Percutaneous Dilatational Tracheostomy Using Tube Exchanger

We describe a modified technique for percutaneous dilatational tracheostomy using a 15F tube exchanger or Eschmann catheter. A retrospective review of 1180 procedures using this modified technique demonstrated it to be effective with a failure rate of only 0.25% (3 patients). Moreover, it provides an additional safeguard with the ability to rapidly reintroduce the endotracheal tube into the trachea guided by the exchange catheter in the event of accidental extubation during the procedure. This technique needs no additional special devices or equipment (eg, a bronchoscope). However, a prospective study is needed to better define its complication rate. Accepted for publication January 22, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Ohad Ronen, MD, Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, POB 21, Nahariya 2210001, Israel. Address e-mail to ohadr@gmc.gov.il. © 2018 International Anesthesia Research Society

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Perioperative Cardiac Arrest: Focus on Local Anesthetic Systemic Toxicity (LAST) Erratum

No abstract available

http://ift.tt/2pfC5jB

Burnout in American Anesthetists, Comparison With a French Cohort

No abstract available

http://ift.tt/2HCDgQZ

Intrathecal Drug Delivery Systems for Refractory Pancreatic Cancer Pain: Observational Follow-Up Study Over an 11-Year Period in a Comprehensive Cancer Center

BACKGROUND: Pancreatic cancer is the fourth leading cause of cancer-related death in Europe and the United States. Studies have demonstrated that patients with pancreatic cancer have a high prevalence of pain, with rates varying from 47% to 82%. Analgesia using intrathecal drug delivery systems (IDDS) has been poorly studied specifically in this population. METHODS: The IDDS for pancreatic cancer pain was a follow-up observational study designed to evaluate 11-year results of IDDS for refractory pancreatic cancer pain at the Institut de Cancérologie de L'Ouest, Paul Papin in France. Patients were followed from March 2006 to April 2017. Patients were selected for IDDS based on multidisciplinary meeting discussion. All IDDS-treated patients were prescribed a combined intrathecal analgesics regimen through a catheter placed according to painful metameric level. Postimplant assessment of pain was determined using a numerical rating scale (NRS). Patients were followed via day-hospital visits and telephone calls at least monthly until death. Pain scores were compared using the Wilcoxon signed rank test. Overall survival (OS) was estimated using the Kaplan–Meier method and compared between groups by log rank tests. RESULTS: Ninety-three patients received IDDS, and total therapy duration accounts for 10,300 IDDS days. Implanted patients suffered from severe pain before implantation (median presurgical NRS, 8 [interquartile range, 7–9]) despite a median 360 mg (260–600) oral morphine equivalent daily dose. Median OS in the whole cohort after intrathecal treatment start was 82 days (95% confidence interval, 59–95). Median OS after surgery for implantable pump was 91 days (83–111) and for external pump 27 days (20–49; P

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In Response

No abstract available

http://ift.tt/2DsrmXr

Anesthesia for Percutaneous Pulmonary Valve Implantation: A Case Series

BACKGROUND: Twenty percent of patients born with congenital heart disease present with right ventricular outflow tract abnormalities. These patients require multiple surgical procedures in their lifetime. Transcatheter pulmonary valve replacement (TPVR) has become a viable alternative to conventional pulmonary valve and right ventricular outflow tract surgery in pediatric and adult populations. In this retrospective review, we analyze the perioperative management of adult patients who underwent TPVR in our center. METHODS: The study consisted of a chart review of patients who underwent TPVR at Toronto General Hospital between 2006 and 2015. Information about preoperative assessment, intraoperative anesthetic management, and intra- and postprocedural complications was collected. Two types of percutaneous valves have been used for a conduit or valve size between 16 and 28 mm. These procedures are done via the femoral, jugular, or subclavian vein under general anesthesia. RESULTS: Seventy-nine adults (17–68 years of age) who underwent elective TPVR procedures were included. General anesthesia was used in all cases. Defibrillation was necessary in 1 case, and bradycardia was spontaneously resolved in another 1. Eighty-five percent were successfully extubated at the end of the procedure. Five patients required intraoperative inotropic support. Three patients presented self-resolved hemoptysis. Mechanical ventilation for >24 hours was necessary in 3 cases, 2 of which also required concomitant inotropic support. Four failed deployments and 1 case of persistent conduit stenosis were reported. Three patients required reintubation. All patients were discharged home. CONCLUSIONS: Patients undergoing TPVR represent a complex and heterogeneous population. General anesthesia with endotracheal intubation is preferred. Setup for urgent lung isolation and cardiac defibrillation should be considered. Postoperative monitoring and intensive care setting are required. Anesthesiologists with cardiac anesthesia training are probably better suited to manage these patients. Accepted for publication January 22, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Massimiliano Meineri, MD, Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth St, EN3-400, Toronto, ON M5G 2C4, Canada. Address e-mail to massimiliano.meineri@uhn.ca. © 2018 International Anesthesia Research Society

http://ift.tt/2FVS67V

Protective Effect of Punica granatum Extract in Head and Neck Cancer Patients Undergoing Radiotherapy

Abstract

In India, head and neck cancers account for 30–40% cancers of all sites. Due to lack of screening program, wide variation in the availability of infrastructures and expertise, patients present at an advanced stage. The main stay of management of the head and neck tumours is surgery and chemoradiation. Radiation dermatitis and mucositis is one of the most common side effect encountered during the radiotherapy. Aim of our study was to study protective role of pomegranate extract on radiation induced dermatitis and mucositis in head and neck cancer patients. It was a prospective, clinical, double blind, case control study. 60 patients (30 active and controls) undergoing radiotherapy for head and neck cancer were studied for 12 months. Patients in study group were given whole fruit pomegranate extract. Each capsule contained 300 mg of whole fruit extract, each capsule contains 40% polyphenols and 27% punicalagin. Each patient were given 2 capsules every day for a period of 6–7 weeks. The skin and mucosal changes was graded according to the acute radiation morbidity scoring criteria (RTOG) for skin and mucous membrane. The results were statistically significant. Pomegranate extract proved to be radioprotective. Our study is one of the first study in humans to demonstrate the effectiveness of pomegranate extract in preventing radiation dermatitis and mucositis.

http://ift.tt/2FEUGQf

Study Finds Large Racial and Ethnic Disparity in World’s Most Common Curable Sexually Transmitted Infection

In a new Johns Hopkins study, researchers have added to evidence that Trichomonas vaginalis (TV), the world's most common curable sexually transmitted infection (STI), disproportionately affects the black community.

http://ift.tt/2HAREZR

ILC2 frequency and activity are inhibited by glucocorticoid treatment via STAT pathway in patients with asthma

Abstract

Background

Group 2 innate lymphoid cells (ILC2s) were closely associated with asthma. However, there were no perspective studies about the effects of glucocorticoid on ILC2s in asthma patients. Our objective was to perform a perspective study and evaluate the ILC2 activity after glucocorticoid therapy in asthma patients.

Methods

The asthma and asthma with allergic rhinitis patients were treated with glucocorticoid for 3 months. The circulating ILC2 levels were evaluated. The effects of glucocorticoid on ILC2s and possible signaling pathways were investigated in vitro.

Results

The patients were well-controlled and the high ILC2 levels were significantly decreased at 1 and 3 months after treatment. Peripheral blood monocytes from allergic patients produced dramatic IL-5, IL-13 and IL-9 in response to IL-25, IL-33 plus IL-2, and glucocorticoid significantly decreased their levels. Moreover, ILC2s were identified to be the predominant source of IL-5, IL-13 and IL-9, and glucocorticoid treatment was able to reverse their high levels. STAT3, STAT5, STAT6, JAK3 and MEK signaling pathways were proved to be involved in regulating ILC2 activity under the glucocorticoid treatment.

Conclusions

The data suggested that glucocorticoid administration could be effective in treating asthma by regulating ILC2s via MEK/JAK-STAT signaling pathways. This provides a new understanding of glucocorticoid application in regards to allergic diseases.

This article is protected by copyright. All rights reserved.

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2S protein Ara h 7.0201 has unique epitopes compared to other Ara h 7 isoforms and is comparable to 2S proteins Ara h 2 and 6 in basophil degranulation capacity

Abstract

Background

Screening for specific IgE against 2S albumin proteins Ara h 2 and 6 has good positive predictive value in diagnosing peanut allergy. From the third 2S member Ara h 7, three isoforms have been identified. Their allergenicity has not been elucidated.

Objective

This study investigated the allergenicity of Ara h 7 isoforms compared to Ara h 2 and 6.

Methods

Sensitization of 15 DBPCFC confirmed peanut allergic patients to recombinant Ara h 2.0201, 6.01 and isoforms of recombinant Ara h 7 was determined by IgE immunoblotting strips. A basophil activation test (BAT) was performed in nine patients to determine IgE-crosslinking capacities of the allergens. Sensitivity to the allergens was tested in five patients that were sensitized to at least one Ara h 7 isoform, by a concentration range in the BAT. 3D-prediction models and sequence alignments were used to visualize differences between isoforms and to predict allergenic epitope regions.

Results

Sensitization to Ara h 7.0201 was most frequent (80%) and showed to be equally potent as Ara h 2.0201 and 6.01 in inducing basophil degranulation. Sensitization to Ara h 7.0201 together with Ara h 2.0201 and/or 6.01 was observed, indicating the presence of unique epitopes compared to the other two isoforms. Differences between the three Ara h 7 isoforms were observed in C-terminal cysteine residues, pepsin and trypsin cleavage sites and three single amino acid substitutions.

Conclusion & clinical relevance

The majority of peanut-allergic patients are sensitized to isoform Ara h 7.0201, which is functionally as active as Ara h 2.0201 and 6.01. Unique epitopes are most likely located in the C-terminus or an allergenic loop region which is a known allergenic epitope region for Ara h 2.0201 and 6.01. Due to its unique epitopes and allergenicity, it is an interesting candidate to improve the diagnostic accuracy for peanut allergy.

This article is protected by copyright. All rights reserved.

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A Single Radioactive Iodine Treatment Has a Deleterious Effect on Ovarian Reserve in Women with Thyroid Cancer: Results of a Prospective Pilot Study

Thyroid, Ahead of Print.


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Vitamin D Status and Cardiovascular Risk in Obesity: Effect of Physical Activity in Nonvitamin D Supplemented Adolescents

Metabolic Syndrome and Related Disorders, Ahead of Print.


http://ift.tt/2FIk6Zh

Untangling Waist Circumference and Hip Circumference from Body Mass Index with a Body Shape Index, Hip Index, and Anthropometric Risk Indicator

Metabolic Syndrome and Related Disorders, Ahead of Print.


http://ift.tt/2GuwQnI

Sexual Coercion and Women's Education: A Pilot Study

Violence and Gender, Ahead of Print.


http://ift.tt/2GsxDFp

Addressing Onset and Desistance of Bullying Behavior: Surveying Perpetrators

Violence and Gender, Ahead of Print.


http://ift.tt/2tOXCEp

Anti-Podocalyxin Monoclonal Antibody 47-mG2a Detects Lung Cancers by Immunohistochemistry

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.


http://ift.tt/2pcoKZt

Myeloid derived-suppressor cells: their role in cancer and obesity

Suzanne Ostrand-Rosenberg

http://ift.tt/2FC1xKj

Mucoepidermoid carcinoma of the parotid gland: A National Cancer Database study

To describe the demographics, tumor characteristics, and prognostic features of mucoepidermoid carcinoma of the parotid gland.

http://ift.tt/2FzLe0F

Are surgeons overdosing patients with lidocaine?

Local anesthetics have long been used since the 1850s following the first pure extraction of cocaine from coca leaves. Cocaine was a potent anesthetic, however, it led to deaths and addictions for health care members and patients alike [1]. Other local anesthetics such as tetracaine, tropocaine, lidocaine, bupivacaine and more recently, ropivacaine, were synthesized to minimize the cocaine toxicity. These newer anesthetic agents included both ester and amide preparationswith varying degrees of cardiovascular and neurotoxicity [1].

http://ift.tt/2HAxi2T

Effects of nasal septum perforation repair on nasal airflow: An analysis using computational fluid dynamics on preoperative and postoperative three-dimensional models

Publication date: Available online 13 March 2018
Source:Auris Nasus Larynx
Author(s): Tsutomu Nomura, Munetaka Ushio, Kenji Kondo, Shigeru Kikuchi
ObjectiveThe purpose of this research is to examine the changes in nasal airflow dynamics before and after the nasal perforation repair.MethodsThree dimensional (3D) models of the nasal cavity before and after septal perforation repair was reconstructed using preoperative and postoperative computed tomography (CT) images of a patient. The numerical simulation was carried out using ANSYS CFX V15.0. Pre- and post-operative models were compared by their velocity, pressure (P), pressure gradient (PG), wall shear (WS), shear strain rate (SSR) and turbulence kinetic energy (TKE) in three plains.ResultsIn the post-operative state, the cross flows disappeared. In preoperative state, there were areas showing high PG, WS, SSR at the posterior border of the perforation, which exactly correspond to the area showing erosive mucosa on endoscopic inspection of the patient. In postoperative state, such high PG, WS and SSR areas disappeared. High TKEs also disappeared after surgery.ConclusionThe effects of septal perforation repair on airflow dynamics were evaluated using computer fluid dynamics (CFD). High WS, PG and SSR observed at the edge of the septal perforation may be related to the clinical symptom such as nasal bleeding and pain. TKE was considered to cause nasal symptom.



http://ift.tt/2pe37Ha

Clinical features of nasal and sinonasal inverted papilloma associated with malignancy

Publication date: Available online 13 March 2018
Source:Auris Nasus Larynx
Author(s): Takuya Miyazaki, Yasuharu Haku, Akira Yoshizawa, Ken Iwanaga, Takashi Fujiwara, Masanobu Mizuta, Atsuhiro Yoshida, Shinichi Satou, Hisanobu Tamaki
ObjectiveNasal and sinonasal inverted papilloma (IP) are rare benign tumors and have the potential to exhibit malignancy in approximately 10% of cases. This study aimed to analyze the clinical features of IP associated with malignancy. Furthermore, we reviewed our therapeutic strategy and the clinical course of malignant IP.MethodsOverall, 70 patients with IP at our institution were retrospectively analyzed from April 2006 to December 2015; of these, six (9%) had associated malignancy. Data was collected on sex, age, presenting symptoms (nasal bleeding, rhinorrhea, facial or cheek pain, and nasal obstruction), bone destruction, and extent of disease on CT and MRI. Categorical data of patients with and without malignancy were compared using the chi-square test. A p value of <0.05 was considered statistically significant. Our therapeutic strategy for IP with malignancy, particularly the surgical procedure, i.e., the external incision or the endoscopic nasal approach, varied based on when the carcinoma was detected. In addition, we considered postoperative radiation therapy depending on histological examination.ResultsNasal bleeding (p<0.001), pain (p=0.040), bone destruction (p<0.001), and extent of disease (p=0.026) on CT and MRI findings were significantly associated with malignancy. Carcinoma was diagnosed preoperatively in two (33%) and postoperatively in four patients (67%). We operated five patients (one case was not treated because of end-stage pancreatic cancer). Two patients underwent endoscopic sinus surgery (ESS) alone, two ESS plus Denker's method, and one ESS plus anterior craniotomy. Three patients underwent surgery only, and two patients received postoperative radiotherapy. The median follow-up period was 69.3 months. One patient died of the disease and the remaining patients are alive without recurrence.ConclusionFor IP patients exhibiting these clinical findings preoperatively, we should suspect complication with malignancy and plan a treatment. Even if postoperative histology does not confirm malignancy, we should ensure careful observation because of metachronous malignant transformation or the possibility to overlook small malignant lesions. Our result suggests that our strategy for malignant IP could be a reasonable option.



http://ift.tt/2IrdMr1

Mucoepidermoid carcinoma of the parotid gland: A National Cancer Database study

Publication date: Available online 14 March 2018
Source:American Journal of Otolaryngology
Author(s): Karthik Rajasekaran, Vanessa Stubbs, Jinbo Chen, Pratyusha Yalamanchi, Steven Cannady, Jason Brant, Jason Newman
ObjectiveTo describe the demographics, tumor characteristics, and prognostic features of mucoepidermoid carcinoma of the parotid gland.Materials and methodsA retrospective study of the National Cancer Database was reviewed for all mucoepidermoid carcinomas of the parotid gland between 2004 and 2012). Patient demographics and tumor characteristics were abstracted and analyzed. Univariate and multivariate Cox multivariate regression models were used to identify predictors of survival.ResultsA total of 4431 patients met inclusion criteria. Average age at diagnosis was 57 years (median 62, SD 19), with no overall sex preference (52% female), and majority white (78%). The 1-year overall survival was 92.9% (95% CI [92.1–93.6]) and 5-year overall survival was 75.2% (95% CI [73.8–76.7%]). Median overall survival was not reached at 5 years. Factors associated with decreased survival were increasing age, comorbidities, high tumor grade, advanced pathologic group stage, and positive surgical margins. Female sex was the only factor associated with improved survival. Controlling for either histopathologic grade or pathologic stage to determine how patient demographics and tumor characteristics affected overall survival yielded similar results. Of note, intermediate grade tumors, although not independently associated with worse survival, when seen in conjunction with tumors ≥T2 and/or ≥N2, a negative impact on overall survival was seen.ConclusionAlthough mucoepidermoid carcinoma of the parotid gland is the most common parotid gland malignancy, it is still a rare tumor with a lack of large population-based studies. Advanced stage and high-grade tumors are significant predictors of decreased survival. Females have improved survival compared to males.



http://ift.tt/2pavKpo

Decidual granulomatous reaction in a placenta from a preeclamptic pregnancy: a case report and review of the literature

Abstract

We report a case of decidual perivascular non-necrotizing granulomas in a placenta from a pregnancy complicated by severe preeclampsia with no evidence of infection. The mother was a 20-year-old primigravida with severe preeclampsia diagnosed in the third trimester with subsequent delivery of a healthy baby boy at 37 weeks 5 days gestation. Pathologic examination of the placenta showed scattered non-necrotizing granulomas in decidua, often adjacent to remodeled decidual arteries without fibrinoid necrosis. These were well-formed, non-necrotizing granulomas with scant lymphoid cuffs. Polarization microscopy did not show foreign material. There were no histopathologic or clinical findings suggestive of maternal-fetal infection or systemic vasculitis at the time of delivery, and the mother had no other reported conditions associated with granulomatous inflammation. Our case demonstrates that granulomatous reaction may be seen in the placenta from a pregnancy complicated by severe preeclampsia, although work-up for infection may be indicated.

http://ift.tt/2GqKqZ3

Airway pathological heterogeneity in asthma: Visualization of disease microclusters using topological data analysis

Publication date: Available online 14 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Salman Siddiqui, Aarti Shikotra, Matthew Richardson, Emma Doran, David Choy, Alex Bell, Cary D. Austin, Jeffrey Eastham-Anderson, Beverley Hargadon, Joseph R. Arron, Andrew Wardlaw, Christopher E. Brightling, Liam G. Heaney, Peter Bradding
BackgroundAsthma is a complex chronic disease underpinned by pathological changes within the airway wall. How variations in structural airway pathology and cellular inflammation contribute to the expression and severity of asthma are poorly understood.ObjectivesTherefore we evaluated pathological heterogeneity using topological data analysis (TDA) with the aim of visualizing disease clusters and microclusters.MethodsA discovery population of 202 adult patients (142 asthmatic patients and 60 healthy subjects) and an external replication population (59 patients with severe asthma) were evaluated. Pathology and gene expression were examined in bronchial biopsy samples. TDA was applied by using pathological variables alone to create pathology-driven visual networks.ResultsIn the discovery cohort TDA identified 4 groups/networks with multiple microclusters/regions of interest that were masked by group-level statistics. Specifically, TDA group 1 consisted of a high proportion of healthy subjects, with a microcluster representing a topological continuum connecting healthy subjects to patients with mild-to-moderate asthma. Three additional TDA groups with moderate-to-severe asthma (Airway Smooth Muscle^High, Reticular Basement Membrane^High, and Remodeling^Low groups) were identified and contained numerous microclusters with varying pathological and clinical features. Mutually exclusive TH2 and TH17 tissue gene expression signatures were identified in all pathological groups. Discovery and external replication applied to the severe asthma subgroup identified only highly similar "pathological data shapes" through analyses of persistent homology.ConclusionsWe have identified and replicated novel pathological phenotypes of asthma using TDA. Our methodology is applicable to other complex chronic diseases.

Graphical abstract

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Light Therapies for Acne

This Clinical Evidence Synopsis summarizes a Cochrane review that assessed effectiveness of different light therapies for acne.

http://ift.tt/2FH5MAf

Disseminated Asymptomatic Papules Over the Body

A woman in her 30s had a 15-year history of generalized asymptomatic papules on her arms, trunk, legs, neck, and face; examination revealed skin-colored to red-brown papules distributed over her trunk, extremities, neck, forehead, and periocular regions. What is your diagnosis?

http://ift.tt/2HzZ5Rh

HLA-B*1301 and Dapsone-Induced Cutaneous Adverse Drug Reactions

This systematic review and meta-analysis examines case-control studies to assess the association between the HLA-B*1301 genotype and cutaneous adverse reactions in Asian patients treated with dapsone.

http://ift.tt/2Fy3Wpg

JAMA Dermatology—The Year in Review, 2017

JAMA Dermatology continues to enhance our digital presence, which serves to inform physicians and the public about advances in treatment of skin conditions. The journal content is available online ahead of print, and we connect with our readers via the electronic table of contents and through social media. Each weekly online issue of the journal offers an article free to be downloaded for 1 week; thus, the public has free access to selected articles. Our reach extended to 3.4 million people in 2017 with full-text downloads. Our online presence is international, with more than 100 000 users in Canada, India, the United Kingdom, and the United States.

http://ift.tt/2FFBvln

Spinal Dysraphism Presenting as a Translucent Papule in a Man

This case report describes a man with spinal dysraphism presenting as a translucent papule.

http://ift.tt/2FzSR76

Sun Protection Use and Sunburn Among US Adults

This cross-sectional study using National Health Interview Survey data examined the prevalence of sun protection use and sunburn and the association between sunburn and demographic characteristics and health behaviors in the US population.

http://ift.tt/2FAdwIu

JAMA Dermatology Peer Reviewers in 2017

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Updated Guidelines on Hirsutism in Premenopausal Women

Endocrine Society has released an updated guideline on hirsutism in premenopausal women, cosponsored by the Androgen Excess and PCOS Society and European Society of Endocrinology.
Medscape Medical News

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Media Advisory: Medical Students: Ready, Set, Match!

The wait is almost over for students who will soon graduate from the Johns Hopkins University School of Medicine: At noon on Friday, March 16, they will come together and open the envelopes that let them know where they will spend the next chapter of their lives training for careers in the medical field of their choosing.

http://ift.tt/2FDoInK

In reference to Is multidisciplinary team care for head and neck cancer worth it? and Does a multidisciplinary approach to voice and swallowing disorders improve therapy adherence and outcome?

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Monroe’s Mark

For most of human history, beauty marks have not always considered to be beautiful. In Ancient Rome, the standard of beauty was fair and spotless skin. In medieval Europe, pigmented lesions were one of several cutaneous signs associated with "evil" or demonic connection, the so-called Devil's mark. The attitude toward beauty marks improved in the 18th century, when moles became popular among the royal courts of Europe. Artificial beauty marks, known as mouches, were created from silk, velvet, or taffeta and were worn by both men and women. After a several-centuries–long period of quiescence, however, the beauty mark reemerged in the 1950s in association with the era's greatest sex symbol, Marilyn Monroe. She quickly became known for the off-center mole above her left upper lip, and with it she appealed to generations of women for many years to come.

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Potential COIs in Dermatology Clinical Practice Guidelines

This Viewpoint discusses the importance of achieving balance between the practical and the ideal in clinical practice guideline development.

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Generalized Lichen Nitidus Following Anti–PD-1 Antibody Treatment

This case report describes the occurrence of generalized lichen nitidus following anti–PD-1 antibody treatment.

http://ift.tt/2Dpmvdu

US Food and Drug Administration Approach for Safe Medical Devices

With the increased awareness of skin conditions and demand for aesthetic treatments requiring the expertise of dermatologists, there has been a growth in the associated medical device industry. Dermatology medical devices include point-of-care diagnostics, ablative technologies, skin imaging devices, dermal fillers, lasers, and wound dressings. Many new devices in dermatology offer practitioners and patients additional options for a variety of conditions including diabetic wound care, skin lesion screening, and alopecia treatment.

http://ift.tt/2Dx0Eh8

Trends in Melanoma Incidence Among Non-Hispanic Whites

This analysis examines data from 2 major databases on melanoma incidence trends among the non-Hispanic white population in the United States by 10-year age groups.

http://ift.tt/2FzFIqp

Comorbidities in Autoimmune Skin Diseases

Alvan Feinstein, both a clinician and an epidemiologist, introduced the concept of comorbidity as a peculiar and important feature of chronic diseases almost 50 years ago. This concept may still require a more precise definition and a deeper understanding, but there is no doubt that better knowledge about comorbidities will always be conducive to improvements in clinical care, epidemiology, and health services planning and financing. Also, as noted by Tinetti and Fried nearly 15 years ago, awareness of existing comorbidities of a given chronic disease will facilitate "The End of the Disease Era," as they titled their article, and ultimately bring about the essential paradigm shift in clinical medicine from the "disease-oriented" model to a more "integrated individually tailored model" in which clinical decision making can be "focused primarily on the priorities and preferences of individual patients,"^(p181) and health conditions are recognized as a complex interplay of genetic, environmental, psychological, social, and other factors.

http://ift.tt/2EVSXVD

Evaluating Industry Payments Among Dermatology Clinical Practice Guideline Authors

To the Editor The article by Checketts et al regarding industry payments among dermatology clinical practice guideline (CPG) authors was accompanied by an editorial by Katz highlighting some of the problems with the study's methodology. We have significant additional concerns regarding its conclusions.

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Dermatologic Device Approval by the US Food and Drug Administration

This cross-sectional database study characterizes the postapproval changes to Class III dermatologic devices and evaluates inconsistencies in the use of the premarket approval pathway.

http://ift.tt/2E6cmjX

Sun Safety

This Patient Page provides information on sun protection and safety.

http://ift.tt/2FJ5xEQ

Association Between Pemphigus and Neurologic Diseases

This population-based cross-sectional study estimates the association between pemphigus and 4 neurologic conditions using one of the largest cohorts of patients with pemphigus.

http://ift.tt/2EVT03L

Rituximab as Single Long-term Maintenance Therapy in Difficult-to-Treat Pemphigus

This case-series study of 11 patients with severe, difficult-to-treat pemphigus examines whether rituximab alone can be used long-term as maintenance therapy for prevention of relapse.

http://ift.tt/2lOoZrS

Comorbidity Development in Children With Psoriasis

This cohort study examines the risk ocomorbidities in children with and without psoriasis, after accounting for obesity.

http://ift.tt/2Dfuk2O

Rapid Repigmentation of Vitiligo-Affected Skin After Tofacitinib Plus UV-B

This case report describes 2 patients who experienced rapid repigmentation of vitiligo-affected skin after tofacitinib plus low-dose, narrowband UV-B therapy.

http://ift.tt/2E3HC5e

Skin Microbiome and Gene Mutations in Adult Atopic Dermatitis

This case-control study examines skin and nasal microbiome diversity and composition in patients with atopic dermatitis.

http://ift.tt/2mIhjH8

Congenital Syphilis and The Inheritance by Edvard Munch

This Notable Note provides an example of how an artistic work may unexpectedly provide information about the history of a disease.

http://ift.tt/2FJ5tVC

Follicular and Epidermal Cell Suspension for Vitiligo Treatment

This randomized clinical trial compares the effects of combined epidermal cell suspension and follicular cell suspension with those of epidermal cell suspension alone in treatment of vitiligo.

http://ift.tt/2FzFG1L

Sir James Paget—Contributions of a Surgeon and Pathologist

Sir James Paget is remembered as one of the greatest English surgeons and fathers of pathology. After passing the College of Surgeon's Examination in 1836, he struggled to find a job practicing medicine and spent 7 years doing various odd jobs for minimal compensation.

http://ift.tt/2FJ5oBi

Efficacy and Safety of Guselkumab for Palmoplantar Pustulosis

This randomized clinical trial evaluates the safety and efficacy of guselkumab compared with placebo for the treatment of palmoplantar pustulosis.

http://ift.tt/2E9oxeK

March 2018 Issue Highlights

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Opioid Prescribing Patterns and Complications in the Dermatology Medicare Population

This cross-sectional study characterizes the current status and potential complications of opioid prescribing practices among dermatologists for Medicare beneficiaries.

http://ift.tt/2EOm22L

Curious case of a calcified food bolus

Abstract

Authors present an 80-year-old male attending with obstructive food bolus. Lateral soft tissue neck x-ray demonstrated a suspected calcified foreign body at the level of the larynx. Subsequent senior radiological input reported the findings as incidental calcification of carotid arteries. ENT surgeons should demonstrate increased awareness for potentially calcified soft tissues on interpreting such x-rays.

http://ift.tt/2IpRGF3

Cost-effectiveness analysis of salvage therapies in locoregional previously irradiated head and neck cancer

Abstract

Background

The purpose of this study was to present our evaluation of the cost-effectiveness of salvage therapies for patients with recurrent head and neck cancer.

Methods

A Markov model was developed with 5 salvage treatment strategies: (1) platinum-based chemotherapy alone; (2) chemotherapy plus cetuximab; (3) stereotactic body radiotherapy (SBRT) alone; (4) SBRT plus cetuximab; and (5) intensity-modulated radiotherapy (IMRT) plus chemotherapy. Clinical parameters were obtained from comprehensive literature review and 2016 Medicare reimbursement. Strategies were compared using the incremental cost-effectiveness ratio (ICER), with effectiveness in quality-adjusted life years (QALYs), and evaluated with a willingness-to-pay (WTP) threshold of $100 000 per QALY gained.

Results

In the base case analysis, no treatment strategy was cost-effective at a WTP threshold. The most cost-effective therapy was SBRT alone with $150 866 per QALY gained. If median survival of SBRT alone was ≥11 months, SBRT was considered to be cost-effective.

Conclusion

None of the treatment strategies were cost-effective. However, SBRT-based reirradiation has potential to be cost-effective.

http://ift.tt/2tRo4xs

Comprehensive approach to functional palatomaxillary reconstruction using regional and free tissue transfer: Report of reconstructive and prosthodontic outcomes of 140 patients

Abstract

Background

Palatomaxillary defects were historically restored with a prosthetic obturator; however, advances in local and free tissue transfer has provided a viable alternative for appropriately selected patients with palatomaxillary defects.

Methods

A retrospective chart review of patients who underwent palatomaxillary reconstruction by the lead author between 1998 and 2016 was conducted. Patients who were restored with a palatal obturator were excluded.

Results

One hundred forty patients were reconstructed with a total of 159 local, regional, and free flaps with a 96.7% success rate. Seventy-four patients (52.8%) underwent prosthodontic rehabilitation, with 183 implants placed and an 86% success rate.

Conclusion

Palatomaxillary reconstruction applying a systematic approach, using a multitude of techniques, is a safe and effective way to restore patients without compromising the ability to maintain surveillance. Prosthodontic rehabilitation can be achieved in a high percentage of patients using dental implants, leading to optimal aesthetic and functional results.

http://ift.tt/2FUAPvS

Nasopharyngeal biopsy in adults presenting with serous otitis media: Cross-sectional study

Abstract

Background

The purpose of this study was to investigate the association between isolated serous otitis media (SOM) and/or conductive hearing loss (CHL) and nasopharyngeal carcinoma (NPC) in a low-to-intermediate endemic area.

Methods

Medical records of all adult patients (≥17 years) with SOM/CHL who underwent endoscopic-guided nasopharyngeal biopsy to exclude NPC during a 10-year period were reviewed. Statistical analyses were conducted to identify significant predictors for NPC.

Results

A total of 195 patients were included (121/195; 62.1% men), among whom 169 (86.7%) presented with isolated SOM/CHL. Overall, 12 patients were diagnosed with NPC (12/195; 6.2%), however, only 1 patient (1/169; 0.6%) had isolated SOM/CHL. Coexisting clinical manifestations and suspicious nasopharyngeal findings on fiber-optic nasopharyngoscopy were found to be significant predictors for NPC on univariate and multivariate analyses (P < .05).

Conclusion

Patients with isolated SOM/CHL and without coexisting clinical manifestations or suspicious findings on nasopharyngoscopy may avoid a routine nasopharyngeal biopsy.

http://ift.tt/2tO7GNR

Postoperative mechanical bowel obstruction after pharyngolaryngectomy for hypopharyngeal cancer: Retrospective analysis using a Japanese inpatient database

Abstract

Background

Data have been limited on donor-site mechanical bowel obstruction after pharyngolaryngectomy with free jejunum graft reconstruction.

Methods

Using a nationwide Japanese inpatient database, we extracted data on patients who underwent pharyngolaryngectomy for hypopharyngeal cancer between July 2007 and March 2014. A Cox proportional hazard model was used to determine the association between background characteristics and the occurrence of mechanical bowel obstruction.

Results

Among the 3320 eligible patients from 332 hospitals, 108 patients (3.3%) developed mechanical bowel obstruction after a median 88 (interquartile range 26-217) postoperative days. Multivariable Cox regression analysis revealed that older age (≥60 years old) was independently associated with an increased risk of mechanical bowel obstruction, whereas sex, body mass index [BMI], smoking status, comorbidity at admission, blood transfusion, history of surgery, and hospital type were not.

Conclusion

In pharyngolaryngectomy, careful attention should be paid to the risk of abdominal complications and, thus, to the graft choice, especially in elderly patients.

http://ift.tt/2FUAKZ6

Smoking, environmental tobacco smoke and occupational irritants increase the risk of chronic rhinitis

Allergic and non-allergic rhinitis cause a lot of symptoms in everyday life. To decrease the burden more information of the preventable risk factors is needed. We assessed prevalence and risk factors for chron...

http://ift.tt/2HAFnED

Oral Manifestation of Lymphomatoid Granulomatosis

Abstract

Lymphomatoid granulomatosis (LYG) is a rare B-cell lymphoproliferative disorder driven by Esptein–Barr virus (EBV) that most commonly affects the lungs, although extra pulmonary sites like the central nervous system, skin, liver and kidney can also be involved. It is microscopically characterized by an angiocentric and angiodestructive growth pattern, predominantly composed by small T-cells, although a smaller population of atypical large B-cells is considered the true neoplastic component. Oral cavity involvement of LYG has rarely been described and the diagnosis of this neoplasm is very difficult. The aim of this report is to present a rare case of LYG affecting an 86-year-old female patient that was diagnosed due to an extensive, ulcerated and painful oral lesion affecting the hard palate. Detailed microscopic evaluation together with a large immunohistochemical study were necessary to achieve the correct diagnosis of LYG.

http://ift.tt/2GvTEn7

Vasoactive intestinal peptide overexpression mediated by lentivirus attenuates lipopolysaccharide-induced acute lung injury in mice by inhibiting inflammation

Publication date: May 2018
Source:Molecular Immunology, Volume 97
Author(s): Guo-Ying Sun, Hui-Hui Yang, Xin-Xin Guan, Wen-Jing Zhong, Yong-Ping Liu, Ming-Yuan Du, Xiao-Qin Luo, Yong Zhou, Cha-Xiang Guan
Vasoactive intestinal peptide (VIP) is one of the most abundant neuropeptides in the lungs with various biological characters. We have reported that VIP inhibited the expressions of TREM-1 and IL-17A, which are involved in the initiation and amplification of inflammation in acute lung injury (ALI). However, the overall effect of VIP on ALI remains unknown. The aim of this study is to investigate the therapeutic effect of VIP mediated by lentivirus (Lenti-VIP) on lipopolysaccharide (LPS)-induced murine ALI. We found that the expression of intrapulmonary VIP peaked at day7 after the intratracheal injection of Lenti-VIP. Lenti-VIP increased the respiratory rate, lung compliance, and tidal volume, while decreased airway resistance in ALI mice, detected by Buxco system. Lenti-VIP significantly reduced inflammatory cell infiltration and maintained the integrity of the alveolar septa. Lenti-VIP also remarkably decreased the total protein level, the number of neutrophil and lactate dehydrogenase activity in the bronchoalveolar lavage fluid of LPS-induced ALI mice. In addition, Lenti-VIP down-regulated pro-inflammatory tumor necrosis factor (TNF)-α mRNA and protein expression, while up-regulated anti-inflammatory interleukin-10 mRNA and protein expression in lungs of ALI mice. Furthermore, we observed that VIP reduced the TNF-α expression in murine macrophages under LPS stimulation through protein kinase C and protein kinase A pathways. Together, our findings show that in vivo administration of lentivirus expressing VIP exerts a potent therapeutic effect on LPS-induced ALI in mice via inhibiting inflammation.



http://ift.tt/2FWjaUJ

Modulation of autophagy as a strategy for development of new vaccine candidates against tuberculosis

Publication date: May 2018
Source:Molecular Immunology, Volume 97
Author(s): Mario Alberto Flores-Valdez, Cristian Alfredo Segura-Cerda, Jorge Gaona-Bernal
Effective prevention of tuberculosis (Tb) would undoubtedly be of paramount relevance in the control of its global burden, which resulted in more than 6 million new cases in 2016. Research aimed to improve the current vaccine, Bacillus Calmette- Guérin (BCG), or directed to develop new candidates, has taken into account the interaction between the host and Mycobacterium tuberculosis (Mtb). Recently, autophagy, an intracellular process of the host, has been shown to act as a mechanism that contributes to bacilli clearance in vitro and in vivo. Stimulation of autophagy, if correctly balanced, is an approach that has the potential to enhance the immune response of the host, and offers new avenues for developing immunogens that may give an improved protection upon immunization, given that in fact, some recent rBCG vaccine candidates have been shown to modulate autophagy. In this Discussion, we analyze the role of autophagy in the context of mycobacterial infection, its modulation via mycobacterial elements, and the management of host response as an alternative to develop new, hopefully improved, Tb-vaccine candidates.



http://ift.tt/2HAbAvM

Response to Letter in response to Chiang et al. "A Novel Method of Extending Glaucoma Drainage Tube: "Tube-in-Tube" Technique"

Chiang, MY-M; Camuglia, JE; Bouremel, Y; Henein, C; Khaw, PT; (2018) Response to Letter in response to Chiang et al. "A Novel Method of Extending Glaucoma Drainage Tube: "Tube-in-Tube" Technique". Journal of Glaucoma 10.1097/IJG.0000000000000933 . (In press).

http://ift.tt/2pbLIis

Are We Nearly There Yet? Struggling to Understand Young People as Sexual Subjects

Johnson Ross, F; (2013) Are We Nearly There Yet? Struggling to Understand Young People as Sexual Subjects. Graduate Journal of Social Science , 10 (1) pp. 104-123. Green open access

http://ift.tt/2IpI8dn

Prospective observational study to evaluate the performance of the BioSure HIV Self-Test in the hands of lay users

Saunders, J; Brima, N; Orzol, M; Phillips, L; Milinkovic, A; Carpenter, G; Copas, A; Saunders, J; Brima, N; Orzol, M; Phillips, L; Milinkovic, A; Carpenter, G; Copas, A; Gilson, R; - view fewer (2017) Prospective observational study to evaluate the performance of the BioSure HIV Self-Test in the hands of lay users. Sexually Transmitted Infections 10.1136/sextrans-2017-053231 . (In press). Green open access

http://ift.tt/2pbLGHm

Diagnosis of bowel diseases: The role of imaging and ultrasonography

Roccarina, D; (2013) Diagnosis of bowel diseases: The role of imaging and ultrasonography. World Journal of Gastroenterology , 19 (14) pp. 2144-2153. 10.3748/wjg.v19.i14.2144 . Green open access

http://ift.tt/2IoBYdy

Putting the gender back in digital housekeeping

Rode, JA; Shenan Poole, E; (2018) Putting the gender back in digital housekeeping. In: Proceedings of Gender. Knowledge. Informatics. Network for Research Transfer of Interdisciplinary Knowledge regarding Gender and IT (GEWINN) - 2018. ACM Press: Heilbronn, Germany.. (In press). Green open access

http://ift.tt/2pemfoq

Adherence to a Dietary Approaches to Stop Hypertension (DASH)-type diet over the life course and associated vascular function: a study based on the MRC 1946 British birth cohort

Maddock, J; Ziauddeen, N; Ambrosini, GL; Wong, A; Hardy, R; Ray, S; (2018) Adherence to a Dietary Approaches to Stop Hypertension (DASH)-type diet over the life course and associated vascular function: a study based on the MRC 1946 British birth cohort. British Journal of Nutrition , 119 (5) pp. 581-589. 10.1017/S0007114517003877 . Green open access

http://ift.tt/2IsBV0m

Blood-based immune-endocrine biomarkers of treatment response in depression

Chan, MK; Cooper, JD; Bot, M; Birkenhager, TK; Bergink, V; Drexhage, HA; Steiner, J; ... Bahn, S; + view all Chan, MK; Cooper, JD; Bot, M; Birkenhager, TK; Bergink, V; Drexhage, HA; Steiner, J; Rothermundt, M; Penninx, BWJH; Bahn, S; - view fewer (2016) Blood-based immune-endocrine biomarkers of treatment response in depression. Journal of Psychiatric Research , 83 pp. 249-259. 10.1016/j.jpsychires.2016.08.020 . Green open access

http://ift.tt/2peiAHl

Usefulness of contrast enhanced ultrasound in monitoring therapeutic response after hepatocellular carcinoma treatment

Roccarina, D; (2015) Usefulness of contrast enhanced ultrasound in monitoring therapeutic response after hepatocellular carcinoma treatment. World Journal of Hepatology , 7 (14) p. 1866. 10.4254/wjh.v7.i14.1866 . Green open access

http://ift.tt/2ImOY3g

Measurement of quarkonium production in proton–lead and proton–proton collisions at 5.02TeV with the ATLAS detector

Aaboud, M; Aad, G; Abbott, B; Abdallah, J; Abdinov, O; Abeloos, B; Abidi, SH; ... Arabidze, G; + view all Aaboud, M; Aad, G; Abbott, B; Abdallah, J; Abdinov, O; Abeloos, B; Abidi, SH; AbouZeid, OS; Abraham, NL; Abramowicz, H; Abreu, H; Abreu, R; Abulaiti, Y; Acharya, BS; Adachi, S; Adamczyk, L; Adelman, J; Adersberger, M; Adye, T; Affolder, AA; Agatonovic-Jovin, T; Agheorghiesei, C; Aguilar-Saavedra, JA; Ahlen, SP; Ahmadov, F; Aielli, G; Akatsuka, S; Akerstedt, H; Åkesson, TPA; Akimov, AV; Alberghi, GL; Albert, J; Alconada Verzini, MJ; Aleksa, M; Aleksandrov, IN; Alexa, C; Alexander, G; Alexopoulos, T; Alhroob, M; Ali, B; Aliev, M; Alimonti, G; Alison, J; Alkire, SP; Allbrooke, BMM; Allen, BW; Allport, PP; Aloisio, A; Alonso, A; Alonso, F; Alpigiani, C; Alshehri, AA; Alstaty, MI; Alvarez Gonzalez, B; Álvarez Piqueras, D; Alviggi, MG; Amadio, BT; Amaral Coutinho, Y; Amelung, C; Amidei, D; Amor Dos Santos, SP; Amorim, A; Amoroso, S; Amundsen, G; Anastopoulos, C; Ancu, LS; Andari, N; Andeen, T; Anders, CF; Anders, JK; Anderson, KJ; Andreazza, A; Andrei, V; Angelidakis, S; Angelozzi, I; Angerami, A; Anisenkov, AV; Anjos, N; Annovi, A; Antel, C; Antonelli, M; Antonov, A; Antrim, DJ; Anulli, F; Aoki, M; Aperio Bella, L; Arabidze, G; - view fewer (2018) Measurement of quarkonium production in proton–lead and proton–proton collisions at 5.02TeV with the ATLAS detector. The European Physical Journal C , 78 (3) , Article 171. 10.1140/epjc/s10052-018-5624-4 . Green open access

http://ift.tt/2pdsNUk

Probabilistic disease progression modeling to characterize diagnostic uncertainty: Application to staging and prediction in Alzheimer's disease

Lorenzi, M; Filippone, M; Frisoni, GB; Alexander, DC; Ourselin, S; Alzheimer's Disease Neuroimaging Initiative, ; (2017) Probabilistic disease progression modeling to characterize diagnostic uncertainty: Application to staging and prediction in Alzheimer's disease. NeuroImage 10.1016/j.neuroimage.2017.08.059 . (In press).

http://ift.tt/2Ipxt2v

HER-2 Protein Overexpression in Patients with Gastric and Oesophageal Adenocarcinoma at a Tertiary Care Facility in Ghana

The prognosis of gastric and oesophageal adenocarcinoma remains generally poor. However, mounting evidence suggests a positive role of human epidermal growth factor receptor-2 (HER-2) expression in the prognosis of patients with these cancers. In this work, the patterns of HER-2 protein expression were determined in patients with gastric or oesophageal adenocarcinoma. Retrospectively, we reviewed records of gastric and oesophageal biopsies received from 2008 to 2012 and their corresponding archived formalin-fixed paraffin-embedded tissue blocks selected for immunohistochemical analysis. The prevalence of gastric and oesophageal adenocarcinomas and their association with HER-2 protein overexpression were evaluated. Gastric adenocarcinoma made up 18.79% of the gastric biopsies reviewed, and majority of these cancers occurred in males. Regarding the tumour type, HER-2 overexpression was common in the intestinal subtype compared to the diffuse type. Although squamous cell carcinoma was observed to be the commonest (31%) tumour type in the oesophagus compared to adenocarcinoma (8.79%), HER-2 was overexpressed in 42.9% of oesophageal adenocarcinomas, like gastric adenocarcinoma (41.4%). There is a high prevalence of gastric and oesophageal adenocarcinoma, with significant overexpression of HER-2 in these tumours, a window of hope for the management of patients with these cancers.

http://ift.tt/2peywJz

Oral Manifestation of Lymphomatoid Granulomatosis

Abstract

Lymphomatoid granulomatosis (LYG) is a rare B-cell lymphoproliferative disorder driven by Esptein–Barr virus (EBV) that most commonly affects the lungs, although extra pulmonary sites like the central nervous system, skin, liver and kidney can also be involved. It is microscopically characterized by an angiocentric and angiodestructive growth pattern, predominantly composed by small T-cells, although a smaller population of atypical large B-cells is considered the true neoplastic component. Oral cavity involvement of LYG has rarely been described and the diagnosis of this neoplasm is very difficult. The aim of this report is to present a rare case of LYG affecting an 86-year-old female patient that was diagnosed due to an extensive, ulcerated and painful oral lesion affecting the hard palate. Detailed microscopic evaluation together with a large immunohistochemical study were necessary to achieve the correct diagnosis of LYG.

http://ift.tt/2GvTEn7

Neurogenic pulmonary oedema

Description

A 42-year-old healthy woman was found unresponsive with a peripheral oxygen saturation of 80% after having a thunderclap headache. She had copious pink respiratory secretions. Emergency intubation was performed. Cerebral CT showed subarachnoid haemorrhage from a right internal carotid aneurysm. Thoracic CT revealed extensive bilateral patchy consolidations with air bronchograms, mainly in dependent lung areas (figure 1: coronal plane; figure 2: transverse plane). Her PaO₂/FiO₂ ratio was initially 157 mm Hg and improved significantly over 24 hours. These findings were consistent with acute neurogenic pulmonary oedema (ie, interstitial and alveolar fluid) which results from changes in cardiopulmonary physiology caused by extreme sympathetic discharge after an acute neurological insult. Serial echocardiography showed initially impaired left ventricular function that fully recovered over 2 days. Extubation was successful after 30 hours. The clinical course supports the diagnosis of neurogenic pulmonary oedema. After a complicated recovery (due to vasospasms and hydrocephalus),...

http://ift.tt/2DpoieA

Asymmetric proptosis as a presenting symptom of Hashimotos thyroiditis with hypothyroidism

Description

Thyroid ophthalmopathy is usually associated with Graves' disease; however, in 6.2% of patients with thyroid eye disease it can be associated with hypothyroidism.1 A 54-year-old woman from Tamil Nadu presented to our outpatient department with sudden onset of binocular diplopia for the past 5 months. She subsequently noticed that her right eye became more prominent than her left eye. She had no other focal deficits or features of raised intracranial pressure. Along with these ocular symptoms, the patient had fatigue and increased drowsiness over the past 5 months and had gained around 3 kg of weight over the same duration. She however did not complain of constipation, voice changes, pedal swelling, cold intolerance or facial puffiness. She had no features suggestive of hyperthyroidism in the form of tremors, increased sweating, palpitations, hyperdefecation or restlessness. She had no history of hyperthyroidism. She had no history of receiving treatment for hypothyroidism...

http://ift.tt/2pgqalN

Neglected parasitic infection: toxocariasis

Description

A healthy 34-year-old Japanese man presented with a 10-day history of epigastralgia. He had eaten seared chicken sashimi several times. Physical examination findings were not remarkable. Laboratory findings revealed marked eosinophilia (20 x10⁹/L). Chest CT revealed multiple nodules in the lung surrounded by a halo (figure 1). Abdominal contrast-enhanced CT revealed multiple low-attenuating nodules in the liver (figure 2). An ELISA for Toxocara was strongly positive; thus, a diagnosis of toxocariasis was established. After treatment with albendazole, his symptoms and eosinophilia improved, and the pulmonary and liver lesions disappeared.

Figure 1

Chest CT image showing multiple nodules surrounded by a halo.

Figure 2

Contrast-enhanced abdominal CT image showing multiple low-attenuation lesions in the liver.

Toxocariasis is a parasitic disease caused by the larvae of the roundworm Toxocara canis or Toxocara cati. Toxocariasis...

http://ift.tt/2HxIYTZ

Oral Manifestation of Lymphomatoid Granulomatosis

Abstract

Lymphomatoid granulomatosis (LYG) is a rare B-cell lymphoproliferative disorder driven by Esptein–Barr virus (EBV) that most commonly affects the lungs, although extra pulmonary sites like the central nervous system, skin, liver and kidney can also be involved. It is microscopically characterized by an angiocentric and angiodestructive growth pattern, predominantly composed by small T-cells, although a smaller population of atypical large B-cells is considered the true neoplastic component. Oral cavity involvement of LYG has rarely been described and the diagnosis of this neoplasm is very difficult. The aim of this report is to present a rare case of LYG affecting an 86-year-old female patient that was diagnosed due to an extensive, ulcerated and painful oral lesion affecting the hard palate. Detailed microscopic evaluation together with a large immunohistochemical study were necessary to achieve the correct diagnosis of LYG.

http://ift.tt/2GvTEn7

Research in India Finds Mobile Phone ‘Alerts’ Plus ‘Free Minutes’ Improve Childhood Immunization Rates

In a study conducted in rural India, Johns Hopkins Medicine researchers working in collaboration with Bal Umang Drishya Sanstha (BUDS), a nonprofit Indian organization focused on child health, have found that mobile phone reminders linked with incentives such as free talk time minutes work better than phone alerts alone to improve childhood immunization rates in poor communities.

http://ift.tt/2HAIWuN

Asthma-Related Mortality in the United States of America, 1999-2015: A Multiple Causes of Death Analysis

Publication date: Available online 13 March 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Vijay Kodadhala, Jennifer Obi, Priscilla Wessly, Alem Mehari, R.F. Gillum
BackgroundAsthma mortality based on the underlying cause of death (UCOD) underestimates disease burden.ObjectiveTherefore, in this study, asthma mortality in the US 1999-2015 was analyzed, as well as the pattern of reporting of asthma and its co-morbidities in death certificates, using multiple-cause of death (MCOD) records.MethodsAll 156,517 death certificates with any mention of asthma were analyzed for 1999-2015. Asthma was defined by ICD-10 code J45 based either on the UCOD or MCOD. Annual age-adjusted asthma death rates were computed according to age, gender and race/ethnicity. The 6,304 MCOD coded status asthmaticus (J46) were also examined.ResultsIn years of 1999-2015 a total of 59,067 deaths with UCOD of asthma occurred, of which 37,832 were females and 21,235 were males (F/M = 1.78). A total of 156,517 deaths with MCOD of asthma occurred, of which 101,371 were females and 55,146 were males (F/M=1.83). Hence 37.7% of deaths with any mention of asthma had asthma as the UCOD, 37.3% females and 38.45% males. Percents were White Hispanics (HW), 41.7% in non-Hispanic blacks (NHB) and 36% in non-Hispanic whites (NHW). Between 1999-2015, age adjusted MCOD death rates changed as follows: Females HW -38.1%, NHB -34.1%, and NHW -15.1%; Males HW -28.5%, NHB -21.3% and NHW -25.0%. NHB females and males had the highest MCOD and UCOD rates throughout the period.ConclusionAmong deaths with any mention of asthma, asthma was chosen as UCOD most often in NHBM and least often in NHWF. Age-adjusted MCOD rates declined most in NHWM and least in NHWF.



http://ift.tt/2IoZSWj

Aging Ungracefully: Stored Tissue Samples Might Offer Misleading Results for Common Lab Test Over Time

A method currently used by thousands of laboratories across the country to preserve tissue could render samples useless over time for a common test to assess gene activity, a study led by Johns Hopkins researchers suggests. The findings, published in the November 2, 2017 American Journal of Clinical Pathology, could eventually lead to significant changes in how tissues are stored for clinical and research purposes.

http://ift.tt/2tKSQrJ

Promoting Zero-time Exercise in Patients With Coronary Heart Disease

Condition:   Exercise Adherence
Intervention:   Behavioral: Zero-time exercise
Sponsor:   The University of Hong Kong
Recruiting

http://ift.tt/2FUnCmU

Prevalence of Helicobacter pylori among Alaskans: Factors associated with infection and comparison of urea breath test and anti-Helicobacter pylori IgG antibodies

Abstract

Background

Helicobacter pylori is one of the most common human infections in the world, and studies in Alaska Native people, as well as other Indigenous peoples, have shown a high prevalence of this gastric infection. This study was undertaken to determine the prevalence of H. pylori infection by urea breath test (UBT) and anti- H. pylori IgG among Alaskans living in four regions of the state and to identify factors associated with infection.

Methods

A convenience sample of persons > 6 months old living in five rural and one urban Alaskan community were recruited from 1996 to 1997. Participants were asked about factors possibly associated with infection. Sera were collected and tested for anti- H. pylori IgG antibodies; a UBT was administered to participants > 5 years old.

Results

We recruited 710 people of whom 571 (80%) were Alaska Native and 467 (66%) were from rural communities. Rural residents were more likely to be Alaska Native compared with urban residents (P < .001). Of the 710 people, 699 (98%) had a serum sample analyzed, and 634 (97%) persons > 5 years old had a UBT performed. H. pylori prevalence was 69% by UBT and 68% by anti- H. pylori IgG. Among those with a result for both tests, there was 94% concordance. Factors associated with H. pylori positivity were Alaska Native racial status, age ≥ 20 years, rural region of residence, living in a crowded home, and drinking water that was not piped or delivered.

Conclusions

Helicobacter pylori prevalence is high in Alaska, especially in Alaska Native persons and rural residents. Concordance between UBT and serology was also high in this group. Two socioeconomic factors, crowding and drinking water that was not piped or delivered, were found to be associated with H. pylori positivity.

http://ift.tt/2DqTMRv

Beer, hyponatraemia and cardiac conduction defects

The authors report a case of a 68-year-old man who was diagnosed with an irreversible second-degree atrioventricular (AV) Mobitz II 2:1 block temporally associated with profound hyponatraemia. The cause of the hyponatraemia was beer potomania. The co-occurrence of reversible first, second and third-degree heart blocks and hyponatraemia has been described in a few published case reports. However, this case is noteworthy as the AV block persisted, despite correction of serum sodium concentration as opposed to other published cases, which meant that the patient required a permanent pacemaker.

http://ift.tt/2paBgsa

Aspirin: 120 years of innovation. A report from the 2017 Scientific Conference of the International Aspirin Foundation, 14 September 2017, Charité, Berlin

Walker, J; Hutchison, P; Ge, J; Zhao, D; Wang, Y; Rothwell, PM; Gaziano, JM; ... Hawkey, C; + view all Walker, J; Hutchison, P; Ge, J; Zhao, D; Wang, Y; Rothwell, PM; Gaziano, JM; Chan, A; Burn, J; Chia, J; Langley, R; O'Donnell, V; Rocca, B; Hawkey, C; - view fewer (2018) Aspirin: 120 years of innovation. A report from the 2017 Scientific Conference of the International Aspirin Foundation, 14 September 2017, Charité, Berlin. Ecancermedicalscience , 12 , Article 813. 10.3332/ecancer.2018.813 . Green open access

http://ift.tt/2HyDcSg

The Choreography of the Museum Experience: Visitors’ Designs for Learning

Diamantopoulou, S; Christidou, D; (2016) The Choreography of the Museum Experience: Visitors' Designs for Learning. The International Journal of Arts Education , 11 (3) pp. 1-13. 10.18848/2326-9944/CGP/v11i03 . Green open access

http://ift.tt/2FzdLTS

Prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: An individual participant data meta-analysis of 18 HIV prevention studies

Torrone, EA; Morrison, CS; Chen, P-L; Kwok, C; Francis, SC; Hayes, RJ; Looker, KJ; ... STIMA Working Group, ; + view all Torrone, EA; Morrison, CS; Chen, P-L; Kwok, C; Francis, SC; Hayes, RJ; Looker, KJ; McCormack, S; McGrath, N; van de Wijgert, JHHM; Watson-Jones, D; Low, N; Gottlieb, SL; STIMA Working Group, ; - view fewer (2018) Prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: An individual participant data meta-analysis of 18 HIV prevention studies. PLoS Medicine , 15 (2) , Article e1002511. 10.1371/journal.pmed.1002511 . Green open access

http://ift.tt/2HyMRrR

Controlling Photoconductivity in PBI Films by Supramolecular Assembly

Zwijnenburg, MA; Draper, E; Archibald, L; Nolan, M; Schweins, R; Sproules, S; Adams, D; (2018) Controlling Photoconductivity in PBI Films by Supramolecular Assembly. Chemistry - A European Journal 10.1002/chem.201800201 . (In press). Green open access

http://ift.tt/2GpundW

Managing anaerobic digestate from food waste in the urban environment: Evaluating the feasibility from an interdisciplinary perspective

Fuldauer, L; Parker, B; Yaman, R; Borrion, A; (2018) Managing anaerobic digestate from food waste in the urban environment: Evaluating the feasibility from an interdisciplinary perspective. Journal of Cleaner Production 10.1016/j.jclepro.2018.03.045 . (In press).

http://ift.tt/2FHIdHE

Factors associated with delayed linkage to care following HIV diagnosis in the WHO European Region

Croxford, S; Burns, F; Copas, A; Pharris, A; Rinder Stengaard, A; Delpech, V; OptTEST by HIV in Europe, ; (2018) Factors associated with delayed linkage to care following HIV diagnosis in the WHO European Region. HIV Medicine , 19 (S1) pp. 40-46. 10.1111/hiv.12585 .

http://ift.tt/2GrMFLT

Seeing and Being Seen: The Multimodality of the Museum Spectatorship

Christidou, D; Diamantopoulou, S; (2016) Seeing and Being Seen: The Multimodality of the Museum Spectatorship. Museum and Society , 14 (1) pp. 12-32. Green open access

http://ift.tt/2HB3yTM

Review of UK malaria treatment guidelines 2016 (Public Health England Advisory Committee on Malaria Prevention in UK Travellers)

Fitzgerald, FCS; evans, C; Cunnington, A; (2018) Review of UK malaria treatment guidelines 2016 (Public Health England Advisory Committee on Malaria Prevention in UK Travellers). Archives of Disease in Childhood Education and Practice (In press).

http://ift.tt/2GrSI2Y

Immune-related genetic enrichment in frontotemporal dementia: An analysis of genome-wide association studies

Broce, I; Karch, CM; Wen, N; Fan, CC; Wang, Y; Tan, CH; Kouri, N; ... Sugrue, LP; + view all Broce, I; Karch, CM; Wen, N; Fan, CC; Wang, Y; Tan, CH; Kouri, N; Ross, OA; Hoeglinger, GU; Muller, U; Hardy, J; Momeni, P; Hess, CP; Dillon, WP; Miller, ZA; Bonham, LW; Rabinovici, GD; Rosen, HJ; Schellenberg, GD; Franke, A; Karlsen, TH; Veldink, JH; Ferrari, R; Yokoyama, JS; Miller, BL; Andreassen, OA; Dale, AM; Desikan, RS; Sugrue, LP; - view fewer (2018) Immune-related genetic enrichment in frontotemporal dementia: An analysis of genome-wide association studies. PLoS Medicine , 15 (1) , Article e1002487. 10.1371/journal.pmed.1002487 . Green open access

http://ift.tt/2FGTCaJ

Toll-like receptor 4 deficient mice do not develop remifentanil-induced mechanical hyperalgesia: An experimental randomised animal study

BACKGROUND Drugs with antagonistic actions on the Toll-like receptor 4 (Tlr4), such as naloxone at ultra low doses, have been used to inhibit opioid-induced hyperalgesia in rodents suggesting the involvement of this receptor and pathway on opioid-induced hyperalgesia. OBJECTIVE The aim of this study was to determine whether mice without the Tlr4 gene (Tlr4−/−) would not develop remifentanil-induced hyperalgesia. DESIGN An experimental randomised animal study. SETTING Experimental Unit, Complutense University of Madrid, Madrid, Spain. ANIMALS Twelve adult female wild-type mice and 12 adult Tlr4−/− mice. INTERVENTIONS Under sevoflurane anaesthesia, a 1-h, constant rate subcutaneous infusion of remifentanil (4 μg kg−1 min−1) or 0.9% saline. MAIN OUTCOME MEASURES Mechanical nociceptive thresholds were evaluated using a von Frey hair test before (baseline) and on days 5, 6 and 7 after treatment. Hyperalgesia was considered to be a decrease in the mechanical nociceptive threshold. Changes in mechanical nociceptive thresholds in the different groups were compared with one-sided paired t tests. RESULTS Baseline mechanical nociceptive thresholds were similar in all groups (2.2 ± 0.1 g). Remifentanil produced a 24% decrease in mechanical nociceptive thresholds in the wild-type mice (1.7 ± 0.0 g, averaged over 3 days, P = 0.00021), whereas the nociceptive thresholds were not changed in Tlr4−/− mice (2.2 ± 0.1 g, P = 0.857) or in mice receiving 0.9% saline (Tlr4−/−, 2.2 ± 0.1 g, P = 0.807; wild-type, 2.2 ± 0.1 g, P = 0.962). CONCLUSION Tlr4 receptor involvement is suggested in the development of remifentanil-induced hyperalgesia in mice. TRIAL REGISTRATION CEA-UCM 107/2012). Correspondence to Ignacio A. Gómez de Segura, Department of Animal Medicine and Surgery, Veterinary Faculty, Complutense University of Madrid, Avda. Puerta de Hierro, 28040 Madrid, Spain Tel: +34 913 943 858; fax: +34 913 943 808; e-mail: iagsegura@vet.ucm.es © 2018 European Society of Anaesthesiology

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Prediction of bilateral cerebral oxygen desaturations from a single sensor in adult cardiac surgery: A prospective observational study

BACKGROUND Monitoring regional cerebral oxygen saturation (rcSO2) with near-infrared spectroscopy is increasingly being performed in patients scheduled for cardiac surgery. It is sometimes difficult to monitor both frontal lobes due to anatomical or space compromises. However, it remains unclarified whether the use of only one lateral or medial probe can provide adequate bilateral monitoring. OBJECTIVE To evaluate the efficacy of using a single lateral or medial probe to detect substantial desaturations on both sides. DESIGN A prospective observational study. SETTING Tertiary university teaching hospital. PATIENTS Seventeen adult patients undergoing elective cardiac surgery monitored with three near-infrared spectroscopy probes (two lateral and one medial) using an INVOS 5100C monitor. INTERVENTIONS The value of rcSO2 was registered up to 19 times during each procedure. Substantial desaturation was defined as an absolute rcSO2 value of 50% or less or a decrease of more than 20% compared with basal values on spontaneous ventilation with 21% oxygen. MAIN OUTCOME MEASURES The agreement between the three probes using the Bland–Altman method for repeated measures, and the grade of concordant and discordant results between probes by means of contingency tables and the κ coefficient. RESULTS We obtained 244 records per probe. Greater agreement was observed between the two lateral probes (mean of the differences between recordings was -0.9 ± 5.5 points); mean difference between left and medial, and right and medial probes was 2.4 ± 7.3 and 3.3 ± 6.7, respectively. The rate of discordant results between the two lateral probes was 5.7% [κ coefficient of 0.6 [95% confidence interval (95% CI) 0.4 to 0.8)], and between the left and medial, and right and medial of 8.2 and 7.4%, with κ coefficients of 0.57 (95% CI 0.38 to 0.76) and 0.5 (95% CI 0.29 to 0.71), respectively. CONCLUSION In cardiac surgery patients in whom there is difficulty in accommodating two rcSO2 probes, a single lateral probe can effectively measure bilateral rcSO2 in specific scenarios. Correspondence to Manuel de la Matta, Department of Anaesthesia, Hospital General, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot s/n, Sevilla 41013, Spain. E-mail: mdlmattam@hotmail.com © 2018 European Society of Anaesthesiology

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Psychological Characteristics of Chronic Pain: a Review of Current Evidence and Assessment Tools to Enhance Treatment

Abstract

Purpose of Review

The complicated nature of chronic pain involves an interplay between psychological and physical factors, often resulting in increased emotional distress and reduced quality of life. This review is designed to help the medical practitioner who is working with chronic pain patients to be aware of psychological assessment techniques that can add to comprehensive patient understanding and more effectively guide treatment. Enhanced ability to assess and understand the emotional life of the chronic pain patient provides a basis for intervening and treating more successfully.

Recent Findings

There are a broad range of assessment techniques, some of which require a background in psychology and some that do not, that can identify psychological differences in chronic pain patients and serve to guide intervention strategies. Chronic pain is often comorbid with depression, anxiety, catastrophizing, and various ineffective coping strategies. Some patients, however, have demonstrated more adaptive and effective strategies for cognitively and behaviorally coping with pain and normalizing their lives. Proper assessment enables the individualization of treatment to overcome and/or build upon each patient's psychological frame of mind to maximize the potential for effective functioning.

Summary

The use of standardized and documented psychological assessment techniques can lead to a better understanding of chronic pain patients and contribute in ways that can enhance response to medical treatment and improve quality of life. It is recommended that certain psychological tools be included to supplement the medical assessment of patients who have chronic pain. A basic assessment can include a short psychological-based clinical interview along with brief measures of depression, anxiety, and coping strategies. It is also recommended that the pain physician have access to professional psychological practitioners as a resource for more complicated assessments and psychological intervention services.

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Unilateral Vision Loss after a Dental Visit

Intraoral local anesthetics are widely used for performing painless dental treatments; however, in some cases, they may cause ocular complications such as meiosis, diplopia, nystagmus, ophthalmoplegia, ptosis, and amaurosis. Mostly, the symptoms disappear after several hours; rarely, they have a prolonged character. We describe the case of a 38-year-old young man who had reduced vision in the left eye 5 days after having received intraoral local anesthesia. A diagnosis of cilioretinal artery occlusion with optic disc swelling was made. Ten weeks later, the patient's visual acuity had increased to 20/20, and the swelling of the optic disc had subsided. Although various possible mechanisms for ocular complications after intraoral local anesthetic administration were suggested in the literature, the exact etiology remains unclear. In this case, inadvertent intravascular injection is believed to be the cause.
Case Rep Ophthalmol 2018;9:204–209

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Stable Isotope Ecology and Human Palaeodiet in the Northern Coast of Santa Cruz (Argentine Patagonia)

Abstract

The aim of this paper is to provide information on the analysis of stable isotopes obtained from bones of marine and terrestrial fauna used as potential food by hunter-gatherers on the northern coast of Santa Cruz province (Argentine Patagonia). The results from the isotopic ecology are analyzed to contribute to dietary interpretations of the human populations who lived in this area. The mean of terrestrial resources is -19.1 ‰ ± 1.8 ‰ and 9.2 ‰ ± 2.6 ‰ for δ¹³C and δ¹⁵N respectively. Meanwhile, marine resources recorded a mean of δ¹³C -12.5 ‰ ± 1.2 ‰ and δ¹⁵N of 19.4 ‰ ± 2.4 ‰. The analyzed human samples come from different types of burials dated mainly in the Late Holocene. The δ¹³C and δ¹⁵N isotopic values on human remains suggest the existence of different diets during the Late Holocene, including people who consumed mainly marine, terrestrial and mixed proteins, with a range between -18 ‰ to -10.4 ‰ and 12.4 ‰ to 23.4 ‰ for δ¹³C and δ¹⁵N respectively. Some of these isotopic values, which indicate marine diets, are the highest recorded for Patagonia. The influence of the marine spray on the terrestrial trophic chains is suggested for the Patagonian Atlantic coast, evidenced by higher values in the δ¹⁵N of guanacos from the coast in relation to others studied from the hinterland.

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Impact of Mitochondrial Permeability on Endothelial Cell Immunogenicity in Transplantation

ABSTRACTBackgroundMicrovascular endothelial cells (ECs) are central to an allograft's immunogenicity. Cold ischemia and reperfusion injury associated with static cold storage and warm reperfusion activates ECs and increases the immunogenicity of the allograft. Following reperfusion, mitochondrial permeability transition pore (mPTP) opening contributes to mitochondrial dysfunction in the allograft, which correlates to alloimmune rejection. Current understanding of this relationship, however, centers on the whole allograft instead of ECs. This study aimed to elucidate the relationship between EC mPTP opening and their immuno-phenotype.MethodsMitochondrial metabolic fitness and glycolysis in ECs were assessed in parallel with metabolic gene microarray postreperfusion. NIM811 was used to inhibit mPTP opening to rescue mitochondrial fitness. The immunogenicity of NIM811-treated ECs was determined via levels of EC's pro-inflammatory cytokines and allogeneic CD8+ T cell co-cultures. Finally, EC surface expression of adhesion, co-stimulatory, co-inhibitory, MHC-I molecules, and MHC-I machinery protein levels were characterized.ResultsGenes for glycolysis, tricarboxylic acid cycle, fatty acid synthesis, gluconeogenesis were upregulated at 6 hours postreperfusion but either normalized or downregulated at 24 hours postreperfusion. As mitochondrial fitness was reduced, glycolysis increased during the first 6 hours postreperfusion. EC treatment with NIM811 during the early postreperfusion period rescued mitochondrial fitness and reduced EC immunogenicity by decreasing CCL2, KC release, and VCAM-1, MHC-I, TAP1 expression.ConclusionsStatic cold storage and warm reperfusion leads to a reduction in mitochondrial fitness in microvascular ECs due to mPTP opening. Further, mPTP opening promotes increased EC immunogenicity that can be prevented by NIM811 treatment. Background Microvascular endothelial cells (ECs) are central to an allograft's immunogenicity. Cold ischemia and reperfusion injury associated with static cold storage and warm reperfusion activates ECs and increases the immunogenicity of the allograft. Following reperfusion, mitochondrial permeability transition pore (mPTP) opening contributes to mitochondrial dysfunction in the allograft, which correlates to alloimmune rejection. Current understanding of this relationship, however, centers on the whole allograft instead of ECs. This study aimed to elucidate the relationship between EC mPTP opening and their immuno-phenotype. Methods Mitochondrial metabolic fitness and glycolysis in ECs were assessed in parallel with metabolic gene microarray postreperfusion. NIM811 was used to inhibit mPTP opening to rescue mitochondrial fitness. The immunogenicity of NIM811-treated ECs was determined via levels of EC's pro-inflammatory cytokines and allogeneic CD8+ T cell co-cultures. Finally, EC surface expression of adhesion, co-stimulatory, co-inhibitory, MHC-I molecules, and MHC-I machinery protein levels were characterized. Results Genes for glycolysis, tricarboxylic acid cycle, fatty acid synthesis, gluconeogenesis were upregulated at 6 hours postreperfusion but either normalized or downregulated at 24 hours postreperfusion. As mitochondrial fitness was reduced, glycolysis increased during the first 6 hours postreperfusion. EC treatment with NIM811 during the early postreperfusion period rescued mitochondrial fitness and reduced EC immunogenicity by decreasing CCL2, KC release, and VCAM-1, MHC-I, TAP1 expression. Conclusions Static cold storage and warm reperfusion leads to a reduction in mitochondrial fitness in microvascular ECs due to mPTP opening. Further, mPTP opening promotes increased EC immunogenicity that can be prevented by NIM811 treatment. Correspondence information: Satish N. Nadig, MD PhD, FACS, 96 Jonathan Lucas Street, MSC 613, CSB 409, Charleston, SC 29425. nadigsn@musc.edu Authorship statement: D.T. participated in research design, performance of the research, data analysis, and manuscript preparation. C.A., S.N. participated in research design, data analysis, and manuscript preparation. J.K. participated in research design and data analysis. S.M. participated in research design. S.E. participated in performance of the research Disclosure: The authors declare no conflicts of interest. Funding: NIH/NIBIB K08 EB019495-01A1 NIH/NHLBI Predoctoral Fellowship T32 HL007260 NIH/MSTP Predoctoral Fellowship T32 GM008716 NIH/NCATS KL2 TR001452 & UL1 TR001450 Patterson Barclay Memorial Foundation Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Disruption of the Gut Microbiota With Antibiotics Exacerbates Acute Vascular Rejection

ABSTRACTBackgroundThe gut microbiota influences many immunological processes but how its disruption affects transplant rejection is poorly understood.MethodsInterposition grafting of aortic segments was used to examine vascular rejection. The gut microbiota was disrupted in graft recipients using an antibiotic cocktail (ampicillin, vancomycin, metronidazole, neomycin sulfate) in their drinking water.ResultsTreatment of mice with antibiotics severely reduced total bacterial content in the intestine and disrupted the bacterial composition. Short-term treatment of mice for only the first 3 weeks of life resulted in the population of the intestine in mature mice with bacterial communities that were mildly different from untreated mice, containing slightly more Clostridia and less Bacteroides. Antibiotic disruption of the gut microbiota of graft recipients, either for their entire life or only during the first 3 weeks of life, resulted in increased medial injury of allograft arteries that is reflective of acute vascular rejection but did not affect intimal thickening reflective of transplant arteriosclerosis. Exacerbated vascular rejection resulting from disruption of the gut microbiota was related to increased infiltration of allograft arteries by neutrophils.ConclusionDisruption of the gut microbiota early in life results in exacerbation of immune responses that cause acute vascular rejection. Background The gut microbiota influences many immunological processes but how its disruption affects transplant rejection is poorly understood. Methods Interposition grafting of aortic segments was used to examine vascular rejection. The gut microbiota was disrupted in graft recipients using an antibiotic cocktail (ampicillin, vancomycin, metronidazole, neomycin sulfate) in their drinking water. Results Treatment of mice with antibiotics severely reduced total bacterial content in the intestine and disrupted the bacterial composition. Short-term treatment of mice for only the first 3 weeks of life resulted in the population of the intestine in mature mice with bacterial communities that were mildly different from untreated mice, containing slightly more Clostridia and less Bacteroides. Antibiotic disruption of the gut microbiota of graft recipients, either for their entire life or only during the first 3 weeks of life, resulted in increased medial injury of allograft arteries that is reflective of acute vascular rejection but did not affect intimal thickening reflective of transplant arteriosclerosis. Exacerbated vascular rejection resulting from disruption of the gut microbiota was related to increased infiltration of allograft arteries by neutrophils. Conclusion Disruption of the gut microbiota early in life results in exacerbation of immune responses that cause acute vascular rejection. Address correspondence to: Jonathan Choy, PhD, Department of Molecular Biology and Biochemistry, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6. E-mail: jonathan.choy@sfu.ca AUTHOR CONTRIBUTIONS: K.R., T.V., K.B., R.D.M., F.S.L.B and J.C.C designed the experiments; K.R., S.M., W.E., T.V., and K.B. performed the experiments; K.R., S.M., T.V., K.B., R.D.M., F.S.L.B., and J.C.C analyzed and interpreted the data; K.R., T.V., K.B., R.D.M., F.S.L.B., and J.C.C wrote the manuscript. DISCLOSURES: The authors declare no conflicts of interest. FUNDING: This work was supported by funding from the Heart and Stroke Foundation of Canada (J.C.C), Genome Canada and AllerGen NCE (F.S.L.B), and Natural Sciences and Engineering Research Council of Canada (T.V.R). J.C.C and R.D.M are recipients of Michael Smith Foundation for Health Research Scholar awards. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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OVERCOMING COAGULATION DYSREGULATION IN PIG SOLID ORGAN TRANSPLANTATION IN NONHUMAN PRIMATES: RECENT PROGRESS

There has recently been considerable progress in the results of pig organ transplantation in nonhuman primates (NHPs), largely associated with the availability of (i) pigs genetically-engineered to overcome coagulation dysregulation, and (ii) novel immunosuppressive agents. The barriers of thrombotic microangiopathy and/or consumptive coagulation were believed to be associated with (i) activation of the graft vascular endothelial cells (VECs) by a low level of anti-pig antibody binding and/or complement deposition and/or innate immune cell activity, and (ii) molecular incompatibilities between the NHP and pig coagulation-anticoagulation systems. The introduction of a human coagulation-regulatory transgene, eg, thrombomodulin, endothelial protein C receptor, into the pig VECs has contributed to preventing a procoagulant state from developing, resulting in a considerable increase in graft survival. In the heterotopic (non-life-supporting) heart transplant model, graft survival has increased from a maximum of 179 days in 2005 to 945 days. After life-supporting kidney transplantation, survival has been extended from 90 days in 2004 to 499 days. In view of the more complex coagulation dysfunction seen after pig liver and, particularly, lung transplantation, progress has been less dramatic, but the maximum survival of a pig liver has been increased from 7 days in 2010 to 29 days, and of a pig lung from 4 days in 2007 to 9 days. There is a realistic prospect that the transplantation of a kidney or heart, in combination with a conventional immunosuppressive regimen, will enable long-term recipient survival. Address for correspondence: Hayato Iwase MD, PhD, Xenotransplantation Program, University of Alabama at Birmingham (UAB), ZRB 701, 1720 2nd Avenue South, Birmingham, AL 35294-0007, USA. Tel: 205-975-3938; Fax: 205-934-8344. E-mail: hiwase@uabmc.edu Authorship Data were collected by LW, LB, YW, HI, and DKCC. The manuscript was prepared by LW, LB, YW, HI, and DKCC, and revised and approved by all authors. Disclosure The authors declare no conflicts of interest. Funding Work on xenotransplantation at the University of Alabama at Birmingham is supported in part by NIH NIAID U19 grant AI090959. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Initiating maintenance dialysis prior to living kidney donor transplantation when a donor candidate evaluation is well underway

AbstractBackgroundPreemptive kidney transplants result in better outcomes and patient experiences than transplantation after dialysis onset. It is unknown how often a person initiates maintenance dialysis prior to living kidney donor transplantation when their donor candidate evaluation is well underway.MethodsUsing healthcare databases, we retrospectively studied 478 living donor kidney transplants from 2004-2014 across 5 transplant centres in Ontario, Canada where the recipients were not receiving dialysis when their donor's evaluation was well underway. We also explored some factors associated with a higher likelihood of dialysis initiation before transplant.ResultsA total 167/478 (35%) persons with kidney failure initiated dialysis a median 9.7 (25th-75th percentile 5.4-18.7) months after their donor candidate began their evaluation, and received dialysis for a median 8.8 (3.6-16.9) months before kidney transplantation. The total cohort's dialysis cost was $8.1 million and 44/167 (26%) recipients initiated their dialysis urgently in hospital. The median total donor evaluation time (time from evaluation start to donation) was 10.6 (6.4-21.6) months for preemptive transplants and 22.4 (13.1-38.7) months for donors whose recipients started dialysis prior to transplant. Recipients were more likely to start dialysis if their donor was female, nonwhite, lived in a lower-neighbourhood income, and if the transplant centre received the recipient referral later.ConclusionOne-third of persons initiated dialysis prior to receiving their living kidney donor transplant, despite their donor's evaluation being well underway. Future studies should consider whether some of these events can be prevented by addressing inappropriate delays to improve patient outcomes and reduce healthcare costs. Background Preemptive kidney transplants result in better outcomes and patient experiences than transplantation after dialysis onset. It is unknown how often a person initiates maintenance dialysis prior to living kidney donor transplantation when their donor candidate evaluation is well underway. Methods Using healthcare databases, we retrospectively studied 478 living donor kidney transplants from 2004-2014 across 5 transplant centres in Ontario, Canada where the recipients were not receiving dialysis when their donor's evaluation was well underway. We also explored some factors associated with a higher likelihood of dialysis initiation before transplant. Results A total 167/478 (35%) persons with kidney failure initiated dialysis a median 9.7 (25th-75th percentile 5.4-18.7) months after their donor candidate began their evaluation, and received dialysis for a median 8.8 (3.6-16.9) months before kidney transplantation. The total cohort's dialysis cost was $8.1 million and 44/167 (26%) recipients initiated their dialysis urgently in hospital. The median total donor evaluation time (time from evaluation start to donation) was 10.6 (6.4-21.6) months for preemptive transplants and 22.4 (13.1-38.7) months for donors whose recipients started dialysis prior to transplant. Recipients were more likely to start dialysis if their donor was female, nonwhite, lived in a lower-neighbourhood income, and if the transplant centre received the recipient referral later. Conclusion One-third of persons initiated dialysis prior to receiving their living kidney donor transplant, despite their donor's evaluation being well underway. Future studies should consider whether some of these events can be prevented by addressing inappropriate delays to improve patient outcomes and reduce healthcare costs. Corresponding author: Amit X Garg MD, PhD Institute for Clinical Evaluative Sciences Western facility (ICES Western) Victoria Hospital. 800 Commissioners Rd, Victoria Hospital, Room ELL-215. London, Ontario, Canada N6A 5W9 Tel: 519-685-8502. Email: amit.garg@lhsc.on.ca Authorship Participated in research design: Steven Habbous, Eric McArthur, Stephanie N. Dixon, Susan McKenzie, Carlos Garcia-Ochoa, Ngan N. Lam, Krista L. Lentine, Christine Dipchand, Kenneth Litchfield, Mehmet A. Begen, Sisira Sarma, Amit X. Garg Participated in the writing of the paper: Steven Habbous, Eric McArthur, Stephanie N. Dixon, Susan McKenzie, Carlos Garcia-Ochoa, Ngan N. Lam, Krista L. Lentine, Christine Dipchand, Kenneth Litchfield, Mehmet A. Begen, Sisira Sarma, Amit X. Garg Participated in the performance of the research: Steven Habbous, Eric McArthur, Stephanie N. Dixon, Susan McKenzie, Carlos Garcia-Ochoa, Sisira Sarma, Amit X. Garg Contributed new reagents or analytic tools: N/A Participated in data analysis: Steven Habbous, Eric McArthur, Stephanie N. Dixon, Carlos Garcia-Ochoa, Sisira Sarma, Amit X. Garg Disclosures Dr. Garg received partnership funding from Astellas for a research grant funded by the Canadian Institutes of Health Research. The other authors have no conflicts of interest to disclose. Funding Funding for this analysis was provided by Ontario's Trillium Gift of Life Network. Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (CAN-SOLVE CKD) is a patient-orientated research network to transform the care of people affected by kidney disease. It is led by Drs. Adeera Levin and Braden Manns. Patient partnerships in this project were supported by CAN-SOLVE. Steven Habbous is supported by the Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Doctoral Scholarship. Dr. Ngan N. Lam was supported by a Kidney Research Scientist Core Education and National Training Program (KRESCENT) New Investigator Award. Dr. Amit Garg is supported by the Dr. Adam Linton Chair in Kidney Health Analytics, and a Canadian Institutes of Health Research Clinician Investigator Award. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Post Stapedotomy Vestibular Deficit: Is CO 2 Laser Better than Conventional Technique? A Non-randomized Controlled Trial

Abstract

The current standard of care for surgical management of Otosclerosis is small fenestra stapedotomy, which can be done by CO₂ Laser assisted as well as conventional techniques. Vertigo is the commonest complication after stapes surgery. The use of CO₂ Laser has been rising recently owing to its no touch principle, high precision and possibly lower risk of vertigo post operatively. To compare the post-operative vestibular deficit in patients of Otosclerosis having undergone small fenestra stapedotomy by conventional versus CO₂ Laser assisted technique. 80 clinically diagnosed Otosclerosis patients fulfilling the inclusion criteria were enrolled. They underwent small fenestra stapedotomy by either conventional or CO₂ Laser assisted technique. Vestibular function was assessed objectively by measuring sway velocity using modified clinical test of sensory interaction on balance by static posturography. Subjective measurement of balance was done using Vestibular balance subscore of Vertigo Symptom Score (VSS-sf-V). The outcome measures were compared pre-operatively and at first and fourth week post-operatively. All patients had vestibular deficit 1 week post-operatively in the form of increased sway velocity and symptom scores, which reduced by 4 weeks after Stapedotomy. The vestibular deficit in the two groups was similar at 1 week after surgery. 4 weeks after surgery, the sway velocity in conventional group was significantly greater than Laser group though there was no significant difference in the symptom scores. The use of CO₂ Laser for Stapedotomy results in lesser post-operative vestibular deficit as compared to conventional method.

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Protective Effects of Silymarin Against Age-Related Hearing Loss in an Aging Rat Model

Abstract

Age-related hearing loss (ARHL) is one of the most common chronic degenerative disorders. Several studies have indicated that supplementation with some antioxidants can slow down the progression of ARHL. Despite several lines of evidence about the potent antioxidant and anti-aging effects of silymarin, its protective effect against ARHL has not evaluated yet. The aim of the current study was to investigate the effects of silymarin in prevention of ARHL in a d-Galactose-induced aging rat model for the first time. 45 male wistar rats aged 3-month old were divided into 5 groups: group 1, 2 and 3 received 500 mg/kg/day d-Gal plus 100, 200 and 300 mg/kg/day silymarin respectively for 8 weeks, placebo group received 500 mg/kg/day d-Gal plus propylene glycol as placebo, and control group received normal saline during this period of time. Auditory brainstem responses were measured at several frequencies (4, 6, 8, 12 and 16 kHz) before and after the intervention. Placebo group and group 3 showed significant ABR threshold increase across frequencies of 4, 6, 16 kHz compared with the other groups (P < 0.05). However, rats treated with silymarin 100 and 200 mg/kg/day plus d-Gal did not show any significant ABR threshold shifts. Similarly, ABR amplitude of P2 at 4, 8 kHz and P1, P4 at 4 kHz in the placebo group and group 3 were decreased significantly compared with other groups (P < 0.05). However, no significant differences are found in ABR absolute and inter-peak latencies between groups (P > 0.05). The findings indicates that silymarin with doses of 100 and 200 mg/kg/day has protective effect against ARHL and it can be supplemented into the diet of older people to slow down the progression of age-related hearing loss.

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Quantifying tumor-infiltrating immune cells from transcriptomics data

Abstract

By exerting pro- and anti-tumorigenic actions, tumor-infiltrating immune cells can profoundly influence tumor progression, as well as the success of anti-cancer therapies. Therefore, the quantification of tumor-infiltrating immune cells holds the promise to unveil the multi-faceted role of the immune system in human cancers and its involvement in tumor escape mechanisms and response to therapy. Tumor-infiltrating immune cells can be quantified from RNA sequencing data of human tumors using bioinformatics approaches. In this review, we describe state-of-the-art computational methods for the quantification of immune cells from transcriptomics data and discuss the open challenges that must be addressed to accurately quantify immune infiltrates from RNA sequencing data of human bulk tumors.

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The risk of carotid stenosis in head and neck cancer patients after radiation therapy

Publication date: May 2018
Source:Oral Oncology, Volume 80
Author(s): David J. Carpenter, Yvonne M. Mowery, Gloria Broadwater, Anna Rodrigues, Amy J. Wisdom, Jennifer A. Dorth, Pretesh R. Patel, Cynthia K. Shortell, Robert Clough, David M. Brizel
ObjectivesHead and neck radiotherapy (RT) is a risk factor for cerebrovascular disease. We performed a retrospective cohort study to evaluate carotid artery stenosis (CAS) incidence in head and neck cancer (HNC) patients undergoing RT, characterizing associated risk factors.Materials and methodsRecords were retrospectively reviewed for HNC patients undergoing carotid ultrasound screening after definitive or adjuvant RT between January 2000 and May 2016. CAS was defined as ≥50% stenosis on imaging, stroke, or transient ischemic attack. Actuarial CAS rates were calculated by Kaplan-Meier method. Univariate and multivariate analyses predicted CAS risk based on carotid dosimetric and clinical parameters.Results366 patients met inclusion criteria. Median time from RT completion to last follow-up was 4.1 yr. Actuarial risk for CAS was 29% (95% CI 22–36%) at 8 years. Univariate analysis showed that smoking (HR 1.7; 95% CI 1.1–2.7), hyperlipidemia (HR 1.6; 95% CI 1.03–2.6), diabetes (HR 2.8; 95% CI 1.6–4.8), coronary artery disease (HR 2.4; 95% CI 1.4–4.2), and peripheral artery disease (HR 3.6; 95% CI 1.1–11.6) were significantly associated with increased CAS. In multivariate analysis, diabetes was predictive of time to CAS (HR 1.9; 95% CI 1.1–3.4). Carotid dose parameters were not significantly associated with CAS.ConclusionsCAS incidence is high after head and neck radiotherapy, gradually rising over time. No clear dose-response effect between carotid dose and CAS was identified for HNC patients. Carotid artery screening and preventative strategies should be employed in this high-risk patient population.

Graphical abstract

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Beneficial effects of anti-EGFR agents, Cetuximab or Nimotuzumab, in combination with concurrent chemoradiotherapy in advanced nasopharyngeal carcinoma

Publication date: May 2018
Source:Oral Oncology, Volume 80
Author(s): Mei Lin, Rui You, You-Ping Liu, Yi-Nuan Zhang, Hao-Jiong Zhang, Xiong Zou, Qi Yang, Chao-Feng Li, Yi-Jun Hua, Tao Yu, Jing-Yu Cao, Ji-Bin Li, Hao-Yuan Mo, Ling Guo, Ai-Hua Lin, Ying Sun, Chao-Nan Qian, Jun Ma, Hai-Qiang Mai, Ming-Yuan Chen
ObjectiveThis study aimed to evaluate the efficacy and safety in locoregionally advanced nasopharyngeal carcinoma (NPC) patients receiving concurrent chemoradiotherapy (CCRT) plus Cetuximab (CTX) or Nimotuzumab (NTZ) compared to those receiving induction chemotherapy (IC) plus CCRT.Materials and methodsFrom January 2008 to December 2013, 715 eligible patients were enrolled in the study. Using propensity scores to adjust for gender, age, Karnofsky performance status (KPS), tumor stage, node stage, and clinical stage, a well-balanced cohort was created by matching each patient who received CTX/NTZ plus CCRT (137 patients) with two patients who underwent IC plus CCRT (274 patients). The primary endpoint was overall survival (OS), and other outcome variables included disease-free survival (DFS), distant metastasis-free survival (DMFS) and loco-regional relapse-free survival (LRRFS).Results and conclusionThe median follow-up was 57.0 months and 55.0 months for the CTX/NTZ plus CCRT group and IC plus CCRT group, respectively. No significant differences were found between the CTX/NTZ plus CCRT group and the IC plus CCRT group in 3-year OS (95.5% vs. 94.7%, P = 0.083), 3-year DFS (93.3% vs. 86.1%, P = 0.104), 3-year DMFS (96.2% vs. 92.5%, P = 0.243) and 3-year LRRFS (97.0% vs. 95.1%, P = 0.297). Patients undergoing IC plus CCRT suffered from severe hematologic toxicity and diarrhea compared with those treated with CTX/NTZ plus CCRT. The combination of CTX/NTZ with CCRT is comparable to IC plus CCRT treatment in survival outcomes for locoregionally advanced NPC patients but has a better safety profile than IC plus CCRT treatment.



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