Primary synovial sarcoma (SS) of larynx: An unusual site

Publication date: Available online 26 February 2018
Source:Oral Oncology
Author(s): Irappa Madabhavi, Vishalkumar Bhardawa, Mitul Modi, Apurva Patel, Malay Sarkar
Soft tissue sarcomas (STSs) are heterogeneous disorders comprises myriad subtypes originated from mesenchymal stem cells. Synovial sarcomas (SSs) are belligerent malignant tumours included in this group affecting extremities of patients' age ranging between 15 and 35 years. SS taking place in head and neck region is rare event and primary laryngeal involvement is even rarer happening. There are 20 odd published cases documented in world literature so far. Here we are presenting primary laryngeal SS occurred in 31 year old male patient initially mimicking laryngeal carcinoma as patient was chronic smoker and classic symptom of hoarseness of voice.



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Editorial Board/Aims & Scope

Publication date: March 2018
Source:Oral Oncology, Volume 78





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New research directions for areca nut/betel quid and oral submucous fibrosis for holistic prevention and treatment

Publication date: March 2018
Source:Oral Oncology, Volume 78
Author(s): Sachin C. Sarode, Prashanth Panta, Gargi S. Sarode, Amol R. Gadbail, Shailesh M. Gondivkar, Shankargouda Patil




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RETRACTED: Systemic therapy in the management of metastatic or advanced salivary gland cancers

Publication date: March 2018
Source:Oral Oncology, Volume 78
Author(s): Aymen Lagha, Nesrine Chraiet, Mouna Ayadi, Sarra Krimi, Bassem Allani, Hela Rifi, Henda Raies, Amel Mezlini




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Non Inferiority Trial of Standard RT Versus Hypofractionated Split Course in Elderly Vulnerable Patients With HNSCC

Condition:   Head and Neck Squamous Cell Carcinoma
Interventions:   Radiation: Standard RT;   Radiation: Hypofractionated RT
Sponsors:   Groupe Oncologie Radiotherapie Tete et Cou;   Gustave Roussy, Cancer Campus, Grand Paris
Recruiting

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Clarithromycin-susceptibility Genotype Affects the Treatment Outcome of Patients with Mycobacterium abscessus Lung Disease [PublishAheadOfPrint]

Mycobacterium abscessus accounts for a large proportion of lung disease cases caused by rapidly growing mycobacteria. The association between clarithromycin sensitivity and treatment outcome is clear. However, M. abscessus culture and antibiotic susceptibility testing are time-consuming. Clarithromycin-susceptibility genotyping offers an alternate, rapid approach to predicting the efficacy of clarithromycin-based antibiotic therapy. M. abscessus lung disease patients were divided into two groups based upon the clarithromycin-susceptibility genotype of the organism isolated. A retrospective analysis was conducted to compare the clinical features, microbiological characteristics and treatment outcomes of the two groups; several other potential predictors of the response to treatment were also assessed. Sixty-nine patients were enrolled in the clarithromycin-resistant genotype group, which included five infected with rrl 2058/2059 mutants and 64 infected with erm(41)T28 type M. abscessus; 31 were in the clarithromycin-sensitive group, i.e., 6 and 25 patients infected with genotypes erm(41)C28 and erm (41) M type, respectively. Results showed that lung disease patients infected with clarithromycin-sensitive and -resistant M. abscessus genotypes differed significantly in clarithromycin-based combination treatment outcomes. Patients infected with the clarithromycin-sensitive genotype exhibited higher initial and final sputum negative conversion, radiological improvement rates, and better therapeutic outcomes. Multivariate analysis demonstrated that genotyping was a reliable and, more importantly, rapid means of predicting the efficacy of clarithromycin-based antibiotic treatment for M. abscessus lung disease.

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Treatment of Clostridium difficile infection with a small molecule inhibitor of toxin UDP-glucose hydrolysis activity [PublishAheadOfPrint]

Clostridium difficile infection (CDI) is the leading cause of hospital-acquired infectious diarrhea, with significant morbidity, mortality and associated healthcare costs. The major risk factor for CDI is antimicrobial therapy, which disrupts the normal gut microbiota and allows C. difficile to flourish. Treatment of CDI with antimicrobials is generally effective in the short-term, but recurrent infections are frequent and problematic, indicating that improved treatment options are necessary. Symptoms of disease are largely due to two homologous toxins, TcdA and TcdB, which are glucosyltransferases that inhibit host Rho GTPases. As the normal gut microbiota is an important component of resistance to CDI, our goal was to develop an effective non-antimicrobial therapy. Here we report a highly potent small molecule inhibitor (VB-82252) of TcdA and TcdB. This compound inhibits the UDP-glucose hydrolysis activity of TcdB and protects cells from intoxication after challenge with either toxin. Oral dosing of the inhibitor prevented inflammation in a murine intra-rectal toxin challenge model. In a murine model of recurrent CDI, the inhibitor reduced weight loss and gut inflammation during acute disease and did not cause the recurrent disease that was observed with vancomycin treatment. Lastly, the inhibitor demonstrated similar efficacy to vancomycin in a hamster disease model. Overall, these results demonstrate that small molecule inhibition of C. difficile toxin UDP-glucose hydrolysis activity is a promising non-antimicrobial approach to the treatment of CDI.

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An Antibiotic stewardship program (ASP) blueprint for optimizing Verigene BC-GN within an institution: A tale of two cities [PublishAheadOfPrint]

Rapid diagnostic tests (RDTs) have revolutionized the management of Gram-negative bacteremia by allowing antimicrobial stewardship teams the ability to escalate therapy and improve patient outcomes through timely organism identification and detection of certain resistance determinants. However, given the complex nature of Gram-negative resistance, stewardship teams are left without clear direction for how to respond when resistance determinants are absent as the safety of de-escalation in this setting is unknown. The primary purpose of this analysis was to determine the negative predictive values (NPV) of resistance marker absence to predict susceptibility in target bug/drug scenarios at two geographically distinct institutions. 1,046 Gram-negative bloodstream isolates that were analyzed with Verigene GN-BC were assessed. Outside of P. aeruginosa the absence of resistance determinants by the RDT largely predicted susceptibility to target antibiotics at both institutions. NPVs for ceftriaxone susceptibility in E. coli and K.pneumoniae in the absence of either CTX-M or a carbapenemase gene were 98% and 93-94%, respectively. Similar results were seen with other target bug/drug scenarios with NPVs of 94-100% demonstrated at both institutions, with the exception of P. aeruginosa, where NPVs were poor likely due to the more complex nature of resistance in this pathogen. The results of this study show that clinicians at both institutions should have confidence in de-escalation in the absence of resistance determinant detection by Verigene BC-GN, and the methodology described within this manuscript can serve as a blueprint for other stewardship programs to employ at their institutions to optimize management of Gram-negative bacteremia.

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MICAFUNGIN ENHANCES THE HUMAN MACROPHAGE RESPONSE TO Candida albicans THROUGH {beta}-GLUCAN EXPOSURE [PublishAheadOfPrint]

Micafungin belongs to the antifungal family of echinocandins, which act as non-competitive inhibitors of the fungal cell-wall β-1,3-D-glucan synthase. Since C. albicans is the most prevalent pathogenic fungus in humans, we study the involvement of Micafungin in the modulation of the inflammatory response developed by human tissue macrophages against C. albicans. The MIC for Micafungin was 0.016 μg/ml on the C. albicans SC5314 standard strain. Micafungin induced a drastic reduction in the number of exponential SC5314 viable cells, the fungicidal effect being dependent on the cellular metabolic activity. Notably, Micafungin also caused a structural remodelling of the cell wall, leading to exposure of the β-glucan and chitin content on the external surface. At the higher doses used (0.05 μg/ml), the antifungal also induced the blowing up of budding yeasts. In addition, preincubation with Micafungin before exposure to human tissue macrophages enhanced the secretion of TNF-α, IL-17A and IL-10 cytokines. Our results strongly suggest that in C. albicans treatment with Micafungin, in addition to having the expected toxic antifungal effect, potentiates the immune response, improving the interaction and activation of human macrophages, probably through the unmasking of β-glucans on the cell wall surface.

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Characteristics of Carbapenemase-Producing Enterobacteriaceae in Wastewater Revealed by Genomic Analysis [PublishAheadOfPrint]

Wastewater is considered a major source of antibiotic-resistant bacteria released into the environment. Here, we characterized carbapenemase-producing Enterobacteriaceae (CPE) in wastewater by whole-genome analysis. Wastewater samples (n = 40) were collected from municipal wastewater treatment plants and hospital wastewater in Japan and Taiwan. Samples were screened for CPE using selective media, and the obtained isolates were sequenced using an Illumina MiSeq. The isolates (n = 45) included the following microorganisms: Klebsiella quasipneumoniae (n = 12), Escherichia coli (n = 10), Enterobacter cloacae complex (n = 10), Klebsiella pneumoniae (n = 8), Klebsiella variicola (n = 2), Raoultella ornithinolytica (n = 1), Citrobacter freundii (n = 1), and Citrobacter amalonaticus (n = 1). Among the 45 isolates, 38 harbored at least one carbapenemase-encoding gene. Of these, the bla_GES (bla_GES-5, bla_GES-6, and bla_GES-24) genes were found in 29 isolates. These genes were situated in novel class 1 integrons, but the integron structures were different between the Japanese (In1439 with bla_GES-24 and In1440 with bla_GES-5) and Taiwanese isolates (In1441 with bla_GES-5 and In1442 with bla_GES-6). Other carbapenemase-encoding genes (bla_VIM-1, bla_NDM-5, bla_IMP-8, bla_IMP-19, and bla_KPC-2) were found in one to three isolates. Notably, class 1 integrons previously reported among clinical isolates obtained in the same regions as the present study, namely In477 with bla_IMP-19 and In73 with bla_IMP-8, were found among the Japanese and Taiwanese isolates, respectively. The results indicate that CPE with various carbapenemase-encoding genes in different genetic contexts were present in biologically treated wastewater, highlighting the need to monitor for antibiotic-resistance in wastewater.

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Plasma levels of rifampicin correlate with the TB drug activity (TDA) assay [PublishAheadOfPrint]

The plasma tuberculosis drug activity (TDA) assay may be an alternative tool for therapeutic drug monitoring in resource limited settings. In tuberculosis (TB) patients (n=30), TDA and plasma levels of first-line drugs were analysed two hours post dose, two weeks after treatment initiation. Patients with plasma levels of rifampicin below 8 mg/L had significantly lower median TDA (1.40 vs 1.68, p=0.0013). TDA may be used to identify TB patients with suboptimal rifampicin levels during TB treatment.

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Characterization of the complete nucleotide sequences of IMP-4-encoding plasmids, belonging to diverse Inc families, recovered from Enterobacteriaceae of wildlife origin [PublishAheadOfPrint]

The complete nucleotide sequences of six IMP-4-encoding plasmids recovered from Enterobacteriaceae of wildlife origin were characterized. Sequencing data showed that plasmids of different incompatibility groups (IncM, IncI1, IncF, and nontypeable [including an IncX5_2 and two pPrY2001-like]) carried the bla_IMP-4-carrying integrons, In809 or In1460. Most of the plasmids carried mph(A) region, and chrA-like, aac(3)-IId and bla_TEM-1b genes. Finally, plasmid analysis revealed the involvement of two different, IS26- and Tn1696-associated, mechanisms in the mobilization of IMP-4-encoding integrons.

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Evaluation of the in vitro activity of eravacycline against a broad spectrum of recent clinical anaerobic isolates [PublishAheadOfPrint]

The novel fluorocycline antibiotic, eravacycline, is in development for the treatment of serious infections caused by susceptible and multidrug-resistant (MDR) aerobic and anaerobic Gram-negative and Gram-positive pathogens. Eravacycline and 11 comparator antibiotics were tested against recent anaerobic clinical isolates, including MDR Bacteroides spp. and Clostridium difficile. Eravacycline was potent in vitro against all the isolates tested, including strains with tetracycline-specific resistance determinants and MDR anaerobic pathogens resistant to carbapenems and/or β-lactam/β-lactamase inhibitor combinations.

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Efficacy of human-simulated exposures of ceftolozane/tazobactam alone and in combination with amikacin or colistin against multidrug-resistant Pseudomonas aeruginosa in an in vitro pharmacodynamic model [PublishAheadOfPrint]

Combination therapy is an attractive option for the treatment of multidrug resistant (MDR) Pseudomonas aeruginosa infections; however, limited data are available on combinations with ceftolozane/tazobactam (C/T). The in vitro pharmacodynamic chemostat model was employed to compare human simulated exposures of C/T 3g q8h alone or in combination with amikacin 25 mg/kg daily or colistin 360 mg daily against four MDR P. aeruginosa isolates. C/T alone resulted in 24 hour CFU changes of -0.02±0.21, -1.81±0.55, -1.44±0.40, and +0.62±0.05 log₁₀CFU/ml against isolates with C/T MICs of 4, 4, 8 and 16 μg/ml, respectively. Amikacin and colistin monotherapy displayed varying results. The addition of amikacin to C/T resulted in -2.00±0.23 (p<0.001, additive), -1.50±0.83 (p=0.687, indifferent), -2.84±0.08 (p=0.079, indifferent), and -2.67±0.54 (p<0.001, synergy) log₁₀CFU/ml reductions, respectively. The addition of colistin to C/T resulted in -3.02±0.22 (p<0.001, additive), -3.21±0.24 (p>0.05, indifferent), -4.6±0.11 (p=0.002, synergy), and -3.01±0.28 (p<0.001, synergy) log10CFU/ml reductions, respectively, against these MDR P. aeruginosa. Greater overall reductions in bacterial burden, including additive or synergistic interactions at 24 hours, with C/T plus amikacin or colistin was observed against 3 out of 4 MDR P. aeruginosa tested, particularly those strains that were intermediate or resistant to C/T. Further studies assessing combination regimens containing C/T against MDR P. aeruginosa are warranted.

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Gold(III) macrocycles and chelates targeting Mycobacterium tuberculosis and Mycobacterium abscessus: evidence for inhibition of topoisomerase 1A [PublishAheadOfPrint]

Mycobacterium tuberculosis (Mtb) and the fast-growing Mycobacterium abscessus (Mab) are two important human pathogens causing persistent pulmonary infections that are difficult to cure and require long treatment times. The emergence of drug resistant Mtb strains and the high level of intrinsic resistance of Mab calls for novel drug scaffolds that effectively target both pathogens. In this study, we have evaluated the activity of bis(pyrrolide-imine) gold(III) macrocycles and chelates, originally designed as DNA intercalators capable of targeting human topoisomerase I and II, against Mab and Mtb. We identified a total of 5 non-cytotoxic compounds active against both mycobacterial pathogens under replicating in vitro conditions. We chose one of these hits, 14, for detailed analysis due to its potent bactericidal mode of inhibition and scalable synthesis. The clinical relevance of this compound was demonstrated by its ability to inhibit a panel of diverse Mtb and Mab clinical isolates. Prompted by previous data suggesting that 14 may target topoisomerase/gyrase enzymes, we demonstrated that it lacked cross-resistance with fluoroquinolones, which target the Mtb gyrase. In vitro enzyme assays confirmed potent activity against bacterial topoisomerase IA (Topo1) enzymes, but not gyrase. Novel scaffolds like compound 14 with potent, selective bactericidal activity against Mtb and Mab that act on validated but underexploited targets like Topo1 represent a promising starting point for the development of novel therapeutics for infections by pathogenic mycobacteria.

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The amphibian antimicrobial peptide temporin B inhibits in vitro herpes simplex virus type 1 infection. [PublishAheadOfPrint]

The herpes simplex virus type 1 (HSV-1) is widespread in the population and in most cases its infection is asymptomatic. The currently available anti-HSV-1 drugs are acyclovir and its derivatives, although long-term therapy with these agents can lead to drug resistance. Thus, the discovery of novel anti-herpetic compounds deserves additional effort. Naturally occurring antimicrobial peptides (AMPs) represent an interesting class of molecules with potential antiviral properties. To the best of our knowledge this work is the first demonstration of the in vitro anti-HSV-1 activity of Temporin B (TB), a short membrane-active amphibian AMP. In particular, when HSV-1 was pre-incubated with 20 μg/ml TB, significant antiviral activity (5 log reduction of viral titer) was observed. Such an effect was due to the disruption of the viral envelope, as demonstrated by transmission electron microscopy. Moreover, TB partially affected different stages of HSV-1 life cycle, including the attachment, the entry of the virus into the host cell as well as the following post infection phase. Furthermore, its efficacy was confirmed on human epithelial cells, thus suggesting TB as a novel approach for the prevention and/or treatment of HSV-1 infections.

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Aminomethyl spectinomycins as therapeutics for drug-resistant gonorrhea and chlamydial co-infections [PublishAheadOfPrint]

Bacterial sexually transmitted infections are widespread and common, with Neisseria gonorrhoeae (gonorrhea) and Chlamydia trachomatis (chlamydia) being the two most frequent causes. If left untreated, both infections can cause pelvic inflammatory disease, infertility, ectopic pregnancy and other sequelae. The recommended treatment for gonorrhea is ceftriaxone plus azithromycin (to empirically treat chlamydial co-infections). Antibiotic resistance to all existing therapies has developed in gonorrheal infections. The need for new antibiotics is great and the pipeline for new drugs is alarmingly small. The aminomethyl spectinomycins, a new class of semisynthetic analogs of the antibiotic, spectinomycin, were developed on the basis of a computational analysis of the spectinomycin binding site of the bacterial 30S ribosome and structure-guided synthesis. The compounds display particular potency against common respiratory tract pathogens as well as the sexually transmitted pathogens that cause gonorrhea and chlamydia. Here we demonstrate the in vitro potencies of several compounds of this class against both bacterial species; the compounds displayed increased potencies against N. gonorrhoeae compared to spectinomycin and, significantly, demonstrated activity against C. trachomatis that is not observed with spectinomycin. Efficacies of the compounds were compared to that of spectinomycin and gentamicin in a murine model of infection caused by ceftriaxone/azithromycin-resistant N. gonorrhoeae; the aminomethyl spectinomycins significantly reduced the colonization load and were as potent as the comparator compounds. In summary, data produced by this study support aminomethyl spectinomycins as a promising replacement for spectinomycin and antibiotics such as ceftriaxone for treating drug-resistant gonorrhea, with the added benefit of treating chlamydial co-infections.

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Identification and Characterization of Key Charged Residues in the Cofilin Protein Involved in Azole Susceptibility, Apoptosis, and Virulence of Aspergillus fumigatus [PublishAheadOfPrint]

Through some specific amino acid residues, Cofilin, a ubiquitous actin depolymoerization factor, can significantly affect mitochondrial function related to drug resistance and apoptosis in Saccharomyces cerevisiae; however, this modulation in a major fungal pathogen, A. fumigatus was still unclear. Hereby, it was found firstly that mutations on several charged residues in cofilin to alanine, D19A;R21A, E48A, and K36A increased the formation of reactive oxygen species and induced apoptosis along with typical hallmarks including mitochondrial membrane potential depolarization, the cytochrome c release, upregulation of metacaspases, and DNA cleavage in A. fumigatus. Two of these mutations (D19A;R21A and K36A) increased acetyl-coenzyme A and adenosine triphosphate (ATP) concentrations by triggering fatty acid β-oxidation. The upregulated acetyl-coenzyme A affected the ergosterol biosynthetic pathway, leading to overexpression of cyp51A and -B, while excess ATP fueled ATP-binding cassette transporters. Besides, these two mutations both reduced the susceptibility of A. fumigatus to azole drugs and enhanced the virulence of A. fumigatus in a Galleria mellonella infection model. Taken together, novel and key charged residues in cofilin were identified as essential modules regulating the mitochondrial function involved in azole susceptibility, apoptosis, and virulence of A. fumigatus.

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Integrase-mediated recombination of the bel-1 gene cassette encoding the extended-spectrum {beta}-lactamase BEL-1 [PublishAheadOfPrint]

Integrons are genetic elements that can acquire and rearrange gene cassettes. The bla_BEL-1 gene encodes an extended-spectrum β-lactamase, BEL-1, that is present at second position of the variable region of class 1 integrons identified in Pseudomonas aeruginosa. The mobility of the bel-1 gene cassette was analyzed in physiological conditions and with the integrase gene being overexpressed. Cassette mobility in Escherichia coli was detected by excision/integration into the recipient integron In3 on the conjugative plasmid R388, with the over-produced integrase. Despite several antibiotic pressures, the bel-1 cassette remained at the second position in the integron, highlighting its stability in P. aeruginosa. Overexpression of the integrase gene in E. coli induced the bel-1 cassette recombination. However, cassettes containing two genes (bla_BEL-1/smr2 or bla_BEL-1/aacA4) were excised suggesting that the bel-1 cassette attC site was defective. We showed that bel-1 is a stable gene cassette under physiological growth conditions irrespective of the selective antibiotic pressure, that may be mobilized upon over-overexpression of the integrase gene.

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Resistome analysis of a carbapenemase (OXA-48)-producing and colistin-resistant Klebsiella pneumoniae strain [PublishAheadOfPrint]

Carbapenemase-producing Klebsiella pneumoniae are increasingly reported worldwide (1, 2)....

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In vitro susceptibility of ceftolozane-tazobactam against Burkholderia pseudomallei [PublishAheadOfPrint]

Burkholderia pseudomallei is the cause of melioidosis, a potentially serious and fatal disease characterized by community-acquired pneumonia and/or sepsis mainly in Southeast Asia and Northern Australia, and high case-fatality rates of up to 19% are observed in endemic areas (1).

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In-situ validation of the endothelial cell receptor GRP78 in a case of rhinocerebral mucormycosis -Letter to the Editor- (New-Data Letter) [PublishAheadOfPrint]

Mucormycosis is probably the most devastating and hard to diagnose invasive mold infection caused by fungi belonging to the order Mucorales....

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MEDI3902 correlates of protection against severe Pseudomonas aeruginosa pneumonia in a rabbit acute pneumonia model [PublishAheadOfPrint]

Pseudomonas aeruginosa is among the most formidable antibiotic-resistant pathogens and a leading cause of hospital-associated infections. With dwindling options for antibiotic resistant infections, a new paradigm for treatment and disease resolution is required. MEDI3902, a bispecific antibody targeting the P. aeruginosa type-3-secretion (T3S) protein PcrV and Psl exopolysaccharide, was previously shown to mediate potent protective activity in murine infection models. With the current challenges associated with clinical development of narrow-spectrum agents, robust preclinical efficacy data in multiple animal species are desirable. Here, we sought to develop a rabbit P. aeruginosa acute pneumonia model to further evaluate the activity of MEDI3902 intervention. In the rabbit model of acute pneumonia, prophylaxis with MEDI3902 exhibited potent dose-dependent protection whereas those receiving control IgG developed fatal, hemorrhagic, necrotizing pneumonia between 12 and 54 h after infection. Blood biomarkers (e.g. pO2, pCO2, base excess, lactate, creatinine) were grossly deranged for the vast majority of control IgG-treated animals, but remained within normal limits for MEDI3902-treated animals. In addition, MEDI3902-treated animals exhibited a profound reduction in P. aeruginosa organ burden and a marked reduction in expression of proinflammatory mediators from lung tissue, which correlated with reduced lung histopathology. These results confirm that targeting PcrV and Psl via MEDI3902 is a promising candidate for immunotherapy against P. aeruginosa pneumonia.

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PD-L1, B7-H3, and PD-1 expression in immunocompetent vs. immunosuppressed patients with cutaneous squamous cell carcinoma

Abstract

Background

To characterize the expression of co-signaling molecules PD-L1, PD-1, and B7-H3 in cutaneous squamous cell carcinoma (cSCC) by immune status.

Methods

We retrospectively analyzed 66 cases of cSCC treated with surgical resection from 2012 to 2015. Immunostained tumor sections were analyzed for percent of tumor cells expressing PD-L1 (Tum-PD-L1%), B7-H3 (Tum-B7-H3%), density of peri and intratumoral CD8 T cells (CD8 density), proportion of CD8 T cells expressing PD-1 (CD8-PD-1%) and of tumor-infiltrating immune cells (TII) expressing PD-L1 (TII-PD-L1%).

Results

Of 66 cases, 42 were immunocompetent, 24 immunosuppressed (13 organ transplant, 8 HIV+, 3 other). Defining positive expression at > 5%, 26% of tumors were positive for PD-L1, 85% for B7-H3, 80% had CD8 T cells that expressed PD-1 and 55% had TII that expressed PD-L1. Tum-B7-H3% was significantly higher (median 60 vs. 28%, p = 0.025) in immunocompetent vs. immunosuppressed patients, including when factoring in cause of immunosuppression. No significant difference in Tum-PD-L1%, TII-PD-L1%, CD8 density, or CD8-PD-1% was observed. Tumors from HIV+ patients lacked PD-L1 expression, and had lower B7-H3% (median 2.5 vs. 60%, p = 0.007), and higher CD8 density (median 75% vs. 40%, p = 0.04) compared to immunocompetent patients. Higher tumor grade (R_s = 0.34, p = 0.006) and LVI (R_s = 0.61, p < 0.001) were both associated with higher Tum-PD-L1%.

Conclusion

cSCC showed expression of PD-L1 on tumor in 26% of cases, and high tumor B7-H3 expression (85%) and PD-1 expression on CD8 TILs (80%). Tumor B7-H3 expression was significantly higher in immunocompetent vs. immunosuppressed patients, largely driven by very low expression in HIV+ patients.

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Risk of thromboembolic events in patients treated with thalidomide for cutaneous lupus erythematosus: a multicenter-retrospective study

http://ift.tt/2F5nal5

Atopic dermatitis is an important comorbidity in severe asthma

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease characterized by pruritus and rash. Severe asthma is another heterogeneous chronic inflammatory disease comprising diverse phenotypic subgroups1. With biologic therapies reflected in the Global Initiative for Asthma 2017 guidelines, it is imperative that all available pertinent information including biomarkers are utilized in selecting the optimal biologic therapy. Recently the term "eosinophilic" asthma has been in vogue due to the availability of anti-IL-5 monoclonal antibody class of medications, mepolizumab, benralizumab, and reslizumab2.

http://ift.tt/2t2mbgU

Treatment of hypereosinophilic syndrome and eosinophilic dermatitis with reslizumab

Hypereosinophilic syndrome (HES) is a rare disease defined by organ damage directly attributable to hypereosinophilia that is either primary (neoplastic), secondary (reactive) or idiopathic. The mainstay of therapy in idiopathic HES centers around systemic steroids, and cytoreduction with hydroxyurea and interferon-alfa in steroid refractory cases. We describe the successful treatment of recalcitrant, idiopathic cutaneous HES with reslizumab, a humanized interleukin-5 blocker.

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Bronchiectasis in severe asthma: clinical features and outcomes

Bronchiectasis are increasingly identified in subjects with severe asthma and could contribute to disease severity.

http://ift.tt/2sUgMIy

Should children with an enlarged vestibular aqueduct be restricted from playing contact sports?

http://ift.tt/2F79juF

The impact of adjuvant chemoradiotherapy timing on survival of head and neck cancers

Background

Delays in postoperative head and neck (HN) radiotherapy have been associated with decreased overall survival; however, the impact of delays in postoperative HN chemoradiotherapy remains undefined.

Methods

All patients with nonmetastatic HN cancer (oral cavity, oropharynx, larynx, hypopharynx) who underwent curative intent surgery and received adjuvant chemoradiotherapy were identified from the National Cancer Database (2005–2012). Overall treatment time (OTT) was defined as the time from surgery to the end of radiation therapy. Statistical methods included Cox proportional hazards modeling, which adjusted for clinicopathologic, demographic, and socioeconomic factors. Recursive partitioning analysis (RPA) identified the optimal threshold of OTT via conditional inference trees to estimate the greatest differences in overall survival (OS) on the basis of randomly selected training and validation sets.

Results

A total of 16,733 patients were included, with a median follow-up of 37 months. Median OS for OTT in a predefined threshold of ≤ 13 weeks was 10.1 years (95% confidence interval [CI], 9.8 years; not reached) compared with 8.7 years (95% CI, 8.2–9.2 years) in > 13 weeks. On multivariate analysis, OTT of > 13 weeks versus ≤ 13 weeks independently increased mortality risk (hazard ratio, 1.10; 95% CI, 1.04–1.17; P = < 0.001). RPA identified an optimal OTT threshold of 97 days (interquartile range: 96–98 days). The OTT threshold of 97 days was confirmed in a full Cox regression model estimating the risk of death according to overall treatment time as a continuous variable.

Conclusion

In this large hospital-based national data, an OTT of greater than approximately 14 weeks most consistently increased the risk of death.

Level of Evidence

4. Laryngoscope, 2018

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Osseointegrated implants for auricular prostheses: An alternative to autologous repair

Objectives/Hypothesis

This study compares the hospital cost of osseointegrated implants for retention of an auricular prosthesis to autologous ear reconstruction.

Study Design

Retrospective review.

Methods

This study includes patients who underwent reconstruction for either congenital or acquired ear defects at Duke University Medical Center during 2009 to 2015.

Results

A total of nine patients had autologous repair representing nine operative ears, and 16 patients had an osseointegrated implant representing 18 operative ears (two bilateral). The average age for the autologous repair was 11.6 years with 56% male versus 40.7 years with 56% male for the osseointegrated implant patients. For autologous patients, indications for surgery were anotia/microtia in 8/9 (89%) and trauma in 1/9 (11%) versus 6/16 (387.5%) anotia/microtia, 8/16 (50%) cancer, and 2/16 (132.5%) trauma in the osseointegrated implant group. The mean number of surgeries was 3.1 for autologous repairs and 1.0 for osseointegrated repairs (mean difference confidence interval [CI]: −2.4 to −1.8, P < .001). The average cost to the hospital for an osseointegrated repair was $6,491.39 versus $10,047.93 for autologous repairs (CI: $6,496.38 to $−616.68, P = .02)

Conclusions

Osseointegrated implants for retaining an auricular prosthesis has a similar cost to autologous repair of ear defects, but patients underwent an average of two more surgeries with autologous repair. Patients should be able to choose the reconstruction option that best suits their condition and preferences.

Level of Evidence

4. Laryngoscope, 2018

http://ift.tt/2F73Wvu

Decreasing Revision Surgery in FAMM Flap Reconstruction of the Oral Cavity: Traditional Versus Modified Harvesting Technique

Objective

To compare the surgical and functional outcomes between two harvesting techniques for the inferiorly based facial artery musculomucosal (FAMM) flap for oral cavity and oropharynx reconstructions.

Methods

Multicenter retrospective chart review.

Results

We reviewed 55 cases of FAMM flap, including 29 traditional cases and 26 performed using the modified harvesting method. The overall rate of surgical re-intervention in the traditional group was 31% (n = 9 of 29) and 15% (n = 4 of 26) in the modified group (P = 0.196). The specific re-intervention rate for pedicle sectioning was 27% (n = 8 of 29) in the traditional group versus 0% (n = 0 of 26) in the modified group. The overall rate of complications was 21%. Nine out of 10 dentate patients in the traditional group and four out of five in the modified group needed tooth extraction. There was no difference between the two groups in terms of tracheostomy duration (P = 0.338) and time to first oral intake (P = 0.629). Speech and feeding outcomes were similar among groups (P = 0.922; P = 0.700, respectively). Dental rehabilitation was achieved in 67% and 78% of patients in the traditional and modified groups, respectively.

Conclusion

The FAMM flap offers a low morbidity approach to reconstruct the oral cavity. The modified approach to harvesting the flap is a safe and effective technique, with similar functional results and equally low morbidity profile as the traditional technique. It has the added advantage of lower rates of secondary surgical interventions.

Level of Evidence

4. Laryngoscope, 00:000–000, 2018

http://ift.tt/2CItb23

Utility of the bow and lean test in predicting subtype of benign paroxysmal positional vertigo

Objectives/Hypothesis

To investigate the role of the bow and lean test (BLT) in the diagnosis of benign paroxysmal positional vertigo (BPPV).

Study Design

Retrospective case-control study.

Methods

Between March 2015 and June 2017, we enrolled 113 patients with posterior semicircular canal (PSCC) BPPV, 74 patients with lateral semicircular canal (LSCC) canalolithiasis, 53 patients with LSCC cupulolithiasis, and 32 patients with light cupula. We retrospectively assessed bowing nystagmus (BN) and leaning nystagmus (LN).

Results

In PSCC BPPV, 75% of the patients showed at least one of BN and LN, and direction of nystagmus provoked by a Dix-Hallpike test on the affected side was consistent with that of LN and opposite to that of BN. In LSCC canalolithiasis, 65% (48 of 74) of the patients showed both BN and LN, which were in the same direction in 38 patients (of 48) and in the opposite direction in 10 patients (of 48). The affected side can be determined according to the results of THE BLT in 74% (55 of 74) of LSCC canalolithiasis patients, and among them, the side determined according to the results of head-roll test was discordant with that according to the BLT in 20 of 55 patients (36%). In LSCC cupulopathy (n = 85), both BN and LN were persistent and observed in all cases, but we could not distinguish LSCC cupulolithiasis from light cupula according to nystagmus direction in the BLT.

Conclusions

Although a BLT yields better lateralization in LSCC canalolithiasis, it may be more useful in predicting the diagnosis and lateralization of PSCC BPPV than LSCC canalolithiasis.

Level of Evidence

4 Laryngoscope, 2018

http://ift.tt/2EVyBgd

Computed tomography–fusion image guidance for children with thin calvaria undergoing bone-anchored hearing aid placement

http://ift.tt/2CH5c33

In response to Socioeconomic disparities and comorbidities, not race, affect salivary gland malignancy survival outcomes

http://ift.tt/2EVyukN

Unilateral radiotherapy treatment for p16/human papillomavirus–positive squamous cell carcinoma of unknown primary in the head and neck

Objectives/Hypothesis

The outcomes of unilateral radiotherapy treatment for patients with p16/HPV-positive squamous cell carcinomas of unknown primary (SCCUP) affecting cervical lymph nodes are under-reported. Compared to radiating large volumes of the pharyngeal axis (the more common approach), this is potentially a much less toxic treatment for a good prognosis group.

Study Design

Retrospective cohort study.

Methods

We identified patients with SCCUP who were treated radically at our center and did not have parotid or isolated level IV or V nodal involvement. Failure-free and overall survivals were calculated using Kaplan-Meier methods.

Results

From 2004 to 2012, there were 49 radically treated patients with SCCUP. Fourteen patients had bilateral neck treatment (they had bilateral nodal disease or suspected lesions in the base of tongue, though not proven with biopsy), two had surgery alone, whereas 33 had unilateral radiotherapy (after neck dissection, excisional biopsy, or definitively with concurrent chemotherapy). Of the 33 patients, 21 tested positive to p16/HPV and had median follow-up of 57 months. In this group, no isolated contralateral neck failures or putative primaries emerged. There was 1/21 (4.3%) ipsilateral neck failure, 1/21 (4.3%) concurrent contralateral neck and distant failure, and 1/21 (4.3%) patient with distant failure. The 5-year freedom from failure was 78% (95% confidence interval [CI]: 56%-100%) and overall survival was 90% (95% CI: 79%-100%).

Conclusions

With no emergence of putative primaries and no isolated contralateral neck failures, this single-institution experience in p16/HPV-positive SCCUP patients suggests that unilateral radiotherapy may be an underutilized management strategy.

Levels of Evidence

4 Laryngoscope, 2018

http://ift.tt/2CMPfbW

Factors associated with benefit of active middle ear implants compared to conventional hearing aids

Objective

Identify factors associated with benefit of middle ear implants (MEIs) as compared to conventional hearing aids (HAs).

Study Design

Independent review of audiological data from a multicenter prospective U.S. Food and Drug Administration (FDA) clinical trial. Preoperative and postoperative earphone, unaided/aided/implanted pure-tone thresholds, and word recognition scores were evaluated.

Results

Ninety-one subjects were included in this study. Mean word recognition was better with MEIs than with HAs (81.8% ± 12.0% vs. 77.6% ± 14.6%, P = 0.035). Word recognition with MEIs showed a low positive correlation with word recognition measured with earphones (r = 0.25, P = 0.016) and a moderate positive correlation with aided word recognition (r = 0.42, P < 0.001). Earphone word recognition alone was not predictive of MEI benefit over HA benefit (r = 0.09, P = 0.41), unlike differences between scores with earphone and HAs (earphone-aided differences [EAD]) (r = 0.62, P < 0.011). As compared to those with –EADs, subjects with +EADs showed greater improvement in word recognition from unaided to implanted and from HAs to implanted (P < 0.0001). Using the 95% CI for word recognition scores, 16 subjects showed significantly higher scores with the MEI than with HAs. Of those, 14 had +EAD.

Conclusion

Word recognition benefit derived from conventional HAs and MEIs from this large, multi-center FDA trial provides further evidence of the importance of aided word recognition in clinical decision making, such as determining candidacy for and success with MEIs.

Level of Evidence

2b. Laryngoscope, 2018

http://ift.tt/2F6Sujl

Patterns of concurrent cigarette, alcohol, and e-cigarette use: Off-setting or additive behaviors?

Objectives

To understand nationwide concurrent use of e-cigarettes (Ecig) with alcohol and conventional cigarettes (Ccig), the major risk factors for head and neck cancer.

Study Design

Cross-sectional analysis of nationally representative survey.

Methods

The National Health Interview Surveys for 2014 and 2015 were analyzed for adult responses to specific questions regarding the daily frequency of alcohol, Ccig, and Ecig use. Statistical relationships between these social habits were determined.

Results

A total of 241.1 million adults (raw N = 162,048) were surveyed (mean age 47.1 years, 51.8% female). Of those, 12.1% (29.2 million) and 3.8% (9.08 million) reported being every day Ccig users and some days Ccig users, respectively. A total of 2.3% (5.63 million) and 1.1% (2.76 million) reported being every day Ecig users and some days Ecig users, respectively. In addition, 58.4% of everyday Ecig users reported also being everyday Ccig users (P < 0.001). Furthermore, 25.6% (61.3 million) and 8.3% (20.0 million) of adults reported light drinking (1–3 drinks/week) and moderate/heavy drinking (4–7 drinks/week), respectively. Of the moderate/heavy drinkers, 17.7% were everyday Ccig users, whereas 12.2% of everyday Ccig users were moderate/heavy drinkers (P < 0.001). Among everyday Ecig users, 34.6% and 11.2% were light drinkers and moderate/heavy drinkers, respectively (P < 0.001). Among non-Ccig users, everyday Ecig users were likely to consume higher levels of alcohol given that 36.5% and 8.9% were light drinkers and moderate/heavy drinkers, respectively (P < 0.01).

Conclusion

We demonstrate a substantial level of Ccig use among moderate/heavy drinkers and Ecig users, as well as a novel independent association between Ecig and moderate/heavy alcohol use. These patterns of concurrent risk factor exposure should be considered when counseling patients who report Ecig use.

Level of Evidence

2b. Laryngoscope, 2018

http://ift.tt/2ESOShB

Continuous vagal monitoring value in prevention of vocal cord paralysis following thyroid surgery

Objectives/Hypothesis

Continuous intraoperative neuromonitoring (CIONM) of the vagus nerve was proposed to obtained frequent repetitive electromyography (EMG) data to recognize early change in intraoperative function of the recurrent laryngeal nerve. We examine our initial experience using this technology.

Study Design

Retrospective review.

Methods

Data for all patients who underwent neck surgery by a single surgeon at a North American institution over a 5-year period were reviewed. CIONM was used in cases with possible higher risk of traction injury and according to surgeon preference. In these cases, stretch injury was established by warning alarm with threshold of ≥50% reduction in amplitude and/or ≥ 10% increase in latency. Preoperative and postoperative direct laryngoscopy was performed for all patients.

Results

A total of 879 endocrine neck surgeries were performed. CIONM was used to monitor 455 recurrent laryngeal nerves (RLNs) in 344 (39.1%) surgeries. An automatic periodic stimulation (APS) alarm detected impending nerve injury in 33 (9.6%) cases by 64.9% ± 12.7% decrease in amplitude and by 27.3% increase in latency in one case. A total loss of signal (LOS) was detected in 15 (4.36%) cases. The immediate release of causative retraction successfully preserved the nerves in all cases with impending injury; however, there was no improvement in the LOS cases. Other than the cases with LOS, postoperative laryngoscopy showed normal vocal cord function in all cases.

Conclusions

APS technology is safe, feasible, and helpful in approximately 10% of cases in our series, which developed nascent neurapraxia adverse EMG changes associated with intraoperative RLN stretch that could be reversed intraoperatively.

Level of Evidence

4. Laryngoscope, 2018

http://ift.tt/2FzB9O6

Osseointegrated implants for auricular prostheses: An alternative to autologous repair

Objectives/Hypothesis

This study compares the hospital cost of osseointegrated implants for retention of an auricular prosthesis to autologous ear reconstruction.

Study Design

Retrospective review.

Methods

This study includes patients who underwent reconstruction for either congenital or acquired ear defects at Duke University Medical Center during 2009 to 2015.

Results

A total of nine patients had autologous repair representing nine operative ears, and 16 patients had an osseointegrated implant representing 18 operative ears (two bilateral). The average age for the autologous repair was 11.6 years with 56% male versus 40.7 years with 56% male for the osseointegrated implant patients. For autologous patients, indications for surgery were anotia/microtia in 8/9 (89%) and trauma in 1/9 (11%) versus 6/16 (387.5%) anotia/microtia, 8/16 (50%) cancer, and 2/16 (132.5%) trauma in the osseointegrated implant group. The mean number of surgeries was 3.1 for autologous repairs and 1.0 for osseointegrated repairs (mean difference confidence interval [CI]: −2.4 to −1.8, P < .001). The average cost to the hospital for an osseointegrated repair was $6,491.39 versus $10,047.93 for autologous repairs (CI: $6,496.38 to $−616.68, P = .02)

Conclusions

Osseointegrated implants for retaining an auricular prosthesis has a similar cost to autologous repair of ear defects, but patients underwent an average of two more surgeries with autologous repair. Patients should be able to choose the reconstruction option that best suits their condition and preferences.

Level of Evidence

4. Laryngoscope, 2018

http://ift.tt/2F73Wvu

Decreasing Revision Surgery in FAMM Flap Reconstruction of the Oral Cavity: Traditional Versus Modified Harvesting Technique

Objective

To compare the surgical and functional outcomes between two harvesting techniques for the inferiorly based facial artery musculomucosal (FAMM) flap for oral cavity and oropharynx reconstructions.

Methods

Multicenter retrospective chart review.

Results

We reviewed 55 cases of FAMM flap, including 29 traditional cases and 26 performed using the modified harvesting method. The overall rate of surgical re-intervention in the traditional group was 31% (n = 9 of 29) and 15% (n = 4 of 26) in the modified group (P = 0.196). The specific re-intervention rate for pedicle sectioning was 27% (n = 8 of 29) in the traditional group versus 0% (n = 0 of 26) in the modified group. The overall rate of complications was 21%. Nine out of 10 dentate patients in the traditional group and four out of five in the modified group needed tooth extraction. There was no difference between the two groups in terms of tracheostomy duration (P = 0.338) and time to first oral intake (P = 0.629). Speech and feeding outcomes were similar among groups (P = 0.922; P = 0.700, respectively). Dental rehabilitation was achieved in 67% and 78% of patients in the traditional and modified groups, respectively.

Conclusion

The FAMM flap offers a low morbidity approach to reconstruct the oral cavity. The modified approach to harvesting the flap is a safe and effective technique, with similar functional results and equally low morbidity profile as the traditional technique. It has the added advantage of lower rates of secondary surgical interventions.

Level of Evidence

4. Laryngoscope, 00:000–000, 2018

http://ift.tt/2CItb23

Utility of the bow and lean test in predicting subtype of benign paroxysmal positional vertigo

Objectives/Hypothesis

To investigate the role of the bow and lean test (BLT) in the diagnosis of benign paroxysmal positional vertigo (BPPV).

Study Design

Retrospective case-control study.

Methods

Between March 2015 and June 2017, we enrolled 113 patients with posterior semicircular canal (PSCC) BPPV, 74 patients with lateral semicircular canal (LSCC) canalolithiasis, 53 patients with LSCC cupulolithiasis, and 32 patients with light cupula. We retrospectively assessed bowing nystagmus (BN) and leaning nystagmus (LN).

Results

In PSCC BPPV, 75% of the patients showed at least one of BN and LN, and direction of nystagmus provoked by a Dix-Hallpike test on the affected side was consistent with that of LN and opposite to that of BN. In LSCC canalolithiasis, 65% (48 of 74) of the patients showed both BN and LN, which were in the same direction in 38 patients (of 48) and in the opposite direction in 10 patients (of 48). The affected side can be determined according to the results of THE BLT in 74% (55 of 74) of LSCC canalolithiasis patients, and among them, the side determined according to the results of head-roll test was discordant with that according to the BLT in 20 of 55 patients (36%). In LSCC cupulopathy (n = 85), both BN and LN were persistent and observed in all cases, but we could not distinguish LSCC cupulolithiasis from light cupula according to nystagmus direction in the BLT.

Conclusions

Although a BLT yields better lateralization in LSCC canalolithiasis, it may be more useful in predicting the diagnosis and lateralization of PSCC BPPV than LSCC canalolithiasis.

Level of Evidence

4 Laryngoscope, 2018

http://ift.tt/2EVyBgd

Computed tomography–fusion image guidance for children with thin calvaria undergoing bone-anchored hearing aid placement

http://ift.tt/2CH5c33

In response to Socioeconomic disparities and comorbidities, not race, affect salivary gland malignancy survival outcomes

http://ift.tt/2EVyukN

Unilateral radiotherapy treatment for p16/human papillomavirus–positive squamous cell carcinoma of unknown primary in the head and neck

Objectives/Hypothesis

The outcomes of unilateral radiotherapy treatment for patients with p16/HPV-positive squamous cell carcinomas of unknown primary (SCCUP) affecting cervical lymph nodes are under-reported. Compared to radiating large volumes of the pharyngeal axis (the more common approach), this is potentially a much less toxic treatment for a good prognosis group.

Study Design

Retrospective cohort study.

Methods

We identified patients with SCCUP who were treated radically at our center and did not have parotid or isolated level IV or V nodal involvement. Failure-free and overall survivals were calculated using Kaplan-Meier methods.

Results

From 2004 to 2012, there were 49 radically treated patients with SCCUP. Fourteen patients had bilateral neck treatment (they had bilateral nodal disease or suspected lesions in the base of tongue, though not proven with biopsy), two had surgery alone, whereas 33 had unilateral radiotherapy (after neck dissection, excisional biopsy, or definitively with concurrent chemotherapy). Of the 33 patients, 21 tested positive to p16/HPV and had median follow-up of 57 months. In this group, no isolated contralateral neck failures or putative primaries emerged. There was 1/21 (4.3%) ipsilateral neck failure, 1/21 (4.3%) concurrent contralateral neck and distant failure, and 1/21 (4.3%) patient with distant failure. The 5-year freedom from failure was 78% (95% confidence interval [CI]: 56%-100%) and overall survival was 90% (95% CI: 79%-100%).

Conclusions

With no emergence of putative primaries and no isolated contralateral neck failures, this single-institution experience in p16/HPV-positive SCCUP patients suggests that unilateral radiotherapy may be an underutilized management strategy.

Levels of Evidence

4 Laryngoscope, 2018

http://ift.tt/2CMPfbW

Factors associated with benefit of active middle ear implants compared to conventional hearing aids

Objective

Identify factors associated with benefit of middle ear implants (MEIs) as compared to conventional hearing aids (HAs).

Study Design

Independent review of audiological data from a multicenter prospective U.S. Food and Drug Administration (FDA) clinical trial. Preoperative and postoperative earphone, unaided/aided/implanted pure-tone thresholds, and word recognition scores were evaluated.

Results

Ninety-one subjects were included in this study. Mean word recognition was better with MEIs than with HAs (81.8% ± 12.0% vs. 77.6% ± 14.6%, P = 0.035). Word recognition with MEIs showed a low positive correlation with word recognition measured with earphones (r = 0.25, P = 0.016) and a moderate positive correlation with aided word recognition (r = 0.42, P < 0.001). Earphone word recognition alone was not predictive of MEI benefit over HA benefit (r = 0.09, P = 0.41), unlike differences between scores with earphone and HAs (earphone-aided differences [EAD]) (r = 0.62, P < 0.011). As compared to those with –EADs, subjects with +EADs showed greater improvement in word recognition from unaided to implanted and from HAs to implanted (P < 0.0001). Using the 95% CI for word recognition scores, 16 subjects showed significantly higher scores with the MEI than with HAs. Of those, 14 had +EAD.

Conclusion

Word recognition benefit derived from conventional HAs and MEIs from this large, multi-center FDA trial provides further evidence of the importance of aided word recognition in clinical decision making, such as determining candidacy for and success with MEIs.

Level of Evidence

2b. Laryngoscope, 2018

http://ift.tt/2F6Sujl

Patterns of concurrent cigarette, alcohol, and e-cigarette use: Off-setting or additive behaviors?

Objectives

To understand nationwide concurrent use of e-cigarettes (Ecig) with alcohol and conventional cigarettes (Ccig), the major risk factors for head and neck cancer.

Study Design

Cross-sectional analysis of nationally representative survey.

Methods

The National Health Interview Surveys for 2014 and 2015 were analyzed for adult responses to specific questions regarding the daily frequency of alcohol, Ccig, and Ecig use. Statistical relationships between these social habits were determined.

Results

A total of 241.1 million adults (raw N = 162,048) were surveyed (mean age 47.1 years, 51.8% female). Of those, 12.1% (29.2 million) and 3.8% (9.08 million) reported being every day Ccig users and some days Ccig users, respectively. A total of 2.3% (5.63 million) and 1.1% (2.76 million) reported being every day Ecig users and some days Ecig users, respectively. In addition, 58.4% of everyday Ecig users reported also being everyday Ccig users (P < 0.001). Furthermore, 25.6% (61.3 million) and 8.3% (20.0 million) of adults reported light drinking (1–3 drinks/week) and moderate/heavy drinking (4–7 drinks/week), respectively. Of the moderate/heavy drinkers, 17.7% were everyday Ccig users, whereas 12.2% of everyday Ccig users were moderate/heavy drinkers (P < 0.001). Among everyday Ecig users, 34.6% and 11.2% were light drinkers and moderate/heavy drinkers, respectively (P < 0.001). Among non-Ccig users, everyday Ecig users were likely to consume higher levels of alcohol given that 36.5% and 8.9% were light drinkers and moderate/heavy drinkers, respectively (P < 0.01).

Conclusion

We demonstrate a substantial level of Ccig use among moderate/heavy drinkers and Ecig users, as well as a novel independent association between Ecig and moderate/heavy alcohol use. These patterns of concurrent risk factor exposure should be considered when counseling patients who report Ecig use.

Level of Evidence

2b. Laryngoscope, 2018

http://ift.tt/2ESOShB

Continuous vagal monitoring value in prevention of vocal cord paralysis following thyroid surgery

Objectives/Hypothesis

Continuous intraoperative neuromonitoring (CIONM) of the vagus nerve was proposed to obtained frequent repetitive electromyography (EMG) data to recognize early change in intraoperative function of the recurrent laryngeal nerve. We examine our initial experience using this technology.

Study Design

Retrospective review.

Methods

Data for all patients who underwent neck surgery by a single surgeon at a North American institution over a 5-year period were reviewed. CIONM was used in cases with possible higher risk of traction injury and according to surgeon preference. In these cases, stretch injury was established by warning alarm with threshold of ≥50% reduction in amplitude and/or ≥ 10% increase in latency. Preoperative and postoperative direct laryngoscopy was performed for all patients.

Results

A total of 879 endocrine neck surgeries were performed. CIONM was used to monitor 455 recurrent laryngeal nerves (RLNs) in 344 (39.1%) surgeries. An automatic periodic stimulation (APS) alarm detected impending nerve injury in 33 (9.6%) cases by 64.9% ± 12.7% decrease in amplitude and by 27.3% increase in latency in one case. A total loss of signal (LOS) was detected in 15 (4.36%) cases. The immediate release of causative retraction successfully preserved the nerves in all cases with impending injury; however, there was no improvement in the LOS cases. Other than the cases with LOS, postoperative laryngoscopy showed normal vocal cord function in all cases.

Conclusions

APS technology is safe, feasible, and helpful in approximately 10% of cases in our series, which developed nascent neurapraxia adverse EMG changes associated with intraoperative RLN stretch that could be reversed intraoperatively.

Level of Evidence

4. Laryngoscope, 2018

http://ift.tt/2FzB9O6

Monitoring olfactory function in chronic rhinosinusitis and the effect of disease duration on outcome

Background

Our primary aim in this study was to determine which of the "Sniffin' Sticks" subtest components (threshold, discrimination, or identification) best reflect overall change in olfactory function during treatment for chronic rhinosinusitis (CRS). Our secondary aim was to determine whether duration of CRS affects olfactory outcomes after treatment.

Methods

A retrospective cohort study was performed. Sniffin' Sticks test scores from patients medically treated for CRS at our center from 1999 to 2016 were analyzed. Only patients with 2 test scores available were included.

Results

Results from 408 patients were included (mean age, 56 years; male:female ratio, 217:191). There was a statistically significant improvement in threshold (T), discrimination (D), and identification (I) scores as well as the composite "TDI" score between the two testing sessions. Controlling for age, there was a significantly greater improvement in composite TDI score in patients with CRS of ≤24 months duration. As expected, we found statistically significant correlations between change in overall composite TDI score and change in threshhold, discrimination, and identification, between sessions. Of the individual subcomponents, change in discrimination correlated best with change in composite TDI score (r = 0.82, p < 0.0001). This relationship was maintained irrespective of duration of CRS.

Conclusions

In patients with CRS, odor discrimination appears to best reflect overall changes in olfactory function, as determined using the composite TDI score. Furthermore, olfactory outcomes are better when treatment is started sooner.

http://ift.tt/2ETMqr7

Making a Difference in Conflict Zones

By Nathan Douthit

Large-scale destruction of health services is a feature of modern warfare which today tends to be intrastate (civil war) rather than interstate. Whereas at the time of the World War I 90% of the injured were combatants, by the end of the last century 90% of casualties were civilian. The demand on in-country health services is, therefore, profound, and the destruction of these services a humanitarian disaster, as delivery of the most basic in emergency care becomes a challenge.

            Conflict is a major source of humanitarian emergencies. As mentioned above, it has the potential to devastate the public health systems and primary health systems of a country. It can encourage emigration of health professionals, destroy necessary infrastructure, and threaten the security of providers and patients.[1]–[2] This tends to effect the most vulnerable populations, including, "pregnant women, children, the elderly and patients with chronic health conditions[, who] are among the first to be deprived of the essential healthcare, including vaccines and essential drugs."

According to the International Federation of the Red Cross, "[H]ealth care is most needed where it is most difficult to deliver."[3] Health care can be imported into these difficult situations, but this intervention is often accompanied by force, which can create its own political and ethical problems.[4] Healthcare professionals must be engaged in finding creative ways to meet the needs of vulnerable populations in areas fraught with conflict.

While the rebuilding of the infrastructure of these countries is the most appropriate intervention, this cannot be done in the midst of an acute conflict. In, "Complications of dysgerminoma: meeting the health needs of patients in conflict zones," Hayari et al describe how one young patient was treated appropriately despite her home being destroyed by conflict.

            "The treatment of the war wounded in neighbouring countries, not formally engaged in conflict, is not new…. [T]he ICRC operated through field hospitals in Pakistan during conflict in Afghanistan. Turkey, Lebanon and Jordan have received over two million Syrian refugees in need of acute medical attention; the prevention and treatment of infectious diseases and treatment of chronic conditions poses a prohibitive challenge to the healthcare services of these nations…. The potential to offer high-quality care to a most vulnerable population across national borders warrants further examination as the international community seeks solutions to meeting healthcare needs in conflict zones and postconflict zones begin to reconstruct their cancer care facilities."

Healthcare professionals can make a difference in conflict zones by meeting the needs of patients by innovative solutions. BMJ Case Reports invites authors to publish cases regarding healthcare delivery in conflict zones. Global health case reports can emphasize:

-The methods of identifying and triaging patients in difficult to reach areas.

-Training methods local pracitioners in conflict areas

-Disease spread or exacerbation as a result of conflict

-Successes in healthcare delivery through conflict zones

Manuscripts may be submitted by students, physicians, nurses or other medical professionals to BMJ Case Reports. For more information, review the blog on how to write a global health case report.

Read more about conflict, refugee health and innovative solutions on BMJ Case Reports

– Illegal immigration: the puzzling role of several risk factors for rhabdomyolysis

– Social determinants of health: poverty, national infrastructure and investment

– A Rohingya refugee's journey in Australia and the barriers to accessing healthcare

Read more about conflict, refugee health and innovative solutions from other sources:

[1] Hoeffler A, Reynal-Querol M. Measuring the costs of conflict. Washington, DC: World Bank. 2003 Apr.

[2] Acerra JR, Iskyan K, Qureshi ZA, et al. Rebuilding the health care system in Afghanistan: an overview of primary care and emergency services. Int J Emerg Med 2009;(2):77–82.

[3] Coupland R, Breitegger A, Nathanson V, et al. Health Care in Danger: The responsibilities of health-care personnel working in armed conflicts and other emergencies. International Committee of the Red Cross. Geneva, 2012

[4] Weissman F, editor.  Introduction: the sacrificial international order and humanitarian action. In: In the shadow of 'just wars': violence, politics, and humanitarian action. Cornell University Press; 2004.

Competing Interests

None Declared

http://ift.tt/2CIjoJi

Accurate Telomere Length Test Influences Treatment Decisions for Certain Diseases

Research led by Johns Hopkins physicians and scientists shows that a test for measuring the length of DNA endcaps, called telomeres, which has a variability rate of 5 percent, can alter treatment decisions for patients with certain types of bone marrow failure.

http://ift.tt/2GLORMW

The Experience of Money and Debt Problems in Rural Areas

Balmer, NJ; Patel, A; Legal Services Research Centre, .; (2009) The Experience of Money and Debt Problems in Rural Areas. Legal Services Commission: London, UK.

http://ift.tt/2HMlQ5n

Ezra Pound and Du Fu: Gazing at Mt. Tai

Su, Y; (2017) Ezra Pound and Du Fu: Gazing at Mt. Tai. International Journal of Comparative Literature and Translation Studies , 5 (4) pp. 60-64. 10.7575/aiac.ijclts.v.5n.4p.60 . Green open access

http://ift.tt/2GLi2jv

Community Legal Advice Centres: A Survey of Clients in Reception Areas

Buck, A; Smith, M; Sidaway, J; Balmer, NJ; (2010) Community Legal Advice Centres: A Survey of Clients in Reception Areas. Legal Services Commission: London, UK.

http://ift.tt/2HLTwzQ

English and Welsh Civil and Social Justice Panel Survey: Wave 1. Findings and Technical Report

Pleasence, P; Balmer, NJ; Patel, A; Cleary, A; Huskinson, T; Cotton, T; (2011) English and Welsh Civil and Social Justice Panel Survey: Wave 1. Findings and Technical Report. Legal Services Commission: London, UK.

http://ift.tt/2GLhOZH

Other People's Money: The Role of Reciprocity and Social Uncertainty in Decisions for Others

Vlaev, I; Wallace, B; Wright, N; Nicolle, A; Dolan, P; Dolan, R; (2017) Other People's Money: The Role of Reciprocity and Social Uncertainty in Decisions for Others. JOURNAL OF NEUROSCIENCE PSYCHOLOGY AND ECONOMICS , 10 (2-3) pp. 59-80. 10.1037/npe0000063 . Green open access

http://ift.tt/2HKWDrI

English and Welsh Civil and Social Justice Panel Survey: Wave 2. Summary Findings

Balmer, NJ; (2013) English and Welsh Civil and Social Justice Panel Survey: Wave 2. Summary Findings. Legal Services Commission: London, UK.

http://ift.tt/2GLIB7W

Differential interplay between maternal and paternal affective profiles and parenting practices on children’s externalizing and internalizing behaviour

Orri, M; Girard, L-C; Pingault, JMR; Rouquette, A; Herba, C; Falissard, B; Côté, S; Orri, M; Girard, L-C; Pingault, JMR; Rouquette, A; Herba, C; Falissard, B; Côté, S; Berthoz, S; - view fewer (2018) Differential interplay between maternal and paternal affective profiles and parenting practices on children's externalizing and internalizing behaviour. International Journal of Behavioral Development (In press).

http://ift.tt/2HKWt3A

A mechanism based transition research methodology: Bridging analytical approaches

Papachristos, G; (2018) A mechanism based transition research methodology: Bridging analytical approaches. Futures (In press).

http://ift.tt/2GLhqud

Exile in and from Czechoslovakia during the 1930s and 1940s by Charmian Brinson and Marian Malet

Zusi, PA; (2012) Exile in and from Czechoslovakia during the 1930s and 1940s by Charmian Brinson and Marian Malet. The Modern Language Review , 107 (1) pp. 316-318. 10.5699/modelangrevi.107.1.0316 . Green open access

http://ift.tt/2HNxNYz

Specifications of Standards in Systems and Synthetic Biology: Status and Developments in 2016

Schreiber, F; Bader, GD; Gleeson, P; Golebiewski, M; Hucka, M; Le Novère, N; Myers, C; ... Walthemath, D; + view all Schreiber, F; Bader, GD; Gleeson, P; Golebiewski, M; Hucka, M; Le Novère, N; Myers, C; Nickerson, D; Sommer, B; Walthemath, D; - view fewer (2016) Specifications of Standards in Systems and Synthetic Biology: Status and Developments in 2016. Journal of Integrative Bioinformatics , 13 (3) , Article 289. 10.2390/biecoll-jib-2016-289 . Green open access

http://ift.tt/2GLhcmR

Study of an extended family with CTLA-4 deficiency suggests a CD28/CTLA-4 independent mechanism responsible for differences in disease manifestations and severity

Hou, TZ; Olbrich, P; Soto, JML; Sanchez, B; Moreno, PS; Borte, S; Stauss, HJ; ... Neth, O; + view all Hou, TZ; Olbrich, P; Soto, JML; Sanchez, B; Moreno, PS; Borte, S; Stauss, HJ; Burns, SO; Walker, LSK; Pan-Hammarström, Q; Hammarström, L; Sansom, DM; Neth, O; - view fewer (2018) Study of an extended family with CTLA-4 deficiency suggests a CD28/CTLA-4 independent mechanism responsible for differences in disease manifestations and severity. Clinical Immunology , 188 pp. 94-102. 10.1016/j.clim.2018.01.001 .

http://ift.tt/2HKWUee

A guide to phylogenetic metrics for conservation, community ecology and macroecology

Tucker, CM; Cadotte, MW; Carvalho, SB; Davies, TJ; Ferrier, S; Fritz, SA; Grenyer, R; ... Mazel, F; + view all Tucker, CM; Cadotte, MW; Carvalho, SB; Davies, TJ; Ferrier, S; Fritz, SA; Grenyer, R; Helmus, MR; Jin, LS; Mooers, AO; Pavoine, S; Purschke, O; Redding, DW; Rosauer, DF; Winter, M; Mazel, F; - view fewer (2017) A guide to phylogenetic metrics for conservation, community ecology and macroecology. Biological Reviews , 92 (2) pp. 698-715. 10.1111/brv.12252 . Green open access

http://ift.tt/2GLh4DT

Modular Tableaux Calculi for Separation Theories

Docherty, S; Pym, D; (2018) Modular Tableaux Calculi for Separation Theories. In: Baier, C and Dal Lago, U, (eds.) (Proceedings) FoSSaCS 2018, 21st International Conference on Foundations of Software Science and Computation Structures, 14-20 April 2018, Thessaloniki, Greece. Springer (In press).

http://ift.tt/2HLTtnE

The Arctic sea ice cover of 2016: a year of record-low highs and higher-than-expected lows

Petty, AA; Stroeve, JC; Holland, PR; Boisvert, LN; Bliss, AC; Kimura, N; Meier, WN; (2018) The Arctic sea ice cover of 2016: a year of record-low highs and higher-than-expected lows. The Cryosphere , 12 (2) pp. 433-452. 10.5194/tc-12-433-2018 . Green open access

http://ift.tt/2GLISYI

The burden, epidemiology, costs and treatment for Duchenne muscular dystrophy: an evidence review

Ryder, S; Leadley, RM; Armstrong, N; Westwood, M; de Kock, S; Butt, T; Jain, M; Ryder, S; Leadley, RM; Armstrong, N; Westwood, M; de Kock, S; Butt, T; Jain, M; Kleijnen, J; - view fewer (2017) The burden, epidemiology, costs and treatment for Duchenne muscular dystrophy: an evidence review. Orphanet Journal of Rare Diseases , 12 , Article 79. 10.1186/s13023-017-0631-3 . Green open access

http://ift.tt/2HNEw4r

Diagnosis, pathogenesis and outcome in leucocyte chemotactic factor 2 (ALECT2) amyloidosis

Rezk, T; Gilbertson, JA; Rowczenio, D; Bass, P; Lachmann, HJ; Wechalekar, AD; Fontana, M; ... Gillmore, JD; + view all Rezk, T; Gilbertson, JA; Rowczenio, D; Bass, P; Lachmann, HJ; Wechalekar, AD; Fontana, M; Mahmood, S; Sachchithanantham, S; Whelan, CJ; Wong, J; Rendell, N; Taylor, GW; Hawkins, PN; Gillmore, JD; - view fewer (2018) Diagnosis, pathogenesis and outcome in leucocyte chemotactic factor 2 (ALECT2) amyloidosis. Nephrology Dialysis Transplantation , 33 (2) pp. 241-247. 10.1093/ndt/gfw375 . Green open access

http://ift.tt/2GLIyJu

Strategies employed by older people to manage loneliness: Systematic review of qualitative studies and model development

Kharicha, K; Manthorpe, J; Iliffe, S; Davies, N; Walters, K; (2018) Strategies employed by older people to manage loneliness: Systematic review of qualitative studies and model development. International Psychogeriatrics (In press).

http://ift.tt/2HKjOT8

Two-scale homogenization for a general class of high contrast PDE systems with periodic coefficients

Kamotski, I; Smyshlyaev, V; (2018) Two-scale homogenization for a general class of high contrast PDE systems with periodic coefficients. Applicable Analysis 10.1080/00036811.2018.1441994 . (In press).

http://ift.tt/2GNS9zv

ANNE-MARIE MAI: Galleri 66. En historie om nyere dansk litteratur. Gyldendal, Copenhagen 2016. Pp. 396. ISBN 978-87-02-20968-6.

Stougaard-Nielsen, J; (2018) ANNE-MARIE MAI: Galleri 66. En historie om nyere dansk litteratur. Gyldendal, Copenhagen 2016. Pp. 396. ISBN 978-87-02-20968-6. Scandinavica: An International Journal of Scandinavian Studies (In press).

http://ift.tt/2HNxM6X

Whole body post-ablation scan. (A) Seven days following the administration of 1850 mBq ofI131. The image shows uptake in the thyroid bed and suggestive of uptake in one or more nearby lymph nodes. Additional mild increased activity is seen in the liver. Diffuse liver uptake may be seen on post-therapy scans and is indicative of thyroxine production. Thyroid hormone (T3, T4) is metabolized in the liver and activity can be seen there after 3–7 days. In post-ablation patients, liver activity suggest

Figure 2: Whole body post-ablation scan. (A) Seven days following the administration of 1850 mBq ofI131. The image shows uptake in the thyroid bed and suggestive of uptake in one or more nearby lymph nodes. Additional mild increased activity is seen in the liver. Diffuse liver uptake may be seen on post-therapy scans and is indicative of thyroxine production. Thyroid hormone (T3, T4) is metabolized in the liver and activity can be seen there after 3–7 days. In post-ablation patients, liver activity suggests that I-131 has been incorporated into thyroid hormone by functioning metastases or residual thyroid activity in the neck. (B) Anterior planar view showing I-131 uptake in the thyroid bed, as well as physiologic activity in the salivary glands and nasopharyngeal area. The area outlined in red is a substernal notch marker.

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High prevalence of Helicobacter pylori clarithromycin resistance mutations among Seattle patients measured by droplet digital PCR

Abstract

Background

Treatment of Helicobacter pylori infection is often empiric; however, current guidelines for management of Helicobacter pylori infection advise against the use of standard triple therapy (clarithromycin, amoxicillin, and proton-pump inhibitor) when clarithromycin resistance exceeds 20%. We developed and tested a new culture-free assay to detect clarithromycin resistance-conferring mutations to determine the prevalence of H. pylori clarithromycin resistance in patients from the United States Pacific Northwest.

Materials and Methods

Droplet digital PCR (ddPCR) was used to detect the H. pylori 23S rRNA gene, and resistance-conferring mutations, in archived, formalin-fixed, paraffin-embedded (FFPE) gastric tissue and to retrospectively determine the prevalence of clarithromycin-resistant H. pylori among 110 patients at an academic medical center in the Northwest United States between 2012 and 2014.

Results

Of 102 patients with the H. pylori 23S rRNA gene detected by the ddPCR assay, 45 (44%) had clarithromycin resistance mutations. Thirty-three of the 45 patients with clarithromycin resistance mutations had a mix of wild-type and resistance alleles. Prevalence of clarithromycin resistance mutations differed among racial groups and was highest among Asians, with mutations detected in 14 (67%) of the 21 patient samples.

Conclusions

The prevalence of clarithromycin resistance detected in this region exceeds 20%, indicating that standard triple therapy should not be the first-line antibiotic treatment for H. pylori infection. Culture-free assays for detecting clarithromycin resistance mutations can be performed on archived tissue samples and will aid in informing tailored treatment for effective H. pylori eradication.

http://ift.tt/2EVECFA

Diphencyclopropenone (DPCP) for alopecia areata: a UK survey

Abstract

Alopecia areata (AA) is a T-cell mediated autoimmune hair loss condition with an estimated lifetime risk of 1.7%. It is characterized clinically by sudden-onset non-inflammatory hair loss that may occur at any site. The disease course is unpredictable with many patients experiencing spontaneous re-growth along with episodes of further loss. Unfortunately, around a fifth of patients presenting with patchy alopecia will progress to complete scalp (alopecia totalis (AT)) or scalp & body (alopecia universalis (AU)) hair loss from which spontaneous regrowth is rare (<10%). The adverse psychological consequences of AA include high rates of anxiety and depression.

This article is protected by copyright. All rights reserved.

http://ift.tt/2orpyt8

Simultaneous operative use of both hands during laryngeal rigid endoscopic surgery

Abstract

MLS, FL, and exolaryngoscopy represent the traditional endoscopic technique to treat laryngeal disorders.

The authors describe a novel holder laryngeal system that allows performing rigid endoscopic laryngeal surgery simultaneously using both hands in operative way.

This surgical procedure is easy, less expensive and allows obtaining very good images of the surgical filed and operating under endoscopic control.

This article is protected by copyright. All rights reserved.

http://ift.tt/2orYYQz

Transpalpebral approach for frontal sinus diseases: a camouflaged technique

Abstract

Endoscopic or transfacial external frontal sinus approaches do not provide good monitoring of the frontal sinus lateral extent. Moreover, endoscopic or transfacial external approaches remain associated with numerous complications or therapeutic failure, e.g. frontal sinus drainage pathway synechia, healing problems or residual hypoesthesia.

We propose a rapid, easy-to-perform, 5-step procedure called the transpalpebral approach which is indicated in case of sequestered disease within the lateral extent of the frontal sinus. We use this technique in the following indications (osteomas, mucoceles, inverted papillomas, fungus balls, foreign bodies).

Our transpalpebral approach avoids leaving a visible scar and entails no danger to the skull base, the frontal sinus drainage pathway or the supratrochlear and supraorbital pedicles. It provides wide access to the lateral extent of the frontal sinus and also reduces the number of transfacial external approaches required.

This article is protected by copyright. All rights reserved.

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Nivolumab induced remitting seronegative symmetrical synovitis with pitting edema in a patient with melanoma: a case report

Novel immune checkpoint inhibitors have been often utilized for different types of malignancies as salvage therapy with varying success. One obstacle to immune checkpoint inhibitor use is the higher incidence ...

http://ift.tt/2CKNkUV

Safety and efficacy of biologic therapies in psoriatic patientswith alcoholic cirrhosis: a French retrospective study of 23 cases

Abstract

There are few studies specifically addressing the safety and efficacy of biologic treatments, especially anti TNF-alpha agents, in psoriatic patients with cirrhosis as such patients are usually excluded from prospective interventional studies. However, one should be aware that biologics are often prescribed in this particular population for several reasons. This is probably due to the fact that physicians are usually reluctant to prescribe conventional systemic treatment such as methotrexate or acitretine in psoriatic patients with liver abnormalities because of their liver toxicity. In addition, there is a general agreement that biologics have very few pharmacologic interaction with liver function and are not contraindicated in case of liver insufficiency.

This article is protected by copyright. All rights reserved.

http://ift.tt/2orAVkI

Atopic dermatitis is an important comorbidity in severe asthma

Publication date: Available online 26 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Jason K. Lee, Duhyun Han




http://ift.tt/2ERKSlt

Short-run impact of electricity storage on CO2 emissions in power systems with high penetrations of wind power: A case-study of Ireland

McKenna, E; Barton, J; Thomson, M; (2017) Short-run impact of electricity storage on CO2 emissions in power systems with high penetrations of wind power: A case-study of Ireland. Proceedings of the Institution of Mechanical Engineers, Part A: Journal of Power and Energy , 231 (6) pp. 590-603. 10.1177/0957650916671432 . Green open access

http://ift.tt/2ooNTQg

Reductions in global biodiversity loss predicted from conservation spending

Waldron, A; Miller, DC; Redding, D; Mooers, A; Kuhn, TS; Nibbelink, N; Roberts, JT; ... Gittleman, JL; + view all Waldron, A; Miller, DC; Redding, D; Mooers, A; Kuhn, TS; Nibbelink, N; Roberts, JT; Tobias, JA; Gittleman, JL; - view fewer (2017) Reductions in global biodiversity loss predicted from conservation spending. Nature , 551 (7680) pp. 364-367. 10.1038/nature24295 .

http://ift.tt/2BOPTsi

Sex differences in the gastrointestinal tract of rats and the implications for oral drug delivery

Afonso-Pereira, F; Dou, L; Trenfield, SJ; Madla, CM; Murdan, S; Sousa, J; Veiga, F; Afonso-Pereira, F; Dou, L; Trenfield, SJ; Madla, CM; Murdan, S; Sousa, J; Veiga, F; Basit, AW; - view fewer (2018) Sex differences in the gastrointestinal tract of rats and the implications for oral drug delivery. European Journal of Pharmaceutical Sciences 10.1016/j.ejps.2018.01.043 .

http://ift.tt/2ouTkNt

Simulating residential demand response: Improving socio-technical assumptions in activity-based models of energy demand

McKenna, E; Higginson, S; Grunewald, P; Darby, SJ; (2017) Simulating residential demand response: Improving socio-technical assumptions in activity-based models of energy demand. Energy Efficiency 10.1007/s12053-017-9525-4 . (In press). Green open access

http://ift.tt/2BSRy0j

Surgical efficiency in femtosecond laser cataract surgery compared with phacoemulsification cataract surgery: a case-control study

Day, AC; Smith, PR; Tang, HL; Aiello, F; Hussain, B; Maurino, V; Marshall, J; Day, AC; Smith, PR; Tang, HL; Aiello, F; Hussain, B; Maurino, V; Marshall, J; Saleh, GM; - view fewer (2018) Surgical efficiency in femtosecond laser cataract surgery compared with phacoemulsification cataract surgery: a case-control study. BMJ Open , 8 (2) , Article e018478. 10.1136/bmjopen-2017-018478 . Green open access

http://ift.tt/2EVo3gP

Conceptual and lexical effects on gestures: the case of vertical spatial metaphors for time in Chinese

Gu, Y; Mol, L; Hoetjes, M; Swerts, M; (2017) Conceptual and lexical effects on gestures: the case of vertical spatial metaphors for time in Chinese. Language, Cognition and Neuroscience , 32 (8) pp. 1048-1063. 10.1080/23273798.2017.1283425 . Green open access

http://ift.tt/2BQOWje

Delivery of small-for-gestational-age neonate and association with early-onset impaired maternal endothelial function

Hillman, SL; Kubba, T; Williams, DJ; (2017) Delivery of small-for-gestational-age neonate and association with early-onset impaired maternal endothelial function. Ultrasound in Obstetrics & Gynecology , 49 (1) pp. 150-154. 10.1002/uog.17342 . Green open access

http://ift.tt/2owB7iL

St John's wort (Hypericum perforatum) products – an assessment of their authenticity and quality

Booker, A; Agapouda, A; Frommenwiler, DA; Scotti, F; Reich, E; Heinrich, M; (2018) St John's wort (Hypericum perforatum) products – an assessment of their authenticity and quality. Phytomedicine , 40 pp. 158-164. 10.1016/j.phymed.2017.12.012 .

http://ift.tt/2BOPyWy

Comparative evaluation of parametric design systems for teaching design computation

Aish, R; Hanna, S; (2017) Comparative evaluation of parametric design systems for teaching design computation. Design Studies , 52 pp. 144-172. 10.1016/j.destud.2017.05.002 .

http://ift.tt/2EQ4s1H

Comparison of ESSDAI and ClinESSDAI in potential optimisation of trial outcomes in primary Sjögren's syndrome: examination of data from the UK Primary Sjögren's Syndrome Registry

Dumusc, A; Ng, W-F; James, K; Griffiths, B; Price, E; Pease, C; Emery, P; ... Bowman, S; + view all Dumusc, A; Ng, W-F; James, K; Griffiths, B; Price, E; Pease, C; Emery, P; Lanyon, P; Jones, A; Bombardieri, M; Sutcliffe, N; Pitzalis, C; Gupta, M; McLaren, J; Cooper, A; Giles, I; Isenberg, D; Saravanan, V; Coady, D; Dasgupta, B; McHugh, N; Young-Min, S; Moots, R; Gendi, N; Akil, M; Barone, F; Fisher, B; Rauz, S; Richards, A; Bowman, S; - view fewer (2018) Comparison of ESSDAI and ClinESSDAI in potential optimisation of trial outcomes in primary Sjögren's syndrome: examination of data from the UK Primary Sjögren's Syndrome Registry. Swiss Medical Weekly , 148 , Article w14588. 10.4414/smw.2018.14588 . Green open access

http://ift.tt/2BR7r79

Frustrated Ising chains on the triangular lattice in Sr3NiIrO6

Toth, S; Wu, W; Adroja, DT; Rayaprol, S; Sampathkumaran, EV; (2016) Frustrated Ising chains on the triangular lattice in Sr3NiIrO6. Physical Review B , 93 , Article 174422. 10.1103/PhysRevB.93.174422 . Green open access

http://ift.tt/2EQ4vKV

Hydrophobic durability characteristics of butterfly wing surface after freezing cycles towards the design of nature inspired antiicing surfaces

Chen, T; Cong, Q; Qi, Y; Jin, J; Choy, K-L; (2018) Hydrophobic durability characteristics of butterfly wing surface after freezing cycles towards the design of nature inspired antiicing surfaces. PLoS ONE , 13 (1) , Article e0188775. 10.1371/journal.pone.0188775 . Green open access

http://ift.tt/2BPphaO

Effects of Stimulus Response Compatibility on Covert Imitation of Vowels

Adank, P; Nuttall, HE; Maegherman, G; Bekkering, H; (2018) Effects of Stimulus Response Compatibility on Covert Imitation of Vowels. Attention, Perception, and Psychophysics (In press).

http://ift.tt/2orJ8oV

Martin Gregersen og Tobias Skiveren: Den materialle drejning: Natur, teknologi og krop i (nyere) dansk litteratur

Stougaard-Nielsen, J; (2018) Martin Gregersen og Tobias Skiveren: Den materialle drejning: Natur, teknologi og krop i (nyere) dansk litteratur. Edda , 105 pp. 79-84. 10.18261/issn.1500-1989-2018-01-07 . Green open access

http://ift.tt/2BQd0Tn

Age and gender may be the key points in hyperglycemic patients with Helicobacter pylori infection combined colorectal adenoma

http://ift.tt/2HPlNFW

Furazolidone treatment for Helicobacter Pylori infection: A systematic review and meta-analysis

Abstract

Antibiotic resistance is a major cause of Helicobacter pylori (H. pylori) treatment failures. Because the resistance rate of H. pylori to furazolidone is low, we aimed to assess the efficacy and safety of furazolidone. We searched the PubMed, Web of Science, Cochrane Library, and Embase databases and included randomized controlled trials (RCT) that either compared furazolidone to other antibiotics or changed the administered dose of furazolidone. A total of 18 articles were included in the meta-analysis. According to the intention-to-treat (ITT) analysis, the total eradication rates of furazolidone-containing therapy were superior to those of other antibiotic-containing therapies (relative risk [RR] 1.07, 95% confidence interval [CI] 1.01-1.14) (13 RCTs). Specifically, the eradication rates of furazolidone-containing therapy were better than those for metronidazole-containing therapy (RR 1.10, 95% CI: 1.01-1.21 for ITT). The eradication rate of furazolidone-containing bismuth-containing quadruple therapy was 92.9% (95% CI: 90.7%-95.1%) (PP). In addition, a higher daily dose of furazolidone increased the eradication rate (RR 1.17, 95% CI: 1.05-1.31). And the incidence of some adverse effects, such as fever and anorexia, was higher in the furazolidone group than in the control group, the overall incidences of total side effects and severe side effects showed no significant differences between the groups. Furazolidone-containing treatments could achieve satisfactory eradication rates and did not increase the incidence of total or severe adverse effects, but the incidence of milder side effects, such as fever and anorexia, should be considered when prescribing furazolidone-containing treatments to patients.

http://ift.tt/2GKGilv

A case of shiitake mushroom dermatitis

http://ift.tt/2EVPFhP

The contribution of feedback loops between miRNAs, cytokines and growth factors to the pathogenesis of psoriasis

Abstract

The present review describes in detail the existent data regarding feedback loops between miRNAs and cytokines or growth factors in the psoriatic inflammation. We have chosen to describe the roles of miR- 31, miR-21, miR-146a, miR-155, miR-197 and miR-99a in this process. This choice derives from the fact that among around 250 miRNAs being altered in the psoriatic lesion, the comprehensive functional role was described only in those detailed above. In addition, considering the molecular targets and the pathways, which may possibly be regulated by those miRNAs, it seems that they may be chosen as preferred targets for the therapy of psoriasis.

This article is protected by copyright. All rights reserved.

http://ift.tt/2BTgK6S