Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Πέμπτη 7 Δεκεμβρίου 2017
Author Index to Volume 119, 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
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Development of a brief assessment of activity limitations in children with food allergy
Source:Annals of Allergy, Asthma & Immunology
Author(s): Catherine C. Peterson, Lauren E. Harrison
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IgG4-related disease presenting as hoarseness and postcricoid ulcer
Source:Annals of Allergy, Asthma & Immunology
Author(s): Syeda Hamadani, Beverly Wang, Sudhir Gupta
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Effect of inhaled allergens and air pollutants on childhood rhinitis development
Source:Annals of Allergy, Asthma & Immunology
Author(s): Hui Zhou, Xia (Iona) Li, Jeong Hee Kim, Muhammad T. Salam, Hyo Bin Kim, Rob S. McConnell, Rima Habre, Tracy Bastain, Shohreh F. Farzan, Jill Johnston, Frank D. Gilliland
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Information for Readers
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
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Table of Contents
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
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rAsp f 3 and rAsp f 4 are associated with bronchiectasis in allergic fungal airways disease
Source:Annals of Allergy, Asthma & Immunology
Author(s): Kerry Woolnough, Michelle Craner, Catherine H. Pashley, Andrew J. Wardlaw
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Instructions for Authors
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
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Toxocara species exposure, symptoms of asthma, and fractional exhaled nitric oxide in the US population
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): Funmilola Ogundipe, Edward Christian Anselm Hennis, Alem Mehari, Richard F. Gillum
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Editorial Board
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
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Could calcium channel blockers treat 2 illnesses with 1 pill?
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): John Oppenheimer, H. William Kelly
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Baseline asthma burden, comorbidities, and biomarkers in omalizumab-treated patients in PROSPERO
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): John J. Oppenheimer, Paul A. Greenberger
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Increasing our knowledge base of asthma
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): John J. Oppenheimer, Gailen D. Marshall
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Innate lymphoid cells and allergic disease
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): Matthew T. Stier, R. Stokes Peebles
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Rare cause of periorbital and eyelids lesions: Discoid lupus erythematosus misdiagnosed as allergy
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): Anzelika Chomiciene, Ruta Stankeviciute, Laura Malinauskiene, Jurate Grigaitiene, Audra Blaziene
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Spectrum and prevalence of reactions to marijuana in a Colorado allergy practice
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): William S. Silvers, Tiana Bernard
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Baseline asthma burden, comorbidities, and biomarkers in omalizumab-treated patients in PROSPERO
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): Bradley E. Chipps, Robert S. Zeiger, Allan T. Luskin, William W. Busse, Benjamin L. Trzaskoma, Evgeniya N. Antonova, Hooman Pazwash, Susan L. Limb, Paul G. Solari, Noelle M. Griffin, Thomas B. Casale
BackgroundPatients included in clinical trials do not necessarily reflect the real-world population.ObjectiveTo understand the characteristics, including disease and comorbidity burden, of patients with asthma receiving omalizumab in a real-world setting.MethodsThe Prospective Observational Study to Evaluate Predictors of Clinical Effectiveness in Response to Omalizumab (PROSPERO) was a US-based, multicenter, single-arm, and prospective study. Patients (≥12 years of age) with allergic asthma initiating omalizumab treatment based on physician-assessed need were included and followed for 12 months. Exacerbations, health care use, adverse events, and Asthma Control Test (ACT) scores were assessed monthly. Biomarkers (blood eosinophils, fractional exhaled nitric oxide, and periostin) were evaluated and patient-reported outcomes (Asthma Quality of Life Questionnaire for 12 Years and Older [AQLQ+12] and Work Productivity and Activity Impairment: Asthma questionnaire [WPAI:Asthma]) were completed at baseline and months 6 and 12. The Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ) was completed at baseline and 12 months.ResultsMost of the 806 enrollees (91.4%) were adults (mean age 47.3 years, SD 17.4), white (70.3%), and female (63.5%). Allergic comorbidity was frequently reported (84.2%), as were hypertension (35.5%) and depression (22.1%). In the 12 months before study entry, 22.1% of patients reported at least 1 asthma-related hospitalization, 60.7% reported at least 2 exacerbations, and 83.3% reported ACT scores no higher than 19 (uncontrolled asthma). Most patients had low biomarker levels based on prespecified cut-points. Baseline mean patient-reported outcome scores were 4.0 (SD 1.4) for AQLQ+12, 2.7 (SD 1.4) for MiniRQLQ, and 47.7 (SD 28.9) for WPAI:Asthma percentage of activity impairment and 33.5 (SD 28.7) for percentage of overall work impairment.ConclusionThe population initiating omalizumab in PROSPERO reported poorly controlled asthma and a substantial disease burden.Trial RegistrationClinicalTrials.gov Identifier: NCT01922037.
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The clinical role of fractional exhaled nitric oxide in asthma control
Publication date: December 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): Suguru Sato, Junpei Saito, Atsuro Fukuhara, Manabu Uematsu, Yasuhito Suzuki, Ryuichi Togawa, Yuki Sato, Takefumi Nikaido, Xintao Wang, Yoshinori Tanino, Mitsuru Munakata
BackgroundThe potential role and characteristics of fractional exhaled nitric oxide (FeNO) remain unclear in the treatment of asthma.ObjectiveTo explore the clinical role of FeNO in asthmatic treatment.MethodsWe evaluated whether the mean or change of FeNO levels in the treatment period is associated with other conventional control parameters and predicted some clinical outcomes of asthma. We retrospectively analyzed the mean and percentage change of FeNO levels in the first 5 measurements at our hospital.ResultsThe study found a significantly strong correlation between FeNO level at diagnosis and the largest changes of FeNO values from diagnosis. No significant correlations were observed between FeNO levels and other parameters (Asthma Control Test [ACT] score or forced expiratory volume in one second [FEV1]) in mean and percentage change of values under treatment of asthma; however, significant positive correlations were found between ACT scores and FEV1. The mean FeNO level revealed a significant negative correlation with an annual change in FEV1 in individuals with asthma who were followed up for more than 2 years. Both the mean ACT score and percent predicted FEV1 revealed a significant negative correlation with occasional use of systemic corticosteroids.ConclusionDuring conventional treatment of asthma, the largest changes of FeNO values from diagnosis were strongly correlated with FeNO levels at diagnosis. As for the unlikely conventional parameters, no significant associations were observed between FeNO levels and deterioration of asthma during the treatment periods. An elevated mean FeNO level may be a marker of decreased lung function in individuals with asthma.
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Burden of skin pain in atopic dermatitis
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): Paras P. Vakharia, Rishi Chopra, Ryan Sacotte, Kevin R. Patel, Vivek Singam, Neha Patel, Supriya Immaneni, Takeshia White, Robert Kantor, Derek Y. Hsu, Jonathan I. Silverberg
BackgroundAtopic dermatitis (AD) is associated with itch, skin inflammation and barrier disruption, and scratching, all of which may be associated with skin pain.ObjectiveTo characterize the patient burden of skin pain in AD.MethodsWe performed a prospective dermatology practice–based study using questionnaires and evaluation by a dermatologist.ResultsOverall, 305 patients (age range, 13–97 years) were included in the study, with 564 encounters. The cohort included 195 females (63.9%) and 193 whites (63.7%). The mean (SD) age at enrollment was 42.3 (18.1) years, and the mean (SD) age of patient-reported AD onset was 29.6 (31.9) years. At baseline, 144 patients (42.7%) reported skin pain in the past week, with 42 (13.8%) reporting severe or very severe pain. Twenty-four (16.8%) thought the skin pain was part of their itch, 16 (11.2%) from scratching, and 77 (72.0%) from both. Patients with skin pain were more likely to describe their itch using terms that resembled neuropathic pain. Prevalence of skin pain was increased in patients with vs without excoriations (72.6% vs 57.6%; χ2 test P = .02) but not other morphologic characteristics. Skin pain severity was most strongly correlated with the Patient-Oriented Eczema Measure (Spearman ρ = 0.54), followed by ItchyQOL (ρ = 0.52), 5-dimensions of itch scale (ρ = 0.47), Dermatology Life Quality Index (ρ = 0.45), numeric rating scale for itch (ρ = 0.43) and sleep (ρ = 0.36), Patient Health Questionnaire 9 (ρ = 0.36), patient-reported global AD severity (ρ = 0.34), Eczema Area and Severity Index (ρ = 0.23), and objective Scoring AD index (ρ = 0.20) (P < .001 for all). Patients with both severe itch and pain vs those with only one or neither symptom being severe had significant increases in all these measures.ConclusionSkin pain is a common and burdensome symptom in AD. Skin pain severity should be assessed with itch severity in AD patients and may be an important end point for monitoring treatment response.
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Intraoperative anaphylaxis to bacitracin during scleral buckle surgery
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): Juline Caraballo, Elaine Binkley, Ian Han, Amy Dowden
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Dengue hemorrhagic fever complicated with acute liver failure: a case report
Dengue is a common arboviral infection with a clinically diverse spectrum of presentations. Although hepatic dysfunction is commonly identified in patients will dengue illness, acute liver failure is rare. The...
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Clinical examination and X-ray: an old approach to a current problem
Description
Ingesting a foreign body is not an uncommon occurrence. Most pass through the gastrointestinal tract uneventfully, and perforation is rare.1 The preoperative diagnosis, in these cases, is always very difficult and the radiological examinations are not always able to resolve the diagnostic. The mortality and the morbidity remain still high first of all for the delay in the diagnosis and the advanced age of patients.2
A 50-year-old man without relevant medical history was admitted to the emergency department with 4 days evolution of abdominal pain. The patient presented continuous abdominal pain at the left lower quadrant. There was no nausea, vomiting, alterations of bowel habits or fever.
On examination, the patient was in painful distress. Vital signs revealed tachycardia at 110 bpm, blood pressure of 120/64 mm Hg but no fever (36.8°C). Abdominal examination revealed diffuse tenderness and pain more intense at the left lower abdomen,...
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Necrotising pneumonia caused by non-PVL Staphylococcus aureus with 2-year follow-up
Necrotising pneumonia (NP) is a rare but life-threatening complication of pulmonary infection. It is characterised by progressive necrosis of lung parenchyma with cavitating foci evident upon radiological investigation. This article reports the case of a 52-year-old woman, immunocompetent healthcare professional presenting to Accident and Emergency with NP and Staphylococcus aureus septicaemia. The cavitating lesion was not identified on initial chest X-ray leading to a delay in antimicrobial optimisation. However, the patient went on to achieve a full symptomatic recovery in 1 month and complete radiological recovery at 2-year follow-up. Long-term prognosis for adult cases of NP currently remains undocumented. This case serves as the first piece of published evidence documenting full physiological and radiological recovery following appropriate treatment of NP in an immunocompetent adult patient.
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Interhemispheric subdural and subarachnoid haemorrhage in a patient with amphetamine-induced vasculitis
Description
A 27-year-old woman with a history of pulmonary embolism presented with confusion and depressed arousal after a night of alcohol and drug use. On examination, she was found to have lack of motivation and right leg weakness but had no other significant neurological findings. Trauma survey did not detect any signs of injury. CT scan of the head revealed interhemispheric subdural and subarachnoid haemorrhage with the highest volume in left frontoparietal region (figure 1). Urine toxicology showed presence of tetrahydrocannabinol and amphetamines. CT angiography demonstrated a small, incidental left supraclinoid internal carotid artery aneurysm but no other significant findings (figure 1). MRI was remarkable only for the haemorrhage and MR venogram confirmed patent venous sinuses (figure 1). Given the patient's history of drug use and the presence of amphetamines in her urine, conventional cerebral angiography was obtained to evaluate for vasculopathy. Cerebral...
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Fat embolism: a rare cause of perioperative renal transplant dysfunction
Fat embolism is a recognised complication of bony injury and orthopaedic surgery, commonly involving the long bones and pelvis. We report on the case of a 68-year-old renal transplant recipient who developed acute kidney injury following surgical stabilisation of metastatic carcinoma of the acetabulum and replacement of the proximal femur. A CT renal angiogram demonstrated a large fat embolus in the inferior vena cava (IVC) and left iliac veins below the level of IVC filter, with impaired renal perfusion. The risks of open or endovascular lipothrombectomy were felt to outweigh the potential benefits. The patient was managed with systemic anticoagulation and prepared for transplant failure. Subsequently, there was spontaneous improvement in urine output and 4 months postoperatively her transplant function had returned to her baseline level and this has remained stable at 1 year postsurgery.
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Perineal aggressive angiomyxoma in a menopausal woman
Aggressive angiomyxoma (AA) is an uncommon mesenchymal tumour that is principally located in the soft tissues of the pelvis and perineum of young women. The primary features of this benign tumour are a local invasion, a high local recurrence rate and non-specific local clinical signs. We describe the case of a 58-year-old woman, initially treated for a Bartholin's cyst. Histological examination indicated the presence of an AA. The MRI showed a 7 cm soft tissue mass extending from the lateral wall of the vagina, into the left buttock and down into the subcutaneous tissue. We performed a radical excision with wide resection, which is considered the standard gold treatment.
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An uncommon diagnosis for a recurrent erythematous patch in a paediatric patient
A 14-year-old girl presented with a circular erythematous patch over the left buttock for approximately 10 years, with ongoing ulceration and papules developing over the last 4 years. Punch biopsies were taken within and above the patch for diagnosis. Both revealed marked inflammatory infiltrates with atypical, irregular lymphocytes and increased mitosis. Immunostaining revealed CD8 positivity and a pan T helper cell phenotype. T cell receptor gene rearrangement analysis showed T cell clonality in both biopsies. These findings were consistent with mycosisfungoides and associated lymphomatoid papulosis. Both are rare conditions but have been associated in 5%–20% of cases. A definitive association has not yet been established; however, T cell monoclonality shows 50%–60% share a common origin. Management options are extensive with no one treatment showing superiority. Our patient received low-dose radiotherapy with good outcomes, but subsequently required further radiotherapy.
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Development of forced normalisation psychosis with ethosuximide
A 50-year-old man with known multidrug resistant coexistent focal and generalised epilepsy was commenced on ethosuximide, with normalisation of his electroencephalogram and cessation of absence seizures. Within 3 weeks, he developed a rapidly worsening paranoid psychosis with visual and olfactory hallucinations. A month after the cessation of ethosuximide and concurrent treatment with olanzapine, his psychosis resolved and permitted reinitiation of ethosuximide at a lower dose without recurrence of psychotic symptoms.
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Pleural lipoma clinically mimicking the presentation of superior sulcus tumour upon initial evaluation
Here we present a case of a large pleural lipoma which presented with paresthesias of the hand. This is an unusual presentation of an uncommon tumour.
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Pulmonary embolism caused by thrombin-based haemostatic matrix
Description
A 38-year-old woman underwent an outpatient L5/S1 discectomy. The procedure was complicated by intraoperative bleeding, and haemostasis was achieved using a thrombin-based haemostatic matrix (TBHM). She presented to our facility on postoperative day 5 with left-sided chest pain and dyspnoea. CT pulmonary angiography (CTPA) showed a heterogeneous filling defect with mixed attenuation and a 'pseudoair pattern' in the left main pulmonary artery (figure 1). Duplex ultrasound of the upper and lower extremities was negative for venous thrombus. An echocardiogram was normal. Pulmonary angiography showed occlusion of the basal branches of the left pulmonary artery (figure 2). Therapeutic anticoagulation with unfractionated heparin was started, and the patient was discharged home on warfarin. Repeat CT angiography 6 months later revealed no filling defect in the pulmonary arteries.
Figure 1
CT chest with contrast demonstrating the 'pseudoair' filling defect (arrow) in the left main pulmonary...
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Acute pancreatitis following oesophagogastroduodenoscopy.
Acute pancreatitis is a well-recognised complication of endoscopic procedures like endoscopic retrograde cholangiopancreatography but not oesophagogastroduodenoscopy (OGD). I report a case of a 33-year-old woman, admitted with severe epigastric pain and vomiting 2 hours after an elective OGD for evaluation of chronic gastrointestinal symptoms. Pancreatitis was diagnosed on the basis of elevated lipase (40 790 U/L; normal 11–82) and findings on imaging studies. Other common causes of acute pancreatitis such as gallstones, alcohol and medications were ruled out. She had an extended hospital course because of severe disease, characterised by systemic inflammatory response syndrome, pleural effusion and ascites but was successfully managed conservatively with bowel rest, hydration and pain management. Acute pancreatitis should be considered a rare complication of OGD and should be considered in differential diagnosis for abdominal pain post OGD. Pathogenesis is likely from direct trauma to pancreas or gas insufflation.
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Hypersomatotropism induced secondary polycythaemia leading to spontaneous pituitary apoplexy resulting in cure of acromegaly and remission of polycythaemia: 'The virtuous circle
A young man with subtle clinical features suggestive of hypersomatotropism presented with acute-onset severe headache. Relevant investigations confirmed polycythaemia and growth hormone (GH)-secreting pituitary macroadenoma with apoplexy. Secondary polycythaemia and myeloproliferative disorders were ruled out. At follow-up after 3 months, resolution of polycythaemia and acromegaly was observed, evident on normal haemoglobin levels, a normocellular marrow, and normal insulin-like growth factor-1 (IGF-1) with glucose-suppressed GH levels. Direct mitogenic properties of GH-IGF-1 axis on bone marrow progenitor cells may very rarely lead to erythroid hyperplasia and subsequent polycythaemia, reversible with successful therapy of acromegaly. In this case, polycythaemia secondary to hypersomatotropism likely resulted in pituitary apoplexy with subsequent remission of both acromegaly and resultant polycythaemia.
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Inguinoscrotal herniation of a caecal adenocarcinoma
An 84-year-old man with multiple comorbidities presented from a residential care home with a 1-month history of asthenia and moderate abdominal pain. On examination, he was found to have an irreducible right-sided inguinoscrotal hernia. Subsequent blood tests revealed a significant anaemia (haemoglobin 48 g/L), for which he was transfused. A CT scan of the abdomen and pelvis revealed a large caecal tumour, herniating through the right inguinal canal into the scrotum. The patient underwent an elective open right hemicolectomy with inguinal hernia defect repair, from which he recovered well. He was discharged from the ward 12 days postoperatively and is awaiting outpatient follow-up.
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Double duodenal perforation following foreign body ingestion
Intentional ingestion of a foreign body in adults is a rare clinical presentation. This case is one of a 27-year-old Sudanese man who presented having swallowed a ballpoint pen intentionally. Clinical examination and plain chest radiograph exhibited no signs indicative of perforation with only a raised C reactive protein identified on blood tests. Subsequent gastroscopy revealed that the pen had simultaneously perforated the duodenum at both D1 and D3 requiring removal via a laparotomy. The patient fully recovered and was discharged 2 weeks postoperatively following psychiatric input.
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Novel use of a trabecular metal spacer in the treatment of a long-standing ulnar fracture non-union
The use of trabecular metal (TM) implants in spine and joint surgery is well documented. However, their use has yet to be reported as an alternative to either allograft or autograft in the management of fracture non-unions. We present our experience in using a TM implant for treating a patient with a long-standing ulnar fracture non-union. Excision of devitalised bone resulted in a 17 mm defect which the TM implant was used to infill. The defect was then bridged with a locking plate. At 2-year clinical and radiographic review, bony union and a pain-free return to full function was noted. In this case, the use of a TM implant avoided the morbidity associated with an iliac crest autograft.
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One long umbilical cord, four nuchal cord loops and a true knot
Description
A 43-year-old woman G4 P2101 at 36 weeks of gestation presented to the labour floor with non-reactive fetal heart tracing and decreased fetal movement. She had a second-trimester ultrasound showing intrauterine growth retardation (IUGR). Patient had a history of hypothyroidism, two fetal demises at term and a planned preterm delivery at 34 weeks of gestation via caesarean section. Workup was negative for thrombophilia (lupus anticoagulant, anticardiolipin, anti-b2-glycoprotein, factor V Leiden, protein S, protein C, G20210 mutation, antithrombin III, antinuclear antibodies) and infectious diseases. Placental pathology following her second fetal demise revealed chorioamnionitis and necrotising funisitis with negative amniotic fluid cultures. There was no information regarding umbilical cord (UC) length or entanglements in previous pregnancies.
Given her history and the current non-reactive fetal heart tracing, the patient was taken for emergency caesarean delivery. A female infant was born with four loops of nuchal cord and a true knot (
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Catastrophic catheter-induced coronary artery vasospasm successfully rescued using intravascular ultrasound imaging guidance
A 46-year-old man underwent coronary angiography for stable angina. He developed inferior ST-segment myocardial infarction during the angiography. Intravascular ultrasound (IVUS) findings suggested coronary vasospasm. Intracoronary administration of isosorbide dinitrate restored the coronary flow. This case illustrates the essential role IVUS imaging played in establishing the diagnosis of catheter-induced coronary vasospasm.
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Treating patients with brain metastases has evolved: scalp-sparing, hippocampal avoidance whole brain radiotherapy with simultaneous integrated boost
Description
A 43-year-old male with a history of receiving treatment for squamous cell carcinoma (SqCC) of lung 2 years back presented with a complaint of a single episode of self-resolving generalised tonic–clonic seizure 1 day prior. General physical and neurological examinations were unremarkable. An MRI of the brain revealed a well-defined, enhancing, space-occupying lesion (SOL) in the right temporal lobe (figure 1). He was started on oral dexamethasone, oral phenytoin (after an intravenous loading dose) and underwent a whole body 18flourodeoxyglucose positron emission tomography CT (18FDG PET-CT), which revealed increased FDG uptake in the SOL without evidence of metastatic disease elsewhere (figure 1). A diagnosis of oligometastatic SqCC lung (cTx, cNx and cM1b) was made, and the options for management were discussed with the patient.
Figure 1
Pretreatment MRI and positron emission tomography CT (PET-CT) images. (A) T1-weighted contrast-enhanced axial image reveals a well-defined space occupying lesion in...
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Lingual dyskinesia in hyperthyroidism
Description
A 28-year-old female presented to the hospital with a 3-month history of palpitation, weight loss and neck swelling. On examination, she had diffuse soft goitre, warm extremities and fine tremors of hands. In addition, she had an irregular jerky lingual and lip movements suggestive of dyskinesia (see online ). There were no signs of infiltrative ophthalmopathy or dermopathy. Neurological examination was otherwise unremarkable. A clinical diagnosis of Graves' disease was made that was biochemically confirmed by elevated T3 and T4 with suppressed tyroid stimulating hormone (TSH) as well as diffuse increased uptake of technetium in nuclear imaging. Unlike lingual tremors associated with other neurological conditions or adverse effects of drugs, thyrotoxicosis-associated lingual dyskinesia responds very well to beta blockers.1 After 6 months of follow-up on carbimazole and propranolol therapy, her thyrotoxicosis improved, and the abnormal tongue movements had disappeared.
Learning points
Thyrotoxicosis...
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Comparison of transcanal endoscopic tympanoplasty with sterile acellular dermal allograft to conventional endaural microscopic tympanoplasty with tragal perichondrium
Source:American Journal of Otolaryngology
Author(s): Jia Min, Se-Hyung Kim
ObjectivesThis study aimed to compare the outcome of endoscopic tympanoplasty with sterile acellular dermal allograft (ADA) and conventional endaural microscopic tympanoplasty with tragal perichondrium.MethodsThis was a retrospective comparative study of 53 patients (25 males and 28 females) with tympanic membrane perforation who underwent type I tympanoplasty in the department of otorhinolaryngology at a tertiary medical center from March 2011 to April 2017. The subjects were classified into two groups; transcanal endoscopic tympanoplasty with ADA (TET, n=26), conventional endaural microscopic tympanoplasty with autologous tragal perichondrium (EMT, n=27). Demographic data, perforation size of tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3months postoperatively, operation time, sequential postoperative pain scale, and postoperative graft failure rate were evaluated.ResultsThe perforation size of the tympanic membrane in TET and EMT group was 22.3±10.9% and 23.5±9.7%, respectively (P=0.143). Mean operation time of EMT (92.3±16.5min) was longer than that of the TET (65.3±20.5min) with a statistical significance (P=0.004). Graft success rate in the TET and EMT group were 92.3% and 96.3%, respectively; the values were not significantly different (P=0.610). Pre- and postoperative audiometric results including bone and air conduction thresholds and air-bone gap were not significantly different between the groups. In all groups, the postoperative air-bone gap was significantly improved compared to the preoperative air-bone gap. Pain in the immediate postoperative and day 1 after surgery were significantly less in the TET group.ConclusionWith human cadaveric ADA, minimal invasive endoscopic tympanoplasty can be achieved with similar postoperative results and less pain.
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Is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?
Source:American Journal of Otolaryngology
Author(s): Zhengcai-LouZihan-LouZhenqi-Gong
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Anti-cytokine autoantibodies in a patient with a heterozygous NFKB2 mutation
Source:Journal of Allergy and Clinical Immunology
Author(s): Kesava A. Ramakrishnan, William Rae, Gabriela Barcenas-Morales, Yifang Gao, Reuben J. Pengelly, Sanjay V. Patel, Dinkantha S. Kumararatne, Sarah Ennis, Rainer Döffinger, Saul N. Faust, Anthony P. Williams
Teaser
We report a family with a heterozygous NFKB2 mutation in which anti-cytokine autoantibodies were identified in one individual. Rituximab therapy for autoantibodies led to a reduction in anti-cytokine autoantibodies and a marked improvement in infectious susceptibility.http://ift.tt/2ACIwDI
Autophagy deficiency in myeloid cells exacerbates eosinophilic inflammation in chronic rhinosinusitis
Publication date: Available online 7 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Go Eun Choi, Seung-Yong Yoon, Ji-Yun Kim, Do-Young Kang, Yong Ju Jang, Hun Sik Kim
BackgroundEosinophilic inflammation is a major pathologic feature of chronic rhinosinusitis and is frequently associated with severe refractory disease. Prostaglandin D2 level is elevated in chronic rhinosinusitis and is an important contributing factor to eosinophilic inflammation. Autophagy has a pleiotropic effect on immune responses and disease pathogenesis. Recent studies suggest the potential involvement of autophagy in chronic rhinosinusitis and the prostaglandin pathway.ObjectiveTo investigate whether altered function of autophagy is associated with eosinophilic inflammation and dysregulated production of prostaglandin D2 in chronic rhinosinusitis.MethodsWe used myeloid cell-specific deletion of Atg7, which is vital for autophagy, and investigated the effects of impaired autophagy on eosinophilic inflammation in a murine model of eosinophilic chronic rhinosinusitis. The effect of autophagy on prostaglandin D2 production and gene expression profiles associated with allergy and the prostaglandin pathway were assessed.ResultsWe found that impaired autophagy in myeloid cells aggravated eosinophilia, epithelial hyperplasia, and mucosal thickening in eosinophilic chronic rhinosinusitis mice. This aggravation was associated with gene expression profiles that favor eosinophilic inflammation, Th2 response, mast cell infiltration, and prostaglandin D2 dysregulation. Supporting this, prostaglandin D2 production was also significantly increased by impaired autophagy. Among other myeloid cells, macrophages were associated with autophagy deficiency, leading to elevated IL-1β levels. Macrophage depletion or blockade of IL-1 receptor led to alleviation of eosinophilic inflammation and sinonasal anatomic abnormalities associated with autophagy deficiency.ConclusionOur results suggest that impaired autophagy in myeloid cells, particularly macrophages, has a causal role in eosinophilic inflammation and eosinophilic chronic rhinosinusitis pathogenesis.
Graphical abstract
Teaser
Autophagy deficiency in myeloid cells, particularly macrophages, is linked to augmented production of PGD2 and eosinophilic inflammation in a murine model of ECRS. Thus, autophagy dysfunction has a causal role in the development of ECRS.http://ift.tt/2iCM7Yn
Fatigue in Psoriasis: A Controlled Study
How prevalent is fatigue in patients with psoriasis? Is there a correlation of fatigue to measurements of disease activity and inflammation?
The British Journal of Dermatology
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rAsp f 3 and rAsp f 4 are associated with bronchiectasis in allergic fungal airways disease
Allergy to thermotolerant filamentous fungi, particularly Aspergillus fumigatus, is closely associated with fixed airflow obstruction, bronchiectasis, and other radiologically defined abnormalities, such as mucus plugging.1 However, not all asthma patients who are immunoglobulin E (IgE) sensitized to A fumigatus develop these complications. To identify markers of poor outcomes in fungal allergy with asthma (and cystic fibrosis), the term allergic bronchopulmonary aspergillosis (ABPA) was coined.
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Clinical Indicators of the Need for Telemetry Postoperative Monitoring in Patients With Suspected Obstructive Sleep Apnea Undergoing Total Knee Arthroplasty
Background and Objectives Obstructive sleep apnea is associated with increased complication rates postoperatively. Current literature does not provide adequate guidance on management of these patients. This study used the STOP-Bang questionnaire to diagnose patients with possible obstructive sleep apnea (score ≥3). We hypothesized that a STOP-Bang score of 3 or greater would significantly correlate with the number of oxygen desaturation episodes during the first 48 hours after total knee arthroscopy. Methods The STOP-Bang questionnaire was administered to 110 patients preoperatively. All patients underwent spinal-epidural anesthesia with a saphenous nerve block and sedation and were connected to the Nellcor OxiMax N-600x pulse oximeter for 48 hours postoperatively. Results Final analysis included 98 patients. There was no significant difference in the total number of desaturation events between STOP-Bang groups (score
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Intrathecal Morphine for Laparoscopic Segmental Colonic Resection as Part of an Enhanced Recovery Protocol: A Randomized Controlled Trial
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Anti-mumps IgM antibody positive rate with sudden sensorineural hearing loss using second-generation enzyme immunoassay: A retrospective, multi-institutional investigation in Hokkaido, Japan
Although elevated anti-mumps IgM antibody levels were reported in 5.7%–7.2% of Japanese patients with sudden sensorineural hearing loss (SSNHL), there were several reports of false-positive cases, such as the continually IgM positive case and the IgM positive case in normal adults. To improve specificity, the new enzyme immuno assay (EIA) anti-mumps IgM antibody measurement kit was introduced in December 2009. This study re-examined the frequency of anti-mumps IgM antibody test positivity with SSNHL using the new measurement kit and compared the results with those from a previous report that used old kit.
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Improving patient safety during procedural sedation via respiratory volume monitoring: A randomized controlled trial
Assess the utility of a respiratory volume monitor (RVM) to reduce the incidence of low minute ventilation events in procedural sedation.
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Is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?
Dear Editors,
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Comparison of transcanal endoscopic tympanoplasty with sterile acellular dermal allograft to conventional endaural microscopic tympanoplasty with tragal perichondrium
This study aimed to compare the outcome of endoscopic tympanoplasty with sterile acellular dermal allograft (ADA) and conventional endaural microscopic tympanoplasty with tragal perichondrium.
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Live cell imaging reveals different modes of cytotoxic action of extracts derived from commonly used luting cements
Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Rita Trumpaitė-Vanagienė, Alina Čebatariūnienė, Virginijus Tunaitis, Alina Pūrienė, Augustas Pivoriūnas
ObjectiveTo compare cytotoxicity of extracts derived from commonly used luting cements: Hoffmann's Zinc Phosphate (ZPC), GC Fuji Plus Resin Modified Glass Ionomer (RMGIC) and 3M ESPE RelyX Unicem Resin Cement (RC) on primary human gingival fibroblasts (HGFs).DesignHGFs were exposed to different concentrations of the ZPC, RMGIC and RC extracts. The cytotoxicity was assessed with the PrestoBlue Cell Viability Reagent and viable cells were counted by a haemocytometer using the trypan blue exclusion test. In order to determine the primary mechanism of the cell death induced by extracts from different luting cements, the real-time monitoring of caspase-3/-7 activity and membrane integrity of cells was employed.ResultsThe extracts from the RMGIC and ZPC decreased the metabolic activity and numbers of viable cells. Unexpectedly, the extracts from the RC evoked only small effects on the metabolic activity of HGFs with a decreasing number of viable cells in a dose-and time-dependent manner. The live cell imaging revealed that the apoptosis was the primary mechanism of a cell death induced by the extracts derived from the RMGIC, whereas the extracts from the RC and ZPC induced a cell death through a necrotic and caspase-independent pathway.ConclusionsThe apoptosis was the primary mechanism of the cell death induced by the extracts derived from the RMGIC, whereas the extracts from the RC and ZPC induced a cell death via a necrotic pathway. We suggest that metabolic assays commonly used to assess the cytotoxicity of luting cements should be validated by alternative methods.
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Extensive phenotyping of the orofacial and dental complex in Crouzon syndrome
Source:Archives of Oral Biology, Volume 86
Author(s): Alexander Khominsky, Robin Yong, Sarbin Ranjitkar, Grant Townsend, Peter J. Anderson
ObjectivesFibroblast growth factor receptor 2 (FGFR2) C342Y/+ mutation is a known cause of Crouzon syndrome that is characterised by craniosynostosis and midfacial hypoplasia. Our aim was to conduct extensive phenotyping of the maxillary, mandibular and dental morphology associated with this mutation.Materials and methodsMorphometric data were obtained from 40 mice, representing two genotypes (Crouzon and wild-type) and two sexes (males and females) (n=10 in each group). Dental analysis further categorised the first molars into the two jaws (maxillary and mandibular) (n=20 in each group). Maxillary, mandibular and dental morphology was compared by analysing 23 linear landmark-based dimensions in three-dimensional micro-computed tomography reconstructions.ResultsCompared with wild-type, Crouzon (FGFR2C342Y/+) maxillae were significantly shorter in maximum height, anterior and posterior lengths and middle width, but larger in posterior width (p<0.05 for height; p<0.001 for other comparisons). In the Crouzon mandible, the ascending and descending heights, effective and mandibular lengths, and intercoronoid and intercondylar widths were significantly shorter, whereas intergonial width was larger (p<0.01 for intercondylar width; p<0.001 for other comparisons). Crouzon teeth were significantly smaller mesiodistally, but larger in crown height (p<0.001 for each comparison). All Crouzon mice presented with bifid mandibular condyles and a quarter presented with expansive bone lesions in the mandibular incisor alveolus.ConclusionsOur findings of hypoplasia in all three planes in Crouzon maxillae and mandibles, together with the presence of bifid mandibular condyles and expansive bone lesions, may be relevant to maxillofacial surgery and orthodontics. Beyond skeletal effects, the FGFR2C342Y/+ mutation is now implicated in affecting tooth development. This study's skeletal phenomics data also provides baseline data against which the effect of various treatments can now be assessed.
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How bariatric surgery affects liver volume and fat density in NAFLD patients
Abstract
Introduction
Nonalcoholic fatty liver disease (NAFLD) is an epidemic in the obese population. Bariatric surgery is known to reverse multiple metabolic complications of obesity such as diabetes, dyslipidemia, and NAFLD, but the timing of liver changes has not been well described.
Materials and Methods
This was an IRB-approved, two-institutional prospective study. Bariatric patients received MRIs at baseline and after a pre-operative liquid diet. Liver biopsies were performed during surgery and if NAFLD positive, the patients received MRIs at 1, 3, and 6 months. Liver volumes and proton-density fat fraction (PDFF) were calculated from offline MRI images. Primary outcomes were changes in weight, body mass index (BMI), percent excess weight loss (EWL%), liver volume, and PDFF. Resolution of steatosis, as defined as PDFF < 6.4% based on previously published cutoffs, was assessed. Secondarily, outcomes were compared between patients who underwent laparoscopic sleeve gastrectomy (LSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB).
Results
From October 2010 to June 2015, 124 patients were recruited. 49 patients (39.5%) completed all five scans. EWL% at 6 months was 55.6 ± 19.0%. BMI decreased from 45.3 ± 5.9 to 34.4 ± 5.1 kg/m2 and mean liver volume decreased from 2464.6 ± 619.4 to 1874.3 ± 387.8 cm3 with a volume change of 21.4 ± 11.4%. PDFF decreased from 16.6 ± 7.8 to 4.4 ± 3.4%. At 6 months, 83.7% patients had resolution of steatosis. Liver volume plateaued at 1 month, but PDFF and BMI continued to decrease. There were no statistically significant differences in liver volume or PDFF reduction from baseline to 6 months between the LSG versus LRYGB subgroups.
Conclusion
Patients with NAFLD undergoing bariatric surgery can expect significant decreases in liver volume and hepatic steatosis at 6 months, with 83.7% of patients achieving resolution of steatosis. Liver volume reduction plateaus 1-month post-bariatric surgery, but PDFF continues to decrease. LSG and LRYGB did not differ in efficacy for inducing regression of hepatosteatosis.
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Laparoscopic removal of retroperitoneal tumor with maneuver of hanging inferior vena cava
Abstract
Background
Laparoscopic resection of retroperitoneal mass is challenging because of its location close to major vessels and a limited range of laparoscopic instruments [1–3]. We report a case of a huge retroperitoneal paraganglioma that was successfully excised laparoscopically using maneuver of hanging IVC
Method
A 67-year-old female had abdominal mass detected during routine check-up. She had no symptoms associated mass. Hematologic, biochemical investigations, and hormone tests reveal normal results. Preoperative CT shows retroperitoneal tumor, measuring 6.1 cm in diameter, which was closely adhered to right adrenal gland and seemed to originate from adrenal gland. Three 12-mm trocars and two 5-mm trocars were used. Laparoscopic views showed that severe adhesion in peritoneal cavity due to previous subtotal gastrectomy for gastric polyp about 30 years ago. After adhesiolysis, the mass was visualized behind inferior vena cava. The mass was carefully dissected and separated from duodenum and inferior vena cava as well as right adrenal gland. Inferior vena cava was retracted with hanging maneuver of IVC with vascular tape. The fibrotic tissues covering the mass were dissected with ligasure™. The feeding vessels supplying mass were identified and clipped, then subsequently sealed and divided. After complete resection of mass, the specimen was inserted into plastic retrieval bag and extracted via extended umbilical port. And then Jackson Pratt drain was placed around inferior vena cava.
Result
There was no intraoperative transfusion and complications during laparoscopic retroperitoneal excision for paraganglioma. The operation time was 190 min, and estimated blood loss was 100 ml. The patient was discharged on postoperative 5th day without complications. Final pathologic result was paraganglioma of 7.5 cm sized with PASS score 4 (pheochromocytoma of the adrenal gland scaled score).
Conclusion
Laparoscopic surgery for huge retroperitoneal paraganglioma behind IVC was successfully performed with the maneuver of hanging IVC. This procedure could be useful with appropriate laparoscopic technique and proper patient selection.
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The SAGES Fundamental Use of Surgical Energy program (FUSE): history, development, and purpose
Abstract
Background
Adverse events due to energy device use in surgical operating rooms are a daily occurrence. These occur at a rate of approximately 1–2 per 1000 operations. Hundreds of operating room fires occur each year in the United States, some causing severe injury and even mortality. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) therefore created the first comprehensive educational curriculum on the safe use of surgical energy devices, called Fundamental Use of Surgical Energy (FUSE). This paper describes the history, development, and purpose of this important training program for all members of the operating room team.
Methods
The databases of SAGES and the FUSE committee as well as personal photographs and documents of members of the FUSE task force were used to establish a brief history of the FUSE program from its inception to its current status.
Results
The authors were able to detail all aspects of the history, development, and national as well as global implementation of the third SAGES Fundamentals Program FUSE.
Conclusions
The written documentation of the making of FUSE is an important contribution to the history and mission of SAGES and allows the reader to understand the idea, concept, realization, and implementation of the only free online educational tool for physicians on energy devices available today. FUSE is the culmination of the SAGES efforts to recognize gaps in patient safety and develop state-of-the-art educational programs to address those gaps. It is the goal of the FUSE task force to ensure that general FUSE implementation becomes multinational, involving as many countries as possible.
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The role of nonautologous and autologous adipose-derived mesenchymal stem cell in acute pyelonephritis
Abstract
We compared the therapeutic effects of autologous and nonautologous adipose-derived mesenchymal stem cell (ADMSC), in ameliorating the renal function in a rabbit model of acute pyelonephritis. The difference of perirenal and neck subcutaneous ADMSCs were also evaluated. Twenty female rabbits were apportioned to 5 groups. In group I (n = 4), the rabbits were injected direct inoculation of Escherichia coli (E. coli) into the right kidney. In group II (n = 4), autologous ADMSCs obtained from nape adipose tissue were injected into the subcapsular space 1 week after E. coli injection, while nonautologous ADMSCs of the same origin (from male rabbits) were applied in group III (n = 4). In group IV (n = 4), autologous perirenal ADMSCs were applied with the same method, while perirenal nonautologous ADMSCs from male rabbits were used in group V (n = 4). Technetium-99m-DMSA renal scan was performed 1, 2 and 4 months post-injection in all groups. Kidneys were excised for the evaluation of histopathological changes in the same time points. PCR examination for detection of Y-chromosome (in group III and V) and fluorescent evaluation (in group II and IV) were also performed to determine the fate of injected cells. Injection of autologous ADMSCs resulted in more satisfactory outcomes in reduction of interstitial fibrosis, tubular, and glomerular atrophy as compared to nonautologous groups. However, histopathological ameliorations were significantly better in group IV in which autologous perirenal ADMSC was applied. Remarkably, two months after the injection, Technetium-99m-DMSA renal scan showed that right kidney reached to near normal cortical function (48 and 45%) in group IV and V, respectively as compared to groups II (41%) and III (37%). Autologous ADMSCs may have better results in cell therapy as compared to nonautologous cells. However, more satisfactory outcomes may be obtained when the cell source is selected from the surrounding adipose tissue.
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Novel Transforming Glue Treats Emergency Battlefield Eye Injuries
According to statistics, war-related eye injuries have steadily increased from a fraction of a percent to as high as 10 to 15 percent in the past few decades. Many of these injuries lead to permanent vision loss due to a lack of nearby medical facilities or the proper tools to treat them.
Researchers at the University of Southern California have developed an advanced material that medics can rapidly deploy and that is customized for numerous types of ocular trauma. Like superglue for the eyes. Originally developed as an adhesive for USC's famed retinal implants, the glue, a hydrogel called PNIPAM, poly(N-isopropylacrylamide) has unique chemical properties: when cooled, it becomes a liquid for easy application, and when heated, it becomes semi-solid with strong adhesive properties. After some modifications, the researchers found that the hydrogel could form a solid seal after being injected into the eye and reaching the eye's temperature. The process is fully reversible by simply applying cool water, which reverts the hydrogel back into a liquid state for removal. A study on rabbit eyes showed that the hydrogel successfully improved intraocular pressures without inflammation or infection over four weeks.
Additionally, the researchers developed a special portable syringe for the hydrogel. The syringe has a cooling chamber filled with calcium ammonium nitrate crystals (the ones you find in instant cold packs). When the chamber is filled with water, the temperature of the syringe drops in less than 30 seconds so the hydrogel becomes liquid and can be injected.
The hope is that the special hydrogel/cooling syringe combo will be used on the battlefields as well as rural ER's and mass casualty situations. Medics and first-responders can quickly deploy the hydrogel to stabilize the patient until an ophthalmologist can repair the damage.
Journal abstract in Science Translational Medicine: A reversible thermoresponsive sealant for temporary closure of ocular trauma…
More info from USC: A new portable gel that could save an injured eye…
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Multi-agent chemotherapy in advanced soft tissue sarcoma (STS) – A systematic review and meta-analysis
Source:Cancer Treatment Reviews
Author(s): Alona Zer, Rebecca M. Prince, Eitan Amir, Albiruni R Abdul Razak
BackgroundDespite a lack of improvement in overall survival (OS) with doxorubicin-based combinations over doxorubicin alone in advanced STS, the role of multi-agent chemotherapy remains poorly defined.MethodsWe conducted a systematic review and meta-analysis to evaluate benefits and harms of multi-agent chemotherapy in advanced STS. Eligible studies were randomized trials of chemotherapy in advanced STS comparing single agent to multi-agent therapy. Data from studies reporting a hazard ratio (HR) and 95% confidence intervals (CI) for OS and progression-free survival (PFS) were pooled in a meta-analysis. Meta-regression was utilized to explore the association between efficacy (OS and PFS) and both toxicity and dose intensity.ResultsWe identified 22 trials published between 1974 and April 2016 and comprising 5044 patients. Overall, multi-agent chemotherapy was associated with improved OS (HR:0.79, p=0.02), and borderline improvement in PFS (HR:0.86, p=0.05). While the effect on OS was similar in trials with non-anthracycline controls compared to those with anthracycline controls (HR for OS 0.73 vs. 0.82, p for difference=0.63) there was a non-significantly greater effect for multi-agent chemotherapy on PFS in non-anthracycline RCT (HR for PFS 0.73 vs. 0.91, p for difference=0.13). Compared to studies with cytotoxic therapy-based multi-agent therapy, a non-significantly greater magnitude of effect among studies with biological/cytostatic experimental groups was seen (HR for OS 0.64 vs. 0.86, p for difference=0.37). There was a borderline significant association between dose reductions (which were more common in combination arms) and worse PFS (beta=0.70, p=0.053).ConclusionMulti-agent chemotherapy is associated with a modest, but statistically significant improvement in outcomes in STS. Combining chemotherapy with non-cytotoxic agents might represent a promising strategy.
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Orthodontics contest shows students can sculpt more than smiles
Dr. Kaz Kitagaito has taken first place in the annual wire sculpture contest conducted by the School of Dentistry's Department of Orthodontics.
The post Orthodontics contest shows students can sculpt more than smiles appeared first on UW School of Dentistry.
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Unconscious cognitive dysfunction in emotion dysregulation and psychopathology of panic disorder: evidence from the late positive potential
No abstract available
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The effect of the high-approach versus low-approach motivational positive affect on the processing stage of cognitive control: an event-related potential study
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Fluid intelligence relates to the resting state amplitude of low-frequency fluctuation and functional connectivity: a multivariate pattern analysis
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Effects of gynosaponin TN-2 on L-DOPA-induced cytotoxicity in PC12 cells
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Feedback is the breakfast of champions: the significance of self-controlled formal feedback for autonomous task engagement
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Punishment eliminates directed forgetting: an event-related potential study
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Multiple pathological mechanisms contribute to hippocampal damage in the experimental autoimmune encephalomyelitis model of multiple sclerosis
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When the body becomes no more than the sum of its parts: the neural correlates of scrambled versus intact sexualized bodies
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Overexpressed wild-type superoxide dismutase 1 exhibits amyotrophic lateral sclerosis-related misfolded conformation in induced pluripotent stem cell-derived spinal motor neurons
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Simultaneous Speciation Analysis of Arsenic, Chromium, and Selenium in the Bioaccessible Fraction for Realistic Risk Assessment of Food Safety
Analytical Chemistry
DOI: 10.1021/acs.analchem.7b03423
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Analysis and Classification of the Nasal Base Using a Parametric Model
This study assesses using an equation to quantitatively describe nasal base shape and tests it against subjective categorization.
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Masseteric Nerve Transfer for Facial Nerve Paralysis
This systematic review with meta-analysis examines masseteric nerve transfer for treatment of patients with facial paralysis.
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Peak Nasal Inspiratory Flow as an Objective Measure
This study assesses the utility of peak nasal inspiratory flow as an objective diagnostic and outcome measure for functional septorhinoplasty in combination with the Nasal Obstruction Symptom Evaluation scale.
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Length of Stay for Free Tissue Transfer to Head and Neck Defects
This database review evaluates patient and surgical factors associated with length of stay and reoperation following surgical procedures for malignant neoplasm of the head and neck involving microvascular free tissue transfer reconstruction.
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Discrimination threshold for haptic volume perception of fingers and phalanges
Abstract
Humans exhibit a remarkable ability to discriminate variations in object volume based on natural haptic perception. The discrimination thresholds for the haptic volume perception of the whole hand are well known, but the discrimination thresholds for haptic volume perception of fingers and phalanges are still unknown. In the present study, two psychophysical experiments were performed to investigate haptic volume perception in various fingers and phalanges. The configurations of both experiments were completely dependent on haptic volume perception from the fingers and phalanges. The participants were asked to blindly discriminate the volume variation of regular solid objects in a random order by using the distal phalanx, medial phalanx, and proximal phalanx of their index finger, middle finger, ring finger, and little finger. The discrimination threshold of haptic volume perception gradually decreases from the little finger to the index finger as well as from the proximal phalanx to the distal phalanx. Overall, both the shape of the target and the part of the finger in contact with the target significantly influence the precision of haptic perception of volume. This substantial data set provides detailed and compelling perspectives on the haptic system, including for discrimination of the spatial size of objects and for performing more general perceptual processes.
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Flow-assisted Dielectrophoresis: A Low Cost Method for the Fabrication of High Performance Solution-processable Nanowire Devices
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Live-imaging of Breast Epithelial Cell Migration After the Transient Depletion of TIP60
Here, we present the real-time monitoring of cell migration in a wound-healing assay using TIP60-depleted MCF10A breast epithelial cells. The implementation of live-cell imaging techniques in our protocol allows us to analyze and visualize single-cell movement in real time and across time.
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The Bidirectional, Absorbable, No-Drain Abdominoplasty
Abstract
This article outlines the author's technique, and the concepts of Bidirectional, Absorbable, No-Drain Abdominoplasty (BAND-Abdominoplasty). The attendant advantages and disadvantages are reviewed in the context of a retrospective, 5-year, single surgeon series.
Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
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Superomedial Pedicle Vertical Scar Breast Reduction: Objective and Subjective Assessment of Breast Symmetry and Aesthetics
Abstract
Background
The superomedial vertical scar breast reduction (SVBR) described by Hall-Findlay is gaining popularity among surgeons worldwide. The aim of this study was to evaluate its long-term aesthetic outcome, the extent of quality of life improvement and the factors that influence patient satisfaction and reviewers' evaluation of aesthetic/surgical outcome.
Methods
In this historical prospective study, we included women who underwent SVBR at least one year prior to enrollment and responded to a quality of life questionnaire. Their breasts were photographed, measured and evaluated by the plastic surgery staff.
Results
A total of 40 patients responded to the questionnaire, and the breasts of 31 of them were measured and photographed. All 31 patients had good breast symmetry according to objective breast measurements. There was a clear correlation between the patients' and the reviewers' scores of breast symmetry, scar appearance and breast shape (r = 0.4–0.65, r = 0.432–0.495 and r = 0.335–0.403, respectively). The factor that most influenced reviewers' and patients' satisfaction with the overall aesthetic outcome was the breast-to-body proportion.
Conclusions
The proportions between the breast size and the patient's body habitus are pivotal to patient satisfaction and should be taken into consideration when planning a reduction mammaplasty. The SVBR technique for breast reduction provided good cosmetic outcome and symmetry over a long-term follow-up.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
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Can we better predict the biologic behavior of incidental IPMN? A comprehensive analysis of molecular diagnostics and biomarkers in intraductal papillary mucinous neoplasms of the pancreas
Abstract
Purpose
Predicting the biologic behavior of intraductal papillary mucinous neoplasm (IPMN) remains challenging. Current guidelines utilize patient symptoms and imaging characteristics to determine appropriate surgical candidates. However, the majority of resected cysts remain low-risk lesions, many of which may be feasible to have under surveillance. We herein characterize the most promising and up-to-date molecular diagnostics in order to identify optimal components of a molecular signature to distinguish levels of IPMN dysplasia.
Methods
A comprehensive systematic review of pertinent literature, including our own experience, was conducted based on the PRISMA guidelines.
Results
Molecular diagnostics in IPMN patient tissue, duodenal secretions, cyst fluid, saliva, and serum were evaluated and organized into the following categories: oncogenes, tumor suppressor genes, glycoproteins, markers of the immune response, proteomics, DNA/RNA mutations, and next-generation sequencing/microRNA. Specific targets in each of these categories, and in aggregate, were identified by their ability to both characterize a cyst as an IPMN and determine the level of cyst dysplasia.
Conclusions
Combining molecular signatures with clinical and imaging features in this era of next-generation sequencing and advanced computational analysis will enable enhanced sensitivity and specificity of current models to predict the biologic behavior of IPMN.
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Texas fire department welcomes first firefighter-paramedic in 141 years
By Drew Smith Herald Democrat DENISON, Texas — Denison Fire Rescue crews welcomed Hanna Lindemuth to their team last week as not only one of the department's newest employees but as the first female firefighter and paramedic in the department's 141-year history. "We're happy she's here and we're proud of her at the same time," Assistant Fire Chief Mark Escamilla said ...
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Seroprevalence of orf infection based on IgM antibody detection in sheep and goats from selected small ruminant farms in Malaysia
Abstract
Orf is an infectious disease that affects the skin of sheep and goats resulting in lesions that reduce animal productivity. This study was aimed to determine the status of orf infection among small ruminants from selected farms in the state of the Selangor based on IgM antibody detection. Serum samples were collected from 90 goats and 90 sheep and subjected to qualitative enzyme-linked immunosorbent assay (ELISA) to measure IgM antibodies followed by chi-square analysis of the data. The result from this study showed that 33 goats (36.7%) and 7 sheep (7.8%) were positive for orf IgM antibodies, indicating higher seroprevalence among goats as compared to sheep. The risk factors such as species, breed, farm location, and history of orf, age, gender, presence of clinical signs, and farm location were shown to significantly affect the seropositivity of IgM antibodies in these species. In conclusion, this study showed that a significant number of goat populations in Selangor, Malaysia, harbor active orf infection in comparison to sheep.
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Protein Expression of PTTG1 as a Diagnostic Biomarker in Adrenocortical Carcinoma
Abstract
Background
Adrenocortical carcinoma (ACC) has a poor prognosis and there is an unmet clinical need for biomarkers to improve both diagnostic and prognostic assessment. Pituitary-tumor transforming gene (PTTG1) has been shown to modulate cancer invasiveness and response to therapy. The potential role of PTTG1 protein levels in ACC has not been previously addressed. We assessed whether increased nuclear protein expression of PTTG1 distinguished ACCs from adrenocortical adenomas (ACAs).
Methods
Patients with ACC or ACA were identified from prospective tissue banks at two independent institutions. Two tissue microarrays (TMAs) consisting of adrenal specimens from 131 patients were constructed and clinically annotated. Immunohistochemical analysis for PTTG1 and Ki-67 was performed on each TMA.
Results
TMA-1 (n = 80) contained 20 normal adrenals, 20 ACAs, and 40 ACCs, and the validation, TMA-2 (n = 51), consisted of 10 normal adrenals, 14 ACAs, and 27 ACCs. On TMA-1, nuclear staining of PTTG1 was detected in 12 (31%) ACC specimens, while all ACAs and normal adrenal glands were negative for PTTG1. On TMA-2, 20 (74%) of the ACC tumors demonstrated PTTG1 nuclear staining of PTTG1, and 13 (93%) ACA and 4 (44%) normal adrenal glands were negative for PTTG1. ACC tumors with increased PTTG1 protein staining had a significantly higher Ki-67 index (p < 0.001) than those with lower levels of PTTG1.
Conclusions
Increased nuclear protein expression of PTTG1 was observed in malignant adrenal tumors. PTTG1 correlated with Ki-67 in two independent TMAs. PTTG1 is a promising biologic marker in the evaluation of adrenal tumors.
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Real-Ear Measures
Real-ear measures (REM) are recommended in hearing aid fitting. However, reports suggest that only approximately 30 percent of audiologists routinely perform REM. Rationale (or excuses) for not performing REM are numerous, but little peer-reviewed research has been conducted to support or refute the use of REM in regards to benefit in speech understanding and subjective quality of fitting.
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Quick and Selective Dual Mode Detection of H2S Gas by Mobile App Employing Silver Nanorods Array
Analytical Chemistry
DOI: 10.1021/acs.analchem.7b04064
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Anatomical study of medial sural artery and its perforators in Nepalese: an aid to reconstructive surgery
Abstract
Objective
The present study was undertaken to know the anatomical basis of medial sural artery (MSA) and its perforators in Nepalese.
Methods
The popliteal arteries of 16 preserved cadaveric lower limbs were injected with a mixture of red ink and glycerine. The number, location, diameter of perforators; length and intramuscular course of pedicle; the branching pattern of MSA were observed and measured.
Results
The mean of 2.2 ± 1.2 perforators (range 0–4) was observed. The perforators were clustered between 8.6 and 25.7 cm from the popliteal crease and 0.3–7.5 cm from posterior midline of leg. The dominant perforators were observed in middle 1/3rd of the leg. The average pedicle length was 12.04 ± 3.27 cm. The intramuscular courses of pedicles were observed in deep and superficial strata in 65.7 and 34.3%, respectively. The MSA originated from popliteal artery in 62.5% and common sural artery in 37.5%. An accessory MSA was found in 12.5%. Type I and Type III branching patterns of MSA were observed in 31.2% each whereas Type II was found in 37.5%. The mean external diameter of perforators and MSA were 0.85 ± 0.27 mm and 2.2 ± 0.43 mm, respectively.
Conclusions
The metrical presentation of this study provides an easy access to know about the distribution of perforators and branching pattern of MSA which will help the surgeons to make a convenient plan to harvest the MSA perforator flap in Nepalese population.
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Long-Term Survival of Recurrent Intrahepatic Cholangiocarcinoma: The Impact and Selection of Repeat Surgery
Abstract
Background
Definitive guidelines for recurrent intrahepatic cholangiocarcinoma (ICC) do not exist. This study has focused on the repeat surgery when analyzing the survival outcomes of recurrent ICC. We evaluated the relationship between clinicopathological features of the primary tumor and implementation of the repeat surgery to identify its potential selection criteria.
Methods
A total of 108 patients with recurrent ICC between 1993 and 2015 were analyzed. Of these, 15 patients underwent repeat surgery and 93 did not.
Results
Seven out of 29 patients with intrahepatic recurrence and eight out of 44 patients with extrahepatic recurrence were amenable to the repeat surgery. Thirty-five patients with simultaneous or consequent intrahepatic recurrence and extrahepatic recurrence were not amenable to the repeat surgery. Patients who underwent repeat surgery had a lower proportion of lymph node metastases (n = 0 [0%] vs. n = 47 [50.5%], p < 0.001), multiple tumors in the primary tumor (n = 1 [6.7%] vs. n = 31 [33.3%], p = 0.037), or early recurrence (≤ 1 year; n = 4 [26.7%] vs. n = 62 [66.7%], p = 0.003). Survival after recurrence (SAR) was better in patients who underwent repeat surgery than in those who did not (median SAR time: 91.6 vs. 10.4 months, and 3-year survival: 86.7 vs. 8.7%, respectively, p < 0.001).
Conclusions
Repeat surgery for recurrent ICC with an appropriate selection can be associated with prolonged survival. Regarding the feasibility, nodal status, number of tumors on the primary tumor, and time to recurrence may be considered as selection criteria.
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Helicobacter pylori induces CDX2 and COX2 expression by modulating microRNAs in esophageal epithelial cells
Abstract
Dysregulation of microRNAs (miRNAs) has been linked to virulence factors of Helicobacter pylori (H. pylori). The role of H. pylori in esophageal disease has not been clearly defined. We previously reported that H. pylori-esophageal colonization promotes the incidence of Barrett's esophagus and esophageal adenocarcinoma in vivo. Here, we studied the direct effects of H. pylori on the transformation of esophageal epithelial cells, with particular focus on whether H. pylori exerts its effects by modulating miRNAs and their downstream target genes. The human normal esophageal cell line HET-1A was chronically exposed to H. pylori extract and/or acidified deoxycholic acid (DCA) for up to 36 weeks. The miRNA profiles of the esophageal epithelial cells associated with H. pylori infection were determined by microarray analysis. We found that chronic H. pylori exposure promoted acidified DCA-induced morphological changes in HET-1A cells, along with aberrant overexpression of intestinal metaplasia markers and tumorigenic factors, including CDX2, MUC2 and COX2. H. pylori modified the miRNA profiles of esophageal epithelial cells, particularly aberrant silencing of miR-212-3p and miR-361-3p. Moreover, in biopsies from Barrett's esophagus patients, esophageal H. pylori colonization was associated with a significant decrease in miR-212-3p and miR-361-3p expression. Furthermore, we identified COX2 as a target of miR-212-3p, and CDX2 as a target of miR-361-3p. H. pylori infection of esophageal epithelial cells was associated with miRNA-mediated up-regulation of oncoprotein CDX2 and COX2. Our observations provide new evidence about the molecular mechanisms underlying the association between H. pylori infection and esophageal carcinogenesis.
This article is protected by copyright. All rights reserved.
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Combined Annotation Dependent Depletion (CADD) Score for BRCA1/2 variants in patients with Breast and/or Ovarian Cancer
Abstract
The utility of Combined Annotation Dependent Depletion (CADD) Score was recently reported to rank the pathogenicity as C-scores ranging 1 to 99 for both convinced deleterious mutations and missense mutations. Using C-scores for BRCA1/2 variants, we tried to constitute the classification system for Variant of Uncertain Significance (VUS), which had been major problem of genetic testing for Hereditary Breast and/or Ovarian Cancer (HBOC).
We analyzed BRCA1/2 genes for 283 patients with breast and/or ovarian cancer. The deleterious mutation, minor variant, and wild type of BRCA1 and 2 were 5, 27, 251 and 15, 85, 183, respectively. While, the variants with C-score≧10 were involved 19/283 (6.7%) in BRCA1 and 34/283 (12%) in BRCA2. All deleterious mutations were included in this group.
The frequency of personal history and family history of ovarian cancer were significantly high, and frequency of serous adenocarcinoma of ovary and triple negative breast cancer was relatively high in group with deleterious mutations. Similar findings were seen in patients with variants of C-score≧10.
According to the C-score and population frequency, we could define VUS for 11 patients out of 283 patients (3.8%). CADD is useful to classify the variant of BRCA1/2 and selecting the patient who needs further segregation studies.
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Breast cancer: The translation of big genomic data to cancer precision medicine
Abstract
Cancer is a complex genetic disease that consequence from the accumulation of genomic alterations, in which germline variations predispose individuals to cancer and somatic alterations initiate and trigger the progression of cancer. For the past two decades, genomic research has advanced remarkably, evolving from single-gene to whole-genome screening by using genome-wide association study (GWAS) and next generation sequencing (NGS) that contributing to big genomic data. International collaborative efforts have contributed in curating these data to identify clinically significant alterations that could be used in the clinical settings. Focusing on breast cancer, this review summarized the identification of genomic alterations with high throughput screening as well as the utilization of genomic information in clinical trials that match cancer patients to therapies, which further lead to cancer precision medicine. Furthermore, cancer screening and monitoring were enhanced greatly by the employment of liquid biopsies. With the growing data complexity and size, there are much anticipations in exploiting deep machine learning and artificial intelligence to curate integrative "–omics" data to refine the current medical practice to be applied in near future.
This article is protected by copyright. All rights reserved.
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The 2016 revision of the WHO Classification of Central Nervous System Tumours: retrospective application to a cohort of diffuse gliomas
Abstract
The classification of central nervous system tumours has more recently been shaped by a focus on molecular pathology rather than histopathology. We re-classified 82 glial tumours according to the molecular-genetic criteria of the 2016 revision of the World Health Organization (WHO) Classification of Tumours of the Central Nervous System. Initial diagnoses and grading were based on the morphological criteria of the 2007 WHO scheme. Because of the impression of an oligodendroglial component on initial histological assessment, each tumour was tested for co-deletion of chromosomes 1p and 19q and mutations of isocitrate dehydrogenase (IDH-1 and 2) genes. Additionally, expression of proteins encoded by alpha-thalassemia X-linked mental retardation (ATRX) and TP53 genes was assessed by immunohistochemistry. We found that all but two tumours could be assigned to a specific category in the 2016 revision. The most common change in diagnosis was from oligoastrocytoma to specifically astrocytoma or oligodendroglioma. Analysis of progression free survival (PFS) for WHO grade II and III tumours showed that the objective criteria of the 2016 revision separated diffuse gliomas into three distinct molecular categories: chromosome 1p/19q co-deleted/IDH mutant, intact 1p/19q/IDH mutant and IDH wild type. No significant difference in PFS was found when comparing IDH mutant grade II and III tumours suggesting that IDH status is more informative than tumour grade. The segregation into distinct molecular sub-types that is achieved by the 2016 revision provides an objective evidence base for managing patients with grade II and III diffuse gliomas based on prognosis.
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Long-term safety of subcutaneous immunotherapy with TO-204 in Japanese patients with house dust mite-induced allergic rhinitis and allergic bronchial asthma: Multicenter, open label clinical trial
Publication date: Available online 7 December 2017
Source:Allergology International
Author(s): Takao Fujisawa, Terufumi Shimoda, Keisuke Masuyama, Kimihiro Okubo, Kohei Honda, Mitsuhiro Okano, Toshio Katsunuma, Atsuo Urisu, Yasuto Kondo, Hiroshi Odajima, Kazuyuki Kurihara, Makoto Nagata, Masami Taniguchi, Shoichiro Taniuchi, Satoru Doi, Tomoshige Matsumoto, Shoji Hashimoto, Akihiko Tanaka, Kensuke Natsui, Nahoko Abe, Hideki Ozaki
BackgroundTo evaluate the long-term safety of subcutaneous immunotherapy with TO-204, a standardized house dust mite (HDM) allergen extracts, we conducted a multicenter, open label clinical trial.MethodsJapanese patients aged 5–65 years were eligible for the study, if they had HDM-induced allergic rhinitis (AR), allergic bronchial asthma (BA), or both. TO-204 was administered in a dose titration scheme, and the maintenance dose was determined according to the predefined criteria. The treatment period was 52 weeks, and patients who were willing to continue the treatment received TO-204 beyond 52 weeks. This clinical trial is registered at the Japan Pharmaceutical Information Center (Japic CTI-121900).ResultsBetween July 2012 and May 2015, 44 patients (28 with AR and 16 with allergic BA) were enrolled into the study. All patients were included in the analysis. The duration of treatment ranged from 23 to 142 weeks and the median maintenance dose was 200 Japanese allergy units (JAU). Adverse events occurred in 22 patients (50%). The most common adverse event was local reactions related to the injection sites. Four patients experienced anaphylactic reactions when they were treated with the dose of 500 JAU. Two patients experienced anaphylactic shock with the doses of 1000 JAU at onset. These 6 patients could continue the study with dose reduction.ConclusionsSafety profile of TO-204 was acceptable in Japanese patients with HDM-induced AR or allergic BA. Higher doses should be administered carefully, because the risk of anaphylaxis increased at doses of 500 or 1000 JAU.
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NHC-catalyzed [4+2] cycloaddition reactions for the synthesis of 3'-spirocyclic oxindoles via C-F bond cleavage protocol
Chem. Commun., 2017, Accepted Manuscript
DOI: 10.1039/C7CC08048D, Communication
DOI: 10.1039/C7CC08048D, Communication
Jun Yan, Kuangxi Shi, Chengtao Zhao, liyuan Ding, Shengsheng Jiang, Limin Yang, Guofu Zhong
A chiral NHC-catalyzed [4+2] cycloaddition of [gamma]-fluoroenals is developed. This catalytically generated nucleophlic [gamma]-carbon via C-F bond cleavage undergoes highly enantioselective cycloaddition (up to >99% ee) to isatins and provides...
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A chiral NHC-catalyzed [4+2] cycloaddition of [gamma]-fluoroenals is developed. This catalytically generated nucleophlic [gamma]-carbon via C-F bond cleavage undergoes highly enantioselective cycloaddition (up to >99% ee) to isatins and provides...
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Base-Catalyzed Thio-Lactamization of 2-(1-Arylvinyl)anilines with CS2 for the Synthesis of Quinoline-2-thiones
Chem. Commun., 2017, Accepted Manuscript
DOI: 10.1039/C7CC07633A, Communication
DOI: 10.1039/C7CC07633A, Communication
Tong-Lin Wang, Xiaojun Liu, Xicun Wang, Cong-De Huo, Zheng-Jun Quan
Here we show that base-catalyzed thio-lactamization of 2-(1-arylvinyl)anilines with CS2 is a powerful methodology to synthesize quinoline-2-thiones. This thio-lactamization use an inexpensive and versatile 2-(1-arylvinyl)anilines, which are easily available from...
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Here we show that base-catalyzed thio-lactamization of 2-(1-arylvinyl)anilines with CS2 is a powerful methodology to synthesize quinoline-2-thiones. This thio-lactamization use an inexpensive and versatile 2-(1-arylvinyl)anilines, which are easily available from...
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Sample preparation for polar metabolites in bioanalysis
Analyst, 2018, Advance Article
DOI: 10.1039/C7AN01333G, Minireview
DOI: 10.1039/C7AN01333G, Minireview
Nicolas Drouin, Serge Rudaz, Julie Schappler
Sample preparation is a primary step of any bioanalytical workflow, especially in metabolomics where maximum information has to be obtained without spoiling the analytical instrument. The sample extraction of polar metabolites is still challenging but strategies exist to enable the phase transfer of hydrophilic metabolites from the biological phase to a clean interference-free phase.
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Sample preparation is a primary step of any bioanalytical workflow, especially in metabolomics where maximum information has to be obtained without spoiling the analytical instrument. The sample extraction of polar metabolites is still challenging but strategies exist to enable the phase transfer of hydrophilic metabolites from the biological phase to a clean interference-free phase.
To cite this article before page numbers are assigned, use the DOI form of citation above.
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