Laryngopharyngeal Reflux: Current Concepts on Etiology and Pathophysiology and Its Role in Dysphagia

Abstract

Purpose of Review

Laryngopharyngeal reflux (LPR) is one of the most commonly encountered chronic inflammatory conditions of the larynx. The lack of a unifying consensus regarding diagnosis and management makes it difficult to relate laryngeal disorders and dysphagia to this disease entity, particularly for an otolaryngologist. This article reviews diagnosis and management of LPR from an otolaryngological and gastroenterological perspective by reconciling current trends in the literature.

Recent Findings

More sophisticated testing via multichannel pH probes as well as the implementation of pepsin assays has potential in diagnosing LPR. This will hopefully more clearly delineate this disease entity, in the setting of dysphagia.

Summary

Dysphagia and LPR both have significant overlap with numerous disease entities. Though there is little literature to address outcomes in treatment and management of dysphagia in the setting of LPR, few studies show that managing LPR-related dysphagia may improve with surgical intervention if there is no improvement with conservative management.

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Book review—Diagnostic Pathology: Cytopathology, 2nd edition

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CD14+ monocytes contribute to inflammation in chronic nonbacterial osteomyelitis (CNO) through increased NLRP3 inflammasome expression

Publication date: Available online 30 April 2018
Source:Clinical Immunology
Author(s): D. Brandt, E. Sohr, J. Pablik, A. Schnabel, F. Kapplusch, K. Mäbert, J.H. Girschick, H. Morbach, F. Thielemann, S.R. Hofmann, C.M. Hedrich
The pathophysiology of chronic nonbacterial osteomyelitis (CNO) remains incompletely understood. Increased NLRP3 inflammasome activation and IL-1β release in monocytes from CNO patients was suggested to contribute to bone inflammation. Here, we dissect immune cell infiltrates and demonstrate the involvement of monocytes across disease stages. Differences in cell density and immune cell composition may help to discriminate between BOM and CNO. However, differences are subtle and infiltrates vary in CNO. In contrast to other cells involved, monocytes are a stable element during all stages of CNO, which makes them a promising candidate in the search for "drivers" of inflammation. Furthermore, we link increased expression of inflammasome components NLRP3 and ASC in monocytes with site-specific DNA hypomethylation around the corresponding genes NLRP3 and PYCARD. Our observations deliver further evidence for the involvement of pro-inflammatory monocytes in the pathophysiology of CNO. Cellular and molecular alterations may serve as disease biomarkers and/or therapeutic targets.



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Commonly used oncology drugs decrease antifungal effectiveness against Candida and Aspergillus species [PublishAheadOfPrint]

The incidence of invasive fungal infections has risen significantly in recent decades as medical interventions have become increasingly aggressive. These infections are extremely difficult to treat due to the extremely limited repertoire of systemic antifungals, the development of drug resistance, and the extent of to which the patient's immune function is compromised. Even when the appropriate antifungal therapies are administered in a timely fashion, treatment failure is common, frequently even in the absence of in vitro microbial resistance. In this study, we screened a small collection of FDA approved oncolytic agents for compounds that impact the efficacy of the two most widely used classes of system antifungals against Candida albicans, Candida glabrata, and Aspergillus fumigatus. We have identified several drugs that enhance fungal growth in the presence of the azole antifungals and examine the potential that these drugs directly affect fungal fitness, specifically antifungal susceptibility, and may be contributing to clinical treatment failure.

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Emergence of high-level colistin resistance in an Acinetobacter baumannii clinical isolate mediated by inactivation of the global regulator H-NS. [PublishAheadOfPrint]

Colistin is a crucial last-line drug used for the treatment of life-threatening infections caused by multi-drug resistant strains of the Gram-negative bacteria, Acinetobacter baumannii. However, colistin-resistant A. baumannii isolates can be isolated following failed colistin therapy. Resistance is most often mediated by the addition of phosphoethanolamine (pEtN) to lipid A by PmrC, following missense mutations in the pmrCAB operon encoding PmrC and the two-component signal transduction system PmrA/PmrB. We recovered a pair of A. baumannii isolates from a single patient before (6009-1) and after (6009-2) failed colistin treatment. These strains displayed low and very high levels of colistin resistance, (MICs 8-16 μg/mL and 128 μg/mL) respectively. To understand how increased colistin resistance arose, we genome sequenced each isolate which revealed that 6009-2 had an extra copy of the insertion sequence element ISAba125 within a gene encoding an H-NS-family transcriptional regulator. To confirm the role of H-NS in colistin resistance we generated an hns deletion mutant in 6009-1 and showed that colistin resistance increased upon deletion of hns. We also provided 6009-2 with an intact copy of hns and showed that the strain was no longer resistant to high concentrations of colistin. Transcriptomic analysis of the clinical isolates identified more than 150 genes as differentially expressed in the colistin-resistant, hns mutant, 6009-2. Importantly, expression of eptA, encoding a second lipid A-specific pEtN transferase, but not pmrC, was increased in the hns mutant. This is the first time an H-NS-family transcriptional regulator has been associated with a pEtN transferase and colistin resistance.

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Determination of MIC Distribution and Mechanisms of Decreased Susceptibility to Bedaquiline Among Clinical Isolates of Mycobacterium abscessus [PublishAheadOfPrint]

Chemotherapeutic options are very limited against Mycobacterium abscessus infections. Bedaquiline, a new anti-tuberculosis drug, is effective for the treatment of multidrug-resistant TB. However, little data is available on bedaquiline in treating M. abscessus infections. In this study, we reported the in vitro susceptibility profile of M. abscessus clinical isolates to bedaquiline and investigated the potential molecular mechanisms of decreased susceptibility. A total of 197 M. abscessus clinical isolates were collected from sputum and bronchoalveolar fluid of patients with lung infections. Standard broth microdilution test revealed that bedaquiline exhibited high in vitro killing activity against M. abscessus isolates, with MIC50 of 0.062 and MIC90 of 0.125 mg/L. Whole genome sequencing data showed that no nonsynonymous mutation occurred in atpE, the gene encoding the bedaquiline targeted protein. However, of 6 strains with decreased susceptibility of bedaquiline (MIC=0.5-1 mg/L), 3 strains had nonsynonymous mutations in mab_4384, the gene encoding the repressor of efflux pump MmpS5/MmpL5. qRT-PCR analysis showed that the expression of MmpS5/MmpL5 in the group with decreased susceptibility to bedaquiline were significantly higher than those with medium MIC (MIC=0.125-0.5 mg/L) or low MIC group (MIC≤ 0.062 mg/L). Two isolates with increased MIC didn't show overexpression of MmpS5/MmpL5, which couldn't be explained by known molecular mechanisms. This is the first report showing the association of MmpS5/MmpL5 with decreased bedaquiline susceptibility in M. abscessus clinical isolates, and suggesting the presence of other yet-to-be identified mechanisms for decreased bedaquiline susceptibility in M. abscessus.

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Genetic and functional characterization of an MCR-3-like producing Escherichia coli recovered from swine, Brazil [PublishAheadOfPrint]

A collection of 126 pigs were screened for carriage of colistin-resistant Enterobacteriaceae in a farm in Minas Gerais, Brazil. Out of this collection, eigth colistin-resistant Escherichia coli isolates were recovered, including one from Minas Gerais State, producing a new MCR-3 variant (MCR-3.12). Analysis of the lipopolysaccharide revealed that MCR-3.12 had a similar function as MCR-1 and MCR-2 by adding a phosphoethanolamine group to the lipid A. Genetic analysis showed that the mcr-3.12 gene was carried by an IncA/C₂ plasmid and was embedded in an original genetic environment. This study reports the occurrence of the MCR-3-like determinant in South America and firstly demonstrates the functionality of this group of enzymes as a phosphoethanolamine transferase.

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Novel Mutations Associated with Clofazimine Resistance in Mycobacterium abscessus [PublishAheadOfPrint]

Mycobacterium abscessus (Mab) is a major non-tuberculous mycobacterial (NTM) pathogen responsible for about 80% of all pulmonary infections caused by rapidly growing mycobacteria. Clofazimine is an effective drug active against Mab, but the mechanism of resistance to clofazimine in Mab is unknown. To investigate the molecular basis of clofazimine resistance in Mab. We isolated 29 Mab mutants resistant to clofazimine, and subjected them to whole genome sequencing to identify possible mutations associated with clofazimine resistance. We found that mutations in MAB_2299c gene which encodes possible transcriptional regulatory protein, MAB_1483 and MAB_0540 are most commonly associated with clofazimine resistance. In addition, mutations in MAB_0416c, MAB_4099c, MAB_2613, MAB_0409, and MAB_1426 were also associated with clofazimine resistance but in less frequency. Two identical mutations which are likely to be polymorphisms unrelated to clofazimine resistance were found in MAB_4605c and MAB_4323 in 13 mutants. We conclude that mutations in MAB_2299c, MAB_1483, and MAB_0540 are the major mechanisms of clofazimine resistance in Mab. Future studies are needed to address the role of the identified mutations in clofazimine resistance in Mab. Our findings have implications for understanding mechanisms of resistance of clofazimine and for rapid detection of clofazimine resistance in this organism.

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The Artemisinin Derivative Artemisone Is a Potent Inhibitor of Human Cytomegalovirus Replication [PublishAheadOfPrint]

Human cytomegalovirus (HCMV) is a major cause of disease in immunocompromised individuals and the most common cause of congenital infection and neuro-sensorial disease. The expanding target populations for HCMV antiviral treatment along with the limitations of the currently available HCMV DNA polymerase inhibitors underscore the need for new antiviral agents with alternative modes of action. The anti-malarial artemisinin derivative artesunate was shown to inhibit HCMV in vitro, yet has demonstrated limited antiviral efficacy in vivo, prompting our search for more potent anti-HCMV artemisinin derivatives. Here we show that the innovative artemisinin derivative artemisone, which has been screened against malaria in human clinical studies, is a potent and non-cytotoxic inhibitor of HCMV. Artemisone exhibited an antiviral efficacy comparable to ganciclovir (EC₅₀ 1.20 ± 0.46 μM) in human foreskin fibroblasts, with enhanced relative potency in lung fibroblasts and epithelial cells. Significantly, the antiviral efficacy of artemisone was consistently ≥10-fold superior to that of artesunate in all cells. Artemisone effectively inhibited both laboratory-adapted and low-passage clinical strains, as well as drug-resistant HCMV strains. By using quantitative viral kinetics and gene expression studies, we showed that artemisone is a reversible inhibitor, targeting an earlier phase of the viral replication cycle than ganciclovir. Importantly, artemisone most effectively inhibited HCMV infection ex vivo in a clinically-relevant multicellular model of integral human placental tissues maintained in organ culture. Our promising findings encourage preclinical and clinical studies of artemisone as a new inhibitor against HCMV.

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Incidence of Acute Kidney Injury among Patients Treated with Piperacillin-Tazobactam or Meropenem in combination with Vancomycin [PublishAheadOfPrint]

Acute kidney injury increases during empiric antimicrobial therapy with the combination of piperacillin-tazobactam (TZP) and vancomycin (VAN) when compared to monotherapy or the combination of cefepime and VAN. Limited data regarding the impact of meropenem (MEM) combined with VAN exist. This study examined the AKI incidence among patients treated with MEM+VAN or TZP+VAN. Data were collected from the University of Kentucky Center for Clinical and Translational Science Enterprise Data Trust from September 2007 through October 2015. Adults without previous renal disease, who received MEM+VAN or TZP+VAN for at least 2 days were included. AKI was assessed using RIFLE criteria. Inverse probability of treatment weighting was utilized to control for differences between groups. In total, 10,236 patients met inclusion criteria, with 9,898 receiving TZP+VAN and 338 receiving MEM+VAN. AKI occurred in 15.4% of MEM+VAN patients compared to 27.4% of TZP+VAN patients (p<0.001). TZP+VAN was associated with increased AKI compared to MEM+VAN (OR=2.53; 95%CI 1.82-3.52), after controlling for confounders. MEM+VAN should be considered an appropriate alternative therapy to TZP+VAN if nephrotoxicity is a major concern. The results of this study demonstrate that judicial use of TZP+VAN for empiric coverage of infection is needed.

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Carbapenem-resistant hypervirulent Klebsiella pneumoniae of sequence type 36 [PublishAheadOfPrint]

ST36 Klebsiella pneumoniae distributes worldwide. We found that a ST36 K. pneumoniae clinical isolate was carbapenem resistant, carried bla_KPC-2, had mucoid regulator gene rmpA and exhibited high virulence. The findings suggest the emergence of carbapenem-resistant hypervirulent K. pneumoniae of ST36 and surveillance on carbapenem-resistant hypervirulent K. pneumoniae is required.

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Activity of combinations of antistaphylococcal antibiotics with fusidic acid against staphylococcal biofilms in in vitro static and dynamic models [PublishAheadOfPrint]

Staphylococcal biofilms are a major cause of therapeutic failure, especially when caused by multiresistant strains. Oral fusidic acid is currently being re-developed in the US for skin and skin structure and orthopedic infections, in which biofilms play a major role. The aim of this study was to examine the activity of fusidic acid alone or combined with other anti-staphylococcal drugs against biofilms made by a reference strain and five clinical isolates of Staphylococcus aureus or Staphylococcus epidermidis in in vitro static or dynamic models (microtiter plates and CDC reactor) exposed to clinically-relevant concentrations. In microtiter plates, antibiotics alone were poorly active, with marked differences among strains. At concentrations mimicking free-drug human C_max, combination of fusidic acid with linezolid, daptomycin or vancomycin resulted in increased activity against 4-5 strains and combination with doxycycline, rifampin, or moxifloxacin, increased activity against 1-3 strains only. In the CDC reactor, biofilms were grown under constant flow and antibiotic concentrations decreased over time according to human elimination rates. A bactericidal effect was obtained when fusidic acid was combined with daptomycin or linezolid, but not with vancomycin. The higher tolerance of biofilms to antibiotics in the CDC reactor is probably attributable to the more complex architecture they adopt when growing under constant flow. Because biofilms grown in the CDC reactor are considered more similar to those developing in vivo, the data support further testing of combinations of fusidic acid with daptomycin or linezolid in models pertinent to chronic skin and skin structure or orthopedic infections.

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First penicillin-binding protein occupancy patterns of {beta}-lactams and {beta}-lactamase inhibitors in Klebsiella pneumoniae [PublishAheadOfPrint]

Penicillin-binding proteins (PBPs) are the high affinity target sites of all β-lactam antibiotics in bacteria. It is well known that each β-lactam covalently binds to and thereby inactivates different PBPs with varying affinity. Despite β-lactams serving as cornerstone of our therapeutic armamentarium against Klebsiella pneumoniae, PBP binding data are missing for this pathogen. We aimed to generate the first PBP binding data on 13 chemically diverse and clinically relevant β-lactams and β-lactamase inhibitors in K. pneumoniae. PBP binding was determined using isolated membrane fractions from K. pneumoniae strains ATCC 43816 and ATCC 13883. Binding reactions were conducted using β-lactam concentrations from 0.0075 to 256 mg/liter (or 128 mg/liter). After β-lactam exposure, unbound PBPs were labelled by Bocillin FL. Binding affinities (IC50s) were reported as the β-lactam concentrations that half-maximally inhibited Bocillin FL binding. PBP occupancy patterns by β-lactams were consistent across both strains. Carbapenems bound to all PBPs with PBP2 and PBP4 as highest affinity targets (IC50s <0.0075 mg/liter). Preferential PBP2 binding was observed by mecillinam (IC50: <0.0075 mg/liter) and avibactam (2 mg/liter). Aztreonam showed high affinity for PBP3 (IC50: 0.06 to 0.12 mg/liter). Ceftazidime bound PBP3 at low (IC50: 0.06 to 0.25 mg/liter) and PBP1a/b at higher concentrations (4 mg/liter), whereas cefepime bound PBPs 1-4 more evenly (IC50s: 0.015 to 2 mg/liter). These PBP binding data on a comprehensive set of 13 clinically relevant β-lactams and β-lactamase inhibitors in K. pneumoniae enable, for the first time, rational design and optimization of double β-lactam and β-lactam/β-lactamase inhibitor combinations.

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A Population Pharmacokinetic Model for a Solid Oral Tablet Formulation of Posaconazole [PublishAheadOfPrint]

A delayed-release solid tablet formulation that releases posaconazole in the small intestine was developed to maximize systemic absorption. This study aimed to characterize the pharmacokinetics of the posaconazole solid tablet formulation in adult subjects and to investigate the potential impact of demographic and clinical factors on posaconazole exposure through a population pharmacokinetic approach. Nonlinear mixed-effects modeling was performed using data from several studies conducted in healthy volunteers and patients. The influence of demographic and clinical factors on pharmacokinetic parameters was evaluated using a stepwise forward inclusion/backward exclusion procedure. The final pharmacokinetic model was used to simulate posaconazole exposure in patients at high risk for invasive fungal diseases treated with the proposed posaconazole dose of 300 mg twice daily on day 1, followed by 300 mg daily for 27 days. A one-compartment pharmacokinetic model with sequential zero-order and first-order absorption and a first-order disposition from the central compartment adequately described the pharmacokinetic profile of the posaconazole solid tablet formulation. Significant covariates included disease state (acute myeloid leukemia/myelodysplasia vs allogeneic hematopoietic stem cell transplantation), body weight, and formulation on bioavailability; food status on first-order absorption rate; and dosing regimen (single dose vs multiple doses) on clearance. Except for body weight, the impact of these covariates on posaconazole exposure was considered clinically irrelevant. This population pharmacokinetic analysis confirmed that the proposed dose of the posaconazole solid tablet formulation provides adequate target therapeutic exposure (>0.5 mg/l) to a broad range of patients at high risk for invasive fungal disease.

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Resistance to echinocandins in Candida can be detected by performing the Etest directly on blood culture samples [PublishAheadOfPrint]

Background: We examined the rapid evaluation of susceptibility to echinocandins in Candida spp. using the Etest performed directly on positive blood cultures and anidulafungin-containing agar plates.

Methods: We prospectively collected 80 positive blood cultures (Bactec™-FX system, Becton-Dickinson, Cockeysville, Maryland, USA) with echinocandin-susceptible Candida spp (n=60) and echinocandin-intermediate C. parapsilosis (n=20) from patients with candidemia. Additionally, blood culture bottles of nonfungemic/bacteremic patients were spiked with 35 echinocandin-resistant Candida spp. isolates. A total of 2-4 drops of medium from each bottle was stroked directly both onto RPMI 1640 agar plates with micafungin and anidulafungin Etest strips (ET_DIR) and on Sabouraud agar plates containing 2 mg/L of anidulafungin. Isolates were tested according to the EUCAST method and Etest standard (ET_SD). Essential and categorical agreement between methods was calculated.

Results: Essential agreement and categorical agreement between EUCAST and ET_DIR and ET_SD were both >97.4%. The essential agreement between ET_DIR and EUCAST for both echinocandins was >97%. The categorical agreement between the FKS sequence (gold standard) and ET_DIR was 97.4%. The ET_DIR MIC of anidulafungin and micafungin (≥ 0.19 mg/L and ≥ 0.064 mg/L, respectively) effectively separated all susceptible/FKS wild-type isolates from the resistant/FKS mutant isolates. The categorical agreement (62.6%) between EUCAST and growth on anidulafungin-containing plates was poor, with the best agreement observed for C. glabrata (94.2%).

Conclusions: When performed directly on positive blood cultures from patients with candidemia, the Etest with micafungin and anidulafungin is a reliable procedure for a rapid testing of susceptibility to echinocandins in Candida spp. isolates.

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Pharmacokinetics, pharmacodynamics, and tolerability of single-dose oral LCB01-0371, a novel oxazolidinone with broad-spectrum activity, in healthy volunteers [PublishAheadOfPrint]

LCB01-0371 is a novel oxazolidinone with broad-spectrum activity against Gram-positive pathogens in both in vitro studies and animal infection models. The objectives of this study were to evaluate its safety, tolerability, pharmacokinetics, and pharmacodynamics following single ascending doses (NCT01554995). Single oral doses of 600 mg Linezolid, a placebo, or LCB01-0371 between 50 mg and 3200 mg were tested in 69 healthy male subjects. Blood and urine were sampled, and LCB01-0371 concentrations were measured, and the serum inhibitory and bactericidal titers of LCB01-0371 and Linezolid were determined. LCB01-0371 was well tolerated up to 2400 mg. The most common drug-related clinical and laboratory adverse events were nausea with or without vomiting, decreased neutrophil count, and increased total bilirubin. The frequency of adverse events and drug-related adverse events was similar among the treatment groups. The systemic exposure was approximately dose-proportional over the range of 50mg--800 mg, which includes the anticipated clinical dose. The mean clearance, renal clearance, and volume of distribution were significantly decreased at higher doses (above 800 mg). LCB01-0371 exhibited early bacteriostatic activity against all tested strains except for S. pneumonia, and the potency of LCB01-0371 at 800 mg was similar to that of Linezolid at the therapeutic dose (600 mg). However, LCB01-0371 had less bactericidal activity than Linezolid. Taken together, LCB01-0371 was well tolerated and exhibited approximate dose proportionality within the anticipated clinically relevant dose range, and showed bacteriostatic and bactericidal activity comparable to that of Linezolid. These results support the further clinical development of LCB01-0371.

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Direct Activation of Adenosine Monophosphate-Activated Protein Kinase (AMPK) by PF-06409577 Inhibits Flavivirus Infection through Modification of Host-Cell Lipid Metabolism [PublishAheadOfPrint]

Mosquito-borne flaviviruses are a group of RNA viruses that constitute global threats for human and animal health. Replication of these pathogens is strictly dependent on cellular lipid metabolism. We have evaluated the effect of the pharmacological activation of Adenosine Monophosphate-activated Protein Kinase (AMPK), a master regulator of lipid metabolism, on the infection of three medically relevant flaviviruses: West Nile virus (WNV), Zika virus (ZIKV) and dengue virus (DENV). WNV is responsible for recurrent outbreaks of meningitis and encephalitis affecting humans and horses worldwide. ZIKV has caused a recent pandemic associated with birth defects (microcephaly), reproductive disorders, and severe neurological complications (Guillain-Barré syndrome). DENV is the etiological agent of the most prevalent mosquito-borne viral disease that can induce a potentially lethal complication called severe dengue. Our results showed, for the first time, that activation of AMPK using the specific small molecule activator PF-06409577 reduced both WNV, ZIKV, and DENV infection. This antiviral effect was associated to an impairment of viral replication due to the modulation of host cell lipid metabolism exerted by the compound. These results support that the pharmacological activation of AMPK, which currently constitutes an important pharmacological target for human diseases, could also provide a feasible approach for broad-spectrum host-directed antiviral discovery.

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Pharmacokinetics of anidulafungin in obese and normal-weight adults [PublishAheadOfPrint]

In 2025, approximately one out of five adults will be obese. Physiological changes associated with obesity have shown to influence the pharmacokinetics of drugs. Anidulafungin is frequently used in critically ill patients and to achieve optimal efficacy it is essential that its dose is appropriate for each patients' characteristics. We combined data from obese subjects with data from normal-weight subjects and determined an optimal dosing regimen for obese patients by population-PK modeling.

Twenty adults, of which twelve were normal-weight healthy subjects (median weight 67.7 kg; range: 61.5-93.6 kg) and eight morbidly obese subjects (median weight 149.7 kg; range: 124.1-166.5 kg) were included in the analysis. Subjects received a single dose of 100 mg anidulafungin IV in 90 minutes upon which blood samples were obtained. Monte Carlo simulations were performed to optimize dosing in obesity.

A three-compartment model and equal volumes of distribution described the data best. Total body weight was identified as descriptor for both clearance and volume of distribution but the effect of weight on these parameters was limited. Simulations showed that with the licensed 100 mg dose more than 97% of subjects with a weight above 140 kg will have an AUC_0-24 lower than 99 mg*h/L (reference of normal weight individuals).

We found that anidulafungin pharmacokinetics in obese and normal-weight subjects, weight influenced both clearance and volume of distribution implying a lower exposure to anidulafungin in (morbidly) obese individuals. Consequently, a 25% increase in loading and maintenance dose could be considered in patients weighing more than 140 kg.

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Use of Neodymium magnetic discs as pressure earrings for ear lobe keloid post-excision

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2 to Z flap for reconstruction of adjacent skin defects

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Effect of Petrolatum Coating on Fast-Absorbing Gut Suture

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Split Ear Lobe Repair with Piercing Preservation and Optimal Ear Lobe Aesthetics

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First-Time Detection of Porcine Reproductive and Respiratory Syndrome Virus and Porcine Circovirus 2 in an Albanian Farrow-to-Finish Herd

Viral Immunology, Ahead of Print.


https://ift.tt/2JE8OXt

The Characterization of Monoclonal Antibodies to Mouse TLT-1 Suggests That TLT-1 Plays a Role in Wound Healing

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 2, Page 78-86, April 2018.


https://ift.tt/2KqqeIv

Development of Monoclonal Antibodies Specifically Recognizing the Nonstructural Protein 12 of Type 2 Porcine Reproductive and Respiratory Syndrome Virus

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 2, Page 73-77, April 2018.


https://ift.tt/2FvdigK

Multiple Tolerization Reduces Antibody Binding Against Tolerogen Cells: Implications for the Production of Monoclonal Antibodies

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 2, Page 100-104, April 2018.


https://ift.tt/2KphzpD

Evidence That Graves' Ophthalmopathy Immunoglobulins Do Not Directly Activate IGF-1 Receptors

Thyroid, Ahead of Print.


https://ift.tt/2HCZ9UF

Thyroid Dysfunction and Anemia: A Prospective Cohort Study and a Systematic Review

Thyroid, Ahead of Print.


https://ift.tt/2raCdRG

PAs Less Accurate Than Dermatologists at Diagnosing Melanoma

Compared with dermatologists, physician assistants (PAs) are less likely to diagnose melanoma and more likely to perform more biopsies for each case of diagnosed skin cancer, researchers say.
Reuters Health Information

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Pathologic significance of AKT, mTOR, and GSK3β proteins in oral squamous cell carcinoma-affected patients

Abstract

Phosphatidylinositol-3-kinases are kinases that lead to AKT phosphorylation and thus mTOR and GSK3β activation. These proteins are linked to tumorigenesis, but their roles in driving cervical lymph node (CLN) metastasis of oral squamous cell carcinoma (OSCC) cells are unknown. This study aimed to investigate the role of AKT, mTOR, and GSK3β proteins in the occurrence of CLN metastasis in OSCC patients. Ninety and 18 paraffin-embedded OSCC and oral mucosa samples were included, respectively. We divided our OSCC patients into non-metastasizing (PNM) and metastasizing (PM) groups, and the expression of total AKT, pAKT1^Thr308, pAKT^Ser473, GSK3β, pGSK3β^Ser9, and pmTOR^Ser2448 was analyzed by immunohistochemistry. The mean expression of GSK3β, pGSK3β^Ser9, total AKT, and pmTOR²⁴⁴⁸ was always higher in the OSCC tissues than that in the controls. A positive correlation was also found among these proteins. Total AKT, pmTOR^Ser2448, and pGSK3β^Ser9 expression was significantly higher in the PNM and PM groups than that in the control group. However, only GSK3β expression was significantly higher in the PM group compared with the PNM group. High expression levels of GSK3β and pGSK3β^Ser9 were significantly associated with CLN metastasis, but only GSK3β remained an independent predictor of CLN metastasis. pGSK3β^Ser9 and CLN metastasis were associated with a poor prognosis, but only the latter remained an independent prognostic parameter. Kaplan-Meier survival curves showed that pGSK3β^Ser9 and CLN metastasis were significantly related to reduced survival rates. These results suggest that AKT and mTOR proteins are involved in OSCC biology and that GSK3β itself may drive CLN metastatic spread of OSCC cells.

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Intestinal paracoccidioidomycosis resembling Crohn’s disease in a teenager: a case report

Differential diagnosis of inflammatory bowel disease is often very challenging. Paracoccidioidomycosis is a fungal disease that can mimic manifestations of Crohn's disease.

https://ift.tt/2r9ruaL

De novo subgaleal abscess – a rare presentation of melioidosis: a case report

Melioidosis is an emerging infection in the tropics caused by the bacterium Burkholderia pseudomallei. Poorly controlled diabetes is a known risk factor. Melioidosis has a broad spectrum of clinical manifestation...

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Experiencia clínica en pacientes con síndrome de Meige primario y disfonía espasmódica

Publication date: Available online 30 April 2018
Source:Acta Otorrinolaringológica Española
Author(s): María Fernanda Pedrero-Escalas, Isabel García-López, Susana Santiago-Pérez, Francisco Vivancos, Javier Gavilán
IntroducciónEl síndrome de Meige (SM) es considerado una distonía craneal segmentaria que afecta a dos o más músculos craneales. Específicamente, asocia blefaroespasmo a otra distonía craneal (oromandibular, cervical o laríngea). El objetivo de este artículo es presentar nuestra experiencia clínica en pacientes con disfonía espasmódica (DE) asociada a SM primario.Material y métodosEstudio retrospectivo realizado entre mayo de 2010 y junio de 2015. Incluyó 8 pacientes. Las variables recogidas fueron: sexo, edad, distonías asociadas, electromiografía laríngea y tratamiento. Los resultados clínicos objetivados fueron realizados, siempre por el mismo investigador, con la escala GRBAS(i) y el cuestionario VHI-30.ResultadosCincuenta y seis pacientes fueron tratados de SM por el servicio de Neurología. Ocho pacientes asociaron DE (prevalencia 14%). El 100% de nuestros pacientes tenían DE aductora. La mediana de edad para la aparición de DE fue de 71años. Todos los pacientes fueron tratados con infiltración intralaríngea de toxina botulínica bajo control electromiográfico. Se objetivó mejoría clínica tanto en la escala GRBAS(i) como en los cuestionarios VHI-30.ConclusiónEn el estudio de la DE siempre debe tenerse presente su posible asociación con el SM. Desde el punto de vista otorrinolaringológico, el uso conjunto de la escala GRBAS(i) y los cuestionarios VHI-30 es útil, fiable y eficiente como método para evaluar evolución y respuesta a tratamiento. La infiltración laríngea de toxina botulínica bajo control electromiográfico es la alternativa terapéutica que provee mejores resultados clínicos. El manejo de la DE asociada al SM no difiere del de la DE aislada.IntroductionMeige syndrome (MS) is part of the group of segmental cranial dystonias, which affect more than two cranial muscle groups. Specifically, blepharospasm is associated with another cranial dystonia (oromandibular, cervical or laryngeal). The aim of this paper was to report our experience in patients with spasmodic dysphonia (SD) associated with primary MS.Material and methodsA retrospective study involving 8 patients between May 2010 and June 2015. Variables recorded were: age, sex, associated dystonia, electromyographic pattern in laryngeal muscles and treatment given. Outcomes after treatment were assessed using GRBAS(i) scale and VHI-30 questionnaire, always provided by the same examiner.ResultsFifty-six patients with MS were treated in the Neurology Department. Eight patients of 56 were diagnosed with SD (prevalence of 14%). All of our patients had adductor SD. The median age was 71years. All the patients were treated with intralaryngeal botulinum toxin under electromyographic control. Clinically relevant improvements were found after treatment on both the GRBAS(i) scale and the VHI-30 questionnaire.ConclusionIn the study of SD, we should always rule out an association with MS. From the point of view of otorhinolaryngology, the joint use of the GRBAS(i) scale and the VHI-30 questionnaire are useful, reliable and efficient methods for assessing progress and response to treatment. Laryngeal infiltration under electromyographic control with botulinum toxin is the therapeutic alternative that provides better results. The management of SD associated with MS does not differ from isolated SD.



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"There is a World out There We Can Step Into”: The University of Reading (UK) and the World Rankings

Locke, W; (2016) "There is a World out There We Can Step Into": The University of Reading (UK) and the World Rankings. In: Yudkevich, M and Altbach, PG and Rumbley, LE, (eds.) The Global Academic Rankings Game: Changing Institutional Policy, Practice, and Academic Life. Routledge: New York, New York. Green open access

https://ift.tt/2HC1GhU

In-vivo human sock-mapping validation of a simple model that explains unipolar electrogram morphology in relation to conduction-repolarization dynamics

Orini, M; Taggart, P; Lambiase, PD; (2018) In-vivo human sock-mapping validation of a simple model that explains unipolar electrogram morphology in relation to conduction-repolarization dynamics. Journal of Cardiovascular Electrophysiology 10.1111/jce.13606 . (In press).

https://ift.tt/2raJhhc

Extracardiac 18F-florbetapir imaging in patients with systemic amyloidosis: more than hearts and minds

Wagner, T; Page, J; Burniston, M; Skillen, A; Ross, JC; Manwani, R; McCool, D; ... Wechalekar, AD; + view all Wagner, T; Page, J; Burniston, M; Skillen, A; Ross, JC; Manwani, R; McCool, D; Hawkins, PN; Wechalekar, AD; - view fewer (2018) Extracardiac 18F-florbetapir imaging in patients with systemic amyloidosis: more than hearts and minds. European Journal of Nuclear Medicine and Molecular Imaging 10.1007/s00259-018-3995-2 . (In press). Green open access

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The intracellular component of VERDICT (Vascular, Extracellular, and Restricted Diffusion for Cytometry in Tumors) MRI distinguishes Gleason 4 pattern better than Apparent Diffusion Coefficient

Brizmohun, M; Johnston, E; Latifoltojar, A; O'Callaghan, J; Bonet-Carne, E; Ferizi, U; Yvernault, B; ... Punwani, S; + view all Brizmohun, M; Johnston, E; Latifoltojar, A; O'Callaghan, J; Bonet-Carne, E; Ferizi, U; Yvernault, B; Pye, H; Patel, D; Clemente, J; Piga, W; Heavey, S; Grey, A; Saborowska, A; Ourselin, S; Hawkes, D; Moore, C; Emberton, M; Ahmed, H; Whitaker, H; Rodriguez-Justo, M; Freeman, A; Atkinson, D; Alexander, D; Panagiotaki, E; Punwani, S; - view fewer (2018) The intracellular component of VERDICT (Vascular, Extracellular, and Restricted Diffusion for Cytometry in Tumors) MRI distinguishes Gleason 4 pattern better than Apparent Diffusion Coefficient. Presented at: Joint Annual Meeting ISMRM-ESMRMB 2018, Paris Expo Porte de Versailles, Paris, France.

https://ift.tt/2rakJoh

Full blood count values as a predictor of poor outcome of pneumonia among HIV-infected patients

Camon, S; Quiros, C; Saubi, N; Moreno, A; Marcos, MA; Eto, Y; Rofael, S; ... Perello, R; + view all Camon, S; Quiros, C; Saubi, N; Moreno, A; Marcos, MA; Eto, Y; Rofael, S; Monclus, E; Brown, J; McHugh, TD; Mallolas, J; Perello, R; - view fewer (2018) Full blood count values as a predictor of poor outcome of pneumonia among HIV-infected patients. BMC Infectious Diseases , 18 , Article 189. 10.1186/s12879-018-3090-0 . Green open access

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APT-CEST post Gadolinium. Should it be avoided? Comparison of pre- & post- Gadolinium CEST on glioma at 3T

Torrealdea, F; Hearle, J; Evans, V; Zaiss, M; Carvalho, A; Shankar, A; Hyare, H; ... Rega, M; + view all Torrealdea, F; Hearle, J; Evans, V; Zaiss, M; Carvalho, A; Shankar, A; Hyare, H; Atkinson, D; Golay, X; Barnes, A; Rega, M; - view fewer (2018) APT-CEST post Gadolinium. Should it be avoided? Comparison of pre- & post- Gadolinium CEST on glioma at 3T. Presented at: Joint Annual Meeting ISMRM-ESMRMB 2018, Paris, France.

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Is arterial stiffening associated with adiposity, severity of obesity and other contemporary cardiometabolic markers in a community sample of adolescents with obesity in the UK?

Hudson, L; Kinra, S; Wong, I; Cole, TJ; Deanfield, J; Viner, R; (2017) Is arterial stiffening associated with adiposity, severity of obesity and other contemporary cardiometabolic markers in a community sample of adolescents with obesity in the UK? BMJ Paediatrics Open , 1 (1) , Article e000061. 10.1136/bmjpo-2017-000061 . Green open access

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Spatial Vascular Heterogeneity in the Normal Placenta Assessed with Multicompartment Placental MRI

Pratt, R; Melbourne, A; Owen, D; Sokolska, M; Bainbridge, A; Atkinson, D; Deprest, J; ... David, A; + view all Pratt, R; Melbourne, A; Owen, D; Sokolska, M; Bainbridge, A; Atkinson, D; Deprest, J; Kendall, G; Vercauteren, T; Ourselin, S; David, A; - view fewer (2018) Spatial Vascular Heterogeneity in the Normal Placenta Assessed with Multicompartment Placental MRI. Presented at: Joint Annual Meeting ISMRM-ESMRMB 2018, Paris, France. (In press).

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Hi-C as a tool for precise detection and characterisation of chromosomal rearrangements and copy number variation in human tumours

Harewood, L; Kishore, K; Eldridge, MD; Wingett, S; Pearson, D; Schoenfelder, S; Collins, VP; Harewood, L; Kishore, K; Eldridge, MD; Wingett, S; Pearson, D; Schoenfelder, S; Collins, VP; Fraser, P; - view fewer (2017) Hi-C as a tool for precise detection and characterisation of chromosomal rearrangements and copy number variation in human tumours. Genome Biology , 18 , Article 125. 10.1186/s13059-017-1253-8 . Green open access

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Chemical Exchange Saturation Transfer imaging of prostate cancer at 3T: Repeatability, and initial results of an acquisition and multi-pool analysis protocol

Evans, V; Torrealdea, F; Rega, M; Kim, M; Brizmohun, M; Latifoltojar, A; Punwani, S; ... Atkinson, D; + view all Evans, V; Torrealdea, F; Rega, M; Kim, M; Brizmohun, M; Latifoltojar, A; Punwani, S; Golay, X; Atkinson, D; - view fewer (2018) Chemical Exchange Saturation Transfer imaging of prostate cancer at 3T: Repeatability, and initial results of an acquisition and multi-pool analysis protocol. Presented at: Joint Annual Meeting ISMRM-ESMRMB 2018, Paris, France. (In press).

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MRI assessed small bowel dysmotility and its relationship with patient reported symptoms: An exploration of automated vs subjective assessment techniques

Gollifer, R; Menys, A; Plumb, A; Vos, F; Stoker, J; Taylor, S; Atkinson, D; (2018) MRI assessed small bowel dysmotility and its relationship with patient reported symptoms: An exploration of automated vs subjective assessment techniques. Presented at: Joint Annual Meeting ISMRM-ESMRMB 2018, Paris, France. (In press).

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Multi-echo T2 modelling to predict PIRADS 2.0 score

Devine, W; Giganti, F; Johnston, E; Panagiotaki, E; Punwani, S; Alexander, D; Atkinson, D; (2018) Multi-echo T2 modelling to predict PIRADS 2.0 score. Presented at: Joint Annual Meeting ISMRM-ESMRMB 2018, Paris, France. (In press).

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An identity transformation? Social class, language prejudice and the erasure of multilingual capital in higher education

Preece, S; (2016) An identity transformation? Social class, language prejudice and the erasure of multilingual capital in higher education. In: Preece, S, (ed.) The Routledge Handbook of Language and Identity. (pp. 366-381). Routledge: London, United Kindom. Green open access

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Vascular-derived Vegfa promotes cortical interneuron migration and proximity to the vasculature in the developing forebrain

Barber, M; Andrews, WD; Memi, F; Gardner, P; Ciantar, D; Tata, M; Ruhrberg, C; Barber, M; Andrews, WD; Memi, F; Gardner, P; Ciantar, D; Tata, M; Ruhrberg, C; Parnavelas, JG; - view fewer (2018) Vascular-derived Vegfa promotes cortical interneuron migration and proximity to the vasculature in the developing forebrain. Cerebral Cortex 10.1093/cercor/bhy082 . (In press).

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Two compartment fitting for Luminal Water Imaging: multi-echo T2 in Prostate Cancer

Devine, W; Giganti, F; Johnston, E; Panagiotaki, E; Punwani, S; Alexander, DC; Atkinson, D; (2018) Two compartment fitting for Luminal Water Imaging: multi-echo T2 in Prostate Cancer. Presented at: Joint Annual Meeting ISMRM-ESMRMB 2018, Paris, France. (In press).

https://ift.tt/2HGjloz

Physical computing with plug-and-play toolkits:Key recommendations for collaborative learning implementations

Katterfeldt, ES; Cukurova, M; Spikol, D; Cuartielles, D; (2018) Physical computing with plug-and-play toolkits:Key recommendations for collaborative learning implementations. International Journal of Child-Computer Interaction 10.1016/j.ijcci.2018.03.002 . (In press).

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Placental Insufficiency Investigated with Multi-compartment Placental MRI

Melbourne, A; Pratt, R; Owen, D; Sokolska, M; Bainbridge, A; Atkinson, D; Deprest, J; ... Ourselin, S; + view all Melbourne, A; Pratt, R; Owen, D; Sokolska, M; Bainbridge, A; Atkinson, D; Deprest, J; Kendall, G; Vercauteren, T; David, A; Ourselin, S; - view fewer (2018) Placental Insufficiency Investigated with Multi-compartment Placental MRI. Presented at: Joint Annual Meeting ISMRM-ESMRMB 2018, Paris, France. (In press).

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Reduction in tuberculosis incidence in the UK from 2011 to 2015: a population-based study

Harris, RJ; Muzyamba, MC; Davidson, JA; Lalor, MK; Campbell, CNJ; Anderson, SR; Zenner, D; (2018) Reduction in tuberculosis incidence in the UK from 2011 to 2015: a population-based study. Thorax 10.1136/thoraxjnl-2017-211074 . (In press). Green open access

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Pre-treatment intra- and inter- voxel magnetic resonance diffusion heterogeneity correlates with chemoradiotherapy treatment outcome of patients with head and neck squamous cell carcinoma

Papoutsaki, M; Sidhu, H; Dikaios, N; Atkinson, D; Beale, T; Morley, S; Forster, M; ... Punwani, S; + view all Papoutsaki, M; Sidhu, H; Dikaios, N; Atkinson, D; Beale, T; Morley, S; Forster, M; Carnell, D; Mendes, R; Punwani, S; - view fewer (2018) Pre-treatment intra- and inter- voxel magnetic resonance diffusion heterogeneity correlates with chemoradiotherapy treatment outcome of patients with head and neck squamous cell carcinoma. Presented at: Joint Annual Meeting ISMRM-ESMRMB 2018, Paris, France. (In press).

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Uncertain association between depression and stroke risk in Chinese mega-study

Brunner, EJ; Weinreb, IR; (2017) Uncertain association between depression and stroke risk in Chinese mega-study. Evidence-Based Mental Health , 20 , Article e8. 10.1136/eb-2016-102572 . Green open access

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Safety and efficacy of HCV eradication during etanercept treatment for severe psoriasis

Dermatologic Therapy, EarlyView.


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Few Patients Maximize Opioid-Sparing Medications after Orthopaedic Surgery, Study Finds

A new study led by Johns Hopkins researchers adds to growing evidence that patients underuse nonopioid pain relievers to supplement opioid pain management after spine and joint surgery.

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A Comprehensive Analysis of Benign Vocal Fold Lesions Causing Hoarseness of Voice and Our Experience with Cold Knife Endolaryngeal Surgery in a Tertiary Healthcare Centre

Abstract

Benign vocal fold lesions (BVFL) frequently affect the general population and cause significant hoarseness by interfering with daily communication. Healthcare for low income groups in India is all about affordability and availability without giving up on quality and providing maximum satisfaction. (1) To analyse over a period of 4 years, the demographics, clinical profile, diagnostics and management options of BVFL. (2) To assess the diagnostic potential of rigid laryngoscopy in diagnosing these lesions. (3) Cold knife endolaryngeal surgery as a cost effective, satisfactory and efficient treatment modality to tackle majority of these BVFL. A prospective cross sectional study over a period of 4 years from 2013 to 2017. 114 patients presenting with hoarseness of voice were evaluated by indirect laryngoscopy followed by video laryngoscopy and stroboscopy in the department of ENT, MYH Hospital Indore (M.P.). Male:female ratio of 1.59:1 with male predominance (61.4%) and maximum incidence in the third decade (32%). All cases presented with hoarseness (100%) while vocal fatigue (63%) was the most common associated complaint followed by foreign body sensation (60%). Housewives (32%) were most commonly involved non professional group while teachers (13%) constituted the most common group of professionals. Laryngitis (26%) involving bilateral vocal folds diffusely was the most common finding followed by vocal fold sulcus (18%) and vocal fold cysts (14%). The duration of symptom was 6 months to 1 year in 52% patients. The positive predictive value for rigid laryngoscopy was 100% for vocal nodules, arytenoid granulomas and anterior glottis web. Out of 114 patients, 66 patients improved on conservative management while 48 patients underwent cold knife endolaryngeal surgery. As per the GRBAS scale to assess the post therapeutic prognosis, all had good outcome of voice with only two recurrences due to patient non compliance. In this rapidly evolving era of sophisticated lasers which is a costly affair that requires skilled personnel and safety precautions, the prime goal in a government run setup has always been to provide affordable and quality healthcare to the common man. Cold knife endolaryngeal surgery is a simple, cost effective and efficient way to tackle most of these lesions and hence helps in achieving this goal.

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Skin neurogenic inflammation

Abstract

The epidermis closely interacts with nerve endings, and both epidermis and nerves produce substances for mutual sustenance. Neuropeptides, like substance P (SP) and calcitonin gene-related protein (CGRP), are produced by sensory nerves in the dermis; they induce mast cells to release vasoactive amines that facilitate infiltration of neutrophils and T cells. Some receptors are more important than others in the generation of itch. The Mas-related G protein-coupled receptors (Mrgpr) family as well as transient receptor potential ankyrin 1 (TRPA1) and protease activated receptor 2(Par2) have important roles in itch and inflammation. The activation of MrgprX1 degranulates mast cells to communicate with sensory nerve and cutaneous cells for developing neurogenic inflammation. Mrgprs and transient receptor potential vanilloid 4 (TRPV4) are crucial for the generation of skin diseases like rosacea, while SP, CGRP, somatostatin, β-endorphin, vasoactive intestinal peptide (VIP), and pituitary adenylate cyclase-activating polypeptide (PACAP) can modulate the immune system during psoriasis development. The increased level of SP, in atopic dermatitis, induces the release of interferon (IFN)-γ, interleukin (IL)-4, tumor necrosis factor (TNF)-α, and IL-10 from the peripheral blood mononuclear leukocytes. We are finally starting to understand the intricate connections between the skin neurons and resident skin cells and how their interaction can be key to controlling inflammation and from there the pathogenesis of diseases like atopic dermatitis, psoriasis, and rosacea.

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Boobs and Barbie: Feminist Posthuman and new materialism perspectives on gender, bodies and practice

Ringrose, JL; Coffey, J; (2016) Boobs and Barbie: Feminist Posthuman and new materialism perspectives on gender, bodies and practice. In: Practice Theory and Education Diffractive readings in professional practice. Routledge

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Cost of hospitalised patients due to complicated urinary tract infections: a retrospective observational study in countries with high prevalence of multidrug-resistant Gram-negative bacteria: the COMBACTE-MAGNET, RESCUING study

Vallejo-Torres, L; Pujol, M; Shaw, E; Wiegand, I; Vigo, JM; Stoddart, M; Grier, S; ... RESCUING Study Group and Study Sites, ; + view all Vallejo-Torres, L; Pujol, M; Shaw, E; Wiegand, I; Vigo, JM; Stoddart, M; Grier, S; Gibbs, J; Vank, C; Cuperus, N; van den Heuvel, L; Eliakim-Raz, N; Carratala, J; Vuong, C; MacGowan, A; Babich, T; Leibovici, L; Addy, I; Morris, S; RESCUING Study Group and Study Sites, ; - view fewer (2018) Cost of hospitalised patients due to complicated urinary tract infections: a retrospective observational study in countries with high prevalence of multidrug-resistant Gram-negative bacteria: the COMBACTE-MAGNET, RESCUING study. BMJ Open , 8 (4) , Article e020251. 10.1136/bmjopen-2017-020251 . Green open access

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Statistical Modeling for Health Economic Evaluations

Baio, G; (2018) Statistical Modeling for Health Economic Evaluations. ANNUAL REVIEW OF STATISTICS AND ITS APPLICATION, VOL 5 , 5 pp. 289-309. 10.1146/annurev-statistics-031017-100404 .

https://ift.tt/2r974xS

Competition, accountability and performativity: Exploring schizoid neo-liberal ‘equality objectives’ in a UK primary school

Harvey, J; Ringrose, J; (2016) Competition, accountability and performativity: Exploring schizoid neo-liberal 'equality objectives' in a UK primary school. In: Education and Political Subjectivities in Neoliberal Times and Places: Emergences of Norms and Possibilities. (pp. 50-67). Green open access

https://ift.tt/2HEAuPL

Cutaneous vasculitis and recurrent infection caused by deficiency in complement factor I

Nanthapisal, S; Eleftheriou, D; Gilmour, K; Leone, V; Ramnath, R; Omoyinmi, E; Hong, Y; ... Brogan, PA; + view all Nanthapisal, S; Eleftheriou, D; Gilmour, K; Leone, V; Ramnath, R; Omoyinmi, E; Hong, Y; Klein, N; Brogan, PA; - view fewer (2018) Cutaneous vasculitis and recurrent infection caused by deficiency in complement factor I. Frontiers in Immunology , 9 , Article 735. 10.3389/fimmu.2018.00735 . Green open access

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Development of the human placenta and fetal heart: Synergic or independent?

Burton, GJ; Jauniaux, E; (2018) Development of the human placenta and fetal heart: Synergic or independent? Frontiers in Physiology , 9 , Article 373. 10.3389/fphys.2018.00373 . Green open access

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Autumn MIST 2017

Sandhu, JK; Graham, GA; Bentley, SN; Coxon, J; (2018) Autumn MIST 2017. Astronomy & Geophysics , 59 (2) pp. 26-29. 10.1093/astrogeo/aty083 . Green open access

https://ift.tt/2rasaMn

Diagnosing cancer in patients with ‘non-alarm’ symptoms: Learning from diagnostic care innovations in Denmark

Forster, AS; Renzi, C; Lyratzopoulos, G; (2018) Diagnosing cancer in patients with 'non-alarm' symptoms: Learning from diagnostic care innovations in Denmark. [Editorial comment]. Cancer Epidemiology , 54 pp. 101-103. 10.1016/j.canep.2018.03.011 . Green open access

https://ift.tt/2HFU2TB

The redshift evolution of rest-UV spectroscopic properties in Lyman Break Galaxies at z ~ 2-4

Du, X; Shapley, AE; Reddy, NA; Jones, T; Stark, DP; Steidel, CC; Strom, AL; ... Pettini, M; + view all Du, X; Shapley, AE; Reddy, NA; Jones, T; Stark, DP; Steidel, CC; Strom, AL; Rudie, GC; Erb, DK; Ellis, R; Pettini, M; - view fewer (2018) The redshift evolution of rest-UV spectroscopic properties in Lyman Break Galaxies at z ~ 2-4. The Astrophysical Journal (In press).

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Accessibility, affordability and equity: Assessing ‘pro-poor’ public transport subsidies in Bogotá

Oviedo Hernandez, DR; Guzman, LA; (2018) Accessibility, affordability and equity: Assessing 'pro-poor' public transport subsidies in Bogotá. Journal of Transport Geography , 68 pp. 37-51. 10.1016/j.tranpol.2018.04.012 .

https://ift.tt/2HBgxZW

Digital Mediation, Connectivity and Affective Materialities

Ringrose, JL; Harvey, L; (2017) Digital Mediation, Connectivity and Affective Materialities. In: Routledge Handbook of Physical Cultural Studies. Routledge

https://ift.tt/2rfc6cr

Risk Factors for Prognosis in Patients With Severely Decreased GFR

Evans, M; Grams, ME; Sang, Y; Astor, BC; Blankestijn, PJ; Brunskill, NJ; Collins, JF; ... Wheeler, DC; + view all Evans, M; Grams, ME; Sang, Y; Astor, BC; Blankestijn, PJ; Brunskill, NJ; Collins, JF; Kalra, PA; Kovesdy, CP; Levin, A; Mark, PB; Moranne, O; Rao, P; Rios, PG; Schneider, MP; Shalev, V; Zhang, H; Chang, AR; Gansevoort, RT; Matsushita, K; Zhang, L; Eckardt, KU; Hemmelgarn, B; Wheeler, DC; - view fewer (2018) Risk Factors for Prognosis in Patients With Severely Decreased GFR. Kidney International Reports 10.1016/j.ekir.2018.01.002 . (In press). Green open access

https://ift.tt/2HBgkpC

Effectiveness of Universal Self-regulation–Based Interventions in Children and Adolescents: A Systematic Review and Meta-analysis

Pandey, A; Hale, D; Das, S; Goddings, AM; Blakemore, S; Viner, RM; (2018) Effectiveness of Universal Self-regulation–Based Interventions in Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatrics 10.1001/jamapediatrics.2018.0232 . (In press).

https://ift.tt/2r8ELzN

Towards the development of Helpful Aspects of Morenian Psychodrama Content Analysis System (HAMPCAS)

Cruz, AS; Sales, CMD; Moita, G; Gomes Alves, PC; (2016) Towards the development of Helpful Aspects of Morenian Psychodrama Content Analysis System (HAMPCAS). In: Psychodrama. Empirical Research and Science 2. (pp. 57-67). Springer: Wiesbaden.

https://ift.tt/2HB3Qy8

Hyperacusis: major research questions

Abstract

Background

Hyperacusis is a troublesome symptom that can have a marked negative impact on quality of life.

Objectives

To identify major research questions in hyperacusis.

Materials and methods

Review of gaps in knowledge regarding hyperacusis, and where opportunities may lie to address these.

Results

Eight major research questions were identified as priorities for future research. These were: What is the prevalence of hyperacusis in adults and children? What are the risk factors associated with hyperacusis? What is the natural history of hyperacusis? How is 'pain hyperacusis' perceived? What mechanisms are involved in hyperacusis? What is the relationship between hyperacusis and tinnitus? Can a questionnaire be developed that accurately measures the impact of hyperacusis and can be used as a treatment outcome measure? What treatments, alone or in combination, are effective for hyperacusis?

Conclusion

This clinical/researcher-led project identified major research questions in hyperacusis. A further development to identify patient-prioritized research will follow.

https://ift.tt/2KnwVeg

Update HNO

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Smartphone-App-gestützte Ansätze in der Tinnitusbehandlung

Zusammenfassung

In den letzten Jahren werden vermehrt Anwendungen für medizinische Zwecke entwickelt und vorgestellt, so auch Applikationen („Apps"), mit denen sich in Verbindung mit Mobiltelefonen (Smartphones) eine Diagnostik und Dokumentation von Hörproblemen wie Schwerhörigkeit und Tinnitus durchführen lässt. Auch Smartphone-Apps zur Therapie, besonders für Tinnitus, wurden auf den Markt gebracht. In dieser Übersichtsarbeit wird die bislang vorliegende wissenschaftliche Literatur zu diesen Smartphone-Applikationen erörtert. Für die Tinnitustherapie wurden internetbasierte und evaluierte Angebote der Verhaltenstherapie entwickelt. Zur Behandlung von Tinnitus vorgestellte Apps verbinden akustische Stimulation und Musik oder dienen der akustischen Stimulation kortikaler Regionen im Bereich der Tinnitusfrequenz. Sie gelten zwar als sehr innovativ, jedoch wurde bislang der wissenschaftliche Nutzen ihrer Wirksamkeit noch nicht erbracht. Ein generelles Problem bezüglich der Anwendung von Smartphone-Applikationen liegt in ihrer tatsächlichen Sicherheit in Bezug auf mögliche Nebenwirkungen wie auch bezüglich des persönlichen Datenschutzes. Dennoch können Internetangebote und Apps eine sinnvolle Ergänzung multimodaler Therapieformen bilden.

https://ift.tt/2r5fZQW

Bothersome tinnitus

Abstract

Tinnitus is not traceable to a single disease or pathology, but merely a symptom, which is distressing to some but not all individuals able to perceive it. The experience of tinnitus does not equate to tinnitus distress. Tinnitus suffering might be understood as a function of tinnitus-related distress in that bothersome tinnitus is an illness rather than a disease. In bothersome (distressing) tinnitus, the perception of the characteristic sound is a very disturbing and bothersome experience because of maladaptive psychological responses. Several cognitive and behavioral theoretical frameworks attempting to explain the nature and cause of tinnitus suffering have been introduced in and will be summarized here. Current treatment approaches are generally based on models that aim to: alleviate the perceptional experience by focusing on the tinnitus perception for habituation or even soothing purposes; decrease awareness of the sound by attentional training and cognitive interventions; decrease the maladaptive responses and the resulting distress by behavioral methods (i. e., exposure). The cognitive behavioral fear-avoidance model may offer an integrative cognitive behavioral approach that can lead to a new set of paradigms for studying the underlying mechanisms explaining chronic tinnitus suffering as well for developing innovative strategies to treat bothersome tinnitus.

https://ift.tt/2HFQbWD

A Comprehensive Analysis of Benign Vocal Fold Lesions Causing Hoarseness of Voice and Our Experience with Cold Knife Endolaryngeal Surgery in a Tertiary Healthcare Centre

Abstract

Benign vocal fold lesions (BVFL) frequently affect the general population and cause significant hoarseness by interfering with daily communication. Healthcare for low income groups in India is all about affordability and availability without giving up on quality and providing maximum satisfaction. (1) To analyse over a period of 4 years, the demographics, clinical profile, diagnostics and management options of BVFL. (2) To assess the diagnostic potential of rigid laryngoscopy in diagnosing these lesions. (3) Cold knife endolaryngeal surgery as a cost effective, satisfactory and efficient treatment modality to tackle majority of these BVFL. A prospective cross sectional study over a period of 4 years from 2013 to 2017. 114 patients presenting with hoarseness of voice were evaluated by indirect laryngoscopy followed by video laryngoscopy and stroboscopy in the department of ENT, MYH Hospital Indore (M.P.). Male:female ratio of 1.59:1 with male predominance (61.4%) and maximum incidence in the third decade (32%). All cases presented with hoarseness (100%) while vocal fatigue (63%) was the most common associated complaint followed by foreign body sensation (60%). Housewives (32%) were most commonly involved non professional group while teachers (13%) constituted the most common group of professionals. Laryngitis (26%) involving bilateral vocal folds diffusely was the most common finding followed by vocal fold sulcus (18%) and vocal fold cysts (14%). The duration of symptom was 6 months to 1 year in 52% patients. The positive predictive value for rigid laryngoscopy was 100% for vocal nodules, arytenoid granulomas and anterior glottis web. Out of 114 patients, 66 patients improved on conservative management while 48 patients underwent cold knife endolaryngeal surgery. As per the GRBAS scale to assess the post therapeutic prognosis, all had good outcome of voice with only two recurrences due to patient non compliance. In this rapidly evolving era of sophisticated lasers which is a costly affair that requires skilled personnel and safety precautions, the prime goal in a government run setup has always been to provide affordable and quality healthcare to the common man. Cold knife endolaryngeal surgery is a simple, cost effective and efficient way to tackle most of these lesions and hence helps in achieving this goal.

https://ift.tt/2HFtbmB

Evaluation of selected skin parameters following the application of 5% vitamin C concentrate

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2rasudV

Analysis of the changes in scalp hair angles: In vivo and in vitro comparison before and after tumescence

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2rbOwwO

Association between clinical characteristics, quality of life, and sleep quality in patients with periorbital hyperchromia

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2HD16QO

Evidence‐based treatment for gynoid lipodystrophy: A review of the recent literature

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2HD0XNg

Platelet‐rich plasma on female androgenetic alopecia: Tested on 10 patients

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2rask6j

Combination of fractional carbon dioxide laser with narrow band ultraviolet B to induce repigmentation in stable vitiligo: A comparative study

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2HD0SJs

Correlation between serum IL‐17A level and SALT score in patients with alopecia areata before and after NB‐UVB therapy

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2ras7A3

Serum Adenosine Deaminase Levels and Human Papillomavirus as Prognostic and Predictive Factors for Laryngeal and Pharyngeal Carcinomas

Abstract

Head and neck cancer is one of the most common cancers in the world, accounting for up to 30–40% malignancies in India. Research is always on the lookout for parameters that help in early diagnosis of such disease and to explore the possibility of discovering such parameters that would assist in management of the disease by its potential to predict and prognosticate the disease. To estimate serum ADA levels and to correlate with response to therapy and also to correlate between different clinical stages and serum ADA levels and to correlate HPV status to response to therapy. A prospective cohort study. 30 patients who were diagnosed with squamous cell carcinoma of the oropharynx, hypopharynx and larynx were considered in this study. The pre and post treatment values of serum ADA was estimated in these patients and the tumour was assessed for HPV status. The difference in the in the serum ADA levels before and after treatment was 9.982 which was statistically significant with a p value of < 0.001. HPV positive status and response to therapy in the form of recurrence shows a p value of 0.485 which is not statistically significant. Serum ADA level can be used as a parameter to assess the severity of the disease and the response to treatment in cases of carcinoma of the oropharynx, hypopharynx and larynx. HPV status of the disease has its limitation in prediction and prognosis of the disease.

https://ift.tt/2FsFYXD

Serum Adenosine Deaminase Levels and Human Papillomavirus as Prognostic and Predictive Factors for Laryngeal and Pharyngeal Carcinomas

Abstract

Head and neck cancer is one of the most common cancers in the world, accounting for up to 30–40% malignancies in India. Research is always on the lookout for parameters that help in early diagnosis of such disease and to explore the possibility of discovering such parameters that would assist in management of the disease by its potential to predict and prognosticate the disease. To estimate serum ADA levels and to correlate with response to therapy and also to correlate between different clinical stages and serum ADA levels and to correlate HPV status to response to therapy. A prospective cohort study. 30 patients who were diagnosed with squamous cell carcinoma of the oropharynx, hypopharynx and larynx were considered in this study. The pre and post treatment values of serum ADA was estimated in these patients and the tumour was assessed for HPV status. The difference in the in the serum ADA levels before and after treatment was 9.982 which was statistically significant with a p value of < 0.001. HPV positive status and response to therapy in the form of recurrence shows a p value of 0.485 which is not statistically significant. Serum ADA level can be used as a parameter to assess the severity of the disease and the response to treatment in cases of carcinoma of the oropharynx, hypopharynx and larynx. HPV status of the disease has its limitation in prediction and prognosis of the disease.

https://ift.tt/2FsFYXD

Acute invasive fungal rhinosinusitis in twenty‐one diabetic patients

Clinical Otolaryngology, EarlyView.


https://ift.tt/2reJlN1

Assessment of auditory discrimination in hearing-impaired patients

Publication date: Available online 30 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Legris, M. Gomot, J. Charpentier, J.M. Aoustin, C. Aussedat, D. Bakhos
Hearing loss can impair auditory discrimination, especially in noisy environments, requiring greater listening effort, which can impact socio-occupational life. To assess the impact of hearing loss in noisy environments, clinicians may use subjective or objective methods. Subjective methods, such as speech audiometry in noise, are used in clinical practice to assess reported discomfort. Objective methods, such as cortical auditory evoked potentials (CAEPs), are mainly used in research. Subjective methods mainly comprise speech audiometry in noise, in which the signal-to-noise ratio can be varied so as to determine the individual speech recognition threshold, with and without hearing rehabilitation, the aim being to highlight any improvement in auditory performance. Frequency discrimination analysis is also possible. Objective methods assess auditory discrimination without the patient's active participation. One technique used for patients with auditory rehabilitation is the study of auditory responses by CAEPs. This electrophysiological examination studies cortical auditory rehabilitation oddball paradigms, enabling wave recordings such as mismatch negativity, P300 or N400, and analysis of neurophysiological markers according to auditory performance. The present article reviews all these methods, in order to better understand and evaluate the impact of hearing loss in everyday life.



https://ift.tt/2HHj4h4

The emergency paediatric surgical airway: A systematic review

BACKGROUND Although an emergency surgical airway is recommended in the guidelines for a paediatric cannot intubate, cannot oxygenate (CICO), there is currently no evidence regarding the best technique for this procedure. OBJECTIVE To review the available literature on the paediatric emergency surgical airway to give recommendations for establishing a best practice for this procedure. DESIGN Systematic review: Considering the nature of the original studies, a meta-analysis was not possible. DATA SOURCES MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Google Scholar and LILACS databases. ELIGIBILITY CRITERIA Studies addressing the paediatric emergency surgical airway and reporting the following outcomes: time to tracheal access, success rate, complications and perceived ease of use of the technique were included. Data were reported using a Strengths, Weaknesses, Opportunities and Threats analysis. Strengths and Weaknesses describe the intrinsic (dis)advantages of the techniques. The opportunities and threats describe the (dis)advantage of the techniques in the setting of a paediatric CICO scenario. RESULTS Five studies described four techniques: catheter over needle, wire-guided, cannula or scalpel technique. Mean time for placement of a definitive airway was 44 s for catheter over needle, 67.3 s for the cannula and 108.7 s for the scalpel technique. No time was reported for the wire-guided technique. Success rates were 43 (10/23), 100 (16/16), 56 (87/154) and 88% (51/58), respectively. Complication rates were 34 (3/10), 69 (11/16), 36 (55/151) and 38% (18/48), respectively. Analysis shows: catheter over needle, quick but with a high failure rate; wire-guided, high success rate but high complication rate; cannula, less complications but high failure rate; scalpel, high success rate but longer procedural time. The available data are limited and heterogeneous in terms of reported studies; thus, these results need to be interpreted with caution. CONCLUSION The absence of best practice evidence necessitates further studies to provide a clear advice on best practice management for the paediatric emergency surgical airway in the CICO scenario. Correspondence to Dr. Markus F. Stevens, Department of Anaesthesiology, Academic Medical Centre, Meibergdreef 15, Amsterdam 1105 AZ, The Netherlands E-mail: m.f.stevens@amc.uva.nl 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 (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

https://ift.tt/2Kk9Wkd

Intra-operative cutaneous temperature monitoring with zero-heat-flux technique (3M SpotOn) in comparison with oesophageal and arterial temperature: A prospective observational study

BACKGROUND Continuous monitoring of core temperature is essential during major surgery as a way of improving patient safety. Oesophageal probes or specific arterial catheters are invasive methods used in this setting. A new noninvasive device based on zero-heat-flux (ZHF) technique (SpotOn) seems promising but has been poorly investigated during rapid core temperature changes (RCTC). OBJECTIVE To assess the accuracy of a SpotOn sensor vs. an oesophageal probe or specific arterial catheter during a slow change in core temperature of less than 1 °C within 30 min and RCTC ≥ 1 °C within 30 min. DESIGN Prospective observational study. SETTING Operating rooms at the University Hospital of Poitiers, France. PATIENTS Fifty patients scheduled for major abdominal surgery under general anaesthesia were enrolled from June 2015 to March 2016. Data from 49 patients were finally analysed. Among these, 15 patients were treated with hyperthermic intraperitoneal chemotherapy. INTERVENTION Each patient had a ZHF sensor placed on the skin surface of the forehead (TempZHF) and an oesophageal probe (TempEso) used as a reference method. Twenty-two patients also had a thermodilution arterial catheter (TempArt) placed in the axillary artery. MAIN OUTCOME MEASURES Core temperature was continuously recorded from the three devices after induction of anaesthesia. Comparison of temperature measurements between methods was made using the Bland and Altman method during two separate periods according to the speed of core temperature changes. RESULTS Compared with TempEso, bias and limits of agreement for TempZHF were 0.1 ± 0.5 °C during slow core temperature changes periods and 0.6 ± 1.8 °C during RCTC periods (P = 0.0002). Compared with TempArt, these values were −0.1 ± 0.4 and 0.5 ± 1.7 °C, respectively (P = 0.0039). The ZHF sensor was well tolerated. CONCLUSION A SpotOn sensor using the ZHF method seems reliable for core temperature monitoring during abdominal surgery when variations in core temperature are slow rather than rapid. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02869828. Correspondence to Matthieu Boisson, Centre Hospitalier Universitaire de Poitiers, Poitiers, France E-mail: matthieu.boisson@chu-poitiers.fr © 2018 European Society of Anaesthesiology

https://ift.tt/2Kq3TL8

Managing the late effects of chemoradiation on swallowing: bolstering the beginning, minding the middle, and cocreating the end

Purpose of review Late dysphagia has a profound impact on quality of life in patients treated with chemoradiation therapy for advanced head and neck cancer and the number of survivors is growing. Traditional treatment methods are not uniformly successful in reducing the swallow impairment in these patients. Recent findings Manifestations of late dysphagia are complex and do not follow a uniform trajectory. Patient's experience of eating and engagement in treatment is critical given the complex, variable nature of late dysphagia. Novel swallow treatment methods target respiratory function including coordination and strength as well as patient adherence. Summary Head and neck cancer survivors deserve routine and fastidious surveillance beyond the 5-year survival point with respect to swallow function if the enormous biopsychosocial burden of late dysphagia is to be addressed. Correspondence to Tessa Goldsmith, MA, Massachusetts General Hospital, Boston, MA 02114, USA. E-mail: tgoldsmith@mgh.harvard.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2jeRI7v

Managing the late effects of chemoradiation on swallowing: bolstering the beginning, minding the middle, and cocreating the end

Purpose of review Late dysphagia has a profound impact on quality of life in patients treated with chemoradiation therapy for advanced head and neck cancer and the number of survivors is growing. Traditional treatment methods are not uniformly successful in reducing the swallow impairment in these patients. Recent findings Manifestations of late dysphagia are complex and do not follow a uniform trajectory. Patient's experience of eating and engagement in treatment is critical given the complex, variable nature of late dysphagia. Novel swallow treatment methods target respiratory function including coordination and strength as well as patient adherence. Summary Head and neck cancer survivors deserve routine and fastidious surveillance beyond the 5-year survival point with respect to swallow function if the enormous biopsychosocial burden of late dysphagia is to be addressed. Correspondence to Tessa Goldsmith, MA, Massachusetts General Hospital, Boston, MA 02114, USA. E-mail: tgoldsmith@mgh.harvard.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2jeRI7v

Occurrence of anembryonic pregnancy with use of levonorgestrel subdermal implant (JADELLE®): a case report

Progestin-only subdermal implants are one of the most effective contraceptive methods. Anembryonic pregnancy is not reported as a possible outcome in cases of contraceptive failure of these products. We presen...

https://ift.tt/2jilGHM

Ear Prosthesis for Postburn Deformity

Prosthodontics is not just confined to replacement of missing teeth but beyond one's scope. The fabrication of any extraoral maxillofacial prosthesis presents the prosthodontist with several phenomenal challenges. Psychologically, these patients are severely affected either by congenital absence or loss of ear due to trauma or burns. Replacement or reconstruction can be done by surgical or prosthetic approach. However, not all situations are favourable to surgical reconstruction. This article emphasises on the steps in fabrication of ear prosthesis for burn deformity.

https://ift.tt/2r5iZxw

A comparison of morpho-syntactic abilities in deaf children with cochlear implant and 5-year-old normal-hearing children

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Samane Dehghani Golestani, Nahid Jalilevand, Mohammad Kamali
IntroductionChildren with cochlear implants (CIs) have problems in morpho-syntactic abilities more than other language skills. The current study was aimed to evaluate the language samples of children with CIs by using a numerical measurement tool, Persian developmental sentence scoring (PDSS).MethodIn this cross-sectional, descriptive, analytical study, 33 children (22 children with CIs and 11 with normal hearing) were recruited. Language samples of the children were recorded during the description of pictures. The PDSS was used as a reliable numerical measurement tool for analyzing the first 100 consecutive intelligible utterances.ResultsWe found a significant difference in the mean PDSS total scores (p = 0.0001) between the normal-hearing children and deaf children using CIs for 5 years. Similarly, the results revealed a significant difference in the mean PDSS total scores (p = 0.0001) between the normal-hearing children and 5-year-old deaf children with CIs. There was no significant difference in the mean PDSS total scores between the two groups of children with CIs.ConclusionChildren with CIs can form simple sentences but probably exhibit poor abilities for using complex sentences and essential morphology items.



https://ift.tt/2FrYuzl

Fat Embolism Syndrome: A Case Report and Review Literature

Fat embolism syndrome (FES) is a life-threatening complication in patients with orthopedic trauma, especially long bone fractures. The diagnosis of fat embolism is made by clinical features alone with no specific laboratory findings. FES has no specific treatment and requires supportive care, although it can be prevented by early fixation of bone fractures. Here, we report a case of FES in a patient with right femoral neck fracture, which was diagnosed initially by Gurd's criteria and subsequently confirmed by typical appearances on magnetic resonance imaging (MRI) of the brain. The patient received supportive management and a short course of intravenous methylprednisolone.

https://ift.tt/2JAuBiN

The impact of complete embedding of remaining tissue in gynecological lymph node dissection specimen in surgical pathology on lymph node yield: is it clinically relevant?

Abstract

The assessment of nodal metastases in gynecological surgical specimen is an important staging parameter, directing further therapeutic procedures. Since the number of lymph nodes (LNs) removed is seen as an indicator of surgical and pathological quality, the demand for higher lymph node (LN) counts is raising. The goal of this prospective study was the comparison between lymph node counts of macroscopically detectable LNs and the LN yield by complete embedding and proceeding of all submitted LN-containing tissue in the pathology laboratory. One hundred six cases of cervical, uterine, or ovarian cancer, treated in three different hospitals within 3 years, were analyzed. All tissue submitted to the pathology from the surgically performed LN dissections was completely dissected and embedded in the institute of pathology. Subsequently, the amount of LN of all macroscopically detectable nodes was compared to the final histologically reached numbers of LN. Furthermore the histologically visible area of the LNs and their metastases was analyzed to assess the relation of LN numbers to the whole examined LN area. Complete embedding raises the average number of LN counted by 3 to 7 but did only minimally increase the LN area for microscopical examination by about 5% due to the small area of the additional LNs in the remaining fat tissue. The staging was in no case altered by complete embedding, even when additional nodal metastases were detected in the remaining fat tissue, since this was only seen in cases which had already metastatic nodes. Complete embedding of LN-containing tissue did not provide relevant additional staging information and seems therefore unnecessarily laborious, careful pathological work-up assumed.

https://ift.tt/2vXd0j6

Lemierres syndrome: a rare cause of sepsis presenting with an absence of throat symptoms

A 16-year-old boy presented to hospital with a 6-day history of diarrhoea, vomiting and abdominal pain. During his admission he was found to be hypotensive, tachycardic and persistently feverish. Blood cultures taken on admission isolated Fusobacterium necrophorum. CT scanning of his neck showed a non-occlusive thrombus of the right internal jugular vein and a small right parapharyngeal abscess. CT scans of the chest and abdomen revealed multiple pulmonary abscesses, bilateral pleural effusions and splenomegaly. Treatment consisted of an unfractionated heparin infusion and intravenous antibiotics. A right-sided intercostal drain was inserted for a complex right-sided empyema. He subsequently developed a left-sided pleural effusion which was treated with a video-assisted thoracoscopic surgery (VATS) pleurodesis procedure. His fever resolved after his VATS pleurodesis procedure 3 weeks after initial presentation. Clinically he made a slow recovery but now is improved after 6 weeks of intravenous antibiotics and was discharged home.

https://ift.tt/2JB1XxY

Novel management of vaginal chronic graft-versus-host disease causing haematometra and haematocolpos

Genital chronic graft-versus-host disease (GVHD) in women posthaematopoietic cell transplantation may cause vaginal mucosal sclerosis. Human papillomavirus (HPV) reactivation, also common post-transplantation, limits local immunosuppressive, but not oestrogen treatment. A 36-year-old nulliparous woman developed coincidental genital chronic GVHD and HPV 22 months after transplant for aplastic anaemia. Topical immunosuppression for GVHD led to an eruption of warts successfully treated with laser surgery and cone biopsy. She maintained normal ovarian function and used extended cycle combined hormonal contraception. A vaginal oestrogen ring used continuously limited most scarring for 8 years. Progressive apical vaginal scarring obstructed menstrual flow leading to haematocolpos and haematometra. Normal anatomy was restored with a cruciate incision in the cervicovaginal scar performed during menses. When HPV disease limits use of topical immunosuppression in women with vaginal GVHD, the local scar-reducing effect of a vaginal oestrogen ring is limited, and surgery may be needed and can be successful in treating haematocolpos.This study was registered in ClinicalTrials.gov with trial registration number of NCT00003838.

https://ift.tt/2jf7aAk

Treatment of end-stage renal disease with continuous ambulatory peritoneal dialysis in rural Guatemala

A 42-year-old indigenous Maya man presented to a non-profit clinic in rural Guatemala with signs, symptoms and laboratory values consistent with uncontrolled diabetes. Despite appropriate treatment, approximately 18 months after presentation, he was found to have irreversible end-stage renal disease (ESRD) of uncertain aetiology. He was referred to the national public nephrology clinic and subsequently initiated home-based continuous ambulatory peritoneal dialysis. With primary care provided by the non-profit clinic, his clinical status improved on dialysis, but socioeconomic and psychological challenges persisted for the patient and his family. This case shows how care for people with ESRD in low- and middle-income countries requires scaling up renal replacement therapy and ensuring access to primary care, mental healthcare and social work services.

https://ift.tt/2Jwtu3y

Correction: Unilateral retinitis pigmentosa occurring in an individual with a mutation in the CLRN1 gene

Sim PY, Jeganathan VSE, Wright AF et al. Unilateral retinitis pigmentosa occurring in an individual with a mutation in the CLRN1 gene. BMJ Case Rep 2018; doi: 10.1136/bcr-2017-222045.

The following text should have been included in the 'Presented at' section:

Dr V. Swetha E. Jeganathan was finalist for the Novartis Retina Case Awards, held on 27^th February 2013 at the City Hospital, Birmingham. Her case presentation was subsequently published in the Eye News supplement in March 2013.

https://ift.tt/2jd3n6E

Treatment and reconstruction of a complicated infected scalp squamous cell carcinoma with CNS invasion

A 60-year-old male patient with a large infected cranial apex lesion was admitted with lethargy and mental status changes. The patient underwent evaluation with imaging studies, a skin biopsy, cultures with microscopy and a diagnostic burr hole. MRI and positron emission tomography/CT scan revealed a squamous cell carcinoma with ingrowth in the midline of the brain and subdural empyema infected with Streptococcus anginosus and Staphylococcus aureus.

High dose intravenous antibiotic treatment was initiated and the patient subsequently underwent a surgical resection of the carcinoma with a 1 cm margin of surrounding skin and skull. The defect was reconstructed using a titanium plate and a free microvascular lattisimus dorsi muscle flap then covered with a split skin graft.

The patient received 37 radiation therapy sessions (66 GY) as adjuvant therapy.

Intensive neurorehabilitation slowly improved an initial paraparesis. The 7-month follow-up revealed a satisfactory cosmetic result and residual gait impairment secondary to central nervous system invasion.

https://ift.tt/2JB1FqS

Clostridium difficile cure with fecal microbiota transplantation in a child with Pompe disease: a case report

Recurrent Clostridium difficile infection is a growing problem among children due to both the increasing survival of medically fragile children with complicated chronic medical conditions resulting in prolonged a...

https://ift.tt/2vSBRVc

Performance validation of an amplicon-based targeted next-generation sequencing assay and mutation profiling of 648 Chinese colorectal cancer patients

Abstract

Next-generation sequencing (NGS) has become a promising approach for tumor somatic mutation detection. However, stringent validation is required for its application on clinical specimens, especially for low-quality formalin-fixed paraffin-embedded (FFPE) tissues. Here, we validated the performance of an amplicon-based targeted NGS assay, OncoAim™ DNA panel, on both commercial reference FFPE samples and clinical FFPE samples of Chinese colorectal cancer (CRC) patients. Then we profiled the mutation spectrum of 648 Chinese CRC patients in a multicenter study to explore its clinical utility. This NGS assay achieved 100% test specificity and 95–100% test sensitivity for variants with mutant allele frequency (MAF) ≥ 5% when median read depth ≥ 500×. The orthogonal methods including amplification refractory mutation system (ARMS)-PCR and Sanger sequencing validated that NGS generated three false negatives (FNs) but no false positives (FPs) among 516 clinical samples for KRAS aberration detection. Genomic profiling of Chinese CRC patients with this assay revealed that 63.3% of the tumors harbored clinically actionable alterations. Besides the commonly mutated genes including TP53 (52.82%), KRAS (46.68%), APC (24.09%), PIK3CA (18.94%), SMAD4 (9.47%), BRAF (6.15%), FBXW7 (5.32%), and NRAS (4.15%), other less frequently mutated genes were also identified. Statistically significant association of specific mutated genes with certain clinicopathological features was detected, e.g., both BRAF and PIK3CA were more prevalent in right-side CRC (p < 0.001 and p = 0.002, respectively). We concluded this targeted NGS assay is qualified for clinical practice, and our findings could help the diagnosis and prognosis of Chinese CRC patients.

https://ift.tt/2r7L7iP

Detection of abnormally shaped ears by a trained non-specialist allows for early non-surgical intervention

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Daphne Y.D. Lu, Julie Pauwels, Lisa Jin, Frederick K. Kozak, Neil K. Chadha
IntroductionMany children are born with abnormally-shaped ears, including protruding ears or unusually-shaped outer ears. While the majority are benign, these may cause significant issues with self-esteem and bullying in childhood. Early molding can resolve some of these abnormalities, avoiding the need for future corrective surgery. However, newborns with these abnormalities are rarely identified early, within the first few days of life, when molding is most effective. In this study, we investigate whether a trained non-specialist can correctly identify ear shape abnormalities in newborns.MethodsA non-specialist (medical student) was trained on normal and abnormal ear anatomy using photographs and descriptions. Newborns <72 h of age were recruited from maternity wards. Newborns' ears were photographed and these images were assessed independently by two specialists and the non-specialist. External ear shape was classified as either normal or abnormal based on pre-determined criteria.ResultsA total of 661 ears of 334 newborns were photographed and assessed. High inter-rater agreement was achieved with a kappa statistic of 0.863 (SE 0.078). The non-specialist detected abnormally-shaped ears with a sensitivity and specificity of 90.9% and 91.1% respectively.ConclusionsOur study illustrates that non-specialist can be trained to accurately detect newborn ear abnormalities, providing a cost-effective means of ensuring that these children's health care needs are met in a timely fashion. Specifically, we recommend the integration of ear shape assessment into currently established programs such as the newborn hearing screening program.



https://ift.tt/2r5BNfe

Development of a Disease-Specific Ureteral Calculus Patient Reported Outcome Measurement Instrument

Tran, MGB; Sut, MK; Collie, J; Neves, JB; Al-Hayek, S; Armitage, JN; Couturier, D-L; Tran, MGB; Sut, MK; Collie, J; Neves, JB; Al-Hayek, S; Armitage, JN; Couturier, D-L; Wiseman, OJ; - view fewer (2018) Development of a Disease-Specific Ureteral Calculus Patient Reported Outcome Measurement Instrument. Journal of Endourology 10.1089/end.2017.0795 . (In press).

https://ift.tt/2r66xhb

Screening for intimate partner violence in a London HIV clinic: characteristics of those screening positive

Madge, S; Smith, C; Warren-Gash, C; Bayly, J; Bartley, A; (2017) Screening for intimate partner violence in a London HIV clinic: characteristics of those screening positive. HIV Medicine , 18 (1) pp. 66-68. 10.1111/hiv.12404 . Green open access

https://ift.tt/2vT9vKz

The Development Of Executive Functions And Information Processing Speeds In Toddlers Born Preterm

Day, KL; (2018) The Development Of Executive Functions And Information Processing Speeds In Toddlers Born Preterm. Doctoral thesis (Ph.D), UCL (University College London). Green open access

https://ift.tt/2HW86rE

Template-free estimation of intracranial volume: A preterm birth animal model study

Iglesias, JE; Ferraris, S; Modat, M; Gsell, W; Deprest, J; van der Merwe, JL; Vercauteren, T; (2017) Template-free estimation of intracranial volume: A preterm birth animal model study. In: Fetal, Infant and Ophthalmic Medical Image Analysis. (pp. pp. 3-13). Springer Verlag Green open access

https://ift.tt/2vOKNLk

Immediately restored full arch-fixed prosthesis on implants placed in both healed and fresh extraction sockets after computer-planned flapless guided surgery. A 3-year follow-up study

Ciabattoni, G; Acocella, A; Sacco, R; (2018) Immediately restored full arch-fixed prosthesis on implants placed in both healed and fresh extraction sockets after computer-planned flapless guided surgery. A 3-year follow-up study. Clinical Implant Dentistry and Related Research (In press).

https://ift.tt/2HUjMLh

Pottery technology and socio-economic diversity on the Early Helladic III to Middle Helladic II Greek mainland

Spencer, LC; (2007) Pottery technology and socio-economic diversity on the Early Helladic III to Middle Helladic II Greek mainland. Doctoral thesis , University of London. Green open access

https://ift.tt/2vZfOwq

Body Wall Force Sensor for Simulated Minimally Invasive Surgery: Application to Fetal Surgery

Javaux, A; Esteveny, L; Bouget, D; Gruijthuijsen, C; Stoyanov, D; Vercauteren, T; Ourselin, S; ... Vander Poorten, E; + view all Javaux, A; Esteveny, L; Bouget, D; Gruijthuijsen, C; Stoyanov, D; Vercauteren, T; Ourselin, S; Reynaerts, D; Denis, K; Deprest, J; Vander Poorten, E; - view fewer (2017) Body Wall Force Sensor for Simulated Minimally Invasive Surgery: Application to Fetal Surgery. In: Bicchi, A and Okamura, A, (eds.) 2017 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS). (pp. pp. 145-152). IEEE Green open access

https://ift.tt/2HVVTDi

Knockdown of LRP/LR induces apoptosis in pancreatic cancer and neuroblastoma cells through activation of caspases

Chetty, CJ; Ferreira, E; Jovanovic, K; Weiss, SFT; (2017) Knockdown of LRP/LR induces apoptosis in pancreatic cancer and neuroblastoma cells through activation of caspases. Experimental Cell Research , 360 (2) pp. 264-272. 10.1016/j.yexcr.2017.09.016 .

https://ift.tt/2vToTqb

Alginate encapsulation to enhance biopreservation scope and success: a multidisciplinary review of current ideas and applications in cryopreservation and non-freezing storage

Benson, EE; Harding, K; Ryan, M; Petrenko, A; Petrenko, Y; Fuller, B; (2018) Alginate encapsulation to enhance biopreservation scope and success: a multidisciplinary review of current ideas and applications in cryopreservation and non-freezing storage. Cryoletters , 39 (1) pp. 14-38.

https://ift.tt/2r5N3sP

Evolution and Geological Significance of Larger Benthic Foraminifera

Boudagher-Fadel, MK; (2018) Evolution and Geological Significance of Larger Benthic Foraminifera. UCL Press: London, UK. Green open access

https://ift.tt/2vYkSRC

Fast solar radiation pressure modelling with ray tracing and multiple reflections

Li, Z; Ziebart, M; Bhattarai, S; Harrison, D; Grey, S; (2018) Fast solar radiation pressure modelling with ray tracing and multiple reflections. Advances in Space Research , 61 (9) pp. 2352-2365. 10.1016/j.asr.2018.02.019 .

https://ift.tt/2r5MTSf

Foundations for a logic of arguments

Amgoud, L; Besnard, P; Hunter, A; (2017) Foundations for a logic of arguments. Journal of Applied Non-Classical Logics , 27 (3-4) pp. 178-195. 10.1080/11663081.2018.1439356 .

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Listening to a conversation with aggressive content expands the interpersonal space

Vagnoni, E; Lewis, J; Tajadura-Jiménez, A; Cardini, F; (2018) Listening to a conversation with aggressive content expands the interpersonal space. PLoS ONE , 13 (3) 10.1371/journal.pone.0192753 . Green open access

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In this issue

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Dysphagia 27 years after cervical disc arthroplasty

Publication date: Available online 27 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Lemaire, S. Ciftci, C. Debry
IntroductionDysphagia is a frequent postoperative symptom after anterior cervical disc arthroplasty. However, onset of dysphagia and neck pain a long time after surgery should suggest a diagnosis of prosthesis dislocation.Care reportA 65-year-old man with a history of cervical disc arthroplasty 27 years previously consulted for rapidly progressive dysphagia with no other associated symptoms. Physical examination and CT scan confirmed the diagnosis of anterior dislocation of the prosthesis with no signs of perforation. Surgical extraction via a neck incision allowed resolution of the symptoms.DiscussionProsthesis dislocation should be considered in a patient with a history of cervical disc arthroplasty presenting with dysphagia and neck pain. The clinical and radiological assessment confirmed the diagnosis and early surgical management allowed resolution of the symptoms and avoided complications such as pharyngo-oesophageal perforation.



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Semilunar conchal cartilage graft in saddle nose reconstruction

Publication date: Available online 27 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): I. Rašić, A. Košec, A. Pegan
IntroductionThe saddle nose deformity is easily recognized by the loss of septal support and nasal dorsal height with adverse functional and aesthetic consequences.TechniqueWe treated a 50-year-old woman and a 54-year old man that presented with a moderate saddle nose deformity following a previous septorhinoplasty (female patient) and a posttraumatic severe saddle nose deformity (male patient). The patients were treated by open approach rhinoplasty under general anesthesia, and the saddle nose deformity was reconstructed with a semilunar conchal cartilage graft. A semilunar part of the conchal cartilage is excised, lending its name to the graft. A smaller leaf shaped cartilage part is excised and sutured upside-down with PDS 5-0 sutures on the opposite of the cartilage, so that the concave surfaces are facing each other. The newly formed graft is then sutured in its place on the nasal dorsum in the supratip saddle area over the triangular cartilages to widen the inner nasal valve angle. The lateral tips of the semilunar graft are placed below the lateral alar crura to improve external nasal valve functionality.DiscussionThis modified conchal cartilage graft presents itself as an excellent reconstructive option, especially considering its low morbidity, availability and ability to retrieve an adequate amount of cartilage in the vast majority of patients. These modifications of the conchal cartilage are previously unreported, and provide the needed height and elasticity in saddle nose reconstruction without the need for additional grafting. It is important to stress that when positioned properly, a beneficial effect in peak nasal inspiratory flow may be observed, adding to its usefulness in repairing both function and aesthetics.



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The importance of allergic disease in public health: an iCAALL statement

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A novel assessment and treatment approach to patients with Hashimoto’s encephalopathy

Summary

Hashimoto's encephalopathy (HE) is rarely reported with only a few hundred cases published. Diagnosis is made in patients with an appropriate clinical picture and high antithyroperoxidase (anti-TPO) antibodies after infectious, toxic and metabolic causes of encephalopathy have been excluded. There is little objective data on the neurocognitive impairment in patients with HE and their improvement with treatment. We present the case of a 28-year-old woman with HE. Approach to management was novel as objective neuropsychological assessment was used to assess her clinical condition and response to treatment. Intravenous immunoglobulin (IVIg) as the first-line treatment instead of steroids. She responded well. The case illustrates that a different approach is required for the diagnosis and treatment of HE. A new diagnostic criteria is proposed that includes neurocognitive assessment, serum and CSF antibodies, an abnormal EEG and exclusion of other causes of encephalopathy. Furthermore, treatment should be tailored to the patient.

Learning points:

Neurocognitive assessment should be carried out to assess the extent of brain involvement in suspected Hashimoto's encephalopathy pre- and post- treatment.

Treatment of Hashimoto's encephalopathy should be tailored to the patient.

Unifying diagnostic criteria for Hashimoto's encephalopathy must be established.

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Patients Screening Positive for Body Dysmorphic Disorder Show No Significant Health-Related Quality of Life Gain after Functional Septorhinoplasty at a Tertiary Referral Center

Facial plast Surg
DOI: 10.1055/s-0038-1632400

Body dysmorphic disorder (BDD) is a psychiatric disorder defined by an excessive concern about one's physical appearance, especially regarding slight or imagined abnormities of the body. This study was conducted to compare postoperative quality of life (QOL) changes after primary septorhinoplasty among patients screening positive and those screening negative for BDD. Two common instruments for the screening of BDD were used namely the Dysmorphic Concern Questionnaire (DCQ) and the BDD Concern Questionnaire (BDDQ). For the determination of QOL changes, three validated screening instruments were used. The Functional Rhinoplasty Outcome Inventory (FROI-17) and the Rhinoplasty Outcomes Evaluation (ROE) were used as disease-specific instruments and the Short Form 36 Health Survey (SF-36) was used as a general instrument. All patients completed the FROI-17, the ROE, and the SF-36 preoperatively and 60 months postoperatively. The BDD questionnaires were singularly obtained 60 months after surgery. The authors identified 9.8% of our patients with a possible BDD diagnosis. The patients screening positive for BDD showed significantly lower ROE scores postoperatively, compared with those screening negative for BDD. QOL gains detected by the disease-specific instruments (ROE and FROI-17) were only significant in the non-BDD group. No significant QOL gains were detectable with the FROI-17, the ROE, and the SF-36 in the BDD group. In patients screening negative for BDD, QOL, as measured with the SF-36, improved significantly in five categories: physical functioning, role-functioning physical, bodily pain, general health, and social functioning. Patients screening positive for BDD did not improve in any categories of the general SF-36 questionnaire. Instead, their score in the "mental health" category was significantly lower 5 years after their surgery compared with preoperatively. Patients retrospectively screening positive for BDD in our cohort did not improve in QOL postoperatively. Alternative nonsurgical treatments such as cognitive behavioral treatment and/or selective serotonin reuptake inhibitors have been reported to be effective and should be considered as the treatment of choice. Some studies suggest that a smaller subgroup of BDD patients may benefit from functional rhinoplasty. Further research and larger long-term prospective outcome studies are needed to understand the influence of BDD symptoms on postoperative satisfaction and QOL changes after septorhinoplasty.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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Complications of Polydioxanone Foil Use in Nasal Surgery: A Case Series

Facial plast Surg
DOI: 10.1055/s-0038-1632399

Polydioxanone (PDS) foil is widely recognized as a septal cartilage replacement during rhinoplasties and is thought to be completely resorbable and biodegradable. Since its United States Food and Drug Administration approval in 2010, PDS foil has drawn significant enthusiasm and many surgeons consider it an ideal implantable biomaterial as reflected in numerous studies highlighting its benefits. However, scant literature exists highlighting relevant complications of PDS plates that may potentially lead to cavalier overuse. This descriptive case series assesses the outcomes of PDS foil usage in three patients seen for septoplasty at two independent institutions over the past 5 years. Our results demonstrate that PDS plate usage can lead to septal cartilage loss and resultant saddle nose deformıty associated with prolonged postoperative edema and inflammation. To our knowledge, this is the largest case series of this reported phenomenon.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Second Hand Smoke exposure increased the need for inhaled corticosteroids in children with asthma

Exposure to tobacco smoke (ETS) has been associated with increased risk for severity of asthma in children [1,2]. The question to be addressed is whether children with asthma with high environmental tobacco exposure would respond as well to inhaled corticosteroids as those with lower ETS exposure. Urine cotinine is a sensitive and specific biomarker for measuring the exposure to tobacco smoke. The aim of the study was to assess whether the high exposure to tobacco smoke measured by urine cotinine level can influence the daily dose of inhaled corticosteroids needed to achieve asthma control in exposed children.

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Development of a tool predicting severity of allergic reaction during peanut challenge

Reliable prognostic markers for predicting severity of allergic reactions during oral food challenges (OFC) have not been established.

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