Ausschreibung Thieme Teaching Award 2018

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 663-663
DOI: 10.1055/s-0043-118833

Georg Thieme Verlag KG Stuttgart · New York

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Perioperatives Vorhofflimmern: Alter und Art der Operation beeinflussen Inzidenz

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 658-658
DOI: 10.1055/s-0043-117035

Georg Thieme Verlag KG Stuttgart · New York

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Ambulante Anästhesie: Grenzen und Möglichkeiten

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 666-678
DOI: 10.1055/s-0042-120247

Ambulante Operationen werden künftig zunehmend nachgefragt werden – Ursachen sind u. a. die alternde Bevölkerung und die finanzielle Lage der Krankenkassen. Der Beitrag geht ausführlich auf Begleiterkrankungen ein, bei denen die Entscheidung ambulant oder stationär sorgfältig abgewogen werden muss. Darüber hinaus nimmt er die betriebs- und volkswirtschaftlichen Grenzen und Möglichkeiten des ambulanten Operierens unter die Lupe.
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Georg Thieme Verlag KG Stuttgart · New York

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Der zerebrale Notfall – wichtige anästhesiologische Aspekte

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 716-725
DOI: 10.1055/s-0042-120989

Der zerebrale Notfall ist eine häufige Notfallsituation – und das Gehirn unterscheidet sich durch seine Unersetzbarkeit und minimale Ischämietoleranz von allen anderen Organen. Dieser Beitrag verwendet bewusst den Begriff des zerebralen Notfalls und will sich so von einzelnen Erkrankungsbildern lösen. Der Fokus liegt auf der anästhesiologischen Praxis, aber auch auf dem „Notfall in uns", den jeder Notfall für das Behandlungsteam bedeuten kann.
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Georg Thieme Verlag KG Stuttgart · New York

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Paravertebrale Katheteranalgesie – wirksame Alternative zum Kaudalblock

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 660-660
DOI: 10.1055/s-0043-112726

Georg Thieme Verlag KG Stuttgart · New York

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Ambulante Anästhesie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 664-665
DOI: 10.1055/s-0043-118408

Georg Thieme Verlag KG Stuttgart · New York

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Langzeitversorgung von Patienten verbessern

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 662-663
DOI: 10.1055/s-0043-118974

Georg Thieme Verlag KG Stuttgart · New York

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Einfühlsame Ärzte sind die besseren Ärzte

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 662-662
DOI: 10.1055/s-0043-118976

Georg Thieme Verlag KG Stuttgart · New York

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Geburtshilfliche Anästhesie: Altbewährtes, Kontroversen und neue Perspektiven – Teil 1

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 727-736
DOI: 10.1055/s-0043-104921

In der „Whatʼs New in Obstetric Anesthesia" Lecture, die jedem an der anästhesiologischen Kreißsaalversorgung Interessierten in abgedruckter Form sehr ans Herz gelegt werden kann, werden seit 1975 durch die Society for Obstetric Anesthesia and Perinatology die im Rahmen des Annual Meeting als relevant für die klinische Versorgung erachteten Vorträge zusammengefasst. Nach dem Tode von Gerard W. Ostheimer, Professor of Anesthesiology im Brigham and Womenʼs Hospital in Boston, Massachusetts, wurde sie zur Gerard W. Ostheimer „Whatʼs New in Obstetric Anesthesia" Lecture umbenannt, um dessen Beiträge zur Regionalanästhesie und geburtshilflichen Anästhesie zu würdigen. Jedes Jahr gewährt die von ausgewählten Fachvertretern gehaltene Veranstaltung und ihr Abdruck in namhaften Anästhesie-Journalen Einblick in eine kritische Würdigung rezenter Literatur und die möglichen Konsequenzen für – aber nicht nur – die anästhesiologische Kreißsaalpraxis.Eine ähnliche Veranstaltung hat in Deutschland seit über 16 Jahren Tradition: Das Geburtshilfliche Anästhesiesymposium des Wissenschaftlichen Arbeitskreises Regionalanästhesie und Geburtshilfliche Anästhesie. Anders als in den von Einzelpersonen gehaltenen Vortragsveranstaltungen werden „Evergreens" oder „Hot Topics" der anästhesiologischen Kreißsaalversorgung in regelmäßigem Zyklus oder aus aktuellem Anlass aufgegriffen, präsentiert und vor allem diskutiert. In den Vortragsveranstaltungen offenbart sich oft wesentlich früher als in traditionellen Lehrbuchkapiteln der subtile Wandel in Hinblick auf die diskutierten Themen.Der 2-teilige Beitrag fasst das Symposium 2016 zusammen, stellt jedoch keine offizielle Meinungsbekundung seitens des Arbeitskreises dar. Teil 1 geht auf mütterliche Todesursachen während Schwangerschaft, Geburt und Stillzeit sowie strukturelle Voraussetzungen im Kreißsaal, Adipositas in der Schwangerschaft und Sepsis bei der Schwangeren und im Wochenbett ein. Teil 2 behandelt etablierte Standards und neue Perspektiven im Rahmen der geburtshilflichen Analgesie und Anästhesie bezüglich Epiduralanalgesie, postpunktionellem Kopfschmerz, Anästhesie und Analgesie während und nach Sectio, hämodynamischem Monitoring und postpartaler Blutung.
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Georg Thieme Verlag KG Stuttgart · New York

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Analgosedierung bei OSA-Patienten: Ist der Standard hier sinnvoll?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 645-648
DOI: 10.1055/s-0043-114467

Georg Thieme Verlag KG Stuttgart · New York

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Katastrophenmedizin in und außerhalb der Klinik: auf das Ungeplante vorbereitet sein

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 588-593
DOI: 10.1055/s-0043-116913

Georg Thieme Verlag KG Stuttgart · New York

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Differences in medication adherence are associated with beliefs about medicines in asthma and COPD

Adherence to medication is crucial for achieving treatment control in chronic obstructive lung diseases. This study refers to the "necessity-concerns framework" and examines the associations between beliefs a...

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Nephrotic syndrome and acute kidney injury induced by malathion toxicity

We treated a case of acute kidney injury and nephrotic syndrome after malathion inhalation. A 69-year-old Japanese man presented with oedema 15 days after inhalation of malathion, a widely used pesticide. Serum albumin was 2.4 g/dL, urinary protein 8.6 g/gCr and serum creatinine 2.5 mg/dL. Kidney biopsy revealed tubular cell damage, epithelial cell damage in glomeruli and diffuse foot process effacement in electron microscopy. Acute kidney injury progressed to treatment with dialysis. Renal function recovered after corticosteroid administration from the 43rd day after admission. Malathion inhalation should be ruled out as a differential diagnosis in individuals who develop acute kidney injury and nephrotic syndrome, especially in rural-dwelling patients.

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Radiation retinopathy treated successfully with aflibercept

Aflibercept (aflibercept) is a novel anti-vascular endothelial growth factor drug indicated for wet age-related macular degeneration and macular oedema secondary to retinal vein occlusion and diabetic macular oedema. While only newly introduced on the market, it is growing in popularity and over 5.5 million doses have been prescribed worldwide. Due to its versatile mechanism, it is indicated for numerous eye pathologies, and in particular, has been adapted to treat various types of retinopathy. To our knowledge, this is the first case report of solely using aflibercept to treat cystoid macular oedema in radiation retinopathy.

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Eosinophilic oesophagitis and coeliac disease: is there an association?

A 25-year-old man was seen in outpatient clinic for progressive solid food dysphagia. He was already medicated with a proton pump inhibitor with no improvement. His blood tests showed a slight microcytic anaemia and peripheral eosinophilia. The oesophago-gastro-duodenoscopy showed longitudinal furrows in the distal two-thirds of the oesophagus and a concentric distal stenosis. The biopsies taken showed eosinophilic infiltrates consistent with eosinophilic oesophagitis. There was no improvement with topical fluticasone, so the patient was started on a systemic corticosteroid with resolution of dysphagia and of the oesophageal stenosis. He was kept on topical steroids for symptomatic control. On repeat endoscopy, the duodenal mucosa showed multiple papules that were biopsied. Histology showed features consistent with coeliacdisease. The patient was asymptomatic but there was evidence of iron deficiency anaemia, and so a gluten-free diet was started. Despite only a partial adherence to the diet, the iron deficiency anaemia resolved.

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Traditional Chinese medicine-facilitated treatments may relieve anxiety symptoms during drug switching from methadone to buprenorphine/naloxone for treating opioid dependence

This study investigated a 51-year-old married man with a history of heroin dependence who underwent methadone maintenance treatment for 7 years. He received traditional Chinese medicine (TCM)-facilitated treatments and switched from methadone to buprenorphine/naloxone. Strong anxiety symptoms were observed during the initial stage; therefore, we prescribed a combination of Chaihu-Shugan-San, Zhi Bai Di Huang and Chin-Gin-Kuan-Ming decoction as the major herbal synergic regimen to relieve the symptoms of opioid withdrawal, anxiety and insomnia. During the treatment course, no precipitating withdrawal syndromes were noted, and the subject was gradually relieved of his anxiety symptoms through continual TCM treatments. In conclusion, TCM is effective in facilitating the switch from methadone to buprenorphine/naloxone and relieving anxiety symptoms. Therefore, focus on TCM-facilitated treatments for heroin dependence should be increased.

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All sorts of tests, only one question: an unexpected cause of hypertension

A 48-year-old woman presented to the Accident and Emergency department with a 4 month history of headaches, nausea and dizziness. She was found to have severe hypertension and hypokalaemia. Extensive investigations did not find any secondary cause for hypertension. The patient was discharged with oral doxazosin therapy which controlled the blood pressure. Before the follow-up appointment at the hypertension clinic, the patient and her husband identified that her headaches coincided with liquorice tea consumption of up to three cups per day. This information was not obtained in the clinical assessment. The patient is now headache and medication free after cessation of liquorice tea. Liquorice ingestion is often a forgotten reversible cause of hypertension. A good history is key to this diagnosis.

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Tuberculosis epididymitis complicated by a cutaneous fistula

A 63-year-old man developed scrotal swelling that became bilateral over 2 months. His symptoms persisted after treatment for epididymitis, and he developed a scrotal fistula with drainage. Mycobacterium tuberculosis grew from the urine and fistula. His symptoms resolved and fistula closed with medical therapy. His case highlights the importance of early recognition, diagnosis and treatment of this form of extrapulmonary tuberculosis.

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Pleomorphic sarcoma of the breast

Description

This is an 81-year-old man with a history of small bowel carcinoid. He was undergoing routine surveillance (every 6 months) CT chest, abdomen and pelvis with contrast, which showed an incidental left breast mass in the lower inner quadrant, 12x9 mm concerning for breast neoplasm, there was left axillary lymphadenopathy (LAD) as well (figure 1). Correlation with clinical examination, mammography and ultrasound were recommended. A left breast ultrasound noted a hypoechoic irregular mass with indistinct margins, 7 mm in size at the 10 o'clock position on the left breast, 3 cm from the nipple (figure 2). Breast imaging-reporting and data system (BI-RADS) category 4. Bilateral mammogram demonstrated a 1.3 cm irregular shaped mass at the 10 o'clock position of the left breast. No lymphadenopathy (LAD) was noted on the mammogram or ultrasound. It was categorised as BI-RADS 5 on the mammogram. Bilateral axillary ultrasonography was obtained to evaluate for...

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Dermoscopy of pseudoxanthoma elasticum

Description

A 22-year-old woman presented with complaints of gradually progressive yellowish asymptomatic papules coalescing to form plaques over the lateral aspects of the neck since last 3 years. There were no associated systemic complaints. No similar complaints were noted in any of the family members. Systemic examination was normal while mucocutaneous examination revealed the presence of symmetrically distributed yellowish monomorphic papules arranged in a linear and reticulate manner on both sides of the neck, axillae and periumbilical area (figure 1). These plaques were confluent at most of the places, occasionally studded with telangiectasias and had a pebble-like feel on palpation with poor elastic recoil. Polarised light dermoscopy at x10 magnification of these plaques showed multiple irregular yellowish areas alternating with multiple linear vessels. These yellowish plaques coalesced to form parallel strands (figure 2A). The fundus examination was within normal limits except diffuse pigmentary degeneration (figure...

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Abrikossoffs tumour on the upper limb: a rare presentation

Abrikossoff's tumour or granular cell tumour is a rare entity. Most common locations are the head and neck, with only a few cases reported on the upper limbs. A 55-year-old man with a nodular lesion on the left arm resorted to surgery consultation. Nodule was firm, mobile, painless and non-ulcerated. Total excision using a Limberg flap procedure was performed. Following 3 months of follow-up, the patient is fine. Abrikossoff's tumour is frequently presented in the second to sixth decade of life as an ulcerated nodule with progressive growth. Malignant form is rare, with metastases occurring in up to 3% of patients. Excision must be accomplished with free margins. Recurrence is rare. Abrikossoff's tumour on the upper limbs is rare. Although benignity is the rule, doctors must be aware of the possibility of harbouring a cancer. Surgery is the treatment of choice.

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Selective aplasia of global fibres of all extraocular muscles in congenital fibrosis of extraocular muscles (CFEOM): a rare presentation

Description

A 15-year-old boy presented in our strabismus clinic with complaints of bilateral ptosis and limitation of ocular movements since birth. He had a positive family history of consanguinity and similar ocular movement abnormalities in his three siblings. There was no history of systemic illness. Physical examination showed normal growth parameters without craniofacial dysmorphism except blepharoptosis and lagophthalmos in both eyes, more marked in the right eye. Right eye best-corrected visual acuity (BCVA) was 6/12 and left eye BCVA was 6/9. Slit-lamp biomicroscopy of right eye showed exposure keratopathy, rest was unremarkable. Fundus examination was within normal limits, with no pigmentary retinopathy or optic atrophy changes. There was almost total external ophthalmoplegia, with normal reacting pupils to both direct and consensual light reflex in each eye. The patient preferred fixation with the left eye as his right eye had severe ptosis covering the pupillary area. The patient had chin up and 15° right...

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Vancomycin-resistant Enterococcus faecium bacteraemia as a complication of Kayexalate (sodium polystyrene sulfonate, SPS) in sorbitol-induced ischaemic colitis

We present the case report of an 80-year-old woman with chronic kidney disease stage G5 admitted to the hospital with fluid overload and hyperkalaemia. Sodium polystyrene sulfonate (SPS, Kayexalate) in sorbitol suspension was given orally to treat her hyperkalaemia, which precipitated an episode of SPS in sorbitol-induced ischaemic colitis with the subsequent complication of vancomycin-resistant Enterococcus (VRE) bacteraemia. SPS (Kayexalate) in sorbitol suspension has been implicated in the development of intestinal necrosis. Sorbitol, which is added as a cathartic agent to decrease the chance of faecal impaction, may be primarily responsible through several proposed mechanisms. The gold standard of diagnosis is the presence of SPS crystals in the colon biopsy. On a MEDLINE search, no previous reports of a VRE bacteraemia as a complication of biopsy-confirmed SPS in sorbitol ischaemic colitis were found. To the best of our knowledge, ours would be the first such case ever reported.

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Giant atrium, giant clot: need for anticoagulation

Description

We present a patient with medical history of atrial fibrillation, rheumatic mitral valve stenosis and ulcerative colitis who came to the emergency room with onset of bilateral lower extremity pain 2 hours prior to presentation. On examination, feet were pale, cold and pulses were absent. Patient used to be on warfarin for atrial fibrillation which was discontinued 1 month ago by his primary care physician due to recurrent bleeding. Atrial fibrillation with controlled ventricular response was seen on ECG. Emergent arterial Doppler revealed occlusion of the bilateral calf arteries at the level of the tibioperoneal trunk. Patient underwent emergent bilateral right and left groin exploration with bilateral embolectomy and thromboembolectomy. Restoration of flow with no haemodynamically significant atheromatous changes was confirmed by repeat Doppler. Echocardiography revealed severely dilated left atrium measuring 10 cm x 7 cm with large left atrial thrombi (figure 1, online) and severe mitral valve stenosis (mean gradient...

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Vocal assessment of addicts on methadone therapy via the RBH scale and objective acoustic parameters

Publication date: Available online 10 November 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Veljko Mirkov, Slobodan M. Mitrović
IntroductionA large number of people around the world struggle daily to become free of their addiction to illegal psychoactive substances. In order to create an atmosphere of improved supervision, established communication and improved quality of life for drug addicts, centers have been set up to provide methadone as a substitute.ObjectiveThe aim of the research was to assess the vocal features of drug addicts on methadone therapy via subjective and objective parameters, to ascertain if vocal damage has occurred and to determine whether subjective and objective acoustic vocal parameters are related, and how.MethodsThe research included 34 adults of both genders who were undergoing methadone treatment. A subjective vocal evaluation assessed voice pitch and clarity, while the subjective acoustic analysis utilized the Roughness-Breathiness-Hoarseness scale of roughness-breathiness-hoarseness. Objective acoustic analysis was conducted after recording and analyzing an uninterrupted vocal /a/ of at least three seconds duration, using the "GllotisController" software.ResultsThe subjective acoustic analysis using the Roughness-Breathiness-Hoarseness scale showed pathological values in 52.9% male and 47% female participants. The average values of the roughness-breathiness-hoarseness for the entire sample were 0.91, 0.38 and 0.50, respectively. Lower roughness was associated with a higher fundamental frequency (f0) and lower jitter and shimmer values (p<0.05). There was a statistically significant correlation between breathiness, jitter (p<0.01) and shimmer (p<0.05), and between hoarseness and jitter (p<0.01).ConclusionA statistically significant correlation was found between the two subjective vocal assessments, voice clarity and pitch, and Roughness-Breathiness-Hoarseness scale, and the parameters of the objective acoustic vocal assessment.



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The protective effects of whortleberry extract against cisplatin-induced ototoxicity in rats

Publication date: Available online 10 November 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Doğukan Özdemir, Abdulkadir Özgür, Yıldıray Kalkan, Suat Terzi, Levent Tümkaya, Adnan Yılmaz, Metin Çeliker, Engin Dursun
IntroductionCisplatin is one of the main chemotherapeutic agents used for the treatment of many types of cancer. However, ototoxicity, one of the most serious side effects of cisplatin, restricts its usage.ObjectiveWe aimed to investigate the protective effects of whortleberry extract against cisplatin-induced ototoxicity by evaluating hearing and histopathological cochlear damage and by measuring the biochemical parameters affected byoxidative stress.MethodsForty-eight male rats were included in the study after performing Distortion Product Otoacoustic Emission test to confirm that their hearing levels were normal. The rats were randomly divided into six groups: the control group, the sham group, and, which received only whortleberry extract, only cisplatin, cisplatin+100mg whortleberry extract, cisplatin+200mg whortleberry extract, respectively. Audiologic investigation was performed by performing the Distortion Product Otoacoustic Emission test at the beginning and at the eighth day of the study. Cardiac blood samples were collected for biochemical analysis, and the rats were sacrificed to obtain cochlear histopathological specimens on the eighth day.ResultsThe results revealed that whortleberry protects hearing against cisplatin-induced ototoxicity independent of the dose. However, high doses of whortleberry extract are needed to prevent histopathological degeneration and oxidative stress.ConclusionThe results obtained in this study show that whortleberry extract has a protective effect against cisplatin-induced ototoxicity.



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Up-regulation of serum periostin and squamous cell carcinoma antigen levels in infants with acute bronchitis due to respiratory syncytial virus

Publication date: Available online 6 November 2017
Source:Allergology International
Author(s): Hiroaki Nakamura, Kenichi Akashi, Masako Watanabe, Shoichiro Ohta, Junya Ono, Yoshinori Azuma, Noriko Ogasawara, Keisuke Yamamoto, Norikazu Shimizu, Hiroyuki Tsutsumi, Kenji Izuhara, Toshio Katsunuma
BackgroundPeriostin and squamous cell carcinoma antigen (SCCA) are involved in the pathogenesis of asthma. Acute bronchitis due to respiratory syncytial virus (RSV) infection during infancy exhibits an asthma-like pathogenesis, suggesting that it may be associated with the subsequent development of asthma. However, the mechanism by which RSV infection leads to development of asthma has not yet been fully elucidated.MethodsInfants younger than 36 months were enrolled and classified into three groups. Group I included patients hospitalized with RSV-induced bronchitis. These patients were further stratified into two sub-groups according to whether the criteria for the modified Asthma Predictive Index (mAPI) had been met: Group I consisted of mAPI (+) and mAPI (−) patients; Group II included patients with food allergy as a positive control group; and Group III included children with no allergy as a negative control group. Serum periostin and SCCA levels were measured in the groups. This study was registered as a clinical trial (UMIN000012339).ResultsWe enrolled 14 subjects in Group I mAPI (+), 22 in Group I mAPI (−), 18 in Group II, and 18 in Group III. In Group I, the serum periostin and SCCA levels were significantly higher during the acute phase compared with the recovery phase. However, no significant differences were found between Group I mAPI (+) and mAPI (−).ConclusionsThe serum periostin and SCCA levels increased during acute RSV bronchitis. Both periostin and SCCA may play a role in the pathogenesis of acute bronchitis due to RSV.



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How important is allergic sensitization as a cause of atopic asthma?

Publication date: Available online 2 November 2017
Source:Allergology International
Author(s): Jun Kanazawa, Hironori Masuko, Hideyasu Yamada, Yohei Yatagai, Tohru Sakamoto, Haruna Kitazawa, Hiroaki Iijima, Takashi Naito, Tomomitsu Hirota, Mayumi Tamari, Nobuyuki Hizawa




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Efficacy and safety of omalizumab for the treatment of refractory chronic spontaneous urticaria in Japanese patients: Subgroup analysis of the phase 3 POLARIS study

Publication date: Available online 1 November 2017
Source:Allergology International
Author(s): Michihiro Hide, Atsuyuki Igarashi, Akiko Yagami, Yuko Chinuki, Naoko Inomata, Atsushi Fukunaga, Guenther Kaiser, Junyi Wang, Soichiro Matsushima, Steven Greenberg, Sam Khalil
BackgroundOmalizumab, a humanized anti-IgE monoclonal antibody, proved efficacious and well tolerated in patients with chronic spontaneous urticaria (CSU) refractory to H1 antihistamines (H1AH) in the POLARIS study (NCT02329223), a randomized, double-blind, placebo-controlled trial in East Asian patients. However, data in Japanese patients, who have specific baseline characteristics (e.g., low angioedema incidence, different background medications) that may impact clinical outcomes, are lacking. This pre-specified analysis presents additional patient-level data over time, pharmacokinetic and pharmacodynamics data for omalizumab and IgE, and efficacy and safety data for omalizumab in Japanese patients.MethodsJapanese patients (N = 105) were randomized 1:1:1 to omalizumab 300 mg, 150 mg, or placebo by subcutaneous injection every 4 weeks. Efficacy and safety were assessed primarily based on changes from baseline to Week 12 in weekly itch-severity scores (ISS7) and weekly urticaria activity scores (UAS7), and incidence of adverse events (AEs), respectively. Patient-level UAS7 data over time were also reviewed.ResultsAt Week 12, least squares mean (LSM) changes from baseline in ISS7 were greater with omalizumab vs. placebo (−9.54 and −7.29 for omalizumab 300 mg and 150 mg, respectively, vs. placebo [−5.17]). Corresponding LSM changes from baseline in UAS7 were −21.61 and −15.59 (vs. placebo [−10.88]). Most responders in the omalizumab 300 mg group displayed improvement of disease activity within 2–4 weeks and had well-controlled symptoms during the treatment period. Overall AE incidence was similar across treatment arms.ConclusionsThis subgroup analysis demonstrated that omalizumab is a well-tolerated, beneficial option for treatment of CSU in H1AH-refractory Japanese patients.



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Successful treatment of refractory alopecia universalis by persuading a patient not to sleep with her dog

Publication date: Available online 31 October 2017
Source:Allergology International
Author(s): Takahiro Arita, Tomoko Nomiyama, Jun Asai, Norito Katoh




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Phenotype classification using the combination of lung sound analysis and fractional exhaled nitric oxide for evaluating asthma treatment

Publication date: Available online 21 October 2017
Source:Allergology International
Author(s): Terufumi Shimoda, Yasushi Obase, Yukio Nagasaka, Sadahiro Asai
BackgroundWe report the utility of combining lung sound analysis and fractional exhaled nitric oxide (FeNO) for phenotype classification of airway inflammation in patients with bronchial asthma.We investigated the usefulness of the combination of the expiration-to-inspiration sound power ratio in the mid-frequency range (E/I MF) of 200–400 Hz and FeNO for comprehensively classifying disease type and evaluating asthma treatment.MethodsA total of 233 patients with bronchial asthma were included. The cutoff values of FeNO and E/I MF were set to 38 ppb and 0.36, respectively, according to a previous study. The patients were divided into 4 subgroups based on the FeNO and E/I MF cutoff values. Respiratory function, the percentages of sputum eosinophils and neutrophils, and patient background characteristics were compared among groups.ResultsRespiratory function was well controlled in the FeNO low/E/I MF low group (good control). Sputum neutrophil was higher and FEV1,%pred was lower in the FeNO low/E/I MF high group (poor control). History of childhood asthma and atopic asthma were associated with the FeNO high/E/I MF low group (insufficient control). The FeNO high/E/I MF high group corresponded to a longer disease duration, increased blood or sputum eosinophils, and lower FEV1/FVC (poor control).ConclusionsThe combination of FeNO and E/I MF assessed by lung sound analysis allows the condition of airway narrowing and the degree of airway inflammation to be assessed in patients with asthma and is useful for evaluating bronchial asthma treatments.



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Efficacy and safety of benralizumab in Japanese patients with severe, uncontrolled eosinophilic asthma

Publication date: Available online 8 November 2017
Source:Allergology International
Author(s): Ken Ohta, Mitsuru Adachi, Yuji Tohda, Tadashi Kamei, Motokazu Kato, J. Mark Fitzgerald, Masayuki Takanuma, Tadahiro Kakuno, Nobuyuki Imai, Yanping Wu, Magnus Aurivillius, Mitchell Goldman
BackgroundIn the Phase III CALIMA trial, benralizumab significantly reduced asthma exacerbations, increased lung function, and alleviated symptoms for patients with severe, uncontrolled eosinophilic asthma. The aim of this subgroup analysis was to evaluate the efficacy and safety of benralizumab for Japanese patients in the CALIMA trial.MethodsCALIMA was a randomised, controlled trial of 1306 patients (aged 12–75 years; registered at ClinicalTrials.gov: NCT01914757) with severe asthma uncontrolled by medium- to high-dosage inhaled corticosteroids and long-acting β2-agonists (ICS/LABA). Patients received 56 weeks' benralizumab 30 mg either every 4 weeks (Q4W) or every 8 weeks (Q8W; first three doses Q4W), or placebo Q4W. The primary analysis population was patients receiving high-dosage ICS/LABA with blood eosinophils ≥300 cells/μL. This subgroup analysis covered Japanese patients from this group.ResultsOf 83 patients randomised in Japan, 46 were receiving high-dosage ICS/LABA and had blood eosinophils ≥300 cells/μL. Compared with placebo, benralizumab reduced the annual rate of asthma exacerbations by 66% (Q4W; rate ratio 0.34, 95% CI, 0.11–0.99) and 83% (Q8W; rate ratio 0.17, 95% CI, 0.05–0.60); increased prebronchodilator FEV1 by 0.334 L (Q4W; 95% CI, 0.020–0.647) and 0.198 L (Q8W; 95% CI, −0.118 to 0.514); and decreased total asthma symptom score by 0.17 (Q4W; 95% CI, −0.82 to 0.48) and 0.24 (Q8W; 95% CI, −0.87 to 0.40). Percentages of adverse events were consistent with the overall CALIMA group.ConclusionsBenralizumab reduced annual asthma exacerbations and symptoms, increased lung function, and was well-tolerated by Japanese patients with severe, uncontrolled eosinophilic asthma.



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Response to “Providing dermatological care in resource-limited settings: barriers and potential solutions” – reply from authors

We thank Drs. Mahé and Faye for their interest in our article. We applaud them for their tremendous work in improving the delivery of dermatologic care through their programme with healthcare professionals in Mali.

This article is protected by copyright. All rights reserved.

http://ift.tt/2hpbos6

Psychological stress and psoriasis. A systematic review and meta-analysis

Abstract

Background

Psychological stress has long been linked with psoriasis exacerbation/onset. However, it is unclear if they are associated.

Objective

To determine if antecedent psychological stress and psoriasis exacerbation/onset are associated.

Methods

A comprehensive search of Pubmed, PsycINFO, Cochrane library, and clinicaltrials. gov databases was performed. Studies investigating the association between preceding psychological stress and psoriasis exacerbation/onset were classified as cross-sectional, case-control or cohort. Surveys evaluating beliefs regarding stress-reactivity were analysed separately. Suitable studies were meta-analysed.

Results

Thirty-nine studies were included evaluating 32,537 patients: 19 surveys, 7 cross-sectional, 12 case-controls and 1 cohort. Based on surveys and cross-sectional studies, 46% of patients believed their disease was stress-reactive and 54% recalled preceding stressful events. Case-control studies evaluating stressful events rates prior to psoriasis exacerbation (N=6) or onset (N=6) varied in time lag to recollection (≤9 month to ≥ 5 years). Pooling 5 studies evaluating stressful events preceding psoriasis onset yielded an OR of 3.4 (95%CI, 1.8-6.4, I² =87%), however the only study evaluating documented stress disorder diagnosis reported similar rates (OR 1.2, 95%CI, 0.8-1.8) between patients and controls. Four studies evaluating stressful events prior to psoriasis exacerbation reported comparable rates with controls, while 2 found more frequent/severe preceding events among psoriasis patients. A small prospective cohort study reported a modest association between stress-levels and psoriasis exacerbation (r = 0.28, p < 0.05).

Conclusions

The association between preceding stress and psoriasis exacerbation/onset is based primarily on retrospective studies with many limitations. No convincing evidence exists that preceding stress is strongly associated with psoriasis exacerbation/onset.

This article is protected by copyright. All rights reserved.

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Response to “Providing dermatological care in resource-limited settings: barriers and potential solutions”

We read with interest the paper from Chang et al (1). However, the authors overlooked certain solutions that were developed by our team to improve on a large scale the problem of skin diseases (SD) in resource limited settings (RLS), through an organized, public health approach (2-4).

This article is protected by copyright. All rights reserved.

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Quality requirements for allergen extracts and allergoids for allergen immunotherapy

Publication date: Available online 9 November 2017
Source:Allergologia et Immunopathologia
Author(s): J. Zimmer, A. Bonertz, S. Vieths
All allergen products for allergen immunotherapy currently marketed in the European Union are pharmaceutical preparations derived from allergen-containing source materials like pollens, mites and moulds. Especially this natural origin results in particular demands for the regulatory requirements governing allergen products. Furthermore, the development of regulatory requirements is complicated by the so far missing universal link between certain quality parameters, in particular biological potency, on the one hand and clinical efficacy on the other hand. As a consequence, each allergen product for specific immunotherapy has to be assessed individually for its quality, safety and efficacy. At the same time, biological potency of allergen products is most commonly determined using IgE inhibition assays based on human sera relative to product-specific in house references, ruling out full comparability of products from different manufacturers. This review article aims to summarize the current quality requirements for allergen products including the special requirements implemented for control of chemically modified allergen extracts (allergoids).



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The future of immunotherapy with individual allergens: Immunotherapy with fungi

Publication date: Available online 9 November 2017
Source:Allergologia et Immunopathologia
Author(s): F. Pineda




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Langzeitergebnisse und Patientenzufriedenheit nach Tympanoplastik mit Titan-Clip-Prothesen

Laryngo-Rhino-Otol 2017; 96: 698-703
DOI: 10.1055/s-0042-12450

Ziel der vorliegenden Arbeit ist die Evaluation der Langzeitergebnisse nach Ossikelkettenrekonstruktion mittels Titan-Clip Prothesen. Hierzu wurde eine retrospektive Analyse mit prospektivem Follow-up bei allen Patienten durchgeführt, bei denen in den Jahren 2002–2013 ein Clip-PORP implantiert wurde. Es erfolgten audiologische Messungen, otoskopische Untersuchungen sowie die Evaluation der Lebensqualität mittels Glasgow Benefit Inventory. 48 Patienten (51 Ohren, 29 Männer, 19 Frauen, Durchschnittsalter 44,1 Jahre) konnten für das Follow-up rekrutiert werden, der Nachbeobachtungszeitraum lag im Mittel bei 6,3 Jahren. Die Schallleitungskomponente wurde insgesamt (0,5–4 kHz) von präoperativ 22,8 dB auf 14,6 dB postoperativ reduziert (p≤0,001). Häufigste Operationsindikation waren Cholesteatome und -Rezidive (52%), gefolgt von chronischen Otitiden (12%), Radikalhöhlenrevisionen (8%) und Schallleitungsstörungen nach Voroperation (14%). In 47 Fällen war das Trommelfell verschlossen (92,2%), 4x (7,8%) bestand ein Defekt. Die Prothese war 39 Mal (75%) in situ, 6x (11,8%) lag eine Protrusion bzw. 2x (4%) eine Verkippung vor, 1x (2%) war die Prothese fehlend und 3x (5,9%) konnte es nicht beurteilt werden. Die postinterventionelle Patientenzufriedenheit wurde insgesamt positiv bewertet (8,4 Punkte), ebenso die allgemeine Unterskala während bei den Unterskalen soziale Unterstützung und körperliche Gesundheit keine Veränderung auftraten. Zusammenfassend ist die Ossikuloplastik mittels Titan-Clip Prothesen ein sicheres und etabliertes Verfahren. Auch langfristig werden gute und stabile audiologische Messresultate durch Reduktion der Schallleitungskomponente aufgezeigt. Die subjektive Lebensqualität ist insgesamt nachhaltig verbessert.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Chirurgie der inneren Nase

Laryngo-Rhino-Otol 2017; 96: 743-745
DOI: 10.1055/s-0043-114740

Georg Thieme Verlag KG Stuttgart · New York

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Leserbrief zu Ernst, A, P. Schlattmann, F. Waldfahrer, M. Westhofen Die Behandlung des M. Menière mit Betahistin: Kritische Anmerkungen zur BEMED-Studie. Laryngo-Rhino-Otol 2017; 96 (08): 519–521

Laryngo-Rhino-Otol 2017; 96: 674-674
DOI: 10.1055/s-0043-119253

Georg Thieme Verlag KG Stuttgart · New York

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Hörverbesserung durch Tympanoplastik

Laryngo-Rhino-Otol 2017; 96: 718-740
DOI: 10.1055/s-0043-114744

Die grundlegenden Techniken der Tympanoplastik wurden Anfang der 1950er Jahre entwickelt und seitdem verfeinert und modifiziert; die Grundprinzipien haben aber auch heute noch ihre Bedeutung. Als Transplantatmaterialien finden überwiegend Knorpel und Perichondrium Verwendung. Zur Ossikelrekonstruktion haben sich insbesondere Titanprothesen als vorteilhaft erwiesen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Antwort auf den Leserbrief von Schaaf/Hesse zum Artikel „Die Behandlung des M. Menière mit Betahistin: Kritische Anmerkungen zur BEMED-Studie“ (Laryngo-Rhino-Otol 2017; 96 (08): 519–521)

Laryngo-Rhino-Otol 2017; 96: 675-675
DOI: 10.1055/s-0043-119254

Georg Thieme Verlag KG Stuttgart · New York

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Leitlinien in der Praxis: Die neue S3-Leitlinie „Nicht erholsamer Schlaf/Schlafstörungen“ – Kapitel „Schlafbezogene Atmungsstörungen“

Laryngo-Rhino-Otol 2017; 96: 685-690
DOI: 10.1055/s-0043-114750

Zu den schlafbezogenen Atmungsstörungen zählen die zentrale Schlafapnoe (ZSA), die obstruktive Schlafapnoe (OSA) und die schlafbezogene Hypoventilation bzw. Hypoxämie. Sie sind häufig und von zunehmender klinischer Relevanz. Das Kapitel zu dieser Krankheitsgruppe aus der S3-Leitlinie „Nicht erholsamer Schlaf/Schlafstörungen" der Deutschen Gesellschaft für Schlafmedizin wurde am 29. November 2016 aktualisiert und bietet Neuerungen zu Epidemiologie, Diagnostik, Therapie und Systematik. Zur Epidemiologie wird die deutlich erhöhte Mortalität schwangerer Frauen mit OSA herausgestellt. In der Diagnostik der OSA wird betont, dass die Polygrafie unter bestimmten Voraussetzungen ausreichen kann. Änderungen der diagnostischen Empfehlungen zur ZSA erlauben nun die Diagnosestellung auch bei geringer Apnoerate unter der Voraussetzung einer typischen klinischen Situation. Entscheidende therapeutische Unterschiede haben sich bei der ZSA mit Herzinsuffizienz ergeben. Ferner wird differenziert zwischen schlafbezogener Hypoventilation und schlafbezogener Hypoxämie. Das Obesitas-Hypoventilations-Syndrom wird insgesamt breiter besprochen. Der vorliegende Artikel fasst die Änderungen zusammen und kommentiert sie.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Stimmlippenzyste

Laryngo-Rhino-Otol 2017; 96: 676-677
DOI: 10.1055/s-0043-114751

Georg Thieme Verlag KG Stuttgart · New York

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Behandlungsfehler, wenn Patient nicht wieder kommt

Laryngo-Rhino-Otol 2017; 96: 716-717
DOI: 10.1055/s-0043-114745

Georg Thieme Verlag KG Stuttgart · New York

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Ein neues Lagerungsmanöver zur Behandlung einer Form von Schwankschwindel auf der Basis eines modifizierten Modells der Macula utriculi

Laryngo-Rhino-Otol 2017; 96: 678-684
DOI: 10.1055/s-0043-118632

Schwindel ist eines der Hauptsymptome unseres Fachgebietes, das in vielen Fällen interdisziplinär abgeklärt werden muss. In den letzten Jahren haben sich die diagnostischen Möglichkeiten, ausgehend von den seit Jahren bewährten Lagerungen und der kalorischen Prüfung, erheblich erweitert, so dass heute wesentlich differenzierter die zugrunde liegenden Störungen erkannt werden können. Gleichwohl sind sowohl in diagnostischer als auch therapeutischer Sicht immer noch viele Fragen offen. In dem nachfolgenden Artikel stellt der Kollege Koch ein neues Lagerungsmanöver als Therapieoption vor, das er bei vorwiegend älteren Patienten angewendet hat, die einen diffusen Schwankschwindel beim Gehen und Stehen, nicht jedoch im Sitzen oder Liegen hatten. Ausgehend von seinen Behandlungserfolgen schlägt er als Erklärung eine Modifikation des gängigen Modells der Macula utriculi vor, die ein weiterer Beitrag in der aktuellen Diskussion zum Thema „Schwindel" sein sollen. Zur weiteren Aufklärung wäre es interessant zu untersuchen, ob die von dem Autor vorgestellte Patientengruppe im Video-Kopfimpulstest verdeckte Sakkaden aufweisen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2017; 96: 741-742
DOI: 10.1055/s-0043-114746

Georg Thieme Verlag KG Stuttgart · New York

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Eine rasch zunehmende Raumforderung der Schilddrüse

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-119758

[...]

Georg Thieme Verlag KG Stuttgart · New York

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Akuter progredienter Exophtalmus

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-119756

Georg Thieme Verlag KG Stuttgart · New York

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Nasenmuschelplastik: Welche Technik hat die Nase vorn?

Laryngo-Rhino-Otol 2017; 96: 672-673
DOI: 10.1055/s-0043-108954

Georg Thieme Verlag KG Stuttgart · New York

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Ballondilatation der Eustachischen Röhre unter lokaler Betäubung

Laryngo-Rhino-Otol 2017; 96: 671-672
DOI: 10.1055/s-0043-117012

Georg Thieme Verlag KG Stuttgart · New York

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Kombinierte Antibiotikatherapie wirksamer bei Paukenröhrchen und Otorrhoe

Laryngo-Rhino-Otol 2017; 96: 670-671
DOI: 10.1055/s-0043-117014

Georg Thieme Verlag KG Stuttgart · New York

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Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2017; 96: 666-667
DOI: 10.1055/s-0043-114755

Liebe Leserinnen und Leser,die aktuelle Ausgabe der Laryngo-Rhino-Otologie bietet einen umfangreichen Strauß zu verschiedenen relevanten Themen unseres schönen Faches.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Hörrehabilitation durch Cochlea-Implantation nach Vestibularisschwannom-Entfernung?

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-119546

Ausgewertet wurden in einer Qualitätssicherungsanalyse 10 Patienten mit einem individuellen Behandlungsversuch nach einer simultanen oder konsekutiven Cochlea-Implantation nach translabyrinthärer Vestibularisschwannomentfernung im Kleinhirnbrückenwinkel. Die Ergebnisse zeigen, dass die Mehrzahl der Patienten mit einseitiger Ertaubung durch die stereophone Hörrehabilitation profitiert. Durch eine schonende chirurgische Präparationstechnik im Bereich des inneren Gehörgangs kann die morphologisch-funktionelle Integrität der neurovaskulären Strukturen gewährleistet werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Reconstruction of preauricular soft tissue defects using a superiorly based rotation advancement scalp flap - A novel approach to the surgical treatment of preauricular sinuses

No funding was required for this study and the authors have no conflict of interests to declare.

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Myopericytoma of the neck originating in the middle scalene muscle: A case report

Mark B. Chaskes, MD, MBA; John W. Bishop, MD; Matthew Bobinski, MD, PhD; D. Gregory Farwell, MD

Abstract

We report a case of myopericytoma of the neck. A 23-year-old woman noticed a small, nontender mass in her left supraclavicular fossa. The mass had grown over a period of 5 months, prompting her to seek evaluation. On examination, no motor or sensory deficits were present. Imaging suggested that a mass had originated in the middle scalene muscle. Computed-tomography-guided core needle biopsy demonstrated a spindle-cell neoplasm with smooth-muscle differentiation. Complete surgical excision was performed. Histopathologic and immunohistochemical evaluations of the tissue sample suggested a myopericytoma. Myopericytoma is an extremely rare tumor of the head and neck. To the best of our knowledge, this is the first reported case of a myopericytoma originating in a scalene muscle.

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Management of benign middle ear tumors: A series of 7 cases

Z. Jason Qian, MD; Amy M. Coffey, MD; Kathleen M. O'Toole, MD; Anil K. Lalwani, MD

Abstract

Benign middle ear tumors represent a rare group of neoplasms that vary widely in their pathology, anatomy, and clinical findings. These factors have made it difficult to establish guidelines for the resection of such tumors. Here we present 7 unique cases of these rare and diverse tumors and draw from our experience to recommend optimal surgical management. Based on our experience, a postauricular incision is necessary in nearly all cases. Mastoidectomy is required for tumors that extend into the mastoid cavity. Whenever exposure or hemostasis is believed to be inadequate with simple mastoidectomy, canal-wall-down mastoidectomy should be performed. Finally, disarticulation of the ossicular chain greatly facilitates tumor excision and should be performed early in the procedure.

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A novel etiology for pneumolabyrinth after temporal bone fracture without otic capsule involvement

Thomas J. Muelleman, MD; Vidur Bhalla, MD; Hinrich Staecker, MD, PhD

Abstract

Pneumolabyrinth has been considered an indicator of otic capsule involvement in temporal bone fractures. We present a novel theory for the etiology of pneumolabyrinth in a trauma patient without an otic capsule fracture: passage of intrathecal air into the labyrinth. Our patient experienced transient bilateral pneumolabyrinth after head trauma due to a motor vehicle collision. The patient was noted to have extensive pneumocephalus and a unilateral temporal bone fracture that spared the otic capsule. Initial computed tomography (CT) scans demonstrated air in the cochlea and both internal auditory canals. A high-resolution CT scan 6 hours later showed resolution of this air. Pneumolabyrinth may not be a sensitive indicator of otic capsule involvement in temporal bone fractures. In addition to middle ear sources, air in the labyrinth can also plausibly originate intrathecally, especially in the setting of pneumocephalus.

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Guidelines for radiographic imaging of cranial neuropathies

Aliasgher Khaku, BS; Vijay Patel, BS; Thomas Zacharia, MD; David Goldenberg, MD; Johnathan McGinn, MD

Abstract

Disruption of the complex pathways of the 12 cranial nerves can occur at any site along their course, and many, varied pathologic processes may initially manifest as dysfunction and neuropathy. Radiographic imaging (computed topography or magnetic resonance imaging) is frequently used to evaluate cranial neuropathies; however, indications for imaging and imaging method of choice vary considerably between the cranial nerves. The purpose of this review is to provide an analysis of the diagnostic yield and the most clinically appropriate means to evaluate cranial neuropathies using radiographic imaging. Using the PubMed MEDLINE NCBI database, a total of 49,079 articles' results were retrieved on September 20, 2014. Scholarly articles that discuss the etiology, incidence, and use of imaging in the context of evaluation and diagnostic yield of the 12 cranial nerves were evaluated for the purposes of this review. We combined primary research, guidelines, and best practice recommendations to create a practical framework for the radiographic evaluation of cranial neuropathies.

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A controlled comparison of auditory steady-state responses and pure-tone audiometry in patients with hearing loss

Raman Wadhera, MS; Sharad Hernot, MS; Sat Paul Gulati, MS; Vijay Kalra, MS

Abstract

We performed a prospective interventional study to evaluate correlations between hearing thresholds determined by pure-tone audiometry (PTA) and auditory steady-state response (ASSR) testing in two types of patients with hearing loss and a control group of persons with normal hearing. The study was conducted on 240 ears-80 ears with conductive hearing loss, 80 ears with sensorineural hearing loss, and 80 normal-hearing ears. We found that mean threshold differences between PTA results and ASSR testing at different frequencies did not exceed 15 dB in any group. Using Pearson correlation coefficient calculations, we determined that the two responses correlated better in patients with sensorineural hearing loss than in those with conductive hearing loss. We conclude that measuring ASSRs can be an excellent complement to other diagnostic methods in determining hearing thresholds.

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"Live" tinnitus

Chia-Chun Liu, MD; Ming-Yee Lin, MD

Insects should be killed before removal with instrumentation, irrigation, or suction.

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Laryngeal hemangioma presenting as a laryngocele

Kevin Shaigany, MD; Sidrah M. Ahmad, MD; Nausheen Jamal, MD

Laryngeal hemangiomas and laryngoceles share similar characteristics and should be considered in the differential diagnosis.

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Clinical application of nasometry in patients with nasal obstruction

Georges Ziade, MD; Maher Kasti, MD; Doja Sarieddine, BS; Zein Saadeddine, BS; Abdul-Latif Hamdan, MD

Abstract

The purpose of this case-control study is to report on the clinical application of nasometry as a diagnostic tool in patients with the symptom of nasal obstruction compared with subjects with no history of nasal obstruction. Thirty-eight adult patients (mean age: 28.1 years) complaining of nasal obstruction were enrolled in the study, and another group of 38 adults (mean age: 25.9 years) with no history of nasal obstruction served as controls. Demographic data, including age and sex, were collected. Patients were asked to read three passages; the Zoo passage, the Rainbow passage, and nasal sentences. Nasalance scores were reported on all subjects using a Nasometer II instrument. The control and patient groups each included 22 men and 16 women. No statistically significant difference in nasalance score was found between the study group and the control group in any of the Zoo passage, Rainbow passage and nasal sentences. We conclude that nasometry has limited value in the objective assessment of nasal obstruction as a symptom, which we attribute to nasal obstruction's not always reflecting the volume and pressure in the nasal cavity.

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Endoscopic view of a drainage pathway of a concha bullosa

Eiji Yanagisawa, MD, FACS; Dewey A. Christmas, MD; Joseph P. Mirante, MD, MBA, FACS

A concha bullosa does not require surgical intervention unless it creates obstructive problems with respiration or functional drainage problems.

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Nasal septum granuloma gravidarum

Daniel Thomas Ginat, MD, MS; Charles J. Schatz, MD, FACR

Granuloma gravidarum lesions tend to be highly vascular and demonstrate avid enhancement, but they do not have large draining veins.

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Successful medical management of acute mesenteric ischemia due to superior mesenteric and portal vein thrombosis in a 27-year-old man with protein S deficiency: a case report

Acute mesenteric ischemia poses a diagnostic challenge due to nonspecific clinical clues and lack of awareness owing to its rarity. Ischemia due to mesenteric venous thrombosis has a good prognosis compared to...

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Skin Regeneration Using an Amniotic-Derived Tissue Graft

How might different processing modalities of amniotic tissues impact wound healing outcomes?
Wounds

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Effectiveness of alpine climate treatment for children with difficult to treat atopic dermatitis: results of a pragmatic randomized controlled trial (DAVOS trial)

Abstract

Background

Alpine climate treatment has historically been used in Europe to treat atopic dermatitis (AD), but no randomized trials have been conducted to provide evidence for its effectiveness.

Objective

To investigate the long-term effectiveness of alpine climate treatment for children with difficult to treat AD.

Materials & Methods

A pragmatic, open, randomized controlled trial was conducted. Children diagnosed with AD that was considered difficult to treat, aged between 8 and 18 years and willing to be treated in Switzerland were randomized to a six week personalized integrative multidisciplinary treatment period in a clinical setting in the alpine climate (Switzerland) or an outpatient setting in moderate maritime climate (Netherlands). Study assessments were conducted at the Wilhelmina Children's Hospital; an electronic portal was used for the collection of questionnaire data.

Primary outcomes were disease activity (SAEASI), quality of life (CDLQI), and catastrophizing thoughts (JUCKKI/JU) six months after intervention. Other assessments were immediately and six weeks after intervention. Subgroup analyses concerned asthma-related outcomes. Children were randomly assigned to either the intervention or control group using a covariate adaptive randomization method, taking age and asthma diagnosis into account. Children, parents, and health care professionals involved in treatment were not blinded to group assignment. Data were analyzed according to intention-to-treat with linear mixed effects models for continuous outcomes. The trial is registered at Current Controlled Trials ISCRTN88136485.

Results

Between September 14^th 2010 and September 30^th 2014, 88 children were enrolled in the trial, 84 children were randomized (41 assigned to intervention, 43 to control) of whom 77 completed the intervention (38/41 (93%) intervention, 39/43 (91%) control) and 74 completed follow-up (38/41 (93%) intervention, 36/43 (84%) control). Six months after intervention there were no significant differences between the groups on disease activity (SAEASI mean difference -3.4 (95%CI -8.5 to 1.7)), quality of life (CDLQI mean difference -0.3 (95%CI -2.0 to 1.4)), and catastrophizing thoughts (JUCCKI/JU subscale mean difference -0.7 (95%CI -1.4 to -0.0)). Immediately and six weeks after intervention, disease activity and quality of life were significantly different in favor of alpine climate treatment. Mean differences on SAEASI were -10.1 (95%CI -14.5 to -5.8) and -8.4 (95%CI -12.2 to -4.6) and on CDLQI -1.9 (95%CI -3.3 to -0.5) and -1.5 (95%CI -2.8 to -0.3) immediately and six weeks after the intervention, respectively. There were no long-term differences on asthma related outcomes. Five serious adverse events occurred during the study period, which were not thought to be related to the treatment.

Conclusions & Clinical relevance

For children with difficult to treat AD, there was no additional long-term benefit of alpine climate treatment, in contrast to the short-term, compared to an outpatient treatment program in moderate maritime climate, using a personalized integrative multidisciplinary treatment approach.

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MP29-02 reduces nasal hyperreactivity and nasal mediators in patients with house dust mite allergic rhinitis

Abstract

Background

Nasal hyperreactivity (NHR) is an important clinical feature of allergic rhinitis (AR). The efficacy of MP29-02 (azelastine hydrochloride (AZE) and fluticasone propionate (FP)) nasal spray on local inflammatory mediators and NHR in AR is unknown. We tested if MP29-02 decreases inflammatory mediators and NHR in AR and if this effect is due to restoration of nasal epithelial barrier function.

Methods

A 4-week double-blinded placebo-controlled trial with MP29-02 treatment was conducted in 28 patients with house dust mite (HDM) AR. The presence of NHR was evaluated by measuring reduction of nasal flow upon cold dry air exposure. The effects of AZE+/-FP on barrier integrity and airway inflammation were studied in a murine model of HDM induced NHR and on reduced activation of murine sensory neurons and human mast cells.

Results

MP29-02 but not placebo reduced NHR (p<0.0001 vs. p=0.21), levels of substance P (p=0.026 vs. p=0.941) and β-hexosaminidase (p=0.036 vs. p=0.632) in human nasal secretions. In wild type C57BL6 mice, the reduction of β-hexosaminidase levels (p<0.0001) by AZE+FP treatment upon HDM challenge was found in parallel with a decreased transmucosal passage (p=0.0012) and completely reversed eosinophilic inflammation (p=0.0013). In vitro, repeated applications of AZE+FP desensitized sensory neurons expressing the transient receptor potential channels TRPA1 and TRPV1. AZE+FP reduced MC degranulation to the same extent as AZE alone.

Conclusion

MP29-02 treatment reduces inflammatory mediators and NHR in AR. The effects of AZE+FP on MC degranulation, nasal epithelial barrier integrity and TRP channels provide novel insights into the pathophysiology of allergic rhinitis.

This article is protected by copyright. All rights reserved.

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Strong and frequent T-cell responses to the minor allergen Phl p 12 in Spanish patients IgE-sensitized to Profilins

Abstract

Background

Profilins are dominant pan-allergens known to cause cross-sensitization, leading to clinical symptoms such as the pollen food syndrome. This study aims to determine the T-cell response to Phl p 12 in profilin-sensitized patients, by measuring the prevalence, strength and cross-reactivity to clinically relevant profilins.

Methods

The release of Phl p allergens from pollen was determined by mass spectrometry and immunochemistry. T-cell responses, epitope mapping and cross-reactivity to profilins (Phl p 12, Ole e 2, Bet v 2, and Mal d 4) were measured in-vitro using PBMCs from 26 Spanish grass allergic donors IgE-sensitized to profilin. Cross-reactivity was addressed in-vivo using two different mouse strains (BALB/c and C3H).

Results

Phl p 12 and Phl p 1 are released from pollen simultaneously and in similar amounts. Both T cell response frequency (17/26 donors) and strength were comparable between Phl p 12 and Phl p 1. T-cell cross-reactivity to other profilins correlated with overall sequence homology, and two immunodominant epitope regions of Phl p 12 were identified. Data from mice immunized with Phl p 12 showed that cross-reactivity to Bet v 2 was mediated by conserved epitopes, and further influenced by additional genetic factors, likely to be MHC II.

Conclusion

The strength, prevalence and cross reactivity of T-cell responses towards Phl p 12 is comparable to the major allergen Phl p 1, which supports the hypothesis that T-cells to Phl p 12 can play an important role in development of allergic symptoms, such as those associated with the pollen-food syndrome.

This article is protected by copyright. All rights reserved.

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The journey of adult psoriasis patients towards biologics: past and present. Results from the BioCAPTURE registry

Abstract

Background

A considerable disease period often precedes initiation of a biologic in patients with psoriasis. Little is known about this important period in patients' lives. Evaluation of this 'journey' can reveal important insights and opportunities for physicians and health care decision makers.

Objectives

(1) To describe patient and treatment characteristics until the start of biologic treatment in patients with severe psoriasis, (2) to assess shifts in early (2005-2009) versus established (2010-2015) biologics prescription periods, (3) to assess changes in hospital/day care admissions before vs. after starting biologics.

Methods

Explorative, retrospective study on the treatment characteristics of the period until first biologic presented with descriptive statistics of patients included in the BioCAPTURE registry. Journeys of 2005-2009 and 2010-2015 were compared with statistical tests to identify important shifts.

Results

Median TUS (time until conventional systemic) was 11.0 years and median TUB (time until biologic) was 18.9 years for all patients treated from 2005-2015. Most patients received 3 different conventional antipsoriatic systemic therapies. We noticed a small trend towards a shorter journey (TUB) with only 2 conventional systemic agents instead of 3 before initiating a biologic in later years (2010-2015, vs. 2005-2009). We also noticed a significant decrease of (day care) admissions comparing the two years before, versus the two first years after starting biologic treatment (17.7 versus 8.6 admissions/100 follow-up years, p<0.001). Cyclosporine, intensive topical treatment (dithranol), retinoids and PUVA therapy lost popularity in recent years.

Conclusion

The 'journey' of patients with psoriasis towards a biologic is still long and characterized by many different treatments. Shifts towards fewer conventional drugs before biologic initiation and a clear decrease of hospital and day care admissions before vs. after a biologic are seen. Improvement of this journey, especially in young or recently diagnosed patients can decrease negative influences on patients' lives and reduce societal impact.

This article is protected by copyright. All rights reserved.

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Improve postoperative sleep: what can we do?

Purpose of review We reviewed evidences regarding occurrence, risk factors, harmful effects, prevention, and management of sleep disturbances in patients after surgery. Recent findings Normal sleep is important to maintain physical and mental health. Sleep disturbances frequently occur in patients after surgery. Factors associated with the development of postoperative sleep disturbances include old age, preoperative comorbidity, type of anesthesia, severity of surgical trauma, postoperative pain, environment stress, as well as other factors leading to discomfort of patients. Development of sleep disturbances produces harmful effects on postoperative patients, that is, leading to higher risk of delirium, increased sensitivity to pain, more cardiovascular events, and poorer recovery. Both nonpharmacological and pharmacological measures (such as zolpidem, melatonin, and dexmedetomidine) can be used to improve postoperative sleep. Recent evidences show that sleep promotion may improve patients' outcome, but requires further evidences. Summary Sleep disturbances are common in patients after surgery and produce harmful effects on postoperative recovery. Sleep-promotion therapy may be helpful to improve postoperative recovery, but long-term effects deserve further study. Correspondence to Dong-Xin Wang, MD, PhD, Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China. E-mail: wangdongxin@hotmail.com Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Oncologic considerations in the elderly

Purpose of review Elderly patients presenting with thoracic malignancies tend to be largely undertreated because of a presumption that this group will incur a high treatment-associated morbidity and mortality. The current review highlights the current practice and recent updates in the surgical management of thoracic malignancies, mainly lung cancer, in the elderly population. Recent findings Lung resections appears to be relatively safe in the elderly patients presenting with lung cancer. Whenever possible, a lobectomy should be offered to patients with a good performance status who present with early stage disease. However, a limited resection may offer a valuable comparable alternative in patients with advanced comorbidities and borderline pulmonary functions. The use of minimally invasive approaches, namely video-assisted thoracoscopic surgery and robotic surgery are associated with lower morbidity and improved perioperative outcomes compared with the traditional thoracotomy approach and are ideal for the aged. In elderly patients presenting with advanced staged lung cancer, major lung resections following induction therapy, although feasible, should be discussed in a multispecialty tumor board committee. Summary There is growing evidence from the literature that surgical resection is relatively safe in the elderly population. Age by itself should not preclude patients from having curative resection. Resections can be tailored to performance status of the patient. Correspondence to Jeffrey L. Port, MD, Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Suite M404, Weill Cornell Medicine-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021, USA. Tel: +1 212 746 5043; fax: +1 212 746 8223; e-mail: jlp2002@med.cornell.edu Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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An update on preoperative assessment and preparation of surgical patients with obstructive sleep apnea

Purpose of review There is a high prevalence of obstructive sleep apnea (OSA) in the surgical population, however, a significant proportion of patients are undiagnosed. The Society of Anesthesia and Sleep Medicine (SASM) has issued recent guidelines for preoperative assessment and preparation of patients with known or suspected OSA. The purpose of this review is to highlight key points in the new guidelines and explore the possibilities of different strategies in optimizing patients with OSA preoperatively. Recent findings Recent knowledge on phenotypes and endotypes has provided a better understanding of the disease and its underlying pathogenesis. Phenotypes refer to the predominant morphological characteristics of an individual whereas endotypes refer to the predominant underlying mechanism of the disease. Phenotypes and endotypes in OSA are heterogenous. Heterogeneity in the pathogenic mechanisms implies that opportunities other than the use of continuous positive airway pressure (CPAP) may exist to optimize or manage OSA patients preoperatively. Summary The prevalence of OSA in surgical patients is high. SASM has made recommendations in their published guidelines for the optimum preoperative preparation of patients with OSA. In the future, research may shift towards finding the underlying mechanism of OSA for targeted therapy. Correspondence to Dr Frances F. Chung, MBBS, FRCPC, Professor, Department of Anaesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, ONT M5T 2S8, Canada. Tel: +1 416 603 5118; fax: +1 416 603 6494; e-mail: frances.chung@uhn.ca Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://ift.tt/1qR4umk). Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Risk factors for opioid-induced respiratory depression and failure to rescue: a review

Purpose of review The primary objective of this review is to identify the risk factors for opioid-induced respiratory depression (OIRD) in the postoperative period. Recent findings In the postoperative period, OIRD has often been reported resulting in morbidity and mortality. The risk factors which predispose surgical patients to increased risk of OIRD are not clearly defined. A literature search was performed for adult surgical patients who were prescribed opioids during their hospital stay and any available reports on postoperative respiratory depression/respiratory events. Summary Elderly, female sex, presence of obstructive sleep apnea, chronic obstructive pulmonary disease, cardiac disease, diabetes mellitus, hypertension, neurologic disease, renal disease, obesity, two or more comorbidities, opioid dependence, use of patient controlled analgesia, different routes of administration of opioids and concomitant administration of sedatives are significant risk factors for postoperative OIRD. The majority of patients with OIRD are deeply sedated and inadequately monitored. In patients with underlying risk factors, the dose of opioids should be carefully titrated. Enhanced monitoring of sedation level, respiratory rate, pulse oximetry and capnography is needed in the first 24 h after surgery. Correspondence to Frances Chung, MBBS, Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St., MCL 2-405, Toronto, ON, Canada M5T 2S8. Tel: +1 416 603 5118; fax: +1 416 603 6494; e-mail: Frances.chung@uhn.ca Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Perioperative neurocognition in elderly patients

Purpose of review The extrinsic risk factors for postoperative cognitive disturbance have been a source of concern during the perioperative period, and these risk factors remain the subject of controversy. This review of recent studies focuses on the effect of these factors on postoperative cognitive disturbance during the perioperative period. Recent findings Impairment of cerebral autoregulation may predispose patients to intraoperative cerebral malperfusion, which may subsequently induce postoperative cognitive disturbance. The neurotoxicity of several volatile anesthetics may contribute to cognitive functional decline, and the impact of intravenous anesthesia on cognitive function requires further exploration. Multimodal analgesia may not outperform traditional postoperative analgesia in preventing postoperative delirium. Furthermore, acute pain and chronic pain may exacerbate the cognitive functional decline of patients with preexisting cognitive impairment. The nuclear factor-kappa beta pathway is an important node in the neuroinflammatory network. Summary Several intraoperative factors are associated with postoperative cognitive disturbance. However, if these factors are optimized in perioperative management, postoperative cognitive disturbance will improve. Correspondence to Tianlong Wang, MD, Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China. Tel: +86 10 83199333; fax: +86 10 83199333; e-mail: w_tl5595@hotmail.com Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Enhanced recovery for thoracic surgery in the elderly

Purpose of review Both surgical workload and the age of those patients being considered for radial pulmonary resection are increasing. Enhanced recovery programmes are now well established in most surgical disciplines and are increasingly reported in thoracic procedures. This review will discuss the relevant principles of these programmes as applied to an increasing elderly population. Recent findings Elderly patients undergoing less radial surgical resections without lymphadenectomy have comparable outcomes to those undergoing classical curative treatment. Patients require careful assessment and self-reported quality of life metrics or function may be a better marker of outcome than static measures such as lung function. Hypotension, low values for bispectral index and low anaesthetic gas mean alveolar concentration values are common and independent predictors of mortality in the elderly. Paravertebral blockade is preferred to epidural anaesthesia because of a more favourable side-effect profile and comparable efficacy. As yet no robust work has examined the efficacy of an integrated enhanced recovery programme in thoracic surgery. Summary Elderly patients are suitable for enhanced recovery programmes but these must be tailored to individual circumstance. Further work is required to comprehensively assess their value in a modern healthcare setting. Correspondence to Stephen J. Shepherd, MBBS, Department of Perioperative Medicine, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom. Tel: +44207 34165000; e-mail: sj.shepherd@nhs.net Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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An overview of perioperative considerations in elderly patients for thoracic surgery: demographics, risk/benefit, and resource planning

Purpose of review Increasing numbers of geriatric patients will present for thoracic surgery as the population ages. The changes in physiologic reserve as well as the increase in comorbid conditions among this population must be considered in order to optimize patient care in the perioperative period. Recent findings For elderly patients with cancer, the risk–benefit relationship for thoracic surgery remains favorable. Consideration of comorbidities, especially chronic obstructive pulmonary disease and congestive heart failure, is important in the setting of surgical treatment, as they have implications for perioperative care as well as postoperative morbidity and mortality. Overall survival, quality of life, and health status must be considered in decisions regarding cancer treatment. Summary Elderly patients with early-stage lung cancer derive benefit from surgical treatment, despite their increased prevalence of comorbidities, because survival associated with untreated lung cancer is so dismal. Some studies suggest that even late-stage lung cancer patients may benefit from surgery as part of a multimodal approach. Further studies could help target implementation of resources to optimize overall patient health and physiologic condition in order to decrease morbidity and mortality and to optimize quality of life. Correspondence to Maria Castillo, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, KCC 8th floor, One Gustave L. Levy Place, New York, NY 10029, USA. Tel: +1 646 320 0260; e-mail: Maria.castillo@mountsinai.org Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Cognitive Function and Quality of Life in Head and Neck Cancer Patients

This case series investigates the associations between cognitive function and quality of life in patients prior to treatment for head and neck cancer.

http://ift.tt/2zI0epK

Association Between Head and Neck Squamous Cell Carcinoma Survival, Smoking at Diagnosis, and Marital Status

This cohort study examines the association between survival and smoking status at the time of diagnosis of head and neck squamous cell carcinoma and the association between marital status and smoking in these same patients.

http://ift.tt/2zuhHRA

Weaning Children With Aspiration From Thickened Fluids

This case series describes the experience of a systematic weaning process in children who received thickened liquids due to oropharyngeal dysphagia and identified risk of aspiration.

http://ift.tt/2zI01Tu

The Next 19 Years of the American Head and Neck Society

The Presidential Address presented at the 2017 American Head and Neck Society (AHNS) includes a brief history of the AHNS, current update, and thoughts on the future of the organization.

http://ift.tt/2zvQvSw

Granulomatosis With Polyangiitis

This Viewpoint examines the continued use of the name Wegner granulomatosis despite the 2011 consensus to change the name of the disease to granulomatosis with polyangiitis.

http://ift.tt/2zKDBkJ

The class I/IV HDAC inhibitor mocetinostat increases tumor antigen presentation, decreases immune suppressive cell types and augments checkpoint inhibitor therapy

Abstract

Checkpoint inhibitor therapy has led to major treatment advances for several cancers including non-small cell lung cancer (NSCLC). Despite this, a significant percentage of patients do not respond or develop resistance. Potential mechanisms of resistance include lack of expression of programmed death ligand 1 (PD-L1), decreased capacity to present tumor antigens, and the presence of an immunosuppressive tumor microenvironment. Mocetinostat is a spectrum-selective inhibitor of class I/IV histone deacetylases (HDACs), a family of proteins implicated in epigenetic silencing of immune regulatory genes in tumor and immune cells. Mocetinostat upregulated PD-L1 and antigen presentation genes including class I and II human leukocyte antigen (HLA) family members in a panel of NSCLC cell lines in vitro. Mocetinostat target gene promoters were occupied by a class I HDAC and exhibited increased active histone marks after mocetinostat treatment. Mocetinostat synergized with interferon γ (IFN-γ) in regulating class II transactivator (CIITA), a master regulator of class II HLA gene expression. In a syngeneic tumor model, mocetinostat decreased intratumoral T-regulatory cells (Tregs) and potentially myeloid-derived suppressor cell (MDSC) populations and increased intratumoral CD8+ populations. In ex vivo assays, patient-derived, mocetinostat-treated Tregs also showed significant down regulation of FOXP3 and HELIOS. The combination of mocetinostat and a murine PD-L1 antibody antagonist demonstrated increased anti-tumor activity compared to either therapy alone in two syngeneic tumor models. Together, these data provide evidence that mocetinostat modulates immune-related genes in tumor cells as well as immune cell types in the tumor microenvironment and enhances checkpoint inhibitor therapy.

http://ift.tt/2hg43Hs

News From and About Johns Hopkins Scientists at Society for Neuroscience Annual Meeting

The following Johns Hopkins University School of Medicine faculty are scheduled to speak at the 2017 annual meeting of the Society for Neuroscience in Washington, D.C., on Nov. 11-15. To arrange interviews, or for other information, call or email the media contacts listed above.

http://ift.tt/2Ar3VMV

Clinical signs and electroencephalographic patterns of emergence from sevoflurane anaesthesia in children: An observational study

BACKGROUND Few studies have systematically described relationships between clinical–behavioural signs, electroencephalographic (EEG) patterns and age during emergence from anaesthesia in young children. OBJECTIVE To identify the relationships between end-tidal sevoflurane (ETsevoflurane) concentration, age and frontal EEG spectral properties in predicting recovery of clinical–behavioural signs during emergence from sevoflurane in children 0 to 3 years of age, with and without exposure to nitrous oxide. The hypothesis was that clinical signs occur sequentially during emergence, and that for infants aged more than 3 months, changes in alpha EEG power are correlated with clinical–behavioural signs. DESIGN An observational study. SETTING A tertiary paediatric teaching hospital from December 2012 to August 2016. PATIENTS Ninety-five children aged 0 to 3 years who required surgery below the neck. OUTCOME MEASURES Time–course of, and ETsevoflurane concentrations at first gross body movement, first cough, first grimace, dysconjugate eye gaze, frontal (F7/F8) alpha EEG power (8 to 12 Hz), frontal beta EEG power (13 to 30 Hz), surgery-end. RESULTS Clinical signs of emergence followed an orderly sequence of events across all ages. Clinical signs occurred over a narrow ETsevoflurane, independent of age [movement: 0.4% (95% confidence interval (CI), 0.3 to 0.4), cough 0.3% (95% CI, 0.3 to 0.4), grimace 0.2% (95% CI, 0 to 0.3); P > 0.5 for age vs. ETsevoflurane]. Dysconjugate eye gaze was observed between ETsevoflurane 1 to 0%. In children more than 3 months old, frontal alpha EEG oscillations were present at ETsevoflurane 2.0% and disappeared at 0.5%. Movement occurred within 5 min of alpha oscillation disappearance in 99% of patients. Nitrous oxide had no effect on the time course or ETsevoflurane at which children showed body movement, grimace or cough. CONCLUSION Several clinical signs occur sequentially during emergence, and are independent of exposure to nitrous oxide. Eye position is poorly correlated with other clinical signs or ETsevoflurane. EEG spectral characteristics may aid prediction of clinical–behavioural signs in children more than 3 months. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/OBJ4xP Correspondence to Dr Laura Cornelissen, Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, 333 Longwood Avenue (5th floor), Boston, MA 02115, USA Tel: +1 617 919 4641; e-mail: laura.cornelissen@childrens.harvard.edu Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://ift.tt/2ylyqmW). © 2017 European Society of Anaesthesiology

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Fibrinogen on Admission in Trauma score: Early prediction of low plasma fibrinogen concentrations in trauma patients

BACKGROUND Early recognition of low fibrinogen concentrations in trauma patients is crucial for timely haemostatic treatment and laboratory testing is too slow to inform decision-making. OBJECTIVE To develop a simple clinical tool to predict low fibrinogen concentrations in trauma patients on arrival. DESIGN Retrospective cohort study. SETTING Three designated level 1 trauma centres in the Paris Region, from January 2011 to December 2013. PATIENTS Patients admitted in accordance with national triage guidelines for major trauma and plasma fibrinogen concentration testing on admission. INTERVENTION Construction of a clinical score [Fibrinogen on Admission in Trauma (FibAT) score] in a derivation cohort to predict fibrinogen plasma concentration 1.5 g l−1 or less after multiple regressions. One point was given for each predictive factor. The score was the sum of all. Validation was performed in a separate validation cohort. MAIN OUTCOME MEASURE Predictive accuracy of FibAT score. RESULTS In total, 2936 patients were included, 2124 in the derivation cohort and 812 in the validation cohort. In the derivation cohort, a multivariate logistic model identified the following predictive factors for plasma fibrinogen concentrations 1.5 g l−1 or less: age less than 33 years, prehospital heart rate more than 100 beats per minute, prehospital SBP less than 100 mmHg, blood lactate concentration on admission more than 2.5 mmol l−1, free intraabdominal fluid on sonography, decrease in haemoglobin concentration from prehospital to admission of more than 2 g dl−1, capillary haemoglobin concentration on admission less than 12 g dl−1 and temperature on admission less than 36°C. The FibAT score had an area under the receiver operating characteristic curve of 0.87 [95% confidence interval (0.86 to 0.91)] in the derivation cohort and of 0.82 (95% confidence interval (0.86 to 0.91)] in the validation cohort to predict a low plasma fibrinogen. CONCLUSION The FibAT score accurately predicts plasma fibrinogen levels 1.5 g l−1 or less on admission in trauma patients. This easy-to-use score could allow early, goal-directed therapy to trauma patients. Correspondence to Tobias Gauss, MD, Service Anesthésie et Réanimation, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaire Paris Nord Val de Seine, 100 Bd du Général Leclerc, 92110 Clichy, France. Tel: +33 0 1 40 87 52 33; e-mail: gausstoto@gmail.com © 2017 European Society of Anaesthesiology

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Vaccine responses in newborns

Abstract

Immunisation of the newborn represents a key global strategy in overcoming morbidity and mortality due to infection in early life. Potential limitations, however, include poor immunogenicity, safety concerns and the development of tolerogenicity or hypo-responsiveness to either the same antigen and/or concomitant antigens administered at birth or in the subsequent months. Furthermore, the neonatal immunological milieu is polarised towards Th2-type immunity with dampening of Th1-type responses and impaired humoral immunity, resulting in qualitatively and quantitatively poorer antibody responses compared to older infants. Innate immunity also shows functional deficiency in antigen-presenting cells: the expression and signalling of Toll-like receptors undergo maturational changes associated with distinct functional responses. Nevertheless, the effectiveness of BCG, hepatitis B and oral polio vaccines, the only immunisations currently in use in the neonatal period, is proof of concept that vaccines can be successfully administered to the newborn via different routes of delivery to induce a range of protective mechanisms for three different diseases. In this review paper, we discuss the rationale for and challenges to neonatal immunisation, summarising progress made in the field, including lessons learnt from newborn vaccines in the pipeline. Furthermore, we explore important maternal, infant and environmental co-factors that may impede the success of current and future neonatal immunisation strategies. A variety of approaches have been proposed to overcome the inherent regulatory constraints of the newborn innate and adaptive immune system, including alternative routes of delivery, novel vaccine configurations, improved innate receptor agonists and optimised antigen-adjuvant combinations. Crucially, a dual strategy may be employed whereby immunisation at birth is used to prime the immune system in order to improve immunogenicity to subsequent homologous or heterologous boosters in later infancy. Similarly, potent non-specific immunomodulatory effects may be elicited when challenged with unrelated antigens, with the potential to reduce the overall risk of infection and allergic disease in early life.

http://ift.tt/2jeZ6mH

Recipe for IBD: can we use food to control inflammatory bowel disease?

Abstract

The mucosal immune system and the microbiota in the intestinal tract have recently been shown to play a key role in the pathogenesis of inflammatory bowel disease (IBD). Both of these can be influenced by food. Thus, we propose dietary intervention as a therapeutic option for IBD. In this review, we discuss the interaction of the intestinal mucosal immune system and the intestinal microbiota in the context of IBD. In addition, we discuss the impact of food components on immune responses in IBD. Finally, we address the current evidence of how this interaction (i.e., immune system–microbiota) can be modulated by food components, pre/probiotics, and fecal microbiota transplantation (FMT) and how these approaches can support intestinal homeostasis. By gathering the vast amount of literature available on the impact of food on IBD, we aim to distinguish between scientifically sound data and theories, which have not been included in this review.

http://ift.tt/2jchlsR

Prophylactic DNA vaccine targeting Foxp3 + regulatory T cells depletes myeloid-derived suppressor cells and improves anti-melanoma immune responses in a murine model

Abstract

Regulatory T cells (Treg) and myeloid-derived suppressor cells (MDSC) are the two important and interactive immunosuppressive components of the tumor microenvironment that hamper anti-tumor immune responses. Therefore, targeting these two populations together might be beneficial for overcoming immune suppression in the tumor microenvironment. We have recently shown that prophylactic Foxp3 DNA/recombinant protein vaccine (Foxp3 vaccine) promotes immunity against Treg in tumor-free conditions. In the present study, we investigated the immune modulatory effects of a prophylactic regimen of the redesigned Foxp3 vaccine in the B16F10 melanoma model. Our results indicate that Foxp3 vaccination continuously reduces Treg population in both the tumor site and the spleen. Surprisingly, Treg reduction was associated with a significant decrease in the frequency of MDSC, both in the spleen and in the tumor environment. Furthermore, Foxp3 vaccination resulted in a significant reduction of arginase-1(Arg-1)-induced nitric oxide synthase (iNOS), reactive oxygen species (ROS) and suppressed MDSC activity. Moreover, this concurrent depletion restored production of inflammatory cytokine IFN-γ and enhanced tumor-specific CTL response, which subsequently resulted in the reduction of tumor growth and the improved survival rate of vaccinated mice. In conclusion, our results revealed that Foxp3 vaccine promotes an immune response against tumor by targeting both Treg and MDSC, which could be exploited as a potential immunotherapy approach.

http://ift.tt/2hn970t