

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Kassem Sharif, Abdulla Watad, Nicola Luigi Bragazzi, Micheal Lichtbroun, Howard Amital, Yehuda Shoenfeld
Physical activity, by definition, is any skeletal muscle body movement that results in energy expenditure. In the last few decades, a plethora of scientific evidences have accumulated and confirmed the beneficial role of physical activity as a modifiable risk factor for a wide variety of chronic diseases including cardiovascular diseases (CVDs), diabetes mellitus and cancer, among others. Autoimmune diseases are a heterogeneous group of chronic diseases, which occur secondary to loss of self-antigen tolerance. With the advent of biological therapies, better outcomes have recently been noted in the management of autoimmune diseases. Nonetheless, recent research highlights the salient role of modifiable behaviors such as physical inactivity on various aspects of the immune system and autoimmune diseases. Physical activity leads to a significant elevation in T-regulatory cells, decreased immunoglobulin secretion and produces a shift in the Th1/Th2 balance to a decreased Th1 cell production. Moreover, physical activity has been proven to promote the release of IL-6 from muscles. IL-6 released from muscles functions as a myokine and has been shown to induce an anti-inflammatory response through IL-10 secretion and IL-1β inhibition. Physical activity has been shown to be safe in most of autoimmune diseases including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), multiple sclerosis (MS), inflammatory bowel diseases (IBD), as well as others. Additionally, the incidence of RA, MS, IBD and psoriasis has been found to be higher in patients less engaged in physical activity. As a general trend, patients with autoimmune diseases tend to be less physically active as compared to the general population. Physically active RA patients were found to have a milder disease course, better cardiovascular disease (CVD) profile, and improved joint mobility. Physical activity decreases fatigue, enhances mood, cognitive abilities and mobility in patients with MS. In SLE patients, enhanced quality of life and better CVD profile were documented in more physically active patients. Physically active patients with type 1 diabetes mellitus have a decreased risk of autonomic neuropathy and CVD. Both fibromyalgia and systemic sclerosis patients report decreased disease severity, pain, as well as better quality of life with more physical activity. Further, SSc patients improve their grip strength, finger stretching and mouth opening with increased level of exercise. The purpose of this paper is to review the clinical evidence regarding the safety, barriers to engagement, and impact of physical activity on autoimmune diseases.



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Can we withdraw immunosuppressants in patients with lupus nephritis in remission? An expert debate

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Gabriella Moroni, Mariele Gatto, Francesca Raffiotta, Valentina Binda, Eleni Frangou, Liz Lightstone, Dimitrios T. Boumpas
Lupus nephritis (LN) treatment requires an initial intensive period of therapy followed by a long-term maintenance treatment in order to stabilize disease control and eventually reach renal remission. In this section, Authors discuss the feasibility of safely lowering and even suspending maintenance therapy in LN patients having entered remission, highlighting hurdles in predicting the depth and durability of disease quiescence together with the need for minimizing potentially toxic therapies. Even though no firm conclusions can still be drawn, the treating physician has to find the wise balance between disease control and treatment-related drawbacks by following patients closely and recognizing as early as possible the ones who are likely to reach a deep and durable renal remission; there is consensus that is these are the only patients in whom a potential safe complete withdrawal can be foreseen so far.



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The Immunobiology and clinical features of type 1 autoimmune polyglandular syndrome (APS-1)

Publication date: Available online 4 November 2017
Source:Autoimmunity Reviews
Author(s): Can-Jie Guo, Patrick S.C. Leung, Weici Zhang, Xiong Ma, M. Eric Gershwin
Autoimmune Polyglandular Syndrome type 1 (APS-1) is a subtype of the autoimmune polyendocrine syndrome characterized by the simultaneous or sequential dysfunction of multiple endocrine or non-endocrine glands. A clinical diagnosis of APS-1 is typically based on the presence of at least two of three following criteria: chronic mucocutaneous candidiasis, hypoparathyroidism and adrenal insufficiency. The first identified causative mutated gene for APS-1 is autoimmune regulator (AIRE) encoding a critical transcription factor, which is primarily expressed in the medullary thymic epithelial cells (mTECs) for generating central immune tolerance. A wide range of chronic, debilitating complications, with no obvious correlation with genetics, makes a diagnosis of APS-1 challenging early in the disease course. Managing APS-1 is difficult due to its complexity, especially the intricate relationships within manifestations and genetic mutations. The past decades have witnessed dramatic progress in elucidating the function of AIRE and conducting large-scale cohort studies in APS-1. However, no clear evidence-based guidelines have been established in APS-1. In this review, we provide a detailed critical overview of the study history, epidemiology, clinical features, and related mechanisms of autoimmunity in APS-1, as well as currently available therapies for this autoimmune disorder.



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TNF inhibitors in rheumatoid arthritis and spondyloarthritis: Are they the same?

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Andrea Rubbert-Roth, Fabiola Atzeni, Ignazio Francesco Masala, Roberto Caporali, Carlomaurizio Montecucco, Piercarlo Sarzi-Puttini
The advent of anti-tumour necrosis factor (TNF) drugs for rheumatoid arthritis (RA) or spondyloarthritis (SpA) has revolutionised the approach to patients with active disease who do not respond to conventional therapy. Although there are differences in their structure, morphology, pharmacokinetic properties and activity, all anti-TNF drugs ultimately neutralise the TNFα pathway of inflammation. However, despite their similar clinical efficacy, there are disagreements concerning drug survival and safety, with systematic reviews and meta-analyses confirming one result or the other. The fact that 20–30% of patients fail to respond to TNFα inhibitors indicates the possibility of primary resistance or the development of an immune response to the drugs themselves, which may act as antigens. The overall benefit of switching to another anti-TNF drug or a biological agent with a different mechanism of action, may be a valuable option in individual patients. There are few data concerning the use of anti-TNF drugs in patients with SpA but it seems that there are fewer adverse advents and higher drug survival in comparison with patients with RA.



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Can we manage lupus nephritis without chronic corticosteroids administration?

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Liz Lightstone, Andrea Doria, Hannah Wilson, Frank L. Ward, Maddalena Larosa, Joanne M. Bargman
The outcome of lupus nephritis (LN) has changed since the introduction of glucocorticoids (GCs), which dramatically reduced the mortality related to one of the most severe complications of systemic lupus erythematosus (SLE). Since the 1950′s, other immunosuppressants, including biologic drugs (i.e. rituximab) have aided in maintaining remission, preserving kidney function, but not preventing treatment-related toxicity.GCs still remain the cornerstone in the treatment of SLE, including LN, and they are widely used in clinical practice. However, GC administration represents a double-edged sword. Indeed, from one side they allow a fast and effective control of disease activity by dampening inflammation; from the other side, they have many and severe side effects leading to organ damage.In this paper, we will discuss pros and cons of the chronic use of GCs, especially focusing on LN.



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Brain diffusion tensor MRI in systematic lupus erythematosus: A systematic review

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Beatriz Lavras Costallat, Daniel Miranda Ferreira, Aline Tamires Lapa, Letícia Rittner, Lilian Tereza Lavras Costallat, Simone Appenzeller
Diffusion tensor imaging (DTI) maps the brain's microstructure by measuring fractional anisotropy (FA) and mean diffusivity (MD). This systematic review describes brain diffusion tensor Magnetic resonance imaging (MRI) studies in systemic lupus erythematosus (SLE).The literature was reviewed following the PRISMA guidelines and using the terms "lupus", "systemic lupus erythematosus", "SLE", "diffusion tensor imaging", "DTI", "white matter" (WM), "microstructural damage", "tractography", and "fractional anisotropy"; the search included articles published in English from January 2007 to April 2017. The subjects included in the study were selected according to the ACR criteria and included 195 SLE patients with neuropsychiatric manifestation (NPSLE), 299 without neuropsychiatric manifestation (non-NPSLE), and 423 healthy controls (HC). Most studies identified significantly reduced FA and increased MD values in several WM regions of both NPSLE and non-NPSLE patients compared to HC. Subclinical microstructural changes were observed in either regional areas or the entire brain in both the non-NPSLE and NPSLE groups.



http://ift.tt/2y2hOk3

Are the acr 2010 diagnostic criteria for fibromyalgia better than the 1990 criteria?

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Piercarlo Sarzi-Puttini, Fabiola Atzeni, Ignazio Francesco Masala, Fausto Salaffi, Joab Chapman, Ernest Choy
Fibromyalgia (FM) is difficult to diagnose and manage chronic pain condition whose symptoms have no clear pathophysiological cause, although it is thought that patient hypersensitivity to a range of stimuli may give rise to mechanical hyperalgesia as a result of altered central nociceptive processing. The 1990 American College of Rheumatology (ACR) classification criteria, which have been widely used in clinical practice, require the existence of chronic widespread pain (CWP) for >3months, and the presence of at least 11 out of 18 specified tender points upon digital palpation, although this latter criterion has long been criticised. The newer 2010 ACR diagnostic criteria state that FM can be defined as CWP associated with somatic symptoms, and recommend the use of a widespread pain index and a scale to rate symptom severity. A modified version of the 2010 criteria removed the physician assessment of the extent of somatic symptoms and replaced it by a summary score of three self-reported symptoms, thus making it easier to use while maintaining its sensitivity. This review discusses the advantages and limitations of all of these criteria.



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Controversies in rheumatology and autoimmunity: Approaching the truth by the discussion

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Andrea Doria, Mariele Gatto, Luca Iaccarino, Piercarlo Sarzi-Puttini




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Is undifferentiated Spondyloarthritis a discrete entity? A debate

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Atul Deodhar, Pierre Miossec, Xenofon Baraliakos
The concept of undifferentiated spondyloarthritis has been introduced recently to describe a clinical setting where the classical features of spondyloarthritis (SpA) are not fully present. Whether this is a discrete entity was the basis of a debate during the 4th International Congress on Controversies in Rheumatology & Autoimmunity held in Bologna, Italy 9–11 March 2017. The pro and con aspects of the debate are presented. The implications of the debate are important ranging from diagnostic aspects to consequences for the society and the payers.



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TiF4 incorporated into a self-etching primer in different concentrations: antimicrobial properties and effects on demineralization inhibition around the enamel-dentin/restoration interface

Publication date: Available online 3 November 2017
Source:Archives of Oral Biology
Author(s): G.L. Abbatepaulo, T.M.M.C. Gangana, E.F. Martinez, C.P. Turssi, FMG França, F.L.B. Amaral, R.T. Basting
PurposeTo evaluate the antimicrobial effect by minimum bactericidal concentration (MBC) of titanium tetrafluoride (TiF4) in an aqueous solution (AS) or incorporated into the primer (P) of a self-etching adhesive system against Streptococcus mutans (Sm) and Lactobacillus casei (Lc); the effect of dentin pre-treatment with TiF4 in an AS or incorporated into the P of CL regarding the potential to inhibit the development of carious lesions at the restoration interface.Materials and methodsFor MBC, AS or P with different concentrations (in %) of TiF4 were used (from 0.0 to 4.0). Also, 50 cavities were prepared at the enamel/dentin junction of third molars, which received the dentin pre-treatments (n=10): Clearfil SE Bond (CL); AS of 2.5%TiF4+CL (AS2.5%); AS of 4%TiF4+CL (AS4%); 2.5%TiF4 incorporated into the P (P2.5%); 4%TiF4 incorporated into the P (P4%). Cavities were restored and submitted to pH cycling for artificial caries lesions induction. Microhardness tests were performed after sectioning the restorations to assess the presence of demineralization in margins.ResultsANOVA and Tukey tests showed that TiF4 in AS presented MBC against Sm and Lc over 2.0%. TiF4 into the P of a self-ething adhesive presented MBC over 1% for Lc. For enamel, CL showed no significant differences in microhardness between the depths.ConclusionsAS had an antimicrobial effect against Sm and Lc over 2.0%. Pretreatment with AS or P did not promote inhibition of demineralization at enamel or dentin restoration interfaces.



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Preoperative pulmonary function tests before low-risk surgery in Japan: a retrospective cohort study using a claims database

Abstract

Purpose

Routine preoperative pulmonary function tests (PFTs) are not recommended prior to low-risk surgery because their prognostic value is limited. However, only a few studies have assessed the utilization of healthcare resources regarding preoperative PFTs in a real-world setting. Here, we aimed to assess the prevalence and determinant factors of preoperative PFTs before low-risk surgery in Japan.

Methods

In this retrospective cohort study, we used the nationwide insurance claims databases. Patients who underwent low-risk surgeries under general anesthesia between April 1, 2012, and March 31, 2016, were included. The primary outcome was the receipt of PFTs within 60 days before an index surgery. We performed descriptive analyses to estimate the rates of preoperative PFTs annually starting in 2012, and examined the associations between patient- and institutional-level factors and preoperative PFTs using multilevel logistic regression analyses.

Results

The cohort included 9495 procedures (8866 patients) at 1487 institutions. Preoperative PFTs were conducted before 71.8% of the procedures. The temporal trend of preoperative PFTs remained constant from 72.4% in 2012 to 72.2% in 2015. Multilevel regression analysis revealed that preoperative PFTs were associated with older age, number of beds at a medical facility, and inpatient procedures. The median institutional-specific proportion of PFTs was 75.0% (interquartile range, 14.3–100%) with wide inter-institutional variation.

Conclusions

Our analysis found that preoperative PFTs were performed before 72% of low-risk surgeries under general anesthesia. Apart from age, preoperative PFTs were determined primarily by non-medical factors. Additionally, we observed substantial institutional variation in the use of preoperative PFTs.

http://ift.tt/2lQCcCW

Place des vaccins anti-HPV aujourd’hui dans le traitement des infections génitales à HPV

Publication date: Available online 3 November 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J. Gondry




http://ift.tt/2zvgD0B

Surfactant protein D regulates caspase-8-mediated cascade of the intrinsic pathway of apoptosis while promoting bleb formation

Publication date: December 2017
Source:Molecular Immunology, Volume 92
Author(s): Pascal Djiadeu, Nicole Farmakovski, Dhia Azzouz, Lakshmi P. Kotra, Neil Sweezey, Nades Palaniyar
Surfactant-associated protein D (SP-D) is a soluble innate immune collectin present on many mucosal surfaces. We recently showed that SP-D suppresses the extrinsic pathway of apoptosis by downregulating caspase-8 activation. However, the effects of SP-D on the intrinsic pathway of apoptosis are not clearly understood. In the intrinsic pathway, cytochrome c is released by mitochondria into the cytoplasm. Oxidation of cytochrome c by cytochrome c oxidase activates the apoptosome and caspase-9 cascade. Both caspase-8- and caspase-9-mediated branches are activated in the intrinsic pathway of apoptosis; however, little is known about the relevance of the caspase-8 pathway in this context. Here we studied the effects of SP-D on different branches of the intrinsic pathway of apoptosis using UV-irradiated Jurkat T-cells. We found that SP-D does not inhibit the caspase-9 branch of apoptosis and the relevance of the caspase-8-related branch became apparent when the caspase-9 pathway was inhibited by blocking cytochrome c oxidase. Under these conditions, SP-D reduces the activation of caspase-8, executioner caspase-3 and exposure of phosphatidylserine (PS) on the membranes of dying cells. By contrast, SP-D increases the formation of nuclear and membrane blebs. Inhibition of caspase-8 confirms the effect of SP-D is unique to the caspase-8 pathway. Overall, SP-D suppresses certain aspects of the intrinsic pathway of apoptosis via reduction of caspase-8 activation and PS flipping while at the same time increasing membrane and nuclear bleb formation. This novel regulatory aspect of SP-D could help to regulate intrinsic pathway of apoptosis to promote effective blebbing and breakdown of dying cells.



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Cerebrovascular CO 2 reactivity during isoflurane-nitrous oxide anesthesia in patients with chronic renal failure

Abstract

Purpose

We assessed the cerebrovascular CO₂ reactivity (CO₂R) in chronic renal failure (CRF) patients without diabetes mellitus (DM), uncontrolled hypertension, peripheral vascular disease, or neurological disease under isoflurane-nitrous oxide anesthesia.

Methods

Forty-nine patients undergoing surgery, including 36 CRF patients (30 receiving dialysis and six pre-dialysis patients) and 13 patients without CRF (controls). Middle cerebral artery flow velocity (VMCA) was measured by transcranial Doppler ultrasonography at an end-tidal CO₂ of 35 to 45 mmHg. CO₂R was calculated as an absolute value (change in VMCA per mmHg PaCO₂) and a relative value (absolute CO₂R/baseline VMCA × 100). Factors associated with CO₂R were evaluated simultaneously.

Results

Despite no significant differences in the absolute and relative values of CO₂R between the CRF (mean 2.5 cm/s/mmHg; median 5.0%/mmHg) and control (2.4 cm/s/mmHg; 5.0%/mmHg) groups, blood urea nitrogen (BUN) concentrations in the CRF group correlated inversely with both absolute and relative CO₂R. BUN concentration was higher (mean 72 versus 53 mg/dl, p = 0.006) and relative CO₂R was lower (mean 2.6 versus 5.7%/mmHg, p = 0.011) in patients with pre-dialysis CRF (n = 6) versus CRF patients receiving dialysis (n = 30).

Conclusions

CO₂R in CRF patients was not significantly different from that in controls. However, in CRF patients with high BUN concentrations, CO₂R might be impaired, leading to reduced cerebrovascular reserve capacity. Because DM is a major cause of CRF and we excluded DM patients, our results might not be applicable to patients with DM-induced CRF.

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Seizure Triggered by Sick Sinus Syndrome

Sick sinus syndrome (SSS) is a dysfunction of sinoatrial node resulting in symptomatic bradycardia or sinus pauses causing decreased cardiac output with cerebral hypoperfusion and usually presents as syncope, presyncope or fatigue. The occurrence of a seizure is very rare. A 69-year-old man suffered two episodes of generalised tonic–clonic seizures. MRI and electroencephalogram failed to reveal the cause of seizures. In the emergency room, he experienced presyncope simultaneous to bradycardia and sinus pauses. He was stabilised with atropine and dopamine infusion and underwent definitive therapy with a permanent dual-chamber pacemaker with complete symptom resolution. Diagnostic confounders include convulsive syncope and ictal bradycardia. Syncope may be accompanied by myoclonic jerks (convulsive syncope), but postictal confusion is absent. Bradycardia may be seen during the postictal period (ictal bradycardia syndrome), but protracted sinus dysfunction is not present. Hypoperfusion due to significant SSS triggered seizures in this patient who may have an underlying predisposition.

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Metastatic melanoma: a rare cause of central airway obstruction

A middle-aged woman with recurrent malignant melanoma presented initially with massive left pleural effusion. There was a complete obliteration of the left main bronchus on flexible bronchoscopy caused by a mass. Serial cryo-debulking of the tumour was done under rigid bronchoscopy; however, the outcome was not favourable due to the aggressive tumour growth. Vemurafenib was planned after thoracic radiation. She was not keen for the biologics treatment due to financial constraints. We report a case of central airway obstruction due to recurrent aggressive melanoma. More evaluations are needed on the role of interventional pulmonologist for bronchoscopic debulking of this rapidly growing tumour as well as the role of biological agents in treating such cases.

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A rare localised nasal CD30+ primary cutaneous T-cell lymphoma following liver transplantation

Cutaneous T-cell post-transplant lymphoproliferative disorder (PTLD) is a rare clinical presentation that can potentially turn aggressive in solid-organ transplant recipients if not detected and intervened on early. We encountered a rare case of rapidly worsening primary cutaneous CD30-positive, Epstein-Barr virus-negative anaplastic large cell lymphoma (ALCL) of T-cell origin, manifesting as an isolated nasal tip lesion in a 71-year-old man 4 years after orthotopic liver transplantation. Excisional biopsy with partial rhinectomy showed subepithelial diffuse infiltration of medium-to-large lymphoid cells having round-to-irregular nuclei, partially condensed chromatin and prominent nucleoli. Immunophenotypic studies revealed CD30-positive primary cutaneous ALCL. Positron emission tomography/CT imaging revealed a locally active disease, and radiation therapy was initiated with complete response. A high index of suspicion for PTLD when evaluating skin lesions in a post-transplant patient is paramount for its early recognition, prompt diagnosis and timely intervention while the window for curative therapy remains possible.

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Palm atheroma infection caused by Raoultella planticola

Description

A 74-year-old man presented to the emergency department with pain in the left hand. He had a history of lung carcinoma and was treated with chemotherapy for 2 years. On physical examination, his left hand was found to exhibit swelling and redness. There was an atheroma at the base of his middle finger, which was the most painful area (figure 1-A,B). He was prescribed cephalexin 2 g daily and ordered to see an orthopaedic surgeon the next day. However, the next day, his left hand became worse. There was increased swelling, redness, pain and pus (figure 1-C,D). The patient was treated with surgical drainage and intravenous cefazolin 2 g daily to control the infection (figure 2). A week later, bacterial isolation analysis revealed that the causative agent was Raoultella planticola. He was switched to ceftriaxone based on sensitivities and prior literature on the...

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Anti-LGI1 encephalitis causing faciobrachial dystonic seizures

Anti-leucine-richglioma inactivated protein 1 (LGI1) encephalitis has an autoimmune origin and can be reversed with immunotherapy. It is obvious that identifying and treating this condition early is of paramount importance. We present the case of a 69-year-old man who was admitted to hospital with faciobrachial dystonic seizures and was found to have antibodies to LGI1. His symptoms started approximately 3 months prior admission to the hospital. There had also been some subtle cognitive impairment. He was treated with two courses of intravenous immunoglobulin and commenced on prednisolone 50 mg daily and clonazepam 500 µg at night. Despite these treatments, his seizures were becoming progressively more frequent and severe. He then underwent treatment with a course of plasma exchange followed by an intravenous infusion of methylprednisolone and returned to his previous baseline function.

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Intestinal spirochaetosis mimicking acute appendicitis with review of the literature

Human intestinal spirochaetosis is a well-established micro-organism existing in the colon. It is less commonly seen in the appendix, and rarely presents as acute appendicitis. We present a case of a man presenting with symptoms consistent with acute appendicitis. The literature on spirochaetosis presenting as acute appendicitis is also reviewed.

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Global health challenges in treating an elderly institutionalised patient: an oral medicine perspective

A 64-year-old institutionalised woman presented to our clinic for the management of black hairy tongue. Despite the predictable outcome in treating this disease, this case presents multiple challenges such as the patients' cognitive impairment, her family dynamics, social factors and the health system as a whole, that makes it difficult to treat.

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Frequent neck massage leading to bilateral anterior cerebral artery infarction

Description

The anterior cerebral artery (ACA) is a major vessel responsible for the blood supply to the interhemispheric regions. Infarction of the ACA territory accounts for only 0.3% to 4.4% of cerebral infarctions reported.1 The usual causes are aneurysmal rupture of the anterior communicating artery or thrombosis of the precommunal anterior cerebral artery.2 We are describing here a patient with bilateral ACA infarction due to dual pathology and frequent neck massage being the cause of this young stroke.

A 45-year-old man was admitted with sudden onset aphasia and weakness of both lower limbs with bowel–bladder incontinence. There was no history of loss of consciousness, headache, nausea or vomiting and convulsions. He had no significant medical history and no vascular risk factors. There is history of frequent neck massages from a chiropractor for relaxation purposes with visits amounting to two to four per week. There...

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Giant calvarial haemangioma with classical radiological features

Description

A 12-year-old girl presented with a large painless hard swelling in the left parietal region, gradually increasing in size for 6 years. No complaint of headache or visual disturbance was present. Radiographs showed a large expansile lytic lesion with prominent bony trabeculae radiating centrifugally from the centre of the mass. On CT scan, the lytic area showed areas of rarefaction traversed by radiating bony spicules. On MRI, the lesion was isointense to hyperintense on T1-weighted images (T1WI), hyperintense on T2WI, indenting over underlying brain parenchyma, causing mass effect and midline shift. Avid enhancement was noted on postcontrast scans (figure 1). Based on typical clinical presentation and classical radiological findings, a diagnosis of giant calvarial haemangioma was made.

Figure 1

(A) Clinical photograph showing large left parietal swelling. (B and C) Skull radiograph in frontal and lateral projections showing lytic lesion with centrifugally radiating bony trabeculae...

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The effects of microduplication 1q21.1 and in-utero isotretinoin exposure

The impact of in-utero isotretinoin exposure has been widely reported, with many affected pregnancies failing to reach term.^{1 2} Due to the low numbers of in-utero isotretinoin exposed pregnancies, the interactions between this drug and rare genetic defects such as microduplication 1q21.1 are unclear, particularly how they might manifest phenotypically. We present this case of in-utero isotretinoin exposure occurring in a child with microduplication 1q21.1. The child was born with congenital abnormalities which did not fit into a single syndrome. Regrettably in-utero exposure to isotretinoin continues to occur. We hope this case will trigger further discussion on the dangers of dispensing Isotretinoin without ensuring stringent pregnancy testing and its potential interaction with genetic abnormalities, in particular with microduplication 1q21.1.

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Safety and Effectiveness of a Bioabsorbable Steroid-Releasing Implant for the Paranasal Sinus Ostia: A Randomized Clinical Trial.

Related Articles

Safety and Effectiveness of a Bioabsorbable Steroid-Releasing Implant for the Paranasal Sinus Ostia: A Randomized Clinical Trial.

JAMA Otolaryngol Head Neck Surg. 2017 Nov 02;:

Authors: Luong A, Ow RA, Singh A, Weiss RL, Han JK, Gerencer R, Stolovitzky JP, Stambaugh JW, Raman A

Abstract
Importance: Suboptimal outcomes of endoscopic sinus surgery (ESS) are often associated with restenosis and inflammation of frontal sinus ostia. Steroid-releasing sinus implants have been shown to maintain sinus patency by minimizing inflammation and scar tissue formation. An hourglass-shaped, bioabsorbable, steroid-releasing implant was developed to provide mechanical support and optimize drug delivery to paranasal sinus ostia.
Objective: To assess the safety and efficacy of the hourglass-shaped, bioabsorbable, steroid-releasing sinus implant in improving postoperative outcomes when placed in the frontal sinus ostia (FSO) following ESS in patients with chronic rhinosinusitis (CRS).
Design, Setting, and Participants: In a prospective, multicenter, randomized clinical trial using an intrapatient control design (ESS followed by implant placement within 1 FSO vs ESS alone on the contralateral side) 80 adult patients, with a mean (SD) age of 49.5 (13.4) years and consisting of 53 (66%) men and 27 (34%) women, were enrolled and underwent bilateral frontal sinusotomies with 1 frontal sinus randomized to receive a steroid-releasing implant. The study was carried out in 12 US centers between July 2015 and March 2016.
Interventions: A bioabsorbable steroid-releasing implant with hourglass shape containing 370 µg of mometasone furoate. All patients received standardized postoperative care.
Main Outcomes and Measures: The need for postoperative interventions, medical and surgical, in the FSO at day 30, as determined based on review of video endoscopic findings by an independent blinded surgeon. Also, endoscopic grading by the independent reviewer and clinical investigators at day 30 and day 90 and computed tomographic scan at day 90.
Results: The mean (SD) age of patients was 49.5 (13.4) years, 53 (66%) were men. Implants were successfully placed in all 80 randomized treatment sinuses. At day 30, steroid-releasing implants significantly reduced the need for postoperative interventions to 11.5% compared with 32.8% by surgery alone (mean difference, -21.3%; 95% CI, -35.1% to -7.6%), as assessed by the independent reviewer. Real-time endoscopic assessment by clinical investigators at day 30 demonstrated significant reduction in need for postoperative intervention (mean difference, -17.3%; 95% CI, -27.9% to -6.7%), significant reduction in inflammation score (mean difference, -12.3 mm; 95% CI, -18.3 to -6.4 mm), and significant reduction in rate of frontal restenosis or occlusion (mean difference, -22.7%; 95% CI, -33.5% to -11.9%) on treated compared with control sides. The results favoring the treatment sides were sustained through day 90: reduced need for postoperative interventions (mean difference, -11.7%; 95% CI, -21.0% to -2.4%) and reduction in restenosis and/or occlusion of the frontal ostium (mean difference, -17.4%; 95% CI, -28.6% to -6.1%). No implant-related adverse events were observed.
Conclusions and Relevance: The hourglass-shaped steroid-releasing sinus implant was safe and more effective in maintaining FSO patency and improving surgical outcomes compared with surgery alone in the setting where no other immediate postoperative corticosteroids were administered.
Trial Registration: ClinicalTrials.gov identifier: NCT02266810.

PMID: 29098299 [PubMed - as supplied by publisher]

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Frontal Sinus Drug-Eluting Implants-Effective, but for Which Patients and at What Cost?

Related Articles

Frontal Sinus Drug-Eluting Implants-Effective, but for Which Patients and at What Cost?

JAMA Otolaryngol Head Neck Surg. 2017 Nov 02;:

Authors: Gray ST, Sedaghat AR

PMID: 29098295 [PubMed - as supplied by publisher]

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Association of Treatment at High-Volume Facilities With Survival in Patients Receiving Chemoradiotherapy for Nasopharyngeal Cancer.

Related Articles

Association of Treatment at High-Volume Facilities With Survival in Patients Receiving Chemoradiotherapy for Nasopharyngeal Cancer.

JAMA Otolaryngol Head Neck Surg. 2017 Nov 02;:

Authors: Verma V, Allen PK, Simone CB, Gay HA, Lin SH

PMID: 29098291 [PubMed - as supplied by publisher]

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Hypoglossal Nerve Stimulation in Adolescents With Down Syndrome and Obstructive Sleep Apnea.

Related Articles

Hypoglossal Nerve Stimulation in Adolescents With Down Syndrome and Obstructive Sleep Apnea.

JAMA Otolaryngol Head Neck Surg. 2017 Nov 02;:

Authors: Diercks GR, Wentland C, Keamy D, Kinane TB, Skotko B, de Guzman V, Grealish E, Dobrowski J, Soose R, Hartnick CJ

Abstract
Importance: Obstructive sleep apnea (OSA) affects up to 60% of children with Down syndrome (DS) and may persist in half of patients after adenotonsillectomy. Children with DS who have persistent OSA often do not tolerate treatment with positive pressure airway support devices or tracheotomy for their residual moderate to severe OSA. The hypoglossal nerve stimulator is an implantable device that delivers an electrical impulse to anterior branches of the hypoglossal nerve in response to respiratory variation, resulting in tongue base protrusion that alleviates upper airway obstruction in adults.
Objective: To determine whether hypoglossal nerve stimulation is safe and effective in children with DS.
Design, Setting, and Participants: Case series of the first 6 adolescents with DS to undergo hypoglossal nerve stimulator implantation. Participants were 6 children and adolescents (12-18 years) with DS and severe OSA (apnea hypopnea index [AHI] > 10 events/h) despite prior adenotonsillectomy.
Intervention: Inspire hypoglossal nerve stimulator placement.
Main Outcomes and Measures: Patients were monitored for adverse events. Adherence to therapy was measured by hours of use recorded by the device. Efficacy was evaluated by comparing AHI and OSA-18, a validated quality-of-life instrument, scores at baseline and follow-up.
Results: In 6 patients (4 male, 2 female; aged 12-18 years), hypoglossal nerve stimulator therapy was well tolerated (mean use, 5.6-10.0 h/night) and effective, resulting in significant improvement in OSA. At 6- to 12-month follow-up, patients demonstrated a 56% to 85% reduction in AHI, with an overall AHI of less than 5 events/h in 4 children and less than 10 events/h in 2 children. Children also demonstrated a clinically significant improvement (mean [SD] overall change score, 1.5 [0.6]; range, 0.9-2.3) on the OSA-18, a validated quality-of-life instrument.
Conclusions and Relevance: Hypoglossal nerve stimulation was well tolerated and effective in the study population, representing a potential therapeutic option for patients with DS and refractory OSA after adenotonsillectomy who are unable to tolerate positive pressure airway devices.
Trial Registration: clinicaltrials.gov Identifier: NCT2344108.

PMID: 29098288 [PubMed - as supplied by publisher]

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Adjuvant External Beam Radiotherapy in Locally Advanced Differentiated Thyroid Cancer.

Related Articles

Adjuvant External Beam Radiotherapy in Locally Advanced Differentiated Thyroid Cancer.

JAMA Otolaryngol Head Neck Surg. 2017 Nov 02;:

Authors: Tam S, Amit M, Boonsripitayanon M, Cabanillas ME, Busaidy NL, Gunn GB, Lai SY, Gross ND, Sturgis EM, Zafereo ME

Abstract
Importance: As incidence of differentiated thyroid cancer rises, treatment paradigms have become increasingly defined. Despite this, locally advanced disease continues to be challenging to manage. Postoperative therapy in the form of radioactive iodine (RAI) is generally recommended, but the role of external beam radiation therapy (EBRT) is less well defined.
Objective: To investigate the role of EBRT in locally advanced differentiated thyroid cancer.
Design, Setting, and Participants: For this retrospective cohort study, patients treated surgically for T4a differentiated thyroid cancer at the University of Texas MD Anderson Cancer Center from January 2000 through December 2015 were recruited, and 88 patients were included for analysis.
Exposures: Adjuvant treatment with RAI alone or both RAI and EBRT.
Main Outcomes and Measures: Disease-free survival (DFS), defined as the time from primary surgery to locoregional or distant recurrence or death due to any cause. Kaplan-Meier survival analysis was completed. Univariate and multivariate analysis was completed with Cox proportional hazards model to determine predictors of DFS.
Results: A total of 88 patients (44 women [50%]; mean [SD] age, 58.2 [15.3] years) were included in the analysis. Median (range) follow-up was 117 (12-164) months. Forty-four patients (50%) underwent RAI alone and 44 patients (50%) underwent RAI with adjuvant EBRT. Patients undergoing RAI alone did not receive EBRT owing to invasion into the recurrent laryngeal nerve only (n = 14 [32%]) or invasion into the tracheal perichondrium and/or esophageal muscularis only (n = 18 [41%]). Five-year DFS was 43% in those undergoing RAI alone, compared with 57% in those undergoing RAI and EBRT (effect size = 14%; 95% CI, -7% to 33%). Patients undergoing RAI alone had an increased rate of locoregional failure (effect size = -32%; 95% CI, -47% to -16%), with those undergoing RAI treatment alone, for minimal tracheal perichondrium and/or esophageal muscularis invasion having worse locoregional control than those with recurrent laryngeal nerve invasion only (effect size = 49%; 95% CI, 20% to 71%). Age (adjusted hazard ratio [adjusted HR], 1.02/y; 95% CI, 1.00 to 1.05) and esophageal invasion (adjusted HR, 2.30; 95% CI, 1.16 to 4.60) were independent predictors of worse DFS.
Conclusions and Relevance: The addition of EBRT to RAI results in good disease control in locally advanced differentiated thyroid cancer, particularly in patients with tracheal or esophageal invasion treated with aggressive surgical resection. Increased age and presence of esophageal invasion were independent predictors of poor disease control.

PMID: 29098272 [PubMed - as supplied by publisher]

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Information for Readers

Publication date: November 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 5





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Global issues in allergy and immunology: Parasitic infections and allergy

Publication date: November 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 5
Author(s): Alvaro A. Cruz, Philip J. Cooper, Camila A. Figueiredo, Neuza M. Alcantara-Neves, Laura C. Rodrigues, Mauricio L. Barreto
Allergic diseases are on the increase globally in parallel with a decrease in parasitic infection. The inverse association between parasitic infections and allergy at an ecological level suggests a causal association. Studies in human subjects have generated a large knowledge base on the complexity of the interrelationship between parasitic infection and allergy. There is evidence for causal links, but the data from animal models are the most compelling: despite the strong type 2 immune responses they induce, helminth infections can suppress allergy through regulatory pathways. Conversely, many helminths can cause allergic-type inflammation, including symptoms of "classical" allergic disease. From an evolutionary perspective, subjects with an effective immune response against helminths can be more susceptible to allergy. This narrative review aims to inform readers of the most relevant up-to-date evidence on the relationship between parasites and allergy. Experiments in animal models have demonstrated the potential benefits of helminth infection or administration of helminth-derived molecules on chronic inflammatory diseases, but thus far, clinical trials in human subjects have not demonstrated unequivocal clinical benefits. Nevertheless, there is sufficiently strong evidence to support continued investigation of the potential benefits of helminth-derived therapies for the prevention or treatment of allergic and other inflammatory diseases.



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Global issues in allergy and immunology: Parasitic infections and allergy

Publication date: November 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 5





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Chronic rhinosinusitis in Asia

Publication date: November 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 5
Author(s): Yuan Zhang, Elien Gevaert, Hongfei Lou, Xiangdong Wang, Luo Zhang, Claus Bachert, Nan Zhang
Chronic rhinosinusitis (CRS), although possibly overdiagnosed, is associated with a high burden of disease and is often difficult to treat in those truly affected. Recent research has demonstrated that inflammatory signatures of CRS vary around the world, with less eosinophilic and more neutrophilic inflammation found in Asia compared with Europe and North America. Although in the Western world about 80% of nasal polyps carry a type 2 signature, this might be between 20% and 60% in China and Korea or Thailand, respectively. These differences are associated with a lower asthma comorbidity and risk of disease recurrence after surgery in the Asian population. As a hallmark of severe type 2 inflammation, eosinophils attacking Staphylococcus aureus at the epithelial barrier have been described recently; they also can be found in a subgroup of Asian patients with nasal polyps. Furthermore, the percentage of type 2 signature disease in patients with CRS is dramatically increasing ("eosinophilic shift") in several Asian countries over the last 20 years. Establishing an accurate diagnosis along with considering the current and shifting patterns of inflammation seen in Asia will enable more effective selection of appropriate pharmacotherapy, surgical therapy, and eventually biotherapy. Determining the causes and pathophysiology for this eosinophilic shift will require additional research.



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Cover 1

Publication date: November 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 5





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Interleukin-1/inhibitory kappa B kinase epsilon-induced glycolysis augment epithelial effector function and promote allergic airways disease

Publication date: Available online 3 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Xi Qian, Reem Aboushousha, Cheryl van de Wetering, Shi B. Chia, Eyal Amiel, Robert W. Schneider, Jos LJ. van der Velden, Karolyn G. Lahue, Daisy A. Hoagland, Dylan T. Casey, Nirav Daphtary, Jennifer L. Ather, Matthew J. Randall, Minara Aliyeva, Kendall E. Black, David G. Chapman, Lennart K.A. Lundblad, David H. McMillan, Anne E. Dixon, Vikas Anathy, Charles G. Irvin, Matthew E. Poynter, Emiel. F.M. Wouters, Pamela M. Vacek, Monique Henket, Florence Schleich, Renaud Louis, Albert van der Vliet, Yvonne M.W. Janssen-Heininger
BackgroundEmerging studies suggest that enhanced glycolysis accompanies inflammatory responses. Virtually nothing is known about the relevance of glycolysis in allergic asthma.ObjectivesHere we sought to determine if glycolysis is altered in allergic asthma and to address its importance in the pathogenesis of allergic asthma.MethodsWe examined alterations in glycolysis in sputum samples from asthmatics and primary human nasal cells, and used murine models of allergic asthma as well as primary mouse tracheal epithelial cells to evaluate the relevance of glycolysis.ResultsIn a murine model of allergic asthma, glycolysis was induced in the lungs in an IL-1-dependent manner. Furthermore, administration of IL-1β into airways stimulated lactate production and expression of glycolytic enzymes, with notable expression of lactate dehydrogenase A occurring in the airway epithelium. Indeed, exposure of mouse tracheal epithelial cells to IL-1β or IL-1α resulted in increased glycolytic flux, glucose usage, expression of glycolysis genes, and lactate production. Enhanced glycolysis was required for IL-1β- or IL-1α-mediated pro-inflammatory responses and the stimulatory effects of IL-1β on HDM-induced release of TSLP, and GM-CSF from tracheal epithelial cells. Inhibitor of κB kinase ε was downstream of house dust mite (HDM) or IL-1β, and was required for HDM-induced glycolysis and the pathogenesis of allergic airways disease. SiRNA-ablation of lactate dehydrogenase A attenuated HDM-induced increases in lactate and attenuated HDM-induced disease. Primary nasal epithelial cells from asthmatics intrinsically produced more lactate as compared to cells from healthy subjects. Lactate content was significantly higher in sputum supernatants from asthmatics, notably those patients with >61% neutrophils. A positively correlation was observed between sputum lactate and IL-1β, and lactate content negatively correlated with lung function.ConclusionsCollectively, these findings demonstrate that IL-1β/IKKε signaling plays an important role in HDM-induced glycolysis and the pathogenesis of allergic airways disease.

Graphical abstract

Teaser

IL-1 and IKKε play important roles in HDM-induced glycolysis and the pathogenesis of allergic airways disease, and lactate is a potential biomarker for increased glycolysis and IL-1-associated pro-inflammatory signals in airways of asthmatics.


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The Editors' Choice

Publication date: November 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 5
Author(s): Cezmi A. Akdis, Zuhair K. Ballas




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News Beyond Our Pages

Publication date: November 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 5
Author(s): Marc E. Rothenberg, Jean Bousquet




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Table of Contents

Publication date: November 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 5





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CME Activities Calendar

Publication date: November 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 5





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Brief Overview of This Month's JACI

Publication date: November 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 5





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Editorial Board

Publication date: November 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 5





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News & Notes

Publication date: November 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 5





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Risk factors for asthma after infant bronchiolitis

Abstract

Background

Five studies carried out after bronchiolitis at less than 24 months of age, with a follow up of more than 10 years, reported that atopic dermatitis, family asthma, early-life exposure to tobacco smoke and rhinovirus aetiology were early-life risk factors for later asthma. This study evaluated the long-term outcome at 11-13 years of age of children who were hospitalised for bronchiolitis in early infancy.

Methods

We previously prospectively followed 166 children hospitalised for bronchiolitis at less than six months of age until 5-7 years of age. The current study included a structured questionnaire, parental interviews, clinical examinations and bronchodilation test of 138 of those children at 11-13 years of age.

Results

Respiratory syncytial virus caused 66% of the bronchiolitis cases and nearly half of the patients were exposed to tobacco smoke in early life. Doctor-diagnosed asthma was present in 13% of the former bronchiolitis patients at 11-13 years of age. Maternal asthma was the only independently significant risk factor in early life (adjusted OR 3.45, 95% CI 1.07-11.74), as was allergic rhinitis at 5-7 years of age (adjusted OR 4.06, 95% CI 1.35-12.25).

Conclusions

After bronchiolitis at less than six months of age, the risk of doctor-diagnosed asthma at 11-13 years was about twice that of the general Finnish population. Maternal asthma was the only independently significant early-life risk factor for current asthma at 11-13 years of age.

This article is protected by copyright. All rights reserved.

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The Tension Biology of Wound Healing

Summary

Following skin wounding, the healing outcome can be; regeneration, repair with normal scar tissue, repair with hypertrophic scar tissue, or the formation of keloids. The role of chemical factors in wound healing has been extensively explored, and while there is evidence suggesting the role of mechanical forces, its influence is much less well defined. Here we provide a brief review on the recent progress of the role of mechanical force in skin wound healing by comparing laboratory mice, African spiny mice, fetal wound healing, and adult scar keloid formation. A comparison across different species may provide insight into key regulators. Interestingly, some findings suggest tension can induce an immune response, and this provides a new link between mechanical and chemical forces. Clinically, manipulating skin tension has been demonstrated to be effective for scar prevention and treatment, but not for tissue regeneration. Utilizing this knowledge, specialists may modulate regulatory factors and develop therapeutic strategies to reduce scar formation and promote regeneration.

This article is protected by copyright. All rights reserved.

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TNF stimulates IL-6, CXCL8 and VEGF secretion from human keratinocytes via activation of mTOR, inhibited by tetramethoxyluteolin

Abstract

Psoriasis is an autoimmune skin disease characterized by keratinocyte hyper-proliferation and chronic inflammation. The pathogenesis of psoriasis involves pro-inflammatory cytokines, such as tumor necrosis factor (TNF), but the mechanism of keratinocyte activation is not well understood. Here we show that TNF (10 or 50 ng/mL) stimulates significant (p<0.0001) gene expression and secretion of pro-inflammatory IL-6, CXCL8 and VEGF from both cultured human HaCaT and normal epidermal human keratinocytes (NHEKs). This effect occurs via activation of the mammalian target of rapamycin (mTOR) signaling complex as shown by Western Blot analysis and phospho-ELISAs. Pre-treatment with the novel natural flavonoid tetramethoxyluteolin (10-100 μM) significantly (p<0.0001) inhibits gene expression and secretion (p<0.0001) of all three mediators in a concentration-dependent manner. Moreover, tetramethoxyluteolin (50 μM) appears to be a potent inhibitor of the phosphorylated mTOR substrates (pmTOR^Ser2448, pp70S6K^Thr389 and p4EBP1^Thr37/46) as compared to known mTOR inhibitors in keratinocytes. The present findings indicate that TNF stimulates skin inflammation via mTOR signaling. Inhibition by tetramethoxyluteolin, may be used in the treatment of psoriasis.

This article is protected by copyright. All rights reserved.

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A somewhat unexpected result from the deconvolution of DSC-curves for human hair: There is no apparent relation between cortical cell fractions and hair curliness

Abstract

A deconvolution process has been developed for curves obtained by Differential Scanning Calorimetry in water for Merino wool and the main ethnic hair types. This enables estimation of the fractions of ortho- and para-type cell groups. The results also indicate that hair may contain a further, low-sulphur sub-group of ortho-type cells. The sizes of the major cell fractions are in line with expectations from microscopical investigations. The fractions are comparable for hair types and no consistent association between cell type fractions and hair curvature is observed.

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Standardization of regimens in Narrow-band UVB and PUVA in early stage Mycosis Fungoides: position paper from the Italian Task Force for Cutaneous Lymphomas

Abstract

UV- based (PUVA and Narrow Band UVB) phototherapy is broadly and commonly used in the treatment of Cutaneous T-cell Lymphomas (CTCL), yet unfortunately the evidence for the efficacy of these treatments is based only on cases series or prospective but non-randomized studies. Therefore, no internationally approved guidelines exists and no standardization of schedules have been proposed. Recently, Consensus guidelines have been published by the United States Cutaneous Lymphoma Consortium. The aim of this paper is to review the biologic and clinical evidences on PUVA and NB UVB in CTCL, and to critically evaluate acceptability and feasibility of these guidelines in the real-life setting from the perspective of the Cutaneous Lymphoma Task Force of the Italian Lymphoma Foundation (Fondazione Italiana Linfomi, FIL).

This article is protected by copyright. All rights reserved.

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Who Benefits from Universal Childcare? Estimating Marginal Returns to Early Childcare Attendance

Schoenberg, U; Dustmann, C; Cornelissen, T; Raute, A; (2017) Who Benefits from Universal Childcare? Estimating Marginal Returns to Early Childcare Attendance. Journal of Political Economy (In press).

http://ift.tt/2zwvTdB

Air flow and pollution in a real, heterogeneous urban street canyon: A field and laboratory study

Karra, S; Malki-Epshtein, L; Neophytou, MK-A; (2017) Air flow and pollution in a real, heterogeneous urban street canyon: A field and laboratory study. Atmospheric Environment , 165 pp. 370-384. 10.1016/j.atmosenv.2017.06.035 .

http://ift.tt/2zkhekO

Reactive control of a two-body point absorber using reinforcement learning

Anderlini, E; Forehand, DIM; Bannon, E; Xiao, Q; Abusara, M; (2017) Reactive control of a two-body point absorber using reinforcement learning. Ocean Engineering 10.1016/j.oceaneng.2017.08.017 . (In press). Green open access

http://ift.tt/2zuJbHz

Queering architectural history

Pilkey, BS; (2016) Queering architectural history. Lobby , 2 Clai (Spring) pp. 128-129.

http://ift.tt/2zgDtIx

Multi-modal phase-based micro-tomography with non-micro-focal laboratory sources

Vittoria, FA; Endrizzi, M; Kallon, GK; Hagen, CK; Iacoviello, F; De Coppi, P; Olivo, A; (2017) Multi-modal phase-based micro-tomography with non-micro-focal laboratory sources. Physical Review Applied (In press).

http://ift.tt/2zym1jy

Consumption and investment in resource pooling family networks

Angelucci, M; De Giorgi, G; Rasul, I; (2017) Consumption and investment in resource pooling family networks. The Economic Journal 10.1111/ecoj.12534 . (In press).

http://ift.tt/2zgDpZj

Global position paper on cardiovascular regenerative medicine

Fernández-Avilés, F; Sanz-Ruiz, R; Climent, AM; Badimon, L; Bolli, R; Charron, D; Fuster, V; ... TACTICS Working Group, ; + view all Fernández-Avilés, F; Sanz-Ruiz, R; Climent, AM; Badimon, L; Bolli, R; Charron, D; Fuster, V; Janssens, S; Kastrup, J; Kim, HS; Lüscher, TF; Martin, JF; Menasche, P; Simari, RD; Stone, GW; Terzic, A; Willerson, JT; Wu, JC; TACTICS Working Group, ; - view fewer (2017) Global position paper on cardiovascular regenerative medicine. European Heart Journal , 38 (33) pp. 2532-2546. 10.1093/eurheartj/ehx248 . Green open access

http://ift.tt/2zwiVg4

Reactive control of a wave energy converter using artificial neural networks

Anderlini, E; Forehand, DIM; Bannon, E; Abusara, M; (2017) Reactive control of a wave energy converter using artificial neural networks. International Journal of Marine Energy , 19 (C) pp. 207-220. 10.1016/j.ijome.2017.08.001 . Green open access

http://ift.tt/2zkeVi1

Reducing depressive symptoms after the Great East Japan Earthquake in older survivors through group exercise participation and regular walking: A prospective observational study

Tsuji, T; Sasaki, Y; Matsuyama, Y; Sato, Y; Aida, J; Kondo, K; Kawachi, I; (2017) Reducing depressive symptoms after the Great East Japan Earthquake in older survivors through group exercise participation and regular walking: A prospective observational study. BMJ Open , 7 (3) , Article e013706. 10.1136/bmjopen-2016-013706 . Green open access

http://ift.tt/2zwvSq3

Advancing trial design in progressive multiple sclerosis

Fox, RJ; Chataway, J; (2017) Advancing trial design in progressive multiple sclerosis. Multiple Sclerosis Journal , 23 (12) pp. 1573-1578. 10.1177/1352458517729768 . Green open access

http://ift.tt/2zjnaLd

Building a light-sheet microscope to study the early development of the polyclad flatworm Maritigrella crozieri (Hyman, 1939)

Girstmair, Johannes; (2017) Building a light-sheet microscope to study the early development of the polyclad flatworm Maritigrella crozieri (Hyman, 1939). Doctoral thesis , UCL (University College London).

http://ift.tt/2zwiQZO

The Inter-relationship of Adolescent Unhappiness and Parental Mental Distress

Webb, E; Panico, L; Bécares, L; McMunn, A; Kelly, Y; Sacker, A; (2017) The Inter-relationship of Adolescent Unhappiness and Parental Mental Distress. Journal of Adolescent Health , 60 (2) pp. 196-203. 10.1016/j.jadohealth.2016.10.001 . Green open access

http://ift.tt/2ziyBTd

Economic evaluation of HIV pre-exposure prophylaxis among men-who-have-sex-with-men in England in 2016

Ong, KJ; Desai, S; Field, N; Desai, M; Nardone, A; van Hoek, AJ; Gill, ON; (2017) Economic evaluation of HIV pre-exposure prophylaxis among men-who-have-sex-with-men in England in 2016. Euro Surveillance , 22 (42) , Article pii=17-00192. 10.2807/1560-7917.ES.2017.22.42.17-00192 . Green open access

http://ift.tt/2zwrEyP

To sleep or not to sleep during deep brain stimulation surgery for Parkinson disease?

Aziz, TZ; Hariz, M; (2017) To sleep or not to sleep during deep brain stimulation surgery for Parkinson disease? [Editorial comment]. Neurology , 89 pp. 1-2. 10.1212/WNL.0000000000004635 .

http://ift.tt/2zj9jUX

The Global Boundary Stratotype Section and Point (GSSP) for the base of the Albian Stage, of the Cretaceous, the Col de Pré-Guittard section, Arnayon, Drôme, France

Kennedy, JW; Gale, AS; Huber, BT; Petrizzo, MR; Bown, P; Jenkyns, HC; (2017) The Global Boundary Stratotype Section and Point (GSSP) for the base of the Albian Stage, of the Cretaceous, the Col de Pré-Guittard section, Arnayon, Drôme, France. Episodes , 40 (3) pp. 177-188. 10.18814/epiiugs/2017/v40i3/017021 . Green open access

http://ift.tt/2zwiNNC

Design, synthesis and characterisation of novel materials for photocatalytic water splitting

Glover, EN; (2017) Design, synthesis and characterisation of novel materials for photocatalytic water splitting. Doctoral thesis , UCL (University College London). Green open access

http://ift.tt/2zkbM1B

Simultaneous Remote Observations of Intense Reconnection Effects by DMSP and MMS Spacecraft during a Storm-time Substorm

Varsani, A; Nakamura, R; Sergeev, VA; Baumjohann, W; Owen, CJ; Petrukovich, AA; Yao, Z; ... Ergun, R; + view all Varsani, A; Nakamura, R; Sergeev, VA; Baumjohann, W; Owen, CJ; Petrukovich, AA; Yao, Z; Nakamura, TKM; Kubyshkina, MV; Sotireli, T; Burch, JL; Genestreti, KJ; s, ZVR; Andriopoulou, M; Gershman, DJ; Avanov, LA; Magnes, W; Russell, CT; Plaschke, F; Khotyaintsev, YV; Giles, BL; Coffey, VN; Dorelli, J; Strangeway, RJ; Torbert, RB; Lindqvist, P-A; Ergun, R; - view fewer (2017) Simultaneous Remote Observations of Intense Reconnection Effects by DMSP and MMS Spacecraft during a Storm-time Substorm. Journal of Geophysical Research: Space Physics 10.1002/2017ja024547 . (In press). Green open access

http://ift.tt/2zuJaU1

Regularised inference for changepoint and dependency analysis in non-stationary processes

Gibberd, Alexander James; (2017) Regularised inference for changepoint and dependency analysis in non-stationary processes. Doctoral thesis , UCL (University College London).

http://ift.tt/2zjBqU7

Retirement and mental health: Dose social participation mitigate the association? A fixed-effects longitudinal analysis

Shiba, K; Kondo, N; Kondo, K; Kawachi, I; (2017) Retirement and mental health: Dose social participation mitigate the association? A fixed-effects longitudinal analysis. BMC Public Health , 17 , Article 526. 10.1186/s12889-017-4427-0 . Green open access

http://ift.tt/2zwiL8s

2D IR spectroscopy of high-pressure phases of ice

Tran, H; Cunha, AV; Shephard, JJ; Shalit, A; Hamm, P; Jansen, TLC; Salzmann, CG; (2017) 2D IR spectroscopy of high-pressure phases of ice. Journal of Chemical Physics , 147 (14) , Article 144501. 10.1063/1.4993952 . Green open access

http://ift.tt/2zjsgH1

Parenchymal asbestosis due to primary asbestos exposure among ship-breaking workers: report of the first cases from Bangladesh

We report for the first time asbestosis among ship-breaking workers of Sitakunda in Bangladesh who were exposed to asbestos during ship-based and beach-based operations for at least 10 years. Asbestosis was present among 35% of workers. Years of work (>20) and forced vital capacity (<80% of predicted) were significantly associated with the disease. Currently, global ship-breaking operations are mainly concentrated in the Indian subcontinent, and Bangladesh has the majority share. Ninety per cent of domestic steel is produced in the ship-breaking operations in Bangladesh and is an important contributor to the economy. It also gives employment to more than 100 000 people. It is imperative to medically check up all the workers for benign and malignant diseases causally related to asbestos among these vulnerable population of workers.

http://ift.tt/2xYU7ZR

Postprandial angina: not always due to stenotic coronary artery disease

Description

A 68-year-old man presented with history of postprandial angina for 6 months. He was a diabetic and hypertensive for 10 years. He was also a reformed smoker with 20 pack-years history of smoking. He did not give any history of acute coronary syndrome or any cardiac catheterisation. Clinical examination was unremarkable. ECG and chest X-ray were normal. Echocardiography revealed normal left ventricular function with features of left ventricular hypertrophy.

Coronary angiography revealed abnormal spillage of contrast in the left ventricular apical region with each diastole from obtuse marginal (OM) branch of left circumflex coronary artery (LCx) and distal part of left anterior descending coronary artery (LAD) suggestive of coronary–cameral fistula (CCMF) (figure 1, figure 2, online ). Coronary angiography did not show any signs of atherosclerotic coronary artery disease. Absence of dilated communicative fistulous tracts between the coronary arteries and the drainage chamber was...

http://ift.tt/2zeFEui

Delayed ischemic stroke due to stent marker band occlusion after stent-assisted coiling

A middle-aged patient with an internal carotid-posterior communicating artery aneurysm and basilar artery tip aneurysm was treated by stent-assisted coiling. One ischemic infarction and two transient ischemic attacks occurred with the same symptoms (inability to walk unassisted and tendency to fall to the left) during the first 2 years post-treatment. The ischemic infarction was found in the right side of the pons, consistent with the vascular territory of the stent-containing vessel. The cause of the delayed ischemic stroke was investigated on DSA and cone beam CT, which revealed that the proximal end of the stent, one marker band, was just covering a small perforating artery of the basilar artery trunk. The present case suggests that marker band occlusion can induce delayed ischemic stroke. To prevent this complication, it is important to evaluate the perforating vessels preoperatively and carefully deploy a stent for the marker band to avoid occlusion of large perforating vessels. Post-treatment evaluation is also important because dual antiplatelet therapy will be required for a longer period if an artery is occluded by a marker band.

http://ift.tt/2y2bYyP

Fatal delayed haemolytic transfusion reaction in a patient without previous transfusions but with an obstetric history of 13 pregnancies

Delayed haemolytic transfusion reaction is a rare, life-threatening complication of blood transfusion that has been typically described among patients with sickle cell disease (SCD) due to alloimmunisation induced by their exposure to red blood cell antigens through recurrent transfusions. We report the case of a patient who suffered from fatal delayed haemolytic transfusion reaction (DHTR) occurring 1 week after blood transfusion. Indirect antiglobulin testing confirmed the presence of anti-Kell antibodies that were absent in the pretransfusion sample. The patient did not receive blood transfusions in the past, but her obstetric history was remarkable for 13 pregnancies. Although DHTR occurs more commonly among patients with SCD, this type of reaction can occur in any patient who is able to mount an immune response. We would to like to draw the attention of physicians to this rare and potentially lethal complication of blood transfusion, especially in grand multiparous women.

http://ift.tt/2zeFC5E

Hepatic epithelioid haemangioendothelioma (HEHE): a diagnostic dilemma between haemangioma and angiosarcoma

We present a case of a 77-year-old male patient with a liver tumour diagnosed as hepatic epithelioid haemangioendothelioma (HEHE), a potentially malignant tumour treated with liver resection. The patient is disease-free 3 years after resection. Imaging features using fludeoxyglucose F 18 positron emission tomography CT and MRI with gadoxic acid as well as histopathological findings are discussed.

http://ift.tt/2xYSmvu

Urinary tract aspergillosis in a patient with chronic kidney disease

Invasive aspergillosis is a life-threatening fungal infection, especially in immunocompromised patients. Pulmonary aspergillosis is the most common type of the infection, while urinary tract infection is relatively rare. Here, we describe a case of a 46-year-old man with chronic renal disease presenting with intermittent abdominal pain. The diagnosis of aspergillosis was established by pathological findings of the fungal ball in the bladder. The patient underwent multiple antimicrobial treatments and surgical interventions and was finally cured by posaconazole.

http://ift.tt/2zciHYo

Cabergoline-induced fibrosis of prolactinomas: a neurosurgical perspective

Presently, the standard of care for prolactinomas, a type of pituitary adenoma, is dopaminergic agents such as bromocriptine and cabergoline. However, dopaminergic agents may induce fibrosis of cardiac valves leading to valvular insufficiency, necessitating surgical treatment of prolactinoma. Fibrosis of prolactinoma can be induced by prolonged medical treatment with bromocriptine, and this usually occurs after years of treatment. In comparison to bromocriptine, there have been no reports of cabergoline-induced fibrosis of prolactinoma. There is a potential for greater emphasis to be placed on assessing the tumour consistency from preoperative MRI scans, or even preoperative contrast-enhanced 3D Fast Imaging Employing Steady-state Acquisition imaging to allow better planning of the surgery. We report a rare case of fibrosis of prolactinoma after cabergoline treatment resulting in its subsequent difficult surgical removal. This patient had early MRI changes of fibrosis of prolactinoma after a short period of 6 months of cabergoline treatment.

http://ift.tt/2y0Zp7e

Inflammatory optic disc neovascularisation managed with oral steroids/immunosuppressants and intravitreal ranibizumab

Inflammatory optic disc neovascularisation (NVD) has been treated with periocular or systemic steroids, immunosuppressants, panretinal photocoagulation and bevacizumab. However, the role of intravitreal ranibizumab in inflammatory NVD has not been explored in the peer-reviewed indexed literature. In case 1, NVD and associated subhyaloid haemorrhage showed rapid and dramatic regression after intravitreal ranibizumab. Recurrence was noted 8 weeks after injection which was managed by oral steroids. In case 2, intravitreal ranibizumab led to partial resolution of NVD. The addition of steroids, azathioprine and panretinal photocoagulation led to further fibrosis of the neovascularisation. Ranibizumab may be an important adjunct to anti-inflammatory therapy in the management of inflammatory NVD.

http://ift.tt/2zc6buF

Delayed-onset heparin-induced skin necrosis: a rare complication of perioperative heparin therapy

An uncommon case of delayed-onset dalteparin-induced skin necrosis in an 83-year-old Caucasian female patient associated with heparin-induced thrombocytopaenia (HIT) presenting on day 30 following dalteparin therapy is reported. Investigations revealed mild thrombocytopaenia with normal protein C, protein S, coagulation screen and positive test for heparin–platelet factor-4 antibody. Clinical diagnosis of heparin-induced skin necrosis with HIT was made. Dalteparin injection was discontinued promptly and substituted with fondaparinux therapy. The patient achieved good recovery following cessation of dalteparin therapy and was subsequently discharged.

http://ift.tt/2hcihN9

Giant phaeochromocytoma presenting with an acute stroke: reappraising phaeochromocytoma surveillance for the neurofibromatosis type 1 phakomatosis

Neurofibromatosis type 1 (NF1) is a multisystem genetic disorder associated with reduced lifespan attributed largely to malignancy and vascular causes. One of the tumours associated with NF1 is phaeochromocytoma. The phaeochromocytoma has earned the moniker, a 'great mimicker', due to its varied means of presentation. We present a patient with NF1 who was diagnosed with a giant 20 cm phaeochromocytoma after suffering from an ischaemic stroke. Current guidelines do not advocate surveillance of phaeochromocytoma in asymptomatic patients with NF1, unlike other genetic syndromes associated with phaeochromocytoma. However, there is increasing evidence that this approach may not help in the early detection and treatment of this potentially life-threatening disease. Our patient remained hypertensive after surgery despite achieving biochemical cure. The suggested chronicity of the underlying tumour in our patient is a reminder to practising clinicians to rethink our strategy in identifying phaeochromocytoma in adults with NF1.

http://ift.tt/2ze5kJW

Spontaneous subdural haematoma in a paediatric patient on anticoagulant therapy

Description

A 5-year old girl with congenital mitral and subaortic stenosis on anticoagulant therapy since her mechanical mitral valve replacement, and a remote history of idiopathic intrahepatic cholestasis requiring liver transplantation presented with jaundice and pruritus. She was found to have elevated transaminases, and an echocardiogram revealed significantly increased right ventricular pressures concerning for pulmonary hypertension. Subsequently, the patient needed to be intubated for respiratory insufficiency and poor cardiac output. After several days in the intensive care unit (ICU), she was noted to be bradycardic and have a dilated right pupil. A stat CT of the head demonstrated a large mixed density right-sided subdural haematoma with mass effect, midline shift and early uncal and transtentorial herniation, as well as a small subdural haematoma on the left (figure 1). The mixed density of the haematoma on CT scan was likely a result of multiple haemorrhages over the...

http://ift.tt/2hcie3V

Missed opportunity to diagnose subungual melanoma: potential pitfalls!

Subungual melanoma, an uncommon form of acral melanoma that arises within the nail matrix, accounts for 1%–3% of all cutaneous melanoma in Caucasians. As subungual melanoma presents in a more disguised manner than cutaneous lesions, increased vigilance is required. It most commonly presents as a discolouration of the nail, nail splitting or nail-bed bleeding. Black pigmentation of the adjacent nail fold, termed Hutchinson's sign, may be a diagnostic clue. Treatment of subungual melanoma remains surgical with wide local excision and amputation primary modalities. We present the case of a 61-year-old man with an 18-month history of a left thumb nail-bed abnormality and a 6-week history of left axillary lymphadenopathy. One year earlier, he presented to the emergency department with a purulent discharge from his left thumb but declined nail-bed ablation. He was referred to the 'Hand and Plastic Injuries Clinic' by his general practitioner and diagnosed with a chronic traumatic-induced nail-bed injury. As his symptoms did not improve, he was referred to the 2-week wait Skin Cancer Clinic. The left thumb nail-bed was excised as a nail unit down to bone, and the diagnosis of melanoma was rendered. Left axillary lymphadenopathy was confirmed as metastatic melanoma. He underwent amputation of his left thumb at the interproximal phalangeal joint, and a left axillary node dissection was performed. No residual melanoma was identified in his thumb. Microscopically, his left axillary dissection confirmed 9 out of 36 positive nodes for metastatic melanoma with extracapsular spread. He was staged at IIIC disease. This case report demonstrates missed opportunities to diagnose subungual melanoma and acts as a cautionary tale in considering this pathology in the differential diagnosis of nail-bed lesions with prompt referral for further investigation.

http://ift.tt/2zcmZS5