Use of the hCONSORT Criteria as a Reporting Standard for Herbal Interventions for Common Dermatoses - A Systematic Review

Abstract

Background

The use of complementary and alternative medicine (CAM) is increasing in western countries, including in the area of dermatology. However, western healthcare providers have not integrated CAM into regular practice due to a lack of reliable data supporting its use. In order to encourage high quality research related to the use of CAM and specifically herbal interventions, the CONSORT extension criteria on reporting herbal interventions (hCONSORT) were published in 2006.

Objectives

This study aimed to evaluate the adherence of randomized controlled trials investigating herbal interventions for 3 common dermatoses (acne, atopic dermatitis, and psoriasis) to the hCONSORT criteria.

Methods

A comprehensive search of Medline, Embase, and Cochrane library databases was conducted. Randomized control trials published between 2009 and 2014 assessing therapeutic outcomes of plant-based interventions for acne, atopic dermatitis, or psoriasis were included. Investigators determined the number of unique hCONSORT criteria satisfied per report. Analysis of variance was used to examine differences in scores by disease entity.

Results

The vast majority of reviewed studies reported less than 50% of information recommended in the hCONSORT criteria.

Limitations

Limitations include small number of dermatologic conditions examined, exclusion of reports based on language, and lack of assessment of overall adherence to CONSORT criteria

Conclusions

Our data indicates lack of adherence to hCONSORT extension criteria. Adherence to hCONSORT guidelines should be encouraged in order to provide high quality reporting of research on herbal interventions in dermatology. Doing so may ease the integration of CAM into conventional medical practice and provide actionable data to providers.

This article is protected by copyright. All rights reserved.

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Case report of Schöpf–Schulz–Passarge syndrome resulting from a missense mutation, p.Arg104Cys, in WNT10A

Abstract

Schöpf–Schulz–Passarge syndrome (SSPS) is a rare ectodermal dysplasia characterized by cysts of the eyelids, hypodontia, hypotrichosis, palmoplantar keratosis and onychodystrophy, and it is not common in Asia according to the published work. This autosomal recessive disorder was believed to result from mutations in the WNT10A gene. We report a 54-year-old Taiwanese man with SSPS resulted from a homozygous mutation (p.Arg104Cys) in WNT10A. This mutation has not been reported in odonto-onycho-dermal dysplasia but was demonstrated to link with dental abnormalities. This report implies the significance of WNT10A gene mutation in ectodermal dysplasia and highlights the clinical features of SSPS.

http://ift.tt/2kVxKz2

Vonoprazan- vs proton-pump inhibitor-based first-line 7-day triple therapy for clarithromycin-susceptible Helicobacter pylori: A multicenter, prospective, randomized trial

Abstract

Background

The eradication rate of vonoprazan-based first-line triple therapy (combined with clarithromycin and amoxicillin) (V-AC) was reported to be 97.6% in patients with clarithromycin (CAM)-susceptible Helicobacter pylori in a phase III study, whereas our real-world, prospective, multicenter cohort study yielded an eradication rate <90%.

Objective

To validate the eradication rate of V-AC using CAM-susceptible testing in a multicenter, prospective, randomized trial.

Methods

We included 147 treatment-naïve H. pylori-positive patients [41 with CAM-resistant infections and 106 with CAM-susceptible infections]. The CAM-susceptible group patients were randomized to either the V-AC group (vonoprazan 20 mg bid, amoxicillin 750 mg bid, and clarithromycin 200 or 400 mg bid) or PPI-AC group (lansoprazole 30 mg, rabeprazole 10 mg, or esomeprazole 20 mg bid; amoxicillin 750 mg bid; and clarithromycin 200 or 400 mg bid). All CAM-resistant H. pylori were eradicated by V-AC, as measured by the urea breath test around 8 weeks after eradication. Safety was evaluated by patient questionnaires.

Results

The intention-to-treat and per-protocol eradication rates of V-AC in the CAM-susceptible H. pylori-infected patients were 87.3% (95% confidence interval 75.5%-94.7%) and 88.9% (77.4%-95.8%). The respective eradication rates of PPI-AC were 76.5% (62.5%-87.2%) and 86.7% (73.2%-94.9%). No significant difference was observed between the V-AC and PPI-AC regimes in terms of the intention-to-treat (P = .21) or per-protocol (P = .77) analyses. The questionnaire scores did not differ significantly between the groups. Both the intention-to-treat and per-protocol eradication rates of V-AC in the CAM-resistant patients were 82.9% (67.9%-92.8%).

Conclusion

The eradication rate of V-AC treatment in the CAM-susceptible H. pylori-infected patients was <90%, as was that by PPI-AC, thus V-AC is not ideal regimen in CAM-susceptible H. pylori. However, the 82.9% eradication rate of V-AC in the CAM-resistant infections may indicate the potential of V-AC with modified dose, dosing interval, and treatment duration. (UMIN000016337).

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Real-World Experience with Targeted Therapy for the Treatment of Anaplastic Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Recent Pregnancy Is Not Associated with High-Risk Pathological Features of Well-Differentiated Thyroid Cancer

Thyroid , Vol. 0, No. 0.


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Re: “Low-Dose Childhood Radiation Effects to the Thyroid Follow a Linear Dose–Response Trend and Persist Even 45+ Years After Exposure”

Thyroid , Vol. 0, No. 0.


http://ift.tt/2BlVwvj

Rutin Scavenges Reactive Oxygen Species, Inactivates 5′-Adenosine Monophosphate-Activated Protein Kinase, and Increases Sodium–Iodide Symporter Expression in Thyroid PCCL3 Cells

Thyroid , Vol. 0, No. 0.


http://ift.tt/2BZ4hif

Cancer Risk Associated with Nuclear Atypia in Cytologically Indeterminate Thyroid Nodules: A Systematic Review and Meta-Analysis

Thyroid , Vol. 0, No. 0.


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Neutrophilic urticarial dermatosis: a novel association with poststreptococcal rheumatic disease

Summary

Neutrophilic urticarial dermatosis (NUD), a particular clinical and histological entity, can provide a strong pointer to underlying systemic disease, most frequently rheumatological diseases. We report the first case of NUD in association with a post-streptococcal rheumatic disease, with symptoms including recurrent sore throat, raised antistreptolysin O titre, persistent transient urticaria, polyarthralgia, rheumatic mitral valve disease and Jaccoud arthropathy. Histologically, NUD is characterized by an intense superficial and deep neutrophilic interstitial and perivascular infiltrate, without significant oedema or blood vessel damage. These neutrophils may have a tendency to concentrate along the basement membrane and extend into the epidermis, hair follicles, sebaceous glands and sweat glands (a feature termed 'neutrophilic epitheliotropism'). Clinicians should remain cognizant of NUD, and in particular its frequent association with an underlying inflammatory disorder.

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Rational ideation and empiric validation of an innovative digital dermographic tester

Summary

Background

Dermographism is a condition characterized by a weal response to a combination of pressure and traction on skin surface, and its diagnosis is based on medical history, clinical criteria and provocation test. The Dermographic Tester^®, a pen-sized tool containing a spring-loaded blunt tip, is the most widely used instrument for the provocation test, and it exerts increasing pressures on the skin surface according to an arbitrary units (AU) scale. Analysing the mechanism of function and trying to convert the AUs to SI units (g/mm²), we found that this instrument had some defects and limits that would compromise a true and repeatable quantification of the weal response threshold. Consequently, we decided to develop a new instrument, the Digital Dermographic Tester (DDT), which is engineered with an inside force sensor to implement features lacking in the current tools, in the hope of enhancing the precision of the provocation test.

Aim

To validate the effectiveness and accuracy of the DDT.

Methods

We tested the DDT on 213 participants purposely sampled to obtain three groups, each with a different pattern of reaction to mechanical stimuli. Based on anamnestic, diagnostic and symptomatic criteria, patients were divided into dermographic urticaria (DU), spontaneous urticaria (SU) and healthy control (HC) groups. The DDT was used to apply 12 levels of pressure to the skin surface, and a frequency distribution of positive reactions was displayed for each group.

Results

A force of 36–40 g/mm² appropriately differentiated physiological from pathological conditions with high sensitivity and specificity.

Conclusions

The DDT was found to be capable of differentiating patients with DU patients from those with SU and from HCs, and was able to precisely identify the weal elicitation threshold.

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Cosmetic Procedures During the Holidays? 10 Tips for Patients

As we prepare for the holidays and make New Year's resolutions, for those patients interested in improving their appearance, here are 10 tips from a reputable surgeon.
Medscape Plastic Surgery

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Want More Referrals? Here's How

Getting referrals and developing a referral network have grown more difficult. Physicians have to work harder to cultivate referring relationships. Here are effective ways to get more referrals.
Medscape Business of Medicine

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FDA Bans Triclosan, 23 Other Antiseptic Ingredients

The FDA has finalized a rule that bans marketing of over-the-counter healthcare antiseptic products containing triclosan and 23 other active ingredients.
News Alerts

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Anticholinergics for asthma: a long history

Purpose of review To provide a fast overview about the introduction and development of anticholinergic drugs in Western medicine to their current indications particularly in asthma. Recent findings Although short-acting muscarinic antagonists have been positioned in the last 15 years for the treatment of adults and children with moderate-to-severe acute asthma in the emergency setting (reducing the risk of hospital admissions and improving lung function), a growing body of evidence has recently emerged that positions the long-acting muscarinic anticholinergic tiotropium bromide as add-on therapy to at least inhaled corticosteroids (ICS) maintenance therapy in adults, adolescents, and children with symptomatic asthma. Thus, the addition of tiotropium bromide to ICS alone or ICS and another controller was associated with significant improvements in spirometric measures and asthma control, and a significantly decrease in the rate of asthma exacerbations. Summary Short-acting muscarinic antagonists and tiotropium bromide have a well established role in the treatment of different phases of asthma. Further data are needed to provide more evidence on other selective long-acting muscarinic antagonists in addition to tiotropium as potential treatment options.

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Editorial introductions

No abstract available

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Collection of nasal secretions and tears and their use in allergology

Purpose of review The identification of immunological markers in nasal secretions and tears is becoming essential in the study of allergic diseases. The collection procedure of nasal and ocular secretions directly influences the results, thus it is of paramount importance to validate and standardize the sampling process. Recent findings Current techniques for nasal secretions sampling are mainly based on three principles: collection of spontaneous secretions, nasal washings, and absorption. Collection of spontaneous secretions is appropriate in subjects with nasal hypersecretion, whereas in healthy individuals the collected volume is frequently insufficient. Nasal washings are associated with an unpredictable, high dilution and concentrations of markers often fall below detection limits of immunological assays. Absorption seem to provide the best compromise between sufficient sample amounts and detectability of inflammatory mediators and immunoglobulin E. Tear samples can be obtained by glass capillary tubes, filter paper strips and ophthalmic sponges. Volumes are however small or highly diluted through reflex tearing. Summary Secretions reflect the local inflammatory activity and provide valuable information about the immunological reaction to allergens at the target organ. There is increasing evidence of the potential clinical role of their analysis, for diagnosis, and monitoring of allergic rhino-conjunctivitis. Appropriate collection and processing is very important and requires special attention.

http://ift.tt/2zbdtuq

Asthma: personalized and precision medicine

Purpose of review In this review, we herein describe the progress in management of severe asthma, evolving from a 'blockbuster approach' to a more personalized approach targeted to the utilization of endotype-driven therapies. Recent findings Severe asthma characterization in phenotypes and endotypes, by means of specific biomarkers, have led to the dichotomization of the concepts of 'personalized medicine' and 'precision medicine', which are often used as synonyms, but actually have conceptual differences in meaning. The recent contribute of the omic sciences (i.e. proteomics, transcriptomics, metabolomics, genomics, …) has brought this initially theoretic evolution into a more concrete level. Summary This step-by-step transition would bring to a better approach to severe asthmatic patients as the personalization of their therapeutic strategy would bring to a better patient selection, a more precise endotype-driven treatment, and hopefully to better results in terms of reduction of exacerbation rates, symptoms, pulmonary function and quality of life.

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Prevalence and clinical characteristics of local allergic rhinitis to house dust mites

Purpose of review Local allergic rhinitis (LAR) is a recently classified subtype of rhinitis defined by a nasal allergic response in patients without systemic evidence of atopy. Recent studies have reported the prevalence, clinical course, culprit allergens, diagnostic methods and treatment outcomes of LAR. The purpose of this review is to summarize the most relevant and updated scientific evidence for LAR, especially focusing on its prevalence and clinical characteristics. Recent findings LAR is found in a significant proportion (3.7–61.9%) of patients previously diagnosed with nonallergic rhinitis, but the prevalence may differ among ethnic groups and countries. Common allergens of LAR are similar to those of allergic rhinitis, in which house dust mites are the most common cause, followed by grass pollen, tree pollen, weed pollen and animal dander confirmed by provocation tests. Although the nasal provocation test to a single allergen is considered the gold standard method, the detection of allergen-specific IgE and other inflammatory mediators from nasal secretions and the basophil activation test can assist in the diagnosis of LAR. Conjunctivitis and asthma are the most common comorbid conditions, and the occurrence rate of asthma increases over period. However, the conversion rate to allergic rhinitis was not significantly different between LAR and healthy controls. Summary LAR is a well-differentiated entity of rhinitis, which should be considered in patients with persistent and severe symptoms without any systemic evidence of atopy. Further research is needed to investigate the long-term outcome, and geographic and ethnic differences of LAR.

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Role of epigenetics and DNA-damage in asthma

Purpose of review Although asthma is a common disease worldwide, its pathogenesis remains to be fully elucidated. There is increasing evidence of the interaction between epigenetics, DNA-damage, and environmental allergens in the development of asthma. In this review, we will focus on the role of epigenetics and DNA-damage in asthma. Recent findings There is growing evidence of environmental allergens, particularly house dust mite, stimulating oxidative DNA damage in airway epithelial cells. The repair of this DNA damage has been implicated in the secretion of Th2 cytokines and the induction of allergic inflammation. Summary Studies of the role of epigenetics, DNA-damage, and environmental allergens have begun to reveal the their complex interactions and their roles in the development of asthma. Further study in these areas may lead to novel prevention and treatment approaches.

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Association between allergic and nonallergic rhinitis and obstructive sleep apnea

Purpose of review Allergic rhinitis and nonallergic rhinitis (NAR) are common disorders, which have been considered as potential risk factors for obstructive sleep apnea (OSA). This review summarizes the proposed underlying pathophysiological mechanisms to provide a better understanding of the relationship between these conditions. Recent findings In adults, allergic rhinitis and NAR may be considered as symptoms potentiating, rather than risk potentiating factors in the pathophysiology of OSA, whereas in children, these are considered to be independent predictors for sleep-disordered breathing (SDB) and failure of adeno-tonsillectomy, the recommended first-line therapy for children with OSA. Current advances suggest IL-6 may be important in regulating the sleep–wake cycle, and serum soluble IL-6 receptor (sIL-6R) levels may reflect the severity of OSA. Elevated Th17/Treg ratio correlates positively with apnea–hypopnea index of OSA patients, and Th17 and Treg imbalances caused by allergic rhinitis and OSA, respectively, may possibly promote each other, leading to further imbalance. Moreover, obesity is a strong risk factor for OSA, and leptin plays an important role in ventilatory function and upper airway obstruction. The variant trigeminocardiac reflex and nasotrigeminal reflex may also be involved in the association between rhinitis and OSA. Summary Allergic rhinitis/NAR and OSA are closely associated, and each condition can be detrimental to the other. Thus, clinicians should pay attention to the potential presence of allergic rhinitis/NAR in OSA patients and vice versa.

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Update on questionnaires for assessing adherence to inhaler devices in respiratory patients

Purpose of review It has been estimated that adherence to inhaled medications in patients with asthma and chronic obstructive pulmonary disease (COPD) is around 50%. This low adherence rate increases morbidity and mortality of these disorders. The objective of this review was to update information on main questionnaires used in daily for assessing adherence to inhalers of patients with chronic respiratory diseases. Recent findings The test of the adherence to inhalers (TAI) is a recently developed and validated 12-item questionnaire to assess adherence to inhalers of aerosolized drugs in patients with asthma or COPD. The instrument can easily identify nonadherence, classify the level of adherence into good, intermediate and poor, and establish three nonadherence behaviour patterns of erratic, deliberate, and unwitting, which are useful for tailoring corrective measures. Summary Adherence to inhaler devices may be underestimated with the use of validated self-report questionnaires as compared with other more sensitive methods. However, validated self-report questionnaires are more advantageous from a cost-effective perspective in clinical practice. The recently validated TAI is a reliable and homogeneous instrument to identify easily nonadherence and behavioural barriers to the use of inhalers in patients with asthma or COPD.

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Asthma versus chronic obstructive pulmonary disease, the Dutch versus British hypothesis, and role of interleukin-5

Purpose of review Asthma and COPD represent heterogeneous disorders with broad ranging impact on patients and health systems. This review focuses on evidence for early attempts at understanding their pathogenesis by the British and Dutch hypotheses. It also addresses the role of eosinophils, IL-5, and biologics targeting these pathways in asthma and COPD. Recent findings Among asthma and COPD patients, clusters exist based on phenotypic and biologic markers allowing for further understanding of endotypes. Recent studies suggest the role of eosinophils and optimal therapies for each condition may be different. Summary Although patients with ACOS or overlap symptoms may be an exception, overall there appears to be more evidence supporting that asthma and COPD are distinct processes. Targeting eosinophils with anti-IL-5 therapy appears to be an exciting pathway in the properly selected patient with asthma and recent data also supports its use in COPD.

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Drug-induced anaphylaxis: is it an epidemic?

Purpose of review The present review addresses the epidemiology, analyzes the current data and promotes global awareness of drug-induced anaphylaxis. Recent findings Anaphylaxis is a medical emergency that may cause death! In the last decade, studies have shown an increasing incidence and prevalence of anaphylaxis. Summary Drug-induced anaphylaxis fatalities have increased, and this syndrome remains underdiagnosed and undertreated.

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Injectable poly-L-lactic acid: instant hydration in lukewarm water bath and use of a thin needle to filter particles

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Dipeptidyl peptidase-IV inhibitors, a risk factor for bullous pemphigoid. Retrospective multicenter case-control study in France and Switzerland

Case reports have suggested an association between dipeptidyl peptidase-IV inhibitors (DPP4i) and development of bullous pemphigoid (BP).

http://ift.tt/2zccom3

Prokaryotic Expression of Hepatitis C Virus-NS3 Protein and Preparation of a Monoclonal Antibody

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Dec 2017, Vol. 36, No. 6: 251-258.


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Structural Organization of 6B9 Molecule, a Monoclonal Antibody Against Lycopene

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Dec 2017, Vol. 36, No. 6: 259-263.


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Preparation of a Monoclonal Antibody Against gD Protein of Bovine Herpesvirus I

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Dec 2017, Vol. 36, No. 6: 282-286.


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Endotracheal Tube Connector: Holding Breaths!

No abstract available

http://ift.tt/2BYKWh0

Mu-Opioid Receptors in Ganglia, But Not in Muscle, Mediate Peripheral Analgesia in Rat Muscle Pain

BACKGROUND: Previous studies have demonstrated the participation of peripheral μ-opioid receptors (MOR) in the antinociceptive effect of systemically administered morphine and loperamide in an orofacial muscle pain model, induced by hypertonic saline, but not in a spinally innervated one, in rats. In this study, we determine whether this peripheral antinociceptive effect is due to the activation of MOR localized in the muscle, ganglia, or both. METHODS: To determine the local antinociceptive effect of morphine and loperamide, 2 models of acute muscle pain (trigeminal and spinal) were used. Also, to study the MOR expression, protein quantification was performed in the trigeminal and spinal ganglia, and in the muscles. RESULTS: The behavioral results show that the intramuscular injection of morphine and loperamide did not exert an antinociceptive effect in either muscle (morphine: P = .63, loperamide: P = .9). On the other hand, MOR expression was found in the ganglia but not in the muscles. This expression was on average 44% higher (95% CI, 33.3–53.9) in the trigeminal ganglia than in the spinal one. CONCLUSIONS: The peripheral antinociceptive effect of systemically administered opioids may be due to the activation of MOR in ganglia. The greater expression of MOR in trigeminal ganglia could explain the higher antinociceptive effect of opioids in orofacial muscle pain than in spinal muscle pain. Therefore, peripheral opioids could represent a promising approach for the treatment of orofacial pain. Accepted for publication October 23, 2017. Funding: This study was supported by the Ministry of Science and Innovation of Spain (SAF2012-40075-C02-01) and General Directorate for Scientific Research of Community of Madrid (S-2011/BMD-2308). The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Eva María Sánchez-Robles, PhD, Facultad Ciencias de la Salud, Área de Farmacología y Nutrición, Universidad Rey Juan Carlos, Avda Atenas, s/n. 28922 Alcorcón, Madrid, Spain. Address e-mail to eva.sanchez@urjc.es. © 2017 International Anesthesia Research Society

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The Effect of High-Frequency, Structured Expert Feedback on the Learning Curves of Basic Interventional Ultrasound Skills Applied to Regional Anesthesia

BACKGROUND: Proficiency in needle-to-ultrasound beam alignment and accurate approach to structures are pivotal for ultrasound-guided regional anesthesia. This study evaluated the effects of high-frequency, structured expert feedback on simulation training of such abilities. METHODS: Forty-two subjects randomly allocated as controls or intervention participated in two 25-trial experiments. Experiment 1 consisted of inserting a needle into a bovine muscular phantom parallel to the ultrasound beam while maintaining full imaging of the needle. In experiment 2, the needle aimed to contact a target inside the phantom. Intervention subjects received structured feedback between trials. Controls received a global critique after completing the trials. The slopes of the learning curves derived from the sequences of successes and failures were compared. Change-point analyses identified the start and the end of learning in trial sequences. The number of trials associated with learning, the number of technical errors, and the duration of training sessions were compared between intervention and controls. RESULTS: In experiment 1, learning curves departed from 73% (controls) and 76% (intervention) success rates; slopes (standard error) were 0.79% (0.02%) and 0.71% (0.04), respectively, with mean absolute difference of 0.18% (95% confidence interval [CI], 0.17%–0.19%; P = 0). Intervention subjects' learning curves were shorter and steeper than those of controls. In experiment 2, the learning curves departed from 43% (controls) and 80% (intervention) success rates; slopes (standard error) were 1.06% (0.02%) and 0.42% (0.03%), respectively, with a mean difference of 0.65% (95% CI, 0.64%–0.66%; P = 0). Feedback was associated with a greater number of trials associated with learning in both experiment 1 (mean difference, 1.55 trials; 95% CI, 0.15–3 trials; P = 0) and experiment 2 (mean difference, 4.25 trials; 95% CI, 1.47–7.03 trials; P = 0) and a lower number of technical errors per trial in experiments 1 (mean difference, 0.19; 95% CI, 0.07–0.30; P = .02) and 2 (mean difference, 0.58; 95% CI, 0.45–0.70; P = 0), but longer training sessions in both experiments 1 (mean difference, 9.2 minutes; 95% CI, 4.15–14.24 minutes; P = .01) and 2 (mean difference, 7.4 minutes; 95% CI, 1.17–13.59 minutes; P = .02). CONCLUSIONS: High-frequency, structured expert feedback compared favorably to self-directed learning, being associated with shorter learning curves, smaller number of technical errors, and longer duration of in-training improvement, but increased duration of the training sessions. Accepted for publication November 10, 2017. Funding: None. The authors declare no conflicts of interest. 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/KegmMq). Reprints will not be available from the authors. Address correspondence to Getúlio Rodrigues de Oliveira Filho, MD, PhD, Department of Surgery, Federal University of Santa Catarina, Rua Luiz Delfino 111/902, Florianópolis, Santa Catarina 88015, Brazil. Address e-mail to getulio.filho@ufsc.br. © 2017 International Anesthesia Research Society

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Why a Proactive Perioperative Medicine Policy Is Crucial for a Sustainable Population Health Strategy

No abstract available

http://ift.tt/2BkQSgI

Intravenous Iron for Treatment of Anemia in the 3 Perisurgical Phases: A Review and Analysis of the Current Literature

Anemia is a common comorbidity throughout the entire hospital stay. Treatment options include intravenous (IV) iron, oral iron, erythropoietin, and red blood cell (RBC) transfusions. IV iron has gained in popularity with the implementation of patient blood management programs. A variety of studies have been performed to investigate the use of IV iron in preoperative, perioperative, and postoperative settings. An objective review on these studies has yet to be performed. The current narrative review provides an overview of trials investigating IV iron use in the preoperative, perioperative, and postoperative settings. We performed a literature research of English articles published between 1964 and March 2017 in Pubmed including Medline and The Cochrane Library. Only studies with a control group were included. The final review includes 20 randomized controlled trials (RCTs), 7 observational trials, and 5 retrospective studies. Measured outcomes included hemoglobin (Hb) levels, reticulocyte counts, and/or RBC concentrates. Meta-analyses of RCTs using IV iron administration before surgery led to an increase in Hb levels, a reduction of RBC use, and an improvement in patient outcome. Only a few studies investigated the use of IV iron in the perioperative setting. These studies recommended the use of perioperative IV iron in cases of severe anemia in orthopedic surgery but not in all types of surgery. Published RCTs in the postoperative setting have shown positive effects of IV iron on Hb levels, length of hospital stay, and transfusion requirements. Some studies demonstrated an increase of Hb of 0.5–1 g/dL over 4 weeks postoperatively, but the clinical relevance and effect of this increase on an improvement of patient's long-term outcomes are uncertain. To summarize, the evidence to use IV iron is strongest in the preoperative setting, while it remains an individual treatment decision to administer IV iron perioperatively or postoperatively. Accepted for publication September 15, 2017. Funding: A.U.S. is supported by a DFG grant (STE-1895-4/1). The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Andrea U. Steinbicker, MD, MPH, Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Albert-Schweitzer Campus 1, Bldg A1, 48149 Muenster, Germany. Address e-mail to andrea.steinbicker@ukmuenster.de. © 2017 International Anesthesia Research Society

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Prospective Observational Study of Intraoperative Anesthetic Events in District Hospitals in Namibia

BACKGROUND: Access to safe surgery and anesthesia care is grossly inadequate in low- and middle-income countries, with a shortage of anesthesia providers contributing to this crisis. In Namibia, medical officers typically receive no >3 months of informal training in anesthesia. This study sought to determine the prevalence, currently unknown, of intraoperative adverse anesthetic events in this setting. Further, we assessed surgical volume, complications, and mortality outcomes at the district hospital level. METHODS: This was a prospective observational study over 7 months involving 4 district hospitals from geographically separate and diverse areas of Namibia. A standardized protocol was used to record adverse anesthetic events during surgery, surgical volume, and complications including mortality. RESULTS: A total of 737 surgical procedures were performed during the study period. There was a 10% prevalence of adverse anesthetic events intraoperatively. Of these, 70% were related to hypotension and 17% due to hypoxia and/or difficult/failed intubation. Ninety-eight percent of patients were classed as low risk (American Society of Anesthesiologists I or II). Seventy-two percent of the surgical workload was in obstetrics and gynecology, with over half being for urgent obstetrics. Perioperative mortality rate was 1.4/1000, with an overall surgical complication rate of 1.6% and a surgical infection rate of 0.8%. CONCLUSIONS: We found a 10% prevalence of adverse anesthetic events intraoperatively when anesthesia was administered by medical officers with no >3 months of informal training in this low-resource environment. The patients were considered low risk by the medical officers responsible for the anesthesia, yet these events had the potential to lead to patient harm. Accepted for publication October 23, 2017. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Andrew J. Ottaway, BMBS, MPH, FANZCA, Hobart Anaesthetic Group, 303 Macquarie St, Hobart, Tasmania 7000, Australia. Address e-mail to aottaway@internode.on.net. © 2017 International Anesthesia Research Society

http://ift.tt/2Bfk88N

Continuous Noninvasive Arterial Pressure Monitoring Using the Vascular Unloading Technique (CNAP System) in Obese Patients During Laparoscopic Bariatric Operations

BACKGROUND: Increasing rates of obesity create new challenges for hemodynamic monitoring in the perioperative phase. Continuous monitoring of arterial pressure (AP) is important in severely obese patients who are at particular risk for cardiovascular complications. Innovative technologies for continuous noninvasive AP monitoring are now available. In this study, we aimed to compare continuous noninvasive AP measurements using the vascular unloading technique (CNAP system; CNSystems, Graz, Austria) compared with invasive AP measurements (radial arterial catheter) in severely obese patients during laparoscopic bariatric surgery. METHODS: In 29 severely obese patients (mean body mass index 48.1 kg/m2), we simultaneously recorded noninvasive and invasive AP measurements over a period of 45 minutes and averaged the measurements using 10-second episodes. We compared noninvasive (test method) and invasive (reference method) AP measurements using Bland-Altman analysis and 4-quadrant plot/concordance analysis (2-minute interval). RESULTS: We observed a mean of the differences (±SD, 95% limits of agreement) between the AP values obtained by the CNAP system and the invasively assessed AP values of 7.9 mm Hg (±9.6 mm Hg, −11.2 to 27.0 mm Hg) for mean AP, 4.8 mm Hg (±15.8 mm Hg, −26.5 to 36.0 mm Hg) for systolic AP, and 9.5 mm Hg (±10.3 mm Hg, −10.9 to 29.9 mm Hg) for diastolic AP, respectively. The concordance rate was 97.5% for mean AP, 95.0% for systolic AP, and 96.7% for diastolic AP, respectively. CONCLUSIONS: In the setting of laparoscopic bariatric surgery, continuous noninvasive AP monitoring with the CNAP system showed good trending capabilities compared with continuous invasive AP measurements obtained with a radial arterial catheter. However, absolute CNAP- and arterial catheter–derived AP values were not interchangeable. Accepted for publication September 27, 2017. Funding: CNSystems Medizintechnik AG (Graz, Austria) provided the technical equipment for the study. CNSystems Medizintechnik AG was not involved in the collection of the data, drafting of the manuscript, or decision to submit the manuscript for publication. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Dorothea E. Rogge, MD, Department of Anesthesiology, Centre of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. Address e-mail to d.rogge@uke.de. © 2017 International Anesthesia Research Society

http://ift.tt/2BTzHGT

Misaligned Feeding May Aggravate Pain by Disruption of Sleep–Awake Rhythm

BACKGROUND: Increasing evidence suggests that patients with eating disorders are more likely to develop chronic pain. A misaligned diet has been reported to disrupt the sleep–awake rhythms. Combined with our previous investigation on circadian pain, we aimed to investigate the role of misaligned diet in the pain sensitivity and the underlying mechanisms. METHODS: Two-month-old C57BL/6J male mice were administered chronic constriction injury (CCI) surgery to establish neuropathic pain models. CCI mice were randomized to scheduled food access throughout the whole day (CCI-free), during the daytime (CCI-misaligned), and at night (CCI-aligned), respectively. The paw withdrawal mechanical threshold, indicating pain behavior, was measured by Von Frey. The gross motor activity pattern indicating the sleep–awake rhythm was monitored by Mini-Mitter. Melatonin (Mel) was administered to ameliorate the sleep–awake rhythm (CCI-free + Mel and CCI-misaligned + Mel). The expressions of circadian pain–related proteins were detected by quantitative polymerase chain reaction and western blot. The primary outcome is the pain threshold and the secondary outcome is the sleep–awake rhythm. RESULTS: Misaligned diet during the peri-CCI surgery period significantly decreased the paw withdrawal mechanical threshold compared with the CCI-free mice (day 14: 0.40 ± 0.09 vs 0.64 ± 0.15; P = .03;) and altered the sleep–awake rhythm. Mel pretreatment alleviated the increased pain (day 14, CCI-misaligned + Mel versus CCI-misaligned: day 14: 0.60 ± 0.13 vs 0.35 ± 0.12; P = .022) and the disrupted sleep–awake rhythm caused by misaligned feeding. The mRNA levels of N-methyl-D-aspartate receptor subtype 2B (NR2B), Ca2+/calmodulin-dependent protein kinase II (CaMKII), and cyclic adenosine monophosphate-response element binding protein (CREB) in the spinal dorsal horn increased in CCI-misaligned mice compared with the CCI-free mice. The phosphor-NR2B, phosphor-CaMKII, and phosphor-CREB also increased in CCI-misaligned mice compared with the CCI-free mice. However, the expressions of NR2B, CaMKII, and CREB were decreased in CCI-misaligned + Mel mice compared to CCI-misaligned mice at both transcriptional and translational levels. CONCLUSIONS: Misaligned diet might aggravate pain sensitivity through the disruption of the sleep–awake cycle, which could be recovered by Mel. NR2B-CaMKII-CREB may participate in the disruption of sleep–awake rhythm–mediated pain aggravation. Accepted for publication November 2, 2017. Funding: This study was supported by National Natural Science Foundation of China (81371207, 81171047, 81070892, and 81171048), Natural Science Foundation of Jiangsu Province (BK2010105), and the Grant from the Department of Health of Jiangsu Province of China (XK201140, RC2011006). The authors declare no conflicts of interest. 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/KegmMq). The first authors Xu and Zhao contributed equally to this study. The authors Ma and Gu contributed equally to this study. Reprints will not be available from the authors. Address correspondence to Xiaoping Gu, PhD, MD, and Zhengliang Ma, PhD, MD, Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical School of Nanjing University, 321 Zhong Shan Rd, Nanjing, Jiangsu 210008, People's Republic of China. Address e-mail to xiaopinggu@nju.edu.cn and mazhengliang1964@nju.edu.cn. © 2017 International Anesthesia Research Society

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Extracorporeal Membrane Oxygenation Appropriateness: An Interdisciplinary Consensus-Based Approach

We describe a quality improvement initiative aimed at achieving interdisciplinary consensus about the appropriate delivery of extracorporeal membrane oxygenation (ECMO). Interdisciplinary rounds were implemented for all patients on ECMO and addressed whether care was consistent with a patient's minimally acceptable outcome, maximally acceptable burden, and relative likelihood of achieving either. The rounding process was associated with decreased days on venoarterial ECMO, from a median of 6 days in 2014 (first quartile [Q1]–third quartile [Q3], 3–10) to 5 days in 2015 (Q1–Q3, 2.5–8) and in 2016 (Q1–Q3, 1–8). Our statistical methods do not allow us to conclude that this change was due to our intervention, and it is possible that the observed decreases would have occurred whether or not the rounding process was implemented. Accepted for publication October 26, 2017. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Michael Nurok, MBChB, PhD, Division of Cardiac Surgery, Department of Surgery and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 San Vicente Blvd, Suite 3100, Los Angeles, CA 90048. Address e-mail to michael.nurok@cshs.org. © 2017 International Anesthesia Research Society

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Inhibition of the receptor for advanced glycation promotes proliferation and repair of human periodontal ligament fibroblasts in response to high glucose via the NF-κB signaling pathway

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Danting Zhan, Ling Guo, Lige Zheng
ObjectiveTo observe if inhibition of the receptor for advanced glycation endproducts (RAGE) promotes proliferation and repair of human periodontal ligament fibroblasts (hPDLFs) stimulated by high glucose. In addition, we also discuss the effects of the NF-κB signaling pathway in relation to this process.MethodsPrimary cultured hPDLFs were exposed to either low glucose (5.5 mmol/L) or high glucose (25 mmol/L), and RAGE expression was measured by Western blot analysis. Cells were cultured in high glucose with different concentrations of the RAGE inhibitor, FPS-ZM1. We measured cell proliferation using the Cell Counting Kit-8 and expression of collagen type 1 and fibronectin by real-time PCR and ELISA, respectively. The relative protein expression levels of NF-κB p65 and phosphorylated p65 were measured by Western blot analysis.ResultsHigh glucose enhanced RAGE expression and suppressed cell growth. While FPS-ZM1 increased proliferation and expression of repair-related factors in high glucose, there was a concurrent decline in the phosphorylation level of NF-κB p65.ConclusionFPS-ZM1 rescued the proliferative capacity and repair capability of hPDLFs via the RAGE-NF-κB signaling pathway in response to high glucose.



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IMMUNE RESPONSES OF HLA-HIGHLY-SENSITIZED AND NONSENSITIZED PATIENTS TO GENETICALLY-ENGINEERED PIG CELLS

AbstractBackgroundWe investigated in vitro whether HLA-highly-sensitized patients with end-stage renal disease (ESRD) will be disadvantaged immunologically after a genetically-engineered pig kidney transplant.MethodsBlood was drawn from patients with a cPRA 99-100% (Gp1, n=10) or cPRA 0% (Gp2, n=12), and from healthy volunteers (Gp3, n=10). Serum IgM and IgG binding was measured (i) to Gal and Neu5Gc glycans by ELISA, and (ii) to pRBC, pAEC, and pPBMC from GTKO/CD46 and GTKO/CD46/CMAHKO pigs by flow cytometry. (iii) T and B cell phenotypes were determined by flow cytometry, and (iv) proliferation of T and B cells CFSE-MLR.Results(i) By ELISA, there was no difference in IgM or IgG binding to Gal or Neu5Gc between Gps1 and 2, but binding was significantly reduced in both groups compared to Gp3. (ii) IgM and IgG binding in Gps1 and 2 was also significantly lower to GTKO/CD46 pig cells than in healthy controls, but there were no differences between the 3 groups in binding to GTKO/CD46/CMAHKO cells. (iii and iv) Gp1 patients had more memory T cells than Gp2, but there was no difference in T or B cell proliferation when stimulated by any pig cells. The proliferative responses in all 3 groups were weakest when stimulated by GTKO/CD46/CMAHKO pPBMC.Conclusions(i) ESRD was associated with low anti-pig antibody levels. (ii) Xenoreactivity decreased with increased genetic engineering of pig cells. (iii) High cPRA status had no significant effect on antibody binding or T and B cell response. Background We investigated in vitro whether HLA-highly-sensitized patients with end-stage renal disease (ESRD) will be disadvantaged immunologically after a genetically-engineered pig kidney transplant. Methods Blood was drawn from patients with a cPRA 99-100% (Gp1, n=10) or cPRA 0% (Gp2, n=12), and from healthy volunteers (Gp3, n=10). Serum IgM and IgG binding was measured (i) to Gal and Neu5Gc glycans by ELISA, and (ii) to pRBC, pAEC, and pPBMC from GTKO/CD46 and GTKO/CD46/CMAHKO pigs by flow cytometry. (iii) T and B cell phenotypes were determined by flow cytometry, and (iv) proliferation of T and B cells CFSE-MLR. Results (i) By ELISA, there was no difference in IgM or IgG binding to Gal or Neu5Gc between Gps1 and 2, but binding was significantly reduced in both groups compared to Gp3. (ii) IgM and IgG binding in Gps1 and 2 was also significantly lower to GTKO/CD46 pig cells than in healthy controls, but there were no differences between the 3 groups in binding to GTKO/CD46/CMAHKO cells. (iii and iv) Gp1 patients had more memory T cells than Gp2, but there was no difference in T or B cell proliferation when stimulated by any pig cells. The proliferative responses in all 3 groups were weakest when stimulated by GTKO/CD46/CMAHKO pPBMC. Conclusions (i) ESRD was associated with low anti-pig antibody levels. (ii) Xenoreactivity decreased with increased genetic engineering of pig cells. (iii) High cPRA status had no significant effect on antibody binding or T and B cell response. Address Correspondence to: Martin Wijkstrom, MD, Thomas E Starzl Transplantation Institute, Montefiore University Hospital, MUH 756.2, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15261, USA. Email: wijkstrommn@upmc.edu Author Contributions: All authors participated in revising and approving the manuscript. ZZ, HQ, HH, MW, DKCC designed and initiated this study. ZZ, CL, IH, HH participated in laboratory assay. Data were collected and analyzed by ZZ, CL, HH, CM, MM, AZ, ME, MW, DKCC. The manuscript was prepared by ZZ, HH, ME, CM, AZ, MW, DKCC. Genetically-engineered pig cells were provided by DA. Conflicts of interest: David Ayares is an employee of Revivicor, Inc. No other author has a conflict of interest. Funding: Zhongqiang Zhang was supported by the China Scholarship Council (File No. 201506370112). Work on xenotransplantation in the Thomas E. Starzl Transplantation Institute of the University of Pittsburgh is, or has been, supported in part by NIH grants #U19 AI090959, #U01 AI068642, and # R21 A1074844, and by Sponsored Research Agreements between the University of Pittsburgh and Revivicor, Inc., Blacksburg, VA. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Immediate Effects of External Vibration Therapy vs Placebo in Singers

This randomized clinical trial evaluates the immediate effects of external vibration therapy vs placebo on vocal function in trained singers using acoustic and self-assessment parameters.

http://ift.tt/2kVh2jl

Trustworthy Otolaryngology Clinical Practice Guidelines

Clinical practice guidelines (CPGs) are the cornerstone of the evidence-based practice of otolaryngology–head and neck surgery. The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) CPGs are widely distributed, as judged by frequency of downloads, webpage views, and CPG-related sessions at national meetings. Clinical practice guidelines are developed to reduce variation in care and to improve quality. They create debate and even controversy, with concerns expressed about restraints on clinician decision making as well as the medicolegal implications of recommendations. Clinical practice guidelines must be trustworthy, and the Institute of Medicine (IOM) and the Guideline International Network have provided standards for CPGs. A major threat to the creation of trustworthy guidelines is conflict of interest (COI) among the organizations and the committee members who create CPGs.

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Industry Relationships Among Authors of Otolaryngology Clinical Practice Guidelines

This cross-sectional analysis examines the nature of industry payments to physicians who author otolaryngology clinical practice guidelines.

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Nasopharyngeal Swelling After Sinus Surgery for Cystic Fibrosis

A woman in her 20s with cystic fibrosis underwent bilateral endoscopic sinus surgery and medial maxillectomy 4 months after bilateral lung transplantation; at 6-week follow-up, she presented with throat pain, and 2 weeks later, with nasal obstruction. What is your diagnosis?

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Hypercoagulability and Severe Obstructive Sleep Apnea—Reply

In Reply We appreciate the interest of Dr Ghadami in our recently published study titled "Association Between Hypercoagulability and Severe Obstructive Sleep Apnea." The comments raised by the reader can be summarized as follows: The frequent arousals in sleep might be one of the reasons for elevated coagulability markers in patients with obstructive sleep apnea (OSA).

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Addition to Funding/Support

In the Original Investigation titled "Association of Oral Cavity and Oropharyngeal Cancer Biomarkers in Surgical Drain Fluid With Patient Outcomes," published online April 13, 2017, and in the July 2017 print issue, a funding source and grant information were missing from the Funding/Support section. University of Minnesota Cancer Center (grant P30CA077598) was added. This article has been corrected online.

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Prevalence of Laryngeal Cleft in Patients With Esophageal Atresia

This study uses data from the Esophageal and Airway Treatment Center at Boston Children's Hospital to assess the prevalence of laryngeal cleft in pediatric patients with esophageal atresia with or without tracheoesophageal fistula.

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Generalized Radiopacities of the Craniofacial Skeleton

An adolescent girl presented with multiple, slowly growing masses of the face and head, significant bilateral exophthalmos, visual changes, and dental malocclusion, but no clinical signs of endocrinopathy. What is your diagnosis?

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Indirect vs Direct Voice Therapy for Children With Vocal Nodules

This randomized clinical trial examines the effect of indirect vs direct voice therapy in children with vocal fold nodules according to pretherapy and posttherapy scores on the Pediatric Voice-Related Quality of Life survey.

http://ift.tt/2kA21Em

Hypercoagulability and Severe Obstructive Sleep Apnea

To the Editor I read with interest the study by Hong et al, which assessed the association between hypercoagulability and severe obstructive sleep apnea (OSA). The authors measured several coagulation tests, including platelet count, bleeding time, prothrombin time (PT) in seconds and as international normalized ratio, and activated partial thromboplastin time and their association with severity of OSA. They found that patients with moderate to severe OSA had elevated blood coagulability markers compared with healthy individuals.

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Natural Disasters – Impact on Physicians and Researchers

Publication date: Available online 21 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Javier Chinen




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The activation and function of IL-36γ in neutrophilic inflammation in chronic rhinosinusitis

Publication date: Available online 21 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Hai Wang, Zhi-Yong Li, Wen-Xiu Jiang, Bo Liao, Guan-Ting Zhai, Nan Wang, Zhen Zhen, Jian-wen Ruan, Xiao-Bo Long, Heng Wang, Wei-Hong Liu, Geng-Tian Liang, Wei-Min Xu, Atsushi Kato, Zheng Liu
BackgroundAlthough increased accumulation of neutrophils has been noted in chronic rhinosinusitis (CRS), the function and regulation of neutrophils in CRS are largely unknown. IL-36 family cytokines may play an important role in neutrophilic inflammation.ObjectiveTo investigate the expression and function of IL-36 cytokines in CRS.MethodsQuantitative RT-PCR, immunohistochemistry, immunofluorescence, and ELISA were used to investigate the expression of IL-36 cytokines and IL-36 receptor (IL-36R) in sinonasal mucosa. The expression of IL-36R on neutrophils in polyps and blood was measured by flow cytometry. Purified blood neutrophils were cultured to investigate the regulation of IL-36R expression. The cleavage of IL-36γ was detected by Western blotting. Dispersed nasal polyp cells (DNPCs) were treated with IL-36γ with or without elastase inhibitor and dexamethasone.ResultsNeutrophil infiltration and expression of IL-36 cytokines and IL-36R were up-regulated in both CRS with and without nasal polyps. IL-36γ was the most abundant isoform and mainly expressed by epithelial cells in CRS. Neutrophils were the principal IL-36R⁺ cell type in polyps. IL-36R expression was almost absent in blood neutrophils and up-regulated by IL-6, IL-1β, and Dermatophagoides pteronyssinus group 1. Elastase activity was increased in polyps and degraded full-length IL-36γ. Consistently, the levels of cleaved IL-36γ were increased in polyps. Full-length IL-36γ promoted the production of MMP-9, IL-17A, CXCL1, CXCL2 and CXCL8 from DNPCs, which was abolished by elastase inhibitor. The pro-inflammatory effect of IL-36γ was not suppressed by dexamethasone.ConclusionIncreased production and activation of IL-36γ may act on neutrophils and further exaggerate neutrophilic inflammation in CRS.



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CD151, A Novel Host Factor of Nuclear Export Signaling in Influenza Virus Infection

Publication date: Available online 21 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Yongkang Qiao, Yan Yan, Kai Sen Tan, Sheryl SL. Tan, Ju Ee Seet, Thiruma Valavan Arumugam, Vincent TK. Chow, De Yun Wang, Thai Tran
BackgroundDespite advances in our understanding of the mechanisms of influenza A virus (IAV) infection, the crucial virus-host interactions during the viral replication cycle still remain incomplete. Tetraspanin CD151 is highly expressed in the human respiratory tract, but its pathological role in IAV infection is unknown.ObjectivesTo characterize the functional role and mechanisms of action of CD151 in IAV infection of the upper and lower respiratory tracts with H1N1 and H3N2 strains.MethodsWe used CD151-null mice in an in vivo model of IAV infection and clinical donor samples of in vitro-differentiated human nasal epithelial cells cultured at air-liquid interface.ResultsAs compared with wild-type infected mice, CD151-null infected mice exhibited significant reduction in virus titer and improvement in survival that is associated with pronounced host anti-viral response and inflammasome activation together with accelerated lung repair. Interestingly, we show that CD151 complexes newly synthesized viral proteins with host nuclear export proteins and stabilizes microtubule complexes which are key processes necessary for the polarized trafficking of viral progeny to the host plasma membrane for assembly.ConclusionsOur results provide new mechanistic insights into our understanding of IAV infection. We show that CD151 is a critical novel host factor of nuclear export signaling whereby the IAV nuclear export utilizes it to complement its own nuclear export proteins (a site not targeted by current therapy), making this regulation unique and holds promise for the development of novel alternative/complementary strategies to reduce IAV severity.

Graphical abstract

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The Western Environment Reduces Innate Immune Cytokine Production in Chinese Immigrants

Publication date: Available online 21 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Aarti Saiganesh, Belinda J. Hales, Shu Chen, Emilija Filipovska-Naumovska, Gavin Pereira, Mathieu Garand, Tobias R. Kollmann, Andrew J. Currie, Peter N. Le Souëf, Guicheng Zhang




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Are We What Our Mothers Made Us? Lessons from Epigenetics

Publication date: Available online 20 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Donata Vercelli




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LRP-1 Attenuates House Dust Mite-induced Eosinophilic Airway Inflammation by Suppressing Dendritic Cell-mediated Adaptive Immune Responses

Publication date: Available online 21 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Amarjit Mishra, Xianglan Yao, Ankit Saxena, Elizabeth M. Gordon, Maryann Kaler, Rosemarie A. Cuento, Amisha V. Barochia, Pradeep K. Dagur, J. Philip McCoy, Karen J. Keeran, Kenneth R. Jeffries, Xuan Qu, Zu-Xi Yu, Stewart J. Levine
BackgroundThe LDL-receptor related protein 1 (LRP-1) is a scavenger receptor that regulates adaptive immunity and inflammation. LRP-1 is not known to modulate the pathogenesis of allergic asthma.ObjectiveTo assess whether LRP-1 expression by dendritic cells (DCs) modulates adaptive immune responses in house dust mite (HDM)-induced airways disease.MethodsLRP-1 expression on peripheral blood DCs was quantified by flow cytometry. The role of LRP-1 in modulating HDM-induced airways disease was assessed in mice with a deletion of LRP-1 in CD11c⁺ cells (Lrp1^fl/fl; CD11c-Cre) and by the adoptive transfer of HDM-pulsed CD11b⁺ DCs from Lrp1^fl/fl; CD11c-Cre mice to wild-type mice.ResultsHuman peripheral blood myeloid DC subsets from eosinophilic asthmatics have lower LRP-1 expression than cells from healthy, non-asthmatic subjects. Similarly, LRP-1 expression by CD11b⁺ lung DCs was significantly reduced in HDM-challenged wild-type mice. HDM-challenged LRP-1^fl/fl; CD11c-Cre mice have a phenotype of increased eosinophilic airway inflammation, allergic sensitization, Th2 cytokine production, and mucous cell metaplasia. The adoptive transfer of HDM-pulsed LRP-1-deficient CD11b⁺ DCs into wild-type mice generated a similar phenotype of enhanced eosinophilic inflammation and allergic sensitization. Furthermore, CD11b⁺ DCs in the lungs of Lrp1^fl/fl; CD11c-Cre mice have an increased ability to take up HDM antigen, whereas bone marrow-derived DCs display enhanced antigen presentation capabilities.ConclusionThis identifies a novel role for LRP-1 as a negative regulator of DC-mediated adaptive immune responses in HDM-induced eosinophilic airway inflammation. Furthermore, the reduced LRP-1 expression by circulating myeloid DCs from eosinophilic asthmatics suggests a possible role for LRP-1 in modulating type 2-high asthma.

Graphical abstract

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Epidemiologic Patterns of In-Hospital Anaphylaxis in Pediatric Surgical Patients

Publication date: Available online 20 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Sara A. Sun, Xiaoyue Ma, Guohua Li, Caleb Ing




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Novel ultrasound-guided inter-semispinal plane block: a comparative pilot study in healthy volunteers

Abstract

We previously reported that a novel multifidus cervicis plane (MCP) block could anesthetize the dorsal rami of the cervical spinal nerves. While MCP sonoanatomy is easily detectable in most patients, it is sometimes difficult to recognize the MCP injection plane, especially in elderly patients. Thus, we proposed the inter-semispinal plane (ISP) block as an alternative for the MCP block. The aim of this study was to evaluate the utility of the ISP block by evaluating the area and duration of anesthesia, compared with that of the MCP block in eight healthy volunteers. Each participant underwent unilateral ultrasound-guided MCP block and ISP block. For each block, 20 ml of ropivacaine 0.2% was injected, and the area of anesthesia was determined using the pinprick test. The anesthetic area ranged from C4 to T2 (3/8; 37.5%), T3 (2/8; 25%), or T4 (3/8; 37.5%) in the MCP block, and from C4 to T1 (1/8; 12.5%), T2 (3/8; 37.5%), T3 (2/8; 25%), or T4 (1/8; 12.5%) in the ISP block. The mean (standard deviation) duration of sensory loss following MCP and ISP blocks was 329 (77) min and 349 (70) min, respectively. Thus, the ISP block may be a reliable alternative to the MCP block.

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Safety and efficacy of intratympanic ciprofloxacin otic suspension post-tubes in a real-world pediatric population

Publication date: Available online 21 December 2017
Source:American Journal of Otolaryngology
Author(s): Joseph E. Dohar, Debra Don, Jeffrey Koempel, Chung H. Lu, Dean Hakanson, Kenny H. Chan
PurposeOtorrhea frequently follows tympanostomy tube (TT) placement. We evaluated otorrhea following single 6mg OTO-201 (OTIPRIO®, ciprofloxacin otic suspension 6%) intraoperative injection into each middle ear in a variety of effusion types and concurrent procedures in children undergoing TT placement. Secondary objective: Efficacy based on Medicaid status and safety.Basic proceduresIn this prospective, 8-week, multicenter, open-label study, 501 patients were enrolled: mean age 2.9years, male (56.9%), wet/wet ears (66.9%), wet/dry (16.8%), dry/dry (16.3%), and Medicaid-insured (32.9%).Main findingsIn per-protocol population (n=410), otorrhea rate through Day 15 were 8.8% (CI:5.7%–12.8%), 6.6% (CI:2.2%–14.7%), 3.3% (CI:0.4%–11.3%) in wet/wet, wet/dry, and dry/dry ears, respectively. For Medicaid patients through Day 15, Week 4 and Week 8, otorrhea rates were 8.1% (CI:4.1%–14.1%), 17.0% (CI:11.1%–24.5%), and 17.8% (CI:11.7%–25.3%) compared with those commercially-insured: 7.3% (CI:4.5%–11.0%), 14.5% (CI:10.6%–19.3%), and 21.8% (CI:17.1%–27.2%), respectively. Safety was similar to previous Phase 3 trials.Principal conclusionsOTO-201 demonstrated otorrhea rates consistent with Phase 3 trials in a broader, real-world, ENT practice-based pediatric population. Outcomes were similar in Medicaid- and commercially-insured patients. OTO-201 was well-tolerated.



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Is tracheotomy on the decline in otolaryngology? A single institutional analysis

Publication date: Available online 20 December 2017
Source:American Journal of Otolaryngology
Author(s): Andrew J. Bowen, Amy S. Nowacki, Michael S. Benninger, Eric D. Lamarre, Paul C. Bryson
ObjectiveA recent study reported decreasing trends in tracheotomy procedures by its otolaryngology service. We set out to determine whether the previously reported decrease in otolaryngology performed tracheotomies by one institution is a local or generalizable phenomenon.DesignRetrospective cohort study from 2010 to 2015.SettingTertiary care hospital and affiliated regional hospitals.Subject and methodsAll patients who received tracheotomy during the period of analysis were included. Performing specialty, surgical technique, and procedure location were recorded. Procedures were stratified by year and specialty to generate incidence rate ratios for otolaryngologists and non-otolaryngologists. Incidence rate ratios were estimated with negative binomial regression across services.ResultsThe otolaryngology service demonstrated a yearly decrease of 3.4% in the total number of tracheotomies (95% CI −7.9% to +1.4, P=0.17). While the thoracic service remained constant (+0.3%, 95% CI −2.6% to +3.3%, p=0.83), general surgery demonstrated the greatest increase in procedures (+4.4%, 95% CI −6.0% to +15.8%, P=0.42). Thoracic and general surgery both dramatically increased the number of percutaneous tracheotomies performed, with general surgery also performing a greater number of bedside procedures.Conclusions and relevanceWe observed a similar decline in the number of tracheotomies otolaryngology over six years. Our trend is likely due to changes in consultations patterns, increasing use of the percutaneous method, and an increase in adjunctive gastrostomy tube placements. Investigations on the impact of a greater number of non-otolaryngology performed tracheotomies on follow up care is warranted.



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Endometriosis-associated hydrocele of the canal of Nuck with immunohistochemical confirmation: a case report

The canal of Nuck is an embryological vestige of the processus vaginalis, and presents a potential site for endometriosis seeding. Hydroceles in this region are a rare cause of inguinal swelling in females. In...

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Association of Sudden Sensorineural Hearing Loss With Cardiocerebrovascular Disease

This cohort study uses Korea National Health Insurance Service data to investigate the association between sudden sensorineural hearing loss and cardiocerebrovascular disease.

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Traumatic Tympanic Membrane Perforations Diagnosed in Emergency Departments

This cross-sectional analysis of cases from a national survey system reports the mechanism of injury for traumatic tympanic membrane perforation among patients who presented to the emergency department.

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Adult-Onset Giant Cervical Mass

A man in his 40s presented with a giant, left-sided neck mass; magnetic resonance imaging revealed a homogenous ovoid bilobulated cystic mass in the left lateral region of the neck with displacement of the surrounding musculature and vascular structures but no sign of invasion. What is your diagnosis?

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Association of GERD With Cancer of the Upper Aerodigestive Tract in Elderly Patients

This case-control study uses a database of population-based tumor registries to investigate the association of gastroesophageal reflux disease with the risk of malignancy in the upper aerodigestive tract in elderly patients.

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The Next 19 Years of the American Head and Neck Society

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Sarcopenia and Wound Complication After Total Laryngectomy

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

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Margin Distance and Local Recurrence Rate in Oral Cancer Surgery

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Multidisciplinary Clinic Management of Head and Neck Cancer

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Severity Staging System for Nonmetastatic Papillary Thyroid Carcinoma

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Adjuvant External Beam Radiotherapy in Differentiated Thyroid Cancer

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Clinical Outcomes Among Patients Who Contract to Abstain From Alcohol

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December 2017 Issue Highlights

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Chronic Opioid Use Following Surgery for Oral Cavity Cancer

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Association of Surgical Approach and Margin Status With Outcomes in Sinonasal Melanoma

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Comparison of Output Volume Thresholds for Drain Removal After SLND

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Perineural and Angiolymphatic Invasion in Oropharyngeal Carcinoma

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Perioperative Education Program and Unplanned Readmission After Total Laryngectomy

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Reconstruction—The Final Dimension in Head and Neck Surgery

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Multimodal Analgesia in Outpatient Head and Neck Surgery

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JAMA Otolaryngology–Head & Neck Surgery

Mission Statement:JAMA Otolaryngology–Head & Neck Surgery provides timely information for physicians and scientists concerned with diseases of the head and neck. Given the diversity of structure and function based in this anatomic region, JAMA Otolaryngology–Head & Neck Surgery publishes clinical, translational, and population health research from an array of disciplines. We place a high priority on strong study designs that accurately identify etiologies, evaluate diagnostic strategies, and distinguish among treatment options and outcomes. Our objectives are to (1) publish original contributions that will enhance the clinician's understanding of otolaryngologic disorders, benefit the care of our patients, and stimulate research in our field; (2) forecast important advances within otolaryngology—head and neck surgery, particularly as they relate to the prevention, diagnosis, and treatment of disease through clinical and translational research, including that of the human genome and novel imaging techniques; (3) address questions of clinical outcomes and cost-effectiveness that result from clinical intervention, which grow in importance as health care providers are increasingly challenged to provide evidence of enhanced survival and quality of life; (4) provide expert reviews of topics that keep our readers current with true advances and also to provide a valuable educational resource for trainees in the several disciplines that treat patients with diseases of the head and neck; (5) serve as a forum for the concerns of otolaryngologists such as socioeconomic, legal, ethical, and medical issues; (6) provide helpful critiques that enable contributing authors to improve their submissions. We encourage a concise presentation of information and employ an abstract format that efficiently assesses validity and relevance from a clinical perspective. This approach promotes succinct yet complete presentation for our readers and electronic information resources. We believe this approach typifies the commitment of JAMA Otolaryngology–Head & Neck Surgery to providing important information that is easily interpreted by its diverse readership.

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Neonatal Pneumopericardium in a Nonventilated Term Infant: A Case Report and Review of the Literature

Neonatal pneumopericardium (PPC) is a rare form of neonatal air leak syndrome with high morbidity and mortality. Air leak syndrome in the newborn is usually associated with active resuscitation, respiratory distress syndrome, meconium aspiration syndrome, mechanical ventilation, or trauma associated with labour. Neonatal PPC can be associated with other air leak syndromes such as pneumomediastinum, pneumothorax, pneumoperitoneum, and subcutaneous and interstitial emphysema. Spontaneous PPC is a rare event in the neonatal period. We report a case of PPC in association with pneumothorax in a nonventilated term infant. The infant responded to thoracocentesis without the need for pericardiocentesis.

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Observational long-term follow-up study of rapid food oral immunotherapy with omalizumab

A number of clinical studies focused on treating a single food allergy through oral immunotherapy (OIT) with adjunctive omalizumab treatment have been published. We previously demonstrated safety and tolerabil...

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Feasibility of sustained response through long-term dosing in food allergy immunotherapy

Clinical trials using oral immunotherapy (OIT) for the treatment of food allergies have shown promising results. We previously demonstrated the feasibility of desensitization for up to 5 food allergens simulta...

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Harms of Cigarette Smoking and Health Benefits of Quitting

A fact sheet that lists some of the cancer-causing chemicals in tobacco smoke and describes the health problems caused by cigarette smoking and the benefits of quitting.

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Comparison of Endoscopic Visualization and CT Imaging of Head and Neck Cancers With Pathological Validation Study

Condition:   Head and Neck Cancer
Intervention:  
Sponsor:   University Health Network, Toronto
Recruiting

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IRX-2 Regimen, Durvalumab, Tremelimumab for Incurable Head and Neck Squamous Cell Carcinoma

Conditions:   Squamous Cell Carcinoma;   Squamous Cell Carcinoma of the Head and Neck;   Metastatic Squamous Cell Carcinoma;   Oral Cavity Squamous Cell Carcinoma;   Oropharynx Squamous Cell Carcinoma;   Paranasal Sinus Squamous Cell Carcinoma;   Hypopharynx Squamous Cell Carcinoma;   Larynx Squamous Cell Carcinoma
Interventions:   Drug: Durvalumab;   Drug: Tremelimumab;   Drug: IRX-2 Regimen
Sponsor:   H. Lee Moffitt Cancer Center and Research Institute
Not yet recruiting

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Revision adenoidectomy in children: residual vs regrowth?

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5s Method for Soothing a Baby

 

New parents know it all too well – that cry that just won't stop. Your baby is fed. He's dry. You've done everything right! Well, the one thing you can't do is put him back where he wants to be – which is inside Mom. But, guess what? You can replicate the environment. Dr. Harvey Karp introduced us to the 5S method of soothing a crying baby decades ago, and I love his advice. In this video, I walk you through all five steps – and hopefully closer to a few hours rest.

The post 5s Method for Soothing a Baby appeared first on ChildrensMD.

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Comparison of two surgical suture techniques in uvulopalatopharyngoplasty and expansion sphincter pharyngoplasty

Abstract

Background

Uvulopalatopharyngoplasty (UPPP) and expansion sphincter pharyngoplasty (ESP) are two standard surgical procedures for treatment of snoring and sleep apnea. In a prospective clinical trial, we compared a standard simple interrupted suture technique for closure of the tonsillar pillars with a running locked suture.

Methods

Each suture technique was randomly assigned either to the left or the right tonsillar pillars in 28 patients. During the first week, patients were daily checked for suture dehiscence and again on days 10 and 21, the end of followup. Time to perform the sutures was measured intraoperative and surgical complications were recorded.

Results

During followup, suture dehiscence was observed in 15/28 interrupted and 16/28 running sutures (p > 0.5). If a dehiscence occurred during the observation period, the median day of dehiscence was 10 (1 and 3 quartile: 5.75 and 17) days for the interrupted suture and 10 (5–11) days for the running locked suture technique (p > 0.05). The mean (± SD) surgical time for the interrupted suture was 5.2 ± 1.9 and 3.5 ± 1.8 min for the running locked suture (p < 0.001). Postoperative bleedings occurred in 4/28 running sutures and 2/28 interrupted sutures.

Conclusion

The running locked suture technique is an equally safe and time saving way of wound closure in UPPP and ESP.

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Cytosolic high-mobility group box protein 1 (HMGB1) and/or PD-1+ TILs in the tumor microenvironment may be contributing prognostic biomarkers for patients with locally advanced rectal cancer who have undergone neoadjuvant chemoradiotherapy

Abstract

Rectal cancer, which comprises 30% of all colorectal cancer cases, is one of the most common forms of cancer in the world. Patients with locally advanced rectal cancer (LARC) are often treated with neoadjuvant chemoradiotherapy (neoCRT) followed by surgery. However, after neoCRT treatment, approximately one-third of the patients progress to local recurrence or distant metastasis. In these studies, we found that patients with tumors that exhibited cytosolic HMGB1(Cyto-HMGB1) translocation and/or the presence of PD-1+ tumor-infiltrating lymphocytes (TILs) before treatment had a better clinical outcome. The better outcome is likely due to the release of HMGB1, which triggers the maturation of dendritic cells (DCs) via TLR4 activation, and the subsequent recruitment of PD-1+ tumor-infiltrating lymphocytes to the tumor site, where they participate in immune-scavenging. In conclusion, our results provide evidence that cyto-HMGB1 and/or PD-1+TIL are not only predictive biomarkers before treatment, but they can also potentially designate patients for personalized oncological management including immunotherapy.

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Case 39-2017: A 41-Year-Old Woman with Recurrent Chest Pain

Presentation of Case. Dr. Mahesh K. Vidula (Medicine): A 41-year-old woman presented to this hospital with chest pain. Approximately 1 year before presentation, the patient had had transient tightness in the chest and shoulder on the left side that had prompted a referral to outpatient physical…

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Comparison of Video Head Impulse Test and Caloric Reflex Test in advanced unilateral definite Menière's disease

Publication date: Available online 20 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): F. Rubin, F. Simon, B. Verillaud, P. Herman, R. Kania, C. Hautefort
AimsThere have been very few studies of the Video Head Impulse Test (VHIT) in patients with Menière's Disease (MD). Some reported 100% normal VHIT results, others not. These discrepancies may be due to differences in severity. The present study compared VHIT and caloric reflex test results in advanced unilateral definite MD.Material and methodA prospective study included 37 consecutive patients, with a mean age of 56±12 years. Mean hearing loss was 59±18dB HL; 12 patients were subject to Tumarkin's otolithic crises. Abnormal caloric reflex was defined as ≥20% deficit, and abnormal VHIT as presence of saccades or <0.64 gain in vertical semicircular canals and <0.78 in horizontal canals.ResultsAll patients had normal VHIT results, and 3 had normal caloric reflex; mean caloric reflex deficit was 45%.ConclusionThe present study is the only one to use the August 2015 updated definition of MD. The results showed that, outside of episodes of crisis, VHIT was normal during advanced unilateral definite MD, in contrast to abnormal caloric reflex. This feature could help distinguish MD from other inner ear diseases, and it would be interesting to try to confirm this hypothesis by studying MD patients.



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Evaluation of the impact of hearing loss in adults: Validation of a quality of life questionnaire

Publication date: Available online 21 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Ambert-Dahan, C. Laouénan, M. Lebredonchel, S. Borel, C. Carillo, D. Bouccara, O. Sterkers, E. Ferrary, I. Mosnier
ObjectivesThe impact of hearing loss and of auditory rehabilitation (hearing aid, cochlear implant) on quality of life is a crucial issue. Commonly used questionnaires to assess quality of life in these patients (Nijmegen, APHAB, GBI) are time-consuming, difficult for patients to fill out, and show poor sensitivity to small improvements or deterioration. The objective of the present study was to validate a dedicated quality of life scale for hearing-impaired adults with or without auditory rehabilitation.Material and methodsERSA (Évaluation du Retentissement de la Surdité chez l'Adulte: Evaluation of the Impact of Hearing Loss in Adults) is a self-administered questionnaire. It is divided into 4 domains, each comprising 5 questions graded from 1 to 10. The questions are simple, and formulated so patients will answer according to how they feel at the actual time of the session. Test-retest reliability was measured in 38 patients. Internal coherence and validity against the APHAB questionnaire as gold standard and in relation to hearing performance were measured in 122 patients at auditory assessment. Sensitivity to change in hearing was measured in 36 cochlear implant patients, before and 6 or 12 months after implantation.ResultsTest-retest reliability was very satisfactory (ρ=0.88). Internal coherence was good for all questions. External validity, comparing ERSA to APHAB scores in the same non-implanted hearing-impaired patients, was good (ρ=0.52). Additionally, ERSA scores correlated with hearing performance in adverse conditions (monosyllabic words: ρ=0.22; sentences in noise: ρ=0.19). In patients tested before and after cochlear implantation, improvement in hearing performance in silence and in noise correlated with an improvement in ERSA score (ρ=0.37 to 0.59, depending on the test), but not to GBI score.ConclusionThe ERSA questionnaire is easy and quick to use, reliable, and sensitive to change in hearing performance after cochlear implantation.



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Head and neck squamous cell carcinoma of unknown primary: Outcomes of a pre-defined institutional treatment policy in a region with a high prevalence of skin cancer

Publication date: February 2018
Source:Oral Oncology, Volume 77
Author(s): Michael Huo, Benedict Panizza, Anne Bernard, Sandro V. Porceddu
ObjectivesTo determine the rate of subsequent primary site failure in patients with head and neck squamous cell carcinoma of unknown primary (UKP HNSCC) in a region with a high prevalence of cutaneous squamous cell carcinoma, according to a pre-determined institutional policy. Secondary aims included regional and distant control, and overall survival.Material and methodsPatients presenting between April 2005 and June 2016 to the Princess Alexandra Hospital Head and Neck Multidisciplinary Meeting with UKP HNSCC from either presumed mucosal or cutaneous sites treated with curative intent were eligible. Patients with presumed mucosal origin were treated with radiation therapy (RT) with or without chemotherapy, while patients with presumed cutaneous SCC were treated with surgery and post-operative RT with or without chemotherapy.ResultsA total of 63 patients met the inclusion criteria. Median follow up duration was 3.9 years (IQR 2.07-5.14). There were no subsequent primary site failures. The rate of nodal failure among presumed mucosal patients was 11.5%, and 8.1% among presumed cutaneous patients. The rate of distant metastatic failure was 11.1% among all patients. The estimated 5 year overall survival was 71.2% (95% CI 59.2–85.7%).ConclusionTreatment according to our pre-defined institutional policy for UKP HNSCC in a region with a high prevalence of cutaneous SCC appears to be safe and effective with low rates of mucosal primary emergence and nodal failure.



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