Systematic review of atopic dermatitis disease definition in studies using routinely-collected health data

Abstract

Background

Routinely collected electronic health data (RCD) obtained for administrative and clinical purposes are increasingly used to study atopic dermatitis (AD). Methods for identifying AD patients in RCD differ, and it is unknown how this might affect study results.

Objectives

We sought to evaluate how AD patients have been identified in studies using RCD, to determine whether these methods were validated, and to estimate how the method for identifying AD patients affected variability in prevalence estimates.

Methods

We systematically searched PubMed, EMBASE, and Web of Science for studies utilizing RCD that reported on AD as a primary outcome. Studies of localized AD and other types of dermatitis were excluded. The protocol for this review was registered in PROSPERO (CRD42016037968).

Results

59 studies met eligibility criteria. Medical diagnosis codes for inclusion and exclusion, number of occasions of a code, type of provider associated with a code, and prescription data were used to identify AD patients. Only two studies described validation of their methods and no study reported on disease severity. Prevalence estimates ranged from 0.18%-38.33% (median 4.91%) and up to 3-fold variation in prevalence was introduced by differences in the method for identifying AD patients.

Conclusions

This systematic review highlights the need for clear reporting of methods for identifying AD patients in routinely collected electronic health data to allow for meaningful interpretation and comparison of results.

This article is protected by copyright. All rights reserved.

http://ift.tt/2raDGL4

Dermatology Training Across the Globe

Abstract

Dermatology residency program rankings often stem from assessments by practicing physicians or evaluations of scholarly achievements such as grants and publicatons.^1-3 Such rankings, however, are continuously changing, and fail to account for the specific missions of dermatology training programs.² Additionally, a global comparison of dermatology training requirements and a worldwide understanding of the ideal dermatology curriculum remains missing from the literature. Therefore, this study aims to compare and contrast accreditation requirements for dermatology training programs across the world. As a secondary objective, it attempts to identify the different missions of dermatology training programs around the world to create a global vision of what constitutes an ideal dermatology training program.

This article is protected by copyright. All rights reserved.

http://ift.tt/2mK0OeF

Computerized planimetry to assess clinical responsiveness in a phase II randomized trial of topical R333 for discoid lupus erythematosus

Abstract

Background

R333 is a topical janus kinase and spleen tyrosine kinase inhibitor being evaluated for discoid lupus erythematosus (DLE) treatment. There is no validated measure to assess area of active DLE lesions.

Objectives

To evaluate R333 efficacy and assess a technique to measure responsiveness.

Methods

54 DLE patients were randomized in a double blind design to R333 or placebo. The primary endpoint was the proportion of patients achieving ≥50% decrease in erythema and scale based on lesional CLASI for all treated lesions at week 4. Two-dimensional area measurements for each lesion were recorded at baseline and week 1-6. 88 photographs (44 pre- and 44 post-treatment) were obtained from the trial and change in size of active areas was analyzed by computerized planimetry and physician assessed area change.

Results

36 patients were randomized to R333 and 18 patients were randomized to placebo. The primary endpoint was not achieved. There was a strong association between lesion activity and physician global assessment, a measure of activity of all treated lesions (p<10^-6). Photos of 42 patients assessed by computerized planimetry demonstrated excellent inter-rater and intra-rater reliability. Area change by computerized planimetry showed a strong correlation with physician assessed area change (Spearman r=0.72). Area change by two-dimensional measurements showed a weak correlation with physician assessed area change (Spearman r=0.29)

Conclusion

Four weeks of R333 treatment did not result in significant improvement in lesion activity. Lesion activity and area change using computerized planimetry are better determinants of responsiveness as compared to area change using two-dimensional measurements.

This article is protected by copyright. All rights reserved.

http://ift.tt/2ren8Sc

Vulvo-vaginal rejuvenation: Fact or fiction? Fractional carbon dioxide laser for genitourinary syndrome of menopause

http://ift.tt/2B77pnW

Predictive factors for pharyngocutaneous fistulization after total laryngectomy: a Dutch Head and Neck Society audit

Abstract

Background

Incidences of pharyngocutaneous fistulization (PCF) after total laryngectomy (TL) reported in the literature vary widely, ranging from 2.6 to 65.5%. Comparison between different centers might identify risk factors, but also might enable improvements in quality of care. To enable this on a national level, an audit in the 8 principle Dutch Head and Neck Centers (DHNC) was initiated.

Methods

A retrospective chart review of all 324 patients undergoing laryngectomy in a 2-year (2012 and 2013) period was performed. Overall PCF%, PCF% per center and factors predictive for PCF were identified. Furthermore, a prognostic model predicting the PCF% per center was developed. To provide additional data, a survey among the head and neck surgeons of the participating centers was carried out.

Results

Overall PCF% was 25.9. The multivariable prediction model revealed that previous treatment with (chemo)radiotherapy in combination with a long interval between primary treatment and TL, previous tracheotomy, near total pharyngectomy, neck dissection, and BMI < 18 were the best predictors for PCF. Early oral intake did not influence PCF rate. PCF% varied quite widely between centers, but for a large extend this could be explained with the prediction model. PCF performance rate (difference between the PCF% and the predicted PCF%) per DHNC, though, shows that not all differences are explained by factors established in the prediction model. However, these factors explain enough of the differences that, compensating for these factors, hospital is no longer independently predictive for PCF.

Conclusions

This nationwide audit has provided valid comparative PCF data confirming the known risk factors from the literature which are important for counseling on PCF risks. Data show that variations in PCF% in the DHNCs (in part) are explainable by the variations in these predictive factors. Since elective neck dissection is a major risk factor for PCF, it only should be performed on well funded indication.

http://ift.tt/2FFslWm

Future Meetings

Thyroid Jan 2018, Vol. 28, No. 1: 151-151.


http://ift.tt/2FFmoc1

Breast-Milk Iodine Concentrations and Iodine Levels of Infants According to the Iodine Status of the Country of Residence: A Systematic Review and Meta-Analysis

Thyroid Jan 2018, Vol. 28, No. 1: 124-138.


http://ift.tt/2EINmyb

Thyroid-Related Research in Japan A Spotlight on Recent Important Contributions

Thyroid Jan 2018, Vol. 28, No. 1: 1-3.


http://ift.tt/2FI5zgO

Genotype-Based Epigenetic Differences in Monozygotic Twins Discordant for Positive Antithyroglobulin Autoantibodies

Thyroid Jan 2018, Vol. 28, No. 1: 110-123.


http://ift.tt/2ELz6ou

Treatment of allergic rhinitis using mobile technology with real world data: The MASK observational pilot study

Abstract

Background

Large observational implementation studies are needed to triangulate the findings from randomized control trials (RCTs) as they reflect "real world" everyday practice. In a pilot study, we attempted to provide additional and complementary insights on the real life treatment of allergic rhinitis using mobile technology.

Methods

A mobile phone app (Allergy Diary, freely available Google Play and Apple App stores) collects the data of daily visual analogue scales (VAS) for (i) overall allergic symptoms, (ii) nasal, ocular and asthma symptoms, (iii) work, as well as (iv) medication use using a treatment scroll list including all medications (prescribed and over the counter (OTC)) for rhinitis customized for 15 countries.

Results

A total of 2,871 users filled in 17,091 days of VAS in 2015 and 2016. Medications were reported for 9,634 days. The assessment of days appeared to be more informative than the course of the treatment as, in real life, patients do not necessarily use treatment on a daily basis; rather, they appear to increase treatment use with the loss of symptom control. The Allergy Diary allowed differentiation between treatments within or between classes (intranasal corticosteroid use containing medications and oral H1-antihistamines). The control of days differed between no [best control], single or multiple treatments (worst control).

Conclusions

The present study confirms the usefulness of the Allergy Diary in accessing and assessing everyday use and practice in allergic rhinitis. This pilot observational study uses a very simple assessment (VAS) on a mobile phone, shows novel findings and generates new hypotheses.

This article is protected by copyright. All rights reserved.

http://ift.tt/2mzq2eQ

The EAACI/GA²LEN/EDF/WAO Guideline for the Definition, Classification, Diagnosis and Management of Urticaria. The 2017 Revision and Update

Abstract

This evidence and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on December 1st, 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).

Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life, and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.

This article is protected by copyright. All rights reserved.

http://ift.tt/2DmlN0M

Efficacy and safety of fezakinumab (an anti-IL-22 monoclonal antibody) in adults with moderate-to-severe atopic dermatitis inadequately controlled by conventional treatments - A randomized, double-blind, phase 2a trial

IL-22 promotes epidermal hyperplasia and inhibits skin barrier function.

http://ift.tt/2B2P2Ad

Efficacy and safety of lebrikizumab (an anti-IL-13 monoclonal antibody) in adults with moderate-to-severe atopic dermatitis inadequately controlled by topical corticosteroids: A randomized, placebo-controlled phase II trial (TREBLE)

Interleukin (IL)-13 plays a key role in type 2 inflammation and is an emerging pathogenic mediator in atopic dermatitis.

http://ift.tt/2DgYt5m

Acrodermatitis acidaemica

Summary

Methylmalonic acidaemia (MMA) is an inborn error of amino acid metabolism that may be associated with cutaneous manifestations mimicking other diagnoses, including staphylococcal scalded skin syndrome (SSSS), psoriasis and acrodermatitis enteropathica. Whether this is due to the underlying metabolic disorder itself or occurs as a consequence of dietary restriction has yet to be elucidated. Skin biopsies typically show histological features shared by a number of other metabolic disorders and nutritional deficiency-associated diseases. Some presentations, especially SSSS-like eruptions, may be associated with acute metabolic decompensation. An underlying metabolic disorder, such as MMA, should be considered in a diagnosed adult or undiagnosed child presenting with skin eruptions that resemble those listed above, so that specialist management may be initiated early.

http://ift.tt/2ELnBNI

Is there an association of ABO blood groups and Rhesus factor with alopecia areata?

Summary

Background/Objectives

Alopecia areata (AA) is an autoimmune disease characterized by noncicatricial hair loss localized on hair, beard, mustache, eyebrow, eyelash, and sometimes on the body. Although etiopathogenesis is not fully understood, many studies show remarkable associations between various diseases and ABO blood groups. However, there is no study with AA and blood groups.

Methods

Healthy people and patients with AA were included in this study. A total of 155 patients with AA and 299 healthy controls were included in the study.

Results

ABO blood group distribution in patients with AA and distribution of healthy donors were similar. However, Rhesus factor positivity in the AA group was significantly higher than in healthy donors. The relationship between stress and AA was high as known. But, ABO blood group and Rhesus factor were not in a significant connection with stress.

Conclusion

We conclude that there was no association between ABO blood group and AA, but the observed distribution of Rhesus blood group differed slightly but significantly from that of the healthy population. The result of the study shows a small but statistically significant difference in the Rh blood group between patients with AA and the healthy population blood groups. This result is important because it suggests that genetic factors may influence the development of AA. The role of blood groups in the development of AA remains to be determined. We believe that the studies which will be carried out in other centers with wider series will be more valuable to support this hypothesis.

http://ift.tt/2rbrY2B

Abscopal effects of radiotherapy and combined mRNA-based immunotherapy in a syngeneic, OVA-expressing thymoma mouse model

Abstract

Background

Tumor metastasis and immune evasion present major challenges of cancer treatment. Radiotherapy can overcome immunosuppressive tumor microenvironments. Anecdotal reports suggest abscopal anti-tumor immune responses. This study assesses abscopal effects of radiotherapy in combination with mRNA-based cancer vaccination (RNActive^®).

Methods

C57BL/6 mice were injected with ovalbumin-expressing thymoma cells into the right hind leg (primary tumor) and left flank (secondary tumor) with a delay of 4 days. Primary tumors were irradiated with 3 × 2 Gy, while secondary tumors were shielded. RNA and combined treatment groups received mRNA-based RNActive^® vaccination.

Results

Radiotherapy and combined radioimmunotherapy significantly delayed primary tumor growth with a tumor control in 15 and 53% of mice, respectively. In small secondary tumors, radioimmunotherapy significantly slowed growth rate compared to vaccination (p = 0.002) and control groups (p = 0.01). Cytokine microarray analysis of secondary tumors showed changes in the cytokine microenvironment, even in the non-irradiated contralateral tumors after combination treatment.

Conclusion

Combined irradiation and immunotherapy is able to induce abscopal responses, even with low, normofractionated radiation doses. Thus, the combination of mRNA-based vaccination with irradiation might be an effective regimen to induce systemic anti-tumor immunity.

http://ift.tt/2D6E0vI

The role of T2*-weighted gradient echo in the diagnosis of tumefactive intrahepatic extramedullary hematopoiesis in myelodysplastic syndrome and diffuse hepatic iron overload: a case report and review of the literature

Extramedullary hematopoiesis is the proliferation of hematopoietic cells outside bone marrow secondary to marrow hematopoiesis failure. Extramedullary hematopoiesis rarely presents as a mass-forming hepatic le...

http://ift.tt/2D94ooD

Could conjunctivitis in dupilumab treated atopic dermatitis patients be caused by colonization with Demodex and increased IL-17 levels? Reply from authors

Abstract

In studies in atopic dermatitis (AD), dupilumab has been associated with higher rates of conjunctivitis compared with placebo. Consistent with previous studies, in LIBERTY AD CAFÉ (NCT02755649), all cases but one were mild or moderate, most (62–89%) were recovered/resolved or recovering/resolving by end of treatment, and no patients permanently discontinued study treatment because of conjunctivitis.¹ No patients reported atopic keratoconjunctivitis in this study.

This article is protected by copyright. All rights reserved.

http://ift.tt/2re7wOM

Clinical Thyroidology for the Public – Highlighted Article

From Clinical Thyroidology for the Public: Severe thyroid disease is associated with cognitive deficits that could be misdiagnosed as dementia. The association of milder forms of these thyroid conditions and cognitive deficits is less well understood.  Read More….

We welcome your feedback and suggestions. Let us know what you want to see in this publication.

Feedback & Suggestions

The post Clinical Thyroidology for the Public – Highlighted Article appeared first on American Thyroid Association.

http://ift.tt/2D67R7C

A Significant Treatable Cause of Hearing Loss in Our Time

Otosclerosis is often called the disease in which the patient hears nothing and the physician sees nothing. This alludes to the often significant degree of hearing loss experienced by the patient and the regular lack of visible physical findings in this disorder.

http://ift.tt/2DbqGKy

Antegrade Arterial and Portal Flushing Versus Portal Flushing Only for Right Lobe Live Donor Liver Transplantation - A Randomized Control Trial

AbstractIntroductionIn live donor liver transplantation (LDLT) portal flush only of the graft is done on the bench. There is no data on antegrade arterial flush along with portal flush of the graft.MethodsConsecutive patients undergoing elective right lobe LDLT were block-randomized to receive either portal flush only or both portal and antegrade arterial flush. The primary objectives were safety, rate of early allograft dysfunction (EAD), and impact on vascular and biliary complicationsResultsAfter randomization there were 40 patients in each group. Both groups had comparable preoperative, intra operative and donor variables. There were no adverse events related to arterial flushing. The portal and antegrade arterial flush group had significantly lower postoperative - bilirubin on days 7, 14 and 21(all p

http://ift.tt/2EINk9r

Midterm Outcome of Kidney Transplantation from Donors with Thin Basement Membrane Nephropathy

AbstractBackgroundThin basement membrane nephropathy (TBMN) is the most common cause of persistent glomerular hematuria. Most individuals with TBMN show a benign course, although it can be difficult to distinguish it from early stages of progressive renal diseases. However, only limited studies address the prognosis of donors with TBMN and their recipients.MethodsFrom 2007 to 2016, 11 recipients received kidney grafts from donors with TBMN, and their clinical data were analyzed retrospectively. Follow-up protocol kidney biopsies were given to the recipients at 10 days and 1 year after transplantation. The donors were also received a follow-up evaluation of their renal function and were interviewed via telephone survey.ResultsAll donors were living, and their kidney grafts showed TBMN on pre-transplantation biopsy. The recipients were followed for 57.4 ± 28.6 months posttransplantation. Seven recipients showed acute rejection by a median of 9.7 months and all recipients recovered their renal function after treatment. Although 1 kidney failed due to graft arterial occlusion, the functions of the others were preserved during the follow-up period. The donors were followed for 41.0 ± 39.1 months and additionally contacted via telephone survey (in total, 56.8 ± 32.0 months). All the donors maintained their renal function upon clinical follow-up without significant complications and denied any discomfort at the time of the telephone interview.ConclusionsKidney transplant donors with TBMN and their recipients maintained their renal function through midterm follow-up without significant complications. Therefore, kidney transplantation from donors with TBMN could be a safe option. Background Thin basement membrane nephropathy (TBMN) is the most common cause of persistent glomerular hematuria. Most individuals with TBMN show a benign course, although it can be difficult to distinguish it from early stages of progressive renal diseases. However, only limited studies address the prognosis of donors with TBMN and their recipients. Methods From 2007 to 2016, 11 recipients received kidney grafts from donors with TBMN, and their clinical data were analyzed retrospectively. Follow-up protocol kidney biopsies were given to the recipients at 10 days and 1 year after transplantation. The donors were also received a follow-up evaluation of their renal function and were interviewed via telephone survey. Results All donors were living, and their kidney grafts showed TBMN on pre-transplantation biopsy. The recipients were followed for 57.4 ± 28.6 months posttransplantation. Seven recipients showed acute rejection by a median of 9.7 months and all recipients recovered their renal function after treatment. Although 1 kidney failed due to graft arterial occlusion, the functions of the others were preserved during the follow-up period. The donors were followed for 41.0 ± 39.1 months and additionally contacted via telephone survey (in total, 56.8 ± 32.0 months). All the donors maintained their renal function upon clinical follow-up without significant complications and denied any discomfort at the time of the telephone interview. Conclusions Kidney transplant donors with TBMN and their recipients maintained their renal function through midterm follow-up without significant complications. Therefore, kidney transplantation from donors with TBMN could be a safe option. Corresponding author: Sang-il Min, Division of Transplantation and Vascular Surgery, Department of Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Rep. of Korea (surgeonmsi@gmail.com) Authorship C.C. participated in study design, data acquisition, data analysis, interpretation, and writing of the article. S.A. participated in study design, data analysis, and interpretation. S-K.M. participated in study design, data analysis, and interpretation. J.H. participated in study design, interpretation, and writing of the article. C.A. participated in study design, data acquisition, and interpretation. Y.K. participated in study design, data acquisition, and interpretation. H.L. participated in study design, data acquisition, and interpretation. S-i.M. participated in study design, data acquisition, data analysis, interpretation, and writing of the article. Disclosure The authors declare no conflicts of interest. Funding None Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2FFo6Ko

Beyond JAAD April 2018

http://ift.tt/2r8tYJ1

Evaluation of recombinant factor VIIa, tranexamic acid and desmopressin to reduce prasugrel-related bleeding: A randomised, placebo-controlled study in a rabbit model

BACKGROUND Prasugrel is a thienopyridine that inhibits platelet aggregation more rapidly and effectively than clopidogrel, with an increased bleeding risk. OBJECTIVE The current study aimed to evaluate the efficacy of three nonspecific haemostatic drugs – recombinant activated factor VII (rFVIIa), tranexamic acid and desmopressin (DDAVP) – to limit blood loss after administration of prasugrel in a rabbit model of bleeding while also evaluating any prothrombotic effects. DESIGN Randomised, placebo-controlled study. SETTING Faculty of Medicine, University of Geneva, Switzerland, in 2013. ANIMALS Anaesthetised and artificially ventilated rabbits (n=56). INTERVENTIONS Animals were randomly allocated to one of five groups: control (placebo–placebo), prasugrel–placebo, rFVIIa (prasugrel–rFVIIa 150 μg kg−1), tranexamic acid (prasugrel–tranexamic acid 20 mg kg−1) or DDAVP (prasugrel–DDAVP 1 μg kg−1). Two hours after an oral prasugrel loading dose (4 mg kg−1), a stenosis and an injury were inflicted on the carotid artery to induce cyclic flow reductions (CFRs) due to thrombosis. Haemostatic drugs were administered during the ensuing observation period. MAIN OUTCOME MEASURES Standardised hepatosplenic sections were performed to evaluate the primary endpoint of blood loss, monitored for 15 min. Ear-immersion bleeding time and incidence of CFRs were secondary endpoints. RESULTS Prasugrel decreased ADP-induced platelet aggregation (light transmission method) from 66 ± 4% (mean ± SD) to 41 ± 7% (P 

http://ift.tt/2DAdYC3

Comparing peri-operative complications of paediatric and adult anaesthesia: A retrospective cohort study of 81 267 cases

BACKGROUND Comparisons of peri-operative complications associated with paediatric (≤16 years) and adult anaesthesia are poorly available, especially in which cardiac surgery, organ transplantation and neurosurgery are involved. OBJECTIVE The aim of this study was to evaluate the nature and incidence of peri-operative complications that might be due to anaesthesia and to identify independent risk factors for complications in children and adults, including those undergoing cardiac surgery, organ transplantation and neurosurgery. DESIGN Retrospective cohort study. SETTING The study was performed at the University Medical Centre Groningen in the 4 years between 1 January 2010 and the 31 December 2013. MAIN OUTCOME MEASURES Complications and their severity were graded according to the standard complication score (20 items) of the Dutch Society of Anaesthesia. Univariate and multivariate regression analysis was used to identify independent risk factors for the reported complications. RESULTS A total of 81 267 anaesthetic cases were included. In the paediatric cohort, there were 410 (2.9%) complications and 1675 (2.5%) in the adults. In both cohorts age, American Society of Anaesthesiologists classification and emergency treatment were independent risk factors for complications. With respect to age, infants less than 1 year were at the highest risk, whereas in the adult cohort, increased age was related to a greater number of complications. The incidences of the specific complications were different between both cohorts. Upper airway obstruction was more frequently observed in paediatric patients (26%), whereas in the adults, complications with the highest incidence concerned conversion of regional-to-general anaesthesia (25%) and hypotension (17%). CONCLUSION Risk factors for all peri-operative complications were similar for paediatric and adult anaesthesia. However, the incidence of specific complications differed between both age categories. Correspondence to Andrie C. Westerkamp, MD, PhD, Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Box 30.001, 9700 RB Groningen, The Netherlands Tel: +31 50 3613155; fax: +31 50 3613763; e-mail: ac.westerkamp@umcg.nl © 2018 European Society of Anaesthesiology

http://ift.tt/2D8z0Ha

Chronological Progression of an Enlarged Styloid Process: A Case Report of Eagle Syndrome

Eagle syndrome is characterized by an elongated styloid process. However, the time frame over which the styloid process becomes elongated and extends is unknown. How the condition worsens over time is also unclear. To date, there has been no report describing the chronologic change that occurs in the styloid process in Eagle syndrome. We describe a 53-year-old patient with Eagle syndrome in whom the styloid process enlarged progressively over time and the elongated styloid process fused with the hyoid bone. The styloid process was resected via a transcervical approach, and the patient's subjective symptoms improved. This is the first report showing how the styloid process can enlarge over a few years in a patient with Eagle syndrome. Surgical resection via a transcervical approach is an appropriate treatment for a patient in whom the styloid process has become excessively enlarged and elongated.

http://ift.tt/2DdExA9

The ethics of interventional procedures for patients too ill for surgery

Purpose of review Minimally invasive interventional procedures are increasingly popular options for patients who are high-risk candidates for open surgical procedures. It is unclear how to proceed in the rare circumstance of a complication during an interventional procedure, where addressing the complication would require exposing the patient to the full risk that was being avoided with the minimally invasive technique. This review provides recommendations on how to approach this paradoxical scenario. Recent findings Risk stratification, communication frameworks, and advanced care planning can facilitate shared decision-making between physicians and patients. Risk stratification may include mortality predictive models, disability and frailty scores, and patient-centered outcome studies. In the event of procedural complication or failure, aggressive surgical treatment or limited repair should be guided by patient preferences to best ensure value concordant care. Summary Interventional procedures, and emergent open surgery, should be offered as long as patients are fully informed about the benefits and risks, including the implications of potential life-sustaining treatments, and whether their respective goals of treatment are consistent with the intervention. Implementing this framework will require a cultural shift in physician attitudes to recognize that in some cases, nonintervention or less aggressive treatment may be a reasonable alternative to surgical intervention. Correspondence to Michael Nurok, Cedars-Sinai Heart Institute, 127 S. San Vicente Blvd., A3100, Los Angeles, CA, 90048, USA. Tel: +1 310 248 7369; e-mail: michael.nurok@cshs.org Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2B2SBXp

Oxygen in the critically ill: friend or foe?

Purpose of review To examine the potential harmful effects of hyperoxia and summarize the results of most recent clinical studies evaluating oxygen therapy in critically ill patients. Recent findings Excessive oxygen supplementation may have detrimental pulmonary and systemic effects because of enhanced oxidative stress and inflammation. Hyperoxia-induced lung injury includes altered surfactant protein composition, reduced mucociliary clearance and histological damage, resulting in atelectasis, reduced lung compliance and increased risk of infections. Hyperoxemia causes vasoconstriction, reduction in coronary blood flow and cardiac output and may alter microvascular perfusion. Observational studies showed a close relationship between hyperoxemia and increased mortality in several subsets of critically ill patients. In absence of hypoxemia, the routine use of oxygen therapy in patients with myocardial infarction, stroke, traumatic brain injury, cardiac arrest and sepsis, showed no benefit but rather it seems to be harmful. In patients admitted to intensive care unit, a conservative oxygen therapy aimed to maintain arterial oxygenation within physiological range has been proved to be well tolerated and may improve outcome. Summary Liberal O2 use and unnecessary hyperoxia may be detrimental in critically ill patients. The current evidence supports the use of a conservative strategy in O2 therapy to avoid patient exposure to unnecessary hyperoxemia. Correspondence to Professor Massimo Girardis, Anesthesia and Intensive Care Unit, Department of Anaesthesia and Intensive Care, University Hospital of Modena, Via del Pozzo 71, 41124 Modena, Italy. E-mail: girardis.massimo@unimo.it Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2DdXRxg

Deep vein thrombosis and venous thromboembolism in trauma

Purpose of review Deep vein thrombosis (DVT) and pulmonary embolus are major causes of hospital-related morbidity and mortality, and are recognized as complications in patients with traumatic injury. Despite the significant morbidity and mortality associated with DVTs, prophylaxis and treatment are still not well understood and remain the subject of research and debate. Recent findings Elements of the patient's history and physical examination, along with thromboelastography, can be used to predict patients who are at greatest risk of DVT and venous thromboembolism (VTE). Novel assays and biomarkers hold promise for more accurate evaluation of coagulation status. Patients with traumatic injury are routinely treated with either mechanical or pharmacological treatments to prevent DVT, and a growing body of evidence suggests that DVT prophylaxis should be initiated as early as possible in a patient's hospital course. Summary In trauma patients with traumatic injury, early identification and targeted VTE prophylaxis in trauma patients may prevent this life-threatening complication. Correspondence to Keith J. Ruskin, MD, Department of Anesthesia and Critical Care, University of Chicago School of Medicine, 5841 S Maryland Avenue, MC4028, Chicago, IL 60637, USA. Tel: +1 773 834 2369; e-mail: ruskin@uchicago.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2B1VvLX

Activation state of circulating eosinophils in nasal polyposis

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common disease with an uncertain pathophysiology. It is characterized by polyps rich in eosinophils, with an activation status already investigated at the tissue level. In a group of CRSwNP patients, we assessed the activation status of circulating eosinophils in the blood before migration into tissues.

Methods

Thirteen patients with CRSwNP and 16 healthy volunteers were enrolled. Several biologic parameters were studied: blood count of eosinophils; plasma eosinophil cationic protein; oxidative metabolism by chemiluminescence at baseline or when activated by phorbol 12-myristate 13-acetate or platelet-activating factor, with or without interleukin-5 (IL-5); percent of granulosar cells; and mean fluorescence intensity (MFI) by flow cytometry.

Results

The mean number of eosinophils was significantly higher in patients with CRSwNP, whose eosinophils showed increased oxidative metabolism in the basal or activated state significantly decreasing in the presence of IL-5. There was also a higher percentage of CD49d⁺, CD25⁺, and CCR3⁺ cells in patients, and a nonsignificant decrease in descending order in MFI between the control group, patients with normal eosinophil levels, patients with hypereosinophilia, and patients with aspirin-exacerbated respiratory disease.

Conclusion

This study demonstrates a priming state of circulating eosinophils in CRSwNP patients when compared with healthy controls, as evidenced by the extent of oxidative metabolism, with increased sensitivity to IL-5 and by the observed variations of percent and MFI of CD49d, CCR3, and CD25. This priming is thus found at the peripheral level and occurs before the migration of eosinophils to polyps, reflecting the systemic and not just local nature of abnormalities in CRSwNP.

http://ift.tt/2DhejvF

Preclinical therapeutic efficacy of the ciprofloxacin-eluting sinus stent for Pseudomonas aeruginosa sinusitis

Background

The ciprofloxacin-coated sinus stent (CSS) has unique therapeutic potential to deliver antibiotics to the sinuses. The objective of this study is to evaluate the efficacy of the CSS stent in eliminating Pseudomonas aeruginosa infection in a rabbit model of sinusitis.

Methods

A ciprofloxacin-eluting sinus stent was created by coating ciprofloxacin/Eudragit RS100 on biodegradable poly-D/L-lactic acid (2 mg). After analyzing in-vitro inhibition of P aeruginosa (PAO-1 strain) biofilm formation, a total of 8 stents (4 shams, 4 CSSs) were placed unilaterally in rabbit maxillary sinuses via dorsal sinusotomy after inducing infection for 1 week with PAO-1. Animals were assessed 2 weeks after stent insertion with nasal endoscopy, sinus culture, computed tomography (CT) scan, histopathology, and scanning electron microscopy (SEM).

Results

PAO-1 biofilm formation was significantly reduced in vitro with exposure to the CSS (p < 0.0001). Insertion of the stent in PAO-1–infected rabbits for 2 weeks resulted in significant improvement in sinusitis according to endoscopy scoring (p < 0.0001) and CT scoring (p < 0.002). Histology and SEM revealed marked improvement in the structure of the mucosa and submucosa with no detection of biofilm structures in the CSS cohort.

Conclusion

Although this study had a small sample size, we identified robust therapeutic efficacy of the CSS by reducing bacterial load and biofilm formation of P aeruginosa in a preclinical model of sinusitis after placement for 2 weeks.

http://ift.tt/2myqtWS

Antibiotic use patterns in endoscopic sinus surgery: a survey of the American Rhinologic Society membership

Background

There is a paucity of data supporting antibiotic use in endoscopic sinus surgery (ESS). The objective of this study is to determine perioperative antibiotic use patterns and factors which influence use in ESS.

Methods

An online-based survey was distributed to members of the American Rhinologic Society (ARS). Outcomes included timing of perioperative antibiotic use, practice environment, years of experience, and patient factors that influenced antibiotic use.

Results

There were 204 responses (response rate 18.3%); 36.8% of respondents were in academic positions, 32.8% were in private practice, and 30.4% were in academic-affiliated private practice; 20.6% routinely gave preoperative antibiotics, most commonly to reduce bacterial burden (59.5%) and mucosal inflammation (59.5%); 54.4% routinely gave intraoperative antibiotics, most commonly to reduce the risk of postoperative infection (63.1%); 62.3% routinely gave postoperative antibiotics, citing the need to reduce the risk of postoperative infection (75.6%). Diagnosis influenced postoperative antibiotic use in 63.0%. Preoperative antibiotics were more likely to be prescribed by respondents with more than 5 years of experience (odds ratio [OR] 2.97; 95% confidence interval [CI], 1.04 to 8.54; p = 0.043). Compared to private practitioners, academicians were more likely to give intraoperative antibiotics (OR 2.68; 95% CI, 1.39 to 5.17; p = 0.003), but not preoperative or postoperative antibiotics. Use of nonabsorbable packing was significantly associated with use of postoperative antibiotics (OR 2.01; 95% CI, 1.07 to 3.77; p = 0.031).

Conclusion

This study demonstrates the significant variation in perioperative antibiotic use among otolaryngologists. These results provide support for the establishment of evidence-based practice guidelines for perioperative antibiotic use in ESS.

http://ift.tt/2Dku3hI

Prevalence of metabolic syndrome in children with moderate to severe psoriasis treated with TNF inhibitors in comparison to conventional agents

Abstract

Association of childhood psoriasis with metabolic syndrome has not been studied well. TNF-alfa contributes to the inflammation seen in metabolic syndrome, and recently etanercept has shown to reduce the levels of inflammatory markers. Assessment of prevalence of metabolic syndrome in juvenile psoriasis patients in Kuwait. We included 236 patients with moderate to severe psoriasis below 18 years treated for at least 24 weeks with TNF inhibitors (Group A), and equal number of age and sex matched cases treated with conventional medications (Group B). The metabolic syndrome (MBS) was defined according to the International Diabetes Foundation (IDF 2007 criteria for children). Increased waist circumference was seen in 56.77% of cases in Group A. Triglyceridemia was less frequent in Group A. MBS was higher in Group B [41·52% vs. 50·42%, odds ratio (OR) 1·76, 95% CI 1.19–2.41; p = .005]. Psoriasis is associated with higher prevalence of metabolic syndrome in children. Six months of anti TNF treatment showed lesser association with metabolic syndrome. With fasting blood glucose, and serum TG seen in significantly lesser number of patients in this group.

http://ift.tt/2FE0vtH

Clinical evaluation of a novel fractional radiofrequency device for hair growth: Fractional radiofrequency for hair growth stimulation

Abstract

AGA is a common disorder. Different treatments are available to prevent hair loss and achieve hair growth with variable results. The purpose of the present study was to evaluate the efficacy and safety of a novel fractional radiofrequency (RF) device (HairLux, Innogen Technologies Ltd., Yokneam, Israel), to prevent hair loss and induce hair growth. Twenty-five patients received 10 fractional RF treatments every 2 weeks, and were followed up 2 months after the last treatment. All patients were evaluated by global photography. In 10 patients, blinded manual hair counts were performed. Patients demonstrated less hair shedding, fuller hair, and faster hair growth. There was an average increase of 31.6% in hair density (based on hair counts) and 18% increase in hair shaft thickness. All subjects tolerated the treatments well. The HairLux device is effective and safe for hair growth stimulation in AGA. Ten treatment sessions are recommended to maximize results.

http://ift.tt/2EILOEs

Quality of life and problems associated with obturators of patients with maxillectomies

Abstract

Background

Maxillary defects predispose patients to different undesirable effects. The aim of this study was to assess the quality of life (QoL) of patients with maxillary defects (acquired/congenital) wearing obturators.

Methods

The study comprised 30 patients aged between 16 and 78 years. Interviews were conducted to collect information pertaining to patients; sociodemographic, self-reported function of obturator using Obturator Functioning Scale (OFS), self-evaluation of general health using Visual Analogue Scale (VAS), radiotherapy treatment, salivary gland removal, reconstructive surgery, neck dissection and length of time obturators were worn. Clinical examination included type of maxillectomy, Aramany classification of the defect, and evaluation of obturator function using the Kapur retention and stability scoring system.

Result

Quality of life was affected significantly by marital status (P = 0.026). Married patients had better quality of life 61.3%, followed by divorced patients 38.8%, widowed 37.3% and the least QoL was detected in single patients 36.5%. Significant association between the type of maxillectomy and QoL was detected (P = 0.002). Retention of obturator prosthesis had a highly significant association with QoL (P < 0.001). Type of maxillectomy had a significant relation with obturator retention (P = 0.005). Stability had a significant correlation with QoL (P = 0.022). Obturator wearers who were treated with radiotherapy had lower QoL than those who were not treated with radiotherapy.

Conclusion

Rehabilitation of patients with maxillary defects using obturator prosthesis is an appropriate and not invasive treatment modality. Results support that good obturators contribute to a better life quality.

http://ift.tt/2DyzN52

Granular cell tumors of the tongue: fibroma or schwannoma

Abstract

Background

Granular cell tumors are benign lesions that typically occur in the oral cavity, but can also be found in other sites. However, the characteristics of these tumors are unclear. Thus, the present study aimed to investigate the immunohistological characteristics of these tumors of the tongue.

Methods

Seven patients were treated for granular cell tumors of the tongue at our institution during 2003–2017. Paraffin-embedded specimens were available for all cases; thus, retrospective immunohistochemical analyses were performed.

Results

All cases exhibited cytoplasmic acidophilic granules in the muscle layer of the tumor. Both the normal nerve cells and tumor cells also stained positive for PGP9.5, NSE, calretinin, and GFAP. A nucleus of tumor cells was typically present in the margin. The PAS-positive granules were also positive for CD68 (a lysozyme glycoprotein marker). Various sizes of nerve fibers were observed in each tumor, and granular cells were observed in the nerve fibers of a representative case.

Conclusions

Based on our immunohistological findings, granular cell tumors may be derived from Schwann cells, and the presence of CD68 indicates that Wallerian degeneration after nerve injury may be a contributor to tumor formation. Thus, a safe surgical margin is needed to detect the infiltrative growth of granular cell tumors.

http://ift.tt/2D4v4a1

The Infinity from Nothing paradox and the Immovable Object meets the Irresistible Force

Abstract

In this paper I present a novel supertask in a Newtonian universe that destroys and creates infinite masses and energies, showing thereby that we can have infinite indeterminism. Previous supertasks have managed only to destroy or create finite masses and energies, thereby giving cases of only finite indeterminism. In the Nothing from Infinity paradox we will see an infinitude of finite masses and an infinitude of energy disappear entirely, and do so despite the conservation of energy in all collisions. I then show how this leads to the Infinity from Nothing paradox, in which we have the spontaneous eruption of infinite mass and energy out of nothing. I conclude by showing how our supertask models at least something of an old conundrum, the question of what happens when the immovable object meets the irresistible force.

http://ift.tt/2DdztvN

Childhood alopecia areata—Data from the National Alopecia Areata Registry

Abstract

Background/Objectives

Alopecia areata may occur at any age and is the third-most-common dermatosis in children. The objective of this study was to investigate the clinical and epidemiologic features of children and adolescents with alopecia areata based on the data of the National Alopecia Areata registry on children and adolescents.

Methods

Two thousand two hundred eighteen children and adolescents with alopecia areata self-enrolled in the National Alopecia Areata Registry and completed a web-based, self-administered, short-intake screening questionnaire (first tier). In the second tier, 643 patients participated in a clinical examination and completed a long-form questionnaire.

Results

Mean age of onset was 5.9 ± 4.1 years. With a female to male ratio of 1.5:1, alopecia areata was more prevalent in girls, but boys were significantly more likely to have a severe type (P = .009). One-fourth of all children had a positive family history, with 8% having more than three affected relatives. The disease most commonly associated with alopecia areata was atopic dermatitis (32.7%).

Conclusion

Childhood alopecia areata is more prevalent in girls than in boys, but boys have more extensive alopecia areata. Despite the low prevalence, congenital alopecia areata is an important differential diagnosis for neonatal hair loss. Alopecia areata runs in families, suggesting an underlying genetic background. One-quarter of the children reported at least one affected first-degree relative; 8% had more than three affected relatives.

http://ift.tt/2DfWiP6

Use of antiviral medications in drug reaction with eosinophilia and systemic symptoms (DRESS): A case of infantile DRESS

Abstract

A 3-month-old girl with Sturge-Weber syndrome presented with a morbilliform rash, eosinophilia, and fulminant liver failure to our tertiary pediatric hospital. She was diagnosed with drug reaction with eosinophilia and systemic symptoms complicated by viremia and evidence of viral hepatitis on liver biopsy. We discuss the role of viral reactivation in drug reaction with eosinophilia and systemic symptoms and the relevance of antiviral therapy in management.

http://ift.tt/2B1KkTy

A comprehensive next-generation sequencing assay for the diagnosis of epidermolysis bullosa

Abstract

Background

Historically, diagnosis of epidermolysis bullosa has required skin biopsies for electron microscopy, direct immunofluorescence to determine which gene(s) to choose for genetic testing, or both.

Methods

To avoid these invasive tests, we developed a high-throughput next-generation sequencing (NGS)-based diagnostic assay called EBSEQ that allows simultaneous detection of mutations in 21 genes with known roles in epidermolysis bullosa pathogenicity. Mutations are confirmed with traditional Sanger sequencing.

Results

We present our EBSEQ assay and preliminary studies on the first 43 subjects tested. We identified 11 cases of epidermolysis bullosa simplex, five cases of junctional epidermolysis bullosa, 11 cases of dominant dystrophic epidermolysis bullosa, 15 cases of recessive dystrophic epidermolysis bullosa, and one case that remains without diagnosis. We also found an additional 52 variants of uncertain clinical significance in 17 of the 21 epidermolysis bullosa-associated genes tested. Three of the variants of uncertain clinical significance were also found in three other patients, for a total of 49 unique variants of uncertain clinical significance. We found the clinical sensitivity of the assay to be 75% to 98% and the analytical sensitivity to be 99% in identifying base substitutions and small deletions and duplications. Turnaround time was 3 to 6 weeks.

Conclusions

EBSEQ is a sensitive, relatively rapid, minimally invasive, comprehensive genetic assay for the diagnosis of epidermolysis bullosa.

http://ift.tt/2DbpUNC

Oxybutynin 3% gel for the treatment of primary focal hyperhidrosis in adolescents and young adults

Abstract

Background/Objectives

There are no reliably effective, well-tolerated topical agents for the treatment of hyperhidrosis. We sought to evaluate the efficacy and tolerability of oxybutynin 3% gel in adolescents and young adults with primary focal hyperhidrosis.

Methods

Patients with severe axillary hyperhidrosis were treated with topical oxybutynin 3% gel for 4 weeks. Response to treatment was assessed by calculating change in Hyperhidrosis Disease Severity Score from baseline to weeks 1 and 4. Change in health-related quality of life was assessed using the Children's Dermatology Life Quality Index or the Dermatology Life Quality Index. Adverse effects were evaluated using patient diaries, investigator global review, and physical examination.

Results

Of 10 patients aged 13-24 enrolled, seven completed the study. Of those who completed the study, four (57.1%) reported reduction in axillary Hyperhidrosis Disease Severity Score at week 1 and all seven (100%) at week 4. Six patients (85.7%) reported reduction in Children's Dermatology Life Quality Index or Dermatology Life Quality Index score. Anticholinergic adverse effects were infrequent. The majority of treatment-related adverse events were mild to moderate in severity. One patient experienced a severe adverse event.

Conclusion

Oxybutynin 3% gel reduced hyperhidrosis severity and improved health-related quality of life in this small pilot study. Safety and efficacy should be further evaluated in a large, prospective, placebo-controlled study.

http://ift.tt/2B1K7je

Severe ectropion in lamellar ichthyosis managed medically with oral acitretin

Abstract

Congenital ectropion is commonly associated with lamellar ichthyosis. Severe eyelid ectropion may cause corneal exposure, keratopathy, and permanent corneal scarring. We report a neonate with severe, bilateral, congenital ectropion and eclabium managed using oral retinoids. Both corneas were protected with topical antibiotics and lubricating eyedrops and eye ointments. At 12-month follow-up, the child was doing well, with no ectropion or corneal opacity.

http://ift.tt/2D9Hrps

Neurological prognosis of 6 cases after chest compression during general anesthesia

Abstract

Introduction

Data on the outcomes after chest compression (CC) of patients who are under general anesthesia (GA) are limited. The present study aimed to evaluate the neurological outcomes in patients who received CC while under GA.

Methods

The patients who received CC while under GA, between 2010 and 2015, in Kyoto Medical Center were surveyed retrospectively. The primary outcome was poor neurologic function or death, as defined by a cerebral performance category score (CPC) score of 3–5 on day 28.

Results

Six patients received CC while under GA, and four patients had poor neurological outcomes with a CPC score of 4 or 5 on day 28. All these patients required emergency operation because of their primary disease.

Conclusion

Even if the patients were monitored and immediately managed under GA, ineffective management of preoperative conditions tended to result in the poor neurological prognosis.

http://ift.tt/2DbXQtF

A comparison of semi-automated volumetric vs linear measurement of small vestibular schwannomas

Abstract

Objective

Accurate and precise measurement of vestibular schwannoma (VS) size is key to clinical management decisions. Linear measurements are used in routine clinical practice but are prone to measurement error. This study aims to compare a semi-automated volume segmentation tool against standard linear method for measuring small VS. This study also examines whether oblique tumour orientation can contribute to linear measurement error.

Study design

Experimental comparison of observer agreement using two measurement techniques.

Setting

Tertiary skull base unit.

Participants

Twenty-four patients with unilateral sporadic small (< 15 mm maximum intracranial dimension) VS imaged with 1 mm-thickness T1-weighted Gadolinium enhanced MRI.

Main outcome measures

(1) Intra and inter-observer intraclass correlation coefficients (ICC), repeatability coefficients (RC), and relative smallest detectable difference (%SDD). (2) Mean change in maximum linear dimension following reformatting to correct for oblique orientation of VS.

Results

Intra-observer ICC was higher for semi-automated volumetric when compared with linear measurements, 0.998 (95% CI 0.994–0.999) vs 0.936 (95% CI 0.856–0.972), p < 0.0001. Inter-observer ICC was also higher for volumetric vs linear measurements, 0.989 (95% CI 0.975–0.995) vs 0.946 (95% CI 0.880–0.976), p = 0.0045. The intra-observer %SDD was similar for volumetric and linear measurements, 9.9% vs 11.8%. However, the inter-observer %SDD was greater for volumetric than linear measurements, 20.1% vs 10.6%. Following oblique reformatting to correct tumour angulation, the mean increase in size was 1.14 mm (p = 0.04).

Conclusion

Semi-automated volumetric measurements are more repeatable than linear measurements when measuring small VS and should be considered for use in clinical practice. Oblique orientation of VS may contribute to linear measurement error.

http://ift.tt/2Dj9amO

Patient-Reported-Outcome-Messung (PROM) psychosozialer Belastung und Symptome für ambulante Patienten unter kurativer oder palliativer Tumortherapie

Zusammenfassung

Hintergrund

Palliative Unterstützung sollte früh in die Tumortherapie eingebunden werden, doch der Bedarf der Patienten bleibt oft unerkannt und unbehandelt. Die Autoren analysierten die Rücklaufquote einer quartalsweisen Patientenbefragung mit validierten Fragebögen und erfassten die Bedarfe der Tumorpatienten, die sich in kurativer oder palliativer Behandlung befanden.

Methoden

Bei der Entwicklung des Fragebogens wurden die 3 validierten Instrumente Hornheider Fragebogen (HSI), PHQ4 Fragebogen (Patient Health Questionnaire) und der MIDOS Fragebogen (MInimal DOcumentation System) kombiniert. 96 (13,6 %) kurativ und 609 (81,4 %) palliativ behandelte Patienten füllten einen Fragebogen aus.

Ergebnisse

Zwischen Oktober 2013 und März 2016 wurden 75 % der ausgeteilten Fragebögen ausgefüllt. Unter den kurativ und palliativ behandelten Patienten hatten 34 (35,8 %) und 272 (45,0 %) Patienten einen pathologischen HSI-Score (p = 0,094), bei 7 (11,3 %) und 51 (13,7 %) Patienten ergab der PHQ4 einen mittleren oder schlechten Score (p = 0,845) und 6 (6,5 %) und 70 (12,1 %) Patienten gaben ein schlechtes oder sehr schlechtes Allgemeinbefinden an (p = 0,388). 340 von 669 (50,8 %) Patienten wiesen auf die zusätzliche Belastung ihrer Angehörigen hin.

Schlussfolgerung

Die Analyse zeigt die Durchführbarkeit einer quartalsweise durchgeführten Patientenbefragung zur Erfassung des palliativen Bedarfs im Routinebetrieb einer onkologischen Ambulanz. Hauptsymptome beider Patientengruppen waren Müdigkeit und Schwäche. Weiterhin gab ein Großteil der Patienten eine Belastung der Angehörigen an.

http://ift.tt/2r7CPdT

Neue diagnostische und therapeutische Aspekte zu Chordomen

Zusammenfassung

Hintergrund

Chordome zählen zu den primären, malignen Knochentumoren und treten mit Schwerpunkt im Sakrum und Clivus entlang der Wirbelsäule auf (ICD-O: 9370/3). Man geht davon aus, dass sie aus Resten der Chorda dorsalis entstehen. Aufgrund des seltenen Auftretens zählen sie zu den sog. „orphan diseases".

Methoden

Es wurden eine Recherche und Auswertung aktueller Literatur und klinischer Studien durchgeführt.

Ergebnisse

Die primäre Therapie stellt heutzutage die Chirurgie dar; allerdings kann dies v. a. im Clivus problematisch sein. Zudem treten häufig Rezidive und nicht selten Metastasen auf. In der rezidivierten Situation wird die Hochdosisbestrahlung mit Protonen empfohlen. Aufgrund des generell langsamen Wachstums der Chordome ist eine konventionelle Chemotherapie problematisch. In den letzten Jahren konnten für Chordome molekularpathologische Signalwege mit entsprechenden Zielstrukturen identifiziert werden, die erste Ansätze für eine zielgerichtete Therapie bieten.

http://ift.tt/2mIINgX

T cell responses to tumor: how dominant assumptions on immune activity led to a neglect of pathological functions, and how evolutionary considerations can help identify testable hypotheses for improving immunotherapy

Abstract

Cancer immunotherapy is based on the premise that activated, pro-inflammatory T cell responses to tumor will mostly combat tumor growth. Nowadays accepted as largely valid, this hypothesis has been formed as a result of extensive theoretical and experimental argumentation on the inherent function of the immune system and the nature of the immunological self, dating back to the foundations of immunology. These arguments have also been affected by how current working hypotheses were set by researchers, an issue that has been the focus of study by medical anthropologists. As a result of these processes, cancer immunotherapy has developed into a truly promising anti-cancer strategy, with very substantial benefits in clinical outcomes. However, as immunotherapy still has large margins for improvement, a more thorough examination of both the historical background and evolutionary context of current assumptions for how the immune system responds to cancer can help reveal novel, testable questions. We describe how attempting to answer some of these questions experimentally, such as identifying the contributors of tumor-associated fibrosis, has led to potentially useful insights on how to improve immunotherapy.

http://ift.tt/2DxUNJe

A photonumeric scale for the assessment of atrophic facial photodamage

Summary

Background

Photonumeric scales have consistently shown superiority over descriptive equivalents. They have the advantage of providing a consistent visual frame of reference by minimising variability in perception and subjectivity. A photonumeric scale to assess hypertrophic facial photodamage already exists. However, there is currently no objective measure for atrophic facial photodamage. To address this, we have devised a nine-point photonumeric standardised scale.

Objectives

To design, test and validate a photonumeric scale for the assessment of atrophic facial photodamage against a descriptive scale for the same indication.

Methods

A pool of 393 facial photographs (en face and 45º oblique) from 131 individuals with atrophic facial photodamage was created. Five photographic standards were selected and assigned grades 0 through 8, where 0 is no photodamage and 8 is severe atrophic photodamage, thus making a nine-point scale. Twenty photographs spanning the entire range of values were selected to test the scale. Testing was performed alongside a descriptive equivalent. A panel of 10 dermatologists, 10 non-dermatology clinicians and 14 dermatology scientists marked the two scales; marking was repeated one week later.

Results

There was a significantly greater agreement between the graders using the photonumeric scale than the descriptive scale (kappa values 0.71 and 0.37 with standardised errors of 0.57 and 0.17 respectively) with no significant difference in repeatability between the two methods (p < 0.05).

Conclusions

The study describes a new photonumeric scale for atrophic photodamage. This would be a useful adjunct in both the clinical and research settings.

This article is protected by copyright. All rights reserved.

http://ift.tt/2D3X0Lt

Could conjunctivitis in dupilumab treated atopic dermatitis patients be caused by colonization with demodex and increased IL-17 levels?

Abstract

de Bruin-Weller et al., reported alarmingly high rates of unspecified and allergic conjunctivitis in trial patients with moderate-to-severe atopic dermatitis (AD) who underwent treatment with dupilumab; an antibody that inhibits signaling of IL-4 and IL-13.¹ Importantly, the exact pathogenic mechanism behind incident conjunctivitis in dupilumab-treated patients is unclear. While all, but one case, were considered to be of mild or moderate severity, and most resolved after treatment discontinuation, ocular complications may ultimately deprive AD patients from effective treatment with dupilumab. For these reasons, the medical community needs to rapidly identify the pathogenic mechanism.

This article is protected by copyright. All rights reserved.

http://ift.tt/2DxTQAp

Issue Information - Cover and Editorial Board

http://ift.tt/2mxCT0U

Issue Information - TOC

http://ift.tt/2DijJa0