FDA Clears Tildrakizumab (Ilumya) for Plaque Psoriasis

Tildrakizumab-asmn, a selective interleukin-23 p19 inhibitor given by subcutaneous injection, was shown to be effective for chronic plaque psoriasis in two phase 3 trials.
FDA Approvals

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Wheat amylase/trypsin inhibitors exacerbate intestinal and airway allergic immune responses in humanized mice

Publication date: Available online 21 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Iris Bellinghausen, Benno Weigmann, Victor Zevallos, Joachim Maxeiner, Sonja Reißig, Ari Waisman, Detlef Schuppan, Joachim Saloga
BackgroundAmylase-trypsin inhibitors (ATIs) in wheat and related cereals are potent activators of myeloid innate immune cells via engagement of TLR4. Furthermore, ATIs have been shown to serve as adjuvants in experimental intestinal inflammatory diseases.ObjectiveThe aim of this study was to analyze whether ATIs are also modifiers of allergic inflammation.MethodsTherefore, CD4⁺ T cells from grass or birch pollen sensitized donors were stimulated with autologous allergen-pulsed dendritic cells in the presence or absence of ATIs or the control storage protein zein from corn. To analyze allergen-induced gut and lung inflammation, immunodeficient mice were engrafted with PBMC from these allergic donors plus the respective allergen, and fed with selected diets. Three weeks later, inflammation was induced by rectal or intranasal allergen challenge and monitored by mini-endoscopy or airway hyperreactivity (AHR), respectively.ResultsAllergen-specific T cell proliferation and cytokine production was significantly exacerbated by ATIs and not by zein. In vivo, allergen-specific human IgE was strongly elevated in sera of mice receiving an ATI-containing diet compared to mice that were fed gluten- and thus ATI-free. Importantly, allergen-induced IgE-dependent colitis and AHR were also enhanced in ATI-fed mice. Gut inflammation was further increased in mice receiving an additional ATI injection and even detectable in the absence of the aeroallergen, while zein had no such effect. Injection of anti-human TLR4 mAbs or the anti-human IgE mAb omalizumab completely abolished ATI-induced allergic inflammation.ConclusionThese results underline that wheat ATIs are important nutritional activators and adjuvants of allergy which might be exploited for nutritional therapeutic strategies.Clinical ImplicationsAllergen-induced IgE-mediated inflammation of the intestine and the lung is exacerbated by ATIs which might be important for future therapies.

Graphical abstract

http://ift.tt/2FYBSri

Wheat amylase/trypsin inhibitors exacerbate intestinal and airway allergic immune responses in humanized mice

Publication date: Available online 21 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Iris Bellinghausen, Benno Weigmann, Victor Zevallos, Joachim Maxeiner, Sonja Reißig, Ari Waisman, Detlef Schuppan, Joachim Saloga
BackgroundAmylase-trypsin inhibitors (ATIs) in wheat and related cereals are potent activators of myeloid innate immune cells via engagement of TLR4. Furthermore, ATIs have been shown to serve as adjuvants in experimental intestinal inflammatory diseases.ObjectiveThe aim of this study was to analyze whether ATIs are also modifiers of allergic inflammation.MethodsTherefore, CD4⁺ T cells from grass or birch pollen sensitized donors were stimulated with autologous allergen-pulsed dendritic cells in the presence or absence of ATIs or the control storage protein zein from corn. To analyze allergen-induced gut and lung inflammation, immunodeficient mice were engrafted with PBMC from these allergic donors plus the respective allergen, and fed with selected diets. Three weeks later, inflammation was induced by rectal or intranasal allergen challenge and monitored by mini-endoscopy or airway hyperreactivity (AHR), respectively.ResultsAllergen-specific T cell proliferation and cytokine production was significantly exacerbated by ATIs and not by zein. In vivo, allergen-specific human IgE was strongly elevated in sera of mice receiving an ATI-containing diet compared to mice that were fed gluten- and thus ATI-free. Importantly, allergen-induced IgE-dependent colitis and AHR were also enhanced in ATI-fed mice. Gut inflammation was further increased in mice receiving an additional ATI injection and even detectable in the absence of the aeroallergen, while zein had no such effect. Injection of anti-human TLR4 mAbs or the anti-human IgE mAb omalizumab completely abolished ATI-induced allergic inflammation.ConclusionThese results underline that wheat ATIs are important nutritional activators and adjuvants of allergy which might be exploited for nutritional therapeutic strategies.Clinical ImplicationsAllergen-induced IgE-mediated inflammation of the intestine and the lung is exacerbated by ATIs which might be important for future therapies.

Graphical abstract

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Evaluation of selective attention in patients with misophonia

Publication date: Available online 21 March 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Fúlvia Eduarda da Silva, Tanit Ganz Sanchez
IntroductionMisophonia is characterized by the aversion to very selective sounds, which evoke a strong emotional reaction. It has been inferred that misophonia, as well as tinnitus, is associated with hyperconnectivity between auditory and limbic systems. Individuals with bothersome tinnitus may have selective attention impairment, but it has not been demonstrated in case of misophonia yet.ObjectiveTo characterize a sample of misophonic subjects and compare it with two control groups, one with tinnitus individuals (without misophonia) and the other with asymptomatic individuals (without misophonia and without tinnitus), regarding the selective attention.MethodsWe evaluated 40 normal-hearing participants: 10 with misophonia, 10 with tinnitus (without misophonia) and 20 without tinnitus and without misophonia. In order to evaluate the selective attention, the dichotic sentence identification test was applied in three situations: firstly, the Brazilian Portuguese test was applied. Then, the same test was applied, combined with two competitive sounds: chewing sound (representing a sound that commonly triggers misophonia), and white noise (representing a common type of tinnitus which causes discomfort to patients).ResultsThe dichotic sentence identification test with chewing sound, showed that the average of correct responses differed between misophonia and without tinnitus and without misophonia (p=0.027) and between misophonia and tinnitus (without misophonia) (p=0.002), in both cases lower in misophonia. Both, the dichotic sentence identification test alone, and with white noise, failed to show differences in the average of correct responses among the three groups (p≥0.452).ConclusionThe misophonia participants presented a lower percentage of correct responses in the dichotic sentence identification test with chewing sound; suggesting that individuals with misophonia may have selective attention impairment when they are exposed to sounds that trigger this condition.



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Vascular Malformations and Health-Related Quality of Life

This systematic review and meta-analysis uses validated health-related quality-of-life instruments to compare the health-related quality of life of patients with vascular malformations with that of the US general population.

http://ift.tt/2ptFJGK

Favre-Racouchot Syndrome Following Long-term Exposure to Infrared Waves

This case report describes a patient with monolateral Favre-Racouchot syndrome following long-term exposure to infrared waves.

http://ift.tt/2pvNV8q

Quality of Life and the Dermatologist

This Editorial discusses factors that affect quality of life in those with vascular malformations, and dermatologists' goal of improving these aspects for patients.

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Urticaria and Episcleritis in a Woman With Chronic Cough

A woman in her 30s presented with a 10-month history of painful pruritic eruption and painful red eyes; the eruption was exacerbated by stress but unrelated to time of day, ambient temperature, or sunlight exposure. She also reported recent worsening of a chronic cough. What is your diagnosis?

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Utility of Baseline Transaminase Monitoring During Systemic Terbinafine Therapy for Pediatric Onychomycosis

To the Editor We applaud the important research findings by Patel et al regarding pediatric onychomycosis. In this study, the authors appropriately conclude that routine laboratory monitoring of children during treatment with terbinafine may be unnecessary, considering (1) the low incidence of clinically significant adverse effects; (2) the costs of laboratory tests; (3) workup of spurious laboratory abnormalities; and (4) patient discomfort.

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Utility of Baseline Transaminase Monitoring During Systemic Terbinafine Therapy for Pediatric Onychomycosis—Reply

In Reply We appreciate the comments of Li and Mostaghimi regarding our study. While we generally agree that baseline monitoring of laboratory values in children prior to systemic therapy for onychomycosis may not be cost-effective or informative in otherwise healthy children, we would like to emphasize that, in our opinion, clinicians should be adherent to medication-use directives and current guidelines for patient safety, which at this time are unambiguous with regard to the recommendation for pretreatment laboratory screening for terbinafine. The package insert, which was last revised in January 2017, states "before prescribing Lamisil Tablets, perform liver function tests because hepatotoxicity may occur in patients with and without preexisting liver disease." Furthermore, the US Food and Drug Administration medication guide for terbinafine, which was last issued in August 2016, states "your doctor should do a blood test to check you for liver problems before you start treatment with LAMISIL Tablets." With these guidelines in place, we currently do not feel comfortable, based on this one study, to advise clinicians to dismiss these recommendations. Importantly, this study does give us the opportunity to open up lines of communication with the US regulatory bodies to consider altering the terbinafine medication guidance specifically for pediatric patients and consider additional studies that would help solidify these data. We want to maintain the highest standard of care and safety for the treatment of pediatric patients while continuing to practice cost-effective and evidence-based medicine.

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Chronic Urticaria Associated With Methylisothiazolinone Type IV Hypersensitivity

This case report describes a patient with chronic urticaria associated with methylisothiazolinone type IV hypersensitivity.

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Techniques of knowing in administration: Co-production, models and conservation

Lee, M; Rydin, Y; Natarajan, L; Lock, S; (2018) Techniques of knowing in administration: Co-production, models and conservation. Journal of Law and Society (In press).

http://ift.tt/2psYbz0

We Need Progress in Ideas about how to achieve Progress

Maxwell, N; (2018) We Need Progress in Ideas about how to achieve Progress. Metascience (In press).

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A study of dysphagia symptoms and esophageal body function in children undergoing anti-reflux surgery

Omari, T; Connor, F; McCall, L; Ferris, L; Ellison, S; Hanson, B; Abu-Assi, R; ... Moore, D; + view all Omari, T; Connor, F; McCall, L; Ferris, L; Ellison, S; Hanson, B; Abu-Assi, R; Khurana, S; Moore, D; - view fewer (2018) A study of dysphagia symptoms and esophageal body function in children undergoing anti-reflux surgery. United European Gastroenterology Journal 10.1177/2050640618764936 . (In press). Green open access

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A computational model to determine the optimal orientation for solar greenhouses located at different latitudes in China

Chen, C; Li, Y; Li, N; Wei, S; Yang, F; Ling, H; Yu, N; Chen, C; Li, Y; Li, N; Wei, S; Yang, F; Ling, H; Yu, N; Han, F; - view fewer (2018) A computational model to determine the optimal orientation for solar greenhouses located at different latitudes in China. Journal of Solar Energy , 165 pp. 19-26. 10.1016/j.solener.2018.02.022 . (In press).

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Treatment, outcomes, and demographics in sinonasal sarcoma: a systematic review of the literature

Sarcomas comprise a diverse group of soft tissue mesenchymal malignancies. The sinuses and nasal region are a relatively rare site of sarcomas.

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Nationwide questionnaire-based survey of oral immunotherapy in Japan

Publication date: Available online 20 March 2018
Source:Allergology International
Author(s): Sakura Sato, Chizuko Sugizaki, Noriyuki Yanagida, Komei Ito, Yusei Ohshima, Naoki Shimojo, Takao Fujisawa, Motohiro Ebisawa
BackgroundClinical trials on oral immunotherapy (OIT) have been increasing for nearly a decade; however, several national guidelines do not recommend OIT as a standardized procedure. The aim of this study was to obtain insights into the current use and practice of OIT in Japan.MethodsA first questionnaire was mailed to 524 training and teaching facilities of the Japan Pediatric Society. The first survey requested information on the implementation of OIT, whereas the second survey aimed to gather more detailed information on OIT, such as its safety.ResultsIn total, 360 facilities (69%) responded to the survey; among them, 102 (28%) provided OIT to 7973 patients [1544 received OIT while hospitalized (inpatient OIT), whereas 6429 received OIT without hospitalization (outpatient OIT)]. Approval for OIT was obtained from an ethics committee or institutional review board in 89% and 31% of facilities for inpatient and outpatient OIT, respectively. In inpatient OIT, immediate allergic reactions requiring treatment occurred in 68% of patients while hospitalized, and in another 56%, following discharge. In contrast, 11% of patients developed immediate allergic reactions in outpatient OIT. Adrenaline injections at home were required in 2%. Sixteen patients developed adverse reactions other than immediate allergic reactions, among which eosinophilic gastroenteritis was most common.ConclusionsOIT is widely provided not only as clinical research but also as general practice in Japan. However, because there is a high risk of developing anaphylaxis at home, OIT should be conducted carefully as in a clinical research setting taking safety into consideration.



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Individuality of masticatory performance and of masticatory muscle temporal parameters

Publication date: Available online 20 March 2018
Source:Archives of Oral Biology
Author(s): Claire D. Tewksbury, Kathryn X. Callaghan, Brent A. Fulks, Geoffrey E. Gerstner
ObjectiveMammalian mastication serves to improve intra-oral food reduction. Insufficient food reduction creates potential swallowing problems, whereas over-reduction may accelerate tooth wear and increase feeding time. Either extreme has consequences. The study's objectives were: (1) to study the relationship between food reduction, number of chews in a sequence, and chewing rate, (2) to study how controlling the number of chews and chewing rate variability affects food reduction, and (3) to assess how dentoskeletal morphological and electromyographical (EMG) characteristics impact food reduction.DesignTwenty-three healthy, fully-dentate adults chewed a standardized test food under three conditions: (1) no control, (2) number of chews controlled, and (3) number of chews and chewing rate controlled. EMG activity was sampled from masseter and temporalis muscles bilaterally. Demographic, occlusal contact area in maximum intercuspation, and cephalometric data were obtained.ResultsIn uncontrolled conditions, food reduction and bout duration varied more than expected across subjects. Subjects with poor reduction under controlled conditions were those with poor reduction under uncontrolled conditions. Only occlusal contact area correlated with chewing performance under uncontrolled conditions. Chewing cycle duration, EMG burst duration, and EMG peak onset latency increased when the number of chews was restricted. EMG amplitude, a surrogate for bite force, increased in tasks controlling the number of chews and chewing rate. Chewing rate variability was difficult to diminish below individual-specific levels.ConclusionsResults: provided evidence that bite force, chewing rate, chewing performance and chewing bout duration reflected individual preferences. Future work will determine whether similar findings occur among other mammals.



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Expression and localization of phosphodiesterase 2A in the submandibular gland of mice

Publication date: Available online 20 March 2018
Source:Archives of Oral Biology
Author(s): Kannika Adthapanyawanich, Hiroki Nakata, Shoichi Iseki
ObjectivesPhosphodiesterases comprise a superfamily of enzymes that hydrolyze and inactivate cyclic AMP (cAMP) and/or cyclic GMP (cGMP), thereby regulating cellular signaling mechanisms. We herein investigated the production of phosphodiesterase 2A (PDE2A) in the mouse submandibular gland.DesignThe expression and localization of the mRNA and protein of PDE2A were examined in the submandibular gland of male and female mice using the reverse transcription-polymerase chain reaction, in situ hybridization, Western blotting, and immunohistochemistry.ResultsAmong the different species of phosphodiesterases examined in the mouse submandibular gland, PDE2A, which hydrolyzes cAMP and cGMP, exhibited a marked sexual difference; it was more abundantly expressed in females. The mRNA and protein signals for PDE2A were intense in all acinar and duct portions, including the striated duct, in females, whereas in males, these signals were markedly weaker in the granular convoluted duct, the counterpart of the female striated duct, than in acini and other duct portions. Furthermore, the signals for protein kinases A and G1, which are intracellular effectors of cAMP and cGMP, respectively, were markedly weaker in the male granular convoluted duct.ConclusionsThese results suggest that cyclic nucleotide-dependent signaling mechanisms function poorly in granular convoluted duct cells in the mouse submandibular gland.



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Editorial Board

Publication date: May 2018
Source:Archives of Oral Biology, Volume 89





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Surface free energy of enamel treated with sodium hexametaphosphate, calcium and phosphate

Publication date: Available online 20 March 2018
Source:Archives of Oral Biology
Author(s): José Guilherme Neves, Marcelle Danelon, Juliano Pelim Pessan, Leonardo Raniel Figueiredo, Emerson Rodrigues Camargo, Alberto Carlos Botazzo Delbem
ObjectiveThis study evaluated the capacity of sodium hexametaphosphate (HMP) at different concentrations to alter the surface properties of dental enamel in order to increase calcium and phosphate adsorption.DesignBovine enamel blocks (4 mm x 4 mm, n = 144, 12/group) were divided: 0%; 0.25%; 0.5%; and 1% HMP, followed or not by application of solutions containing Ca or Ca-PO4, totaling 12 groups. The treatments were performed for 2 min, and the surface free energy (mN/m) was calculated by measuring the contact angles of three probing liquids (deionized water, diiodomethane and ethylene glycol), which was used to determine the polar and nonpolar components of the enamel surface. Calcium (Ca), phosphate (PO4) and HMP in the solutions treatment solutions were analyzed before and after treatment. The data presented normal and homogeneous distribution and then were subjected to ANOVA, followed by Student-Newman Keuls' test (p<0.05).ResultsThe higher the % of HMP in the solutions, the greater HMP adsorption and more electron-donor sites on enamel surface were achieved (p < 0.05). Also, Ca adsorption was higher with increasing % HMP in the solutions (p < 0.05), which in turn reduced electron-donor sites on enamel surface. Increased Ca and PO4 adsorption occurred at 0.5% and 1% HMP after treatment with Ca-PO4 solution, resulting in a less electron-donor sites on surface when compared to the other treatments (P<0.05).ConclusionsHMP leads to a more electron-donor sites on enamel surface, what promotes greater adsorption of Ca and PO4 ions.



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Can too little be as bad as too much?

By Madhava Sai Sivapuram

"Any substance which is taken too much or too little is poisonous to our body whether it is a drug or a diet". These were the exact words told by my pharmacology professor when I was studying pharmacology. I thought yes, if there is excessive use of drugs, it is going to cause adverse drug reactions, whereas too little may not help us recover. With regards to the human diet, too much can cause obesity which is a risk for many diseases, whereas too little will make you undernourished. I never thought that a person's diet could be a cause of a life-threatening situation.

I faced such a situation during my BMJ Case Reports elective period[1] It was a completely new environment for me where hospital experiences a very good outpatient and inpatient flow. It was the 3rd or 4th day of my electives where I was still trying to understand the workflow of the hospital. I came across a middle-aged lady waiting outside the ward for my professor, as he was the attending physician of her father, who was admitted due to sudden fall on the ground, following a decrease in blood pressure. He had been taking medication for diabetes and hypertension for the past 10 years.

My professor had asked me to take the patient history and find out the reason for the fall in the blood pressure, but I could not do that as the patient was discharged on the same day.

It was a 3-week elective and I enjoyed working alongside my professor, who always gave me a new prospect to think about. Two days before my departure from the hospital, I got a chance to meet the patient and the family again; they had come in for a follow-up. This time the patient load in the OPD was not as high. My professor spends a lot of time with patients discussing their history and always tells me the cause of the problem is always in the patient's history. If we could figure this out, we would solve the puzzle, which is the beauty of medicine.

The lady told us that her father was having a problem with his blood pressure and during her recent visit to the family doctor, she was told that he should reduce his salt intake. She misunderstood the instruction to be that he should eat no salt at all, and she started cooking dishes exclusively for him without salt in them and was taking extra care that he was not eating any food that contained salt.

From this, we learned that her misunderstanding had cost them a lot of money and precious time. We explained to them what had gone wrong with the patient and suggested they increase his salt intake to a certain threshold.

This BMJ Case Reports elective experience has led me to remember my pharmacology professor's words practically in a real-life scenario. It also made me understand how important it is to fully inform the patient and their attendants, and also the necessity of checking their understanding.  Any misunderstanding with our health education comes at a huge price for the patients and their attendants.

I acknowledge Professor Rakesh Biswas under whom I did this elective.

References:

1. http://promotions.bmj.com/jnl/bmj-case-reports-student-electives-2/

Competing Interests

None Declared

 

 

 

 

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Migration of a fractured inferior vena cava filter strut to the right ventricle of the heart

Inferior vena cava (IVC) filters are increasingly used in patients with recurrent venous thromboembolism in whom anticoagulation is contraindicated or intolerable. Migration of fragments is a known complication of IVC filter use. We present a case of a 32-year-old man, who presented with right-sided chest pain believed to be caused by a migrated IVC fragment to the right ventricle. The filter was removed by an endovascular cook forceps with the assistance of intracardiac echocardiography. This case serves as an addition to the existing reports of successful removal of intracardiac fragments via minimally invasive endovascular approach, amid a larger number of intracardiac fragments that have been removed by an open-heart approach.

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Sequential retinal necrosis secondary to varicella zoster in unrecognised long-standing HIV infection: patient safety report

A retired woman with left ophthalmic shingles of over 2 years' duration attended with bilateral vision loss and systemic upset. Acute retinal necrosis with detachment was detected on right fundus examination. Cataract in left eye precluded funduscopy. Ocular ultrasonography revealed fibrotic retinal detachment in the left eye. MRI brain and orbits also showed signals of retinal detachment. No abnormal MRI signal within the optic nerve or brain was found. Varicella zoster virus was detected in ocular aqueous and blood samples. High-dose intravenous acyclovir was administered. HIV test was positive with a very low CD4 count. Antiretroviral medications were prescribed. There was no recovery of vision. She was certified as blind, and social services were involved in seeking to provide alterations to her home in view of her severe disability. This case highlights the importance of suspecting HIV in patients with severe or chronic ophthalmic shingles. Images and implications for clinical practice are presented.

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Serpentine thrombus in the heart: a rare case of trapped thrombus in patent foramen ovale

A 77-year-old Caucasian woman with recent abdominal surgery was diagnosed with multiple paradoxical systemic emboli in the mesenteric and renal circulation. Diagnosis was made by direct visualisation of a serpentine thrombus traversing both atria through patent foramen ovale (PFO) by transesophageal echocardiogram (TEE). Concomitantly, the patient was found to have deep venous thrombosis and pulmonary embolism. A decision was made to pursue cardiothoracic surgery preceded by inferior vena cava filter placement. She was started on intravenous anticoagulation. Repeat TEE was negative for thrombus and the patient did not present any new clinical signs of embolisation by this time. Consequently, the treatment plan was modified and the patient received oral systemic anticoagulation followed by PFO closure with the use of St. Jude Amplatzer Cribriform septal occluder device. During the outpatient follow-up the patient was asymptomatic and there was no significant flow through the device on transthoracic echocardiogram.

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Self-harm scar revision

This report discusses in detail the case of a patient who underwent a scar revision procedure to have her characteristic self-harm scars altered. A detailed insight into the patient's perspective was gained through semistructured interviews conducted at 6 weeks and 6 months postoperatively. The interviews found that an equally if not more conspicuous scar that was distinct from those created from self-harm had a pronounced psychological benefit for the patient. This article calls for more active management of the psychological sequelae of self-harm scars, with the need to facilitate access to surgical treatment in certain cases.

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Metastatic primary anorectal melanoma developing in a patient treated for multicentric glioblastoma multiforme: two rare malignancies presenting in synchronicity

Description

A 66-year-old woman presented with complaints of dizziness, headache and forgetfulness, which had been worsening over the last 2 months. General physical examination revealed weakness in the left upper and lower limbs (power 4/5) with spasticity (deep tendon reflexes 3+ on left side). A non-contrast MRI brain revealed a mass lesion involving the right thalamus and another lesion in the right cerebellar peduncle. Both lesions were hyperintense on T2 and hypointense on T1 sequences (figure 1). A stereotactic biopsy from the thalamic lesion revealed glioblastoma multiforme (WHO Grade IV) on histopathological evaluation and immunohistochemistry (Ki67 index: 15%–20%). Due to financial constraints, O(6)-methylguanine-DNA methyltransferase(MGMT) promoter methylation status was not determined.

Figure 1

Pretreatment non-contrast MRI images of multicentric glioma. (A) T1-weighted axial image reveals a hypointense space-occupying lesion in the right thalamus involving the right basal ganglia (red arrow). (B) T1-weighted axial image reveals a hypointense space-occupying lesion in the...

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Renal injury in a patient with lumbar scoliosis

Kidney laceration following blunt trauma is responsible for up to 3% of trauma cases. The risk factors associated with renal injury are attributed to the risks of mechanical injury. However, anatomical variations that may accelerate the insult of injury are poorly documented. This case report describes a 25-year-old with degenerative lumbar scoliosis who presented with flank pain and visible haematuria following a low-impact injury. The patient had a grade IV renal injury. The curvature of the spine, shown on CT imaging, revealed a reduced retroperitoneal space around the left kidney. This case explores lumbar scoliosis as a risk factor for kidney laceration. We hypothesise that this increased risk is associated with asymmetry of the spine and reduced anatomical space in the retroperitoneum. Patients with lumbar scoliosis may be considered a high-risk category for renal injury, following low-impact trauma.

http://ift.tt/2ptYoSC

FAST examination diagnosing bladder rupture following blunt pelvic trauma

Description

A 52-year-old man presented as a level 2 trauma notification after a plywood fell on him from 15 feet. On presentation, he was evaluated according to Advanced Trauma Life Support (ATLS) protocol. Secondary survey was significant for suprapubic tenderness and abrasions to bilateral hips. A focused assessment with sonography in trauma (FAST) examination was performed, showing echogenic fluid filling the bladder (video 1).

Video 1

Focused assessment with sonography in trauma examination performed in the trauma bay showing echogenic fluid filling the bladder.

A Foley catheter was placed, and gross haematuria was noted. X-ray in the trauma bay showed fractures of the left superior and inferior pubic rami (figure 1). Subsequently, a CT cystogram was performed which showed large clot within the bladder with small extraperitoneal extravasation (figure 2). The injury was managed with transurethral Foley and gentle...

http://ift.tt/2FZn8sq

Severe autosomal dominant polycystic kidney disease

Description 

A 61-year-old man with a known history of autosomal dominant polycystic kidney disease (ADPKD) and stage IV chronic kidney disease presented with a 6-month history of abdominal pain, nausea, vomiting and fatigue. In addition to the ADPKD, the right kidney had a 4.4 cm inferior pole mass concerning for renal cell carcinoma (RCC). Preoperative imaging (figure 1), a coronal CT of abdomen and pelvis, demonstrates bilateral ADPKD. His total kidney volume was calculated to be 9980.5 mL, which in combination with his age made him a '1E' (most severe) based on the Mayo Clinic risk stratification schema. The following aggregate of issues led the patient to undergo bilateral open nephrectomies: the suspicion for malignancy associated with the right renal mass, a slight increase in malignancy risk associated with polycystic kidney disease in general, and the likely need for postoperative dialysis if left with only a single poorly...

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Multiple Inhibitory Mechanisms of Lidocaine on Bradykinin Receptor Activity in Model Sensory Neurons

Background and Objectives Local anesthetics (LAs) are often infiltrated subcutaneously for localized perioperative numbing. In addition to blocking nerve conduction, LAs act on pathways used by a variety of pain-inducing and inflammatory mediators. We describe the effects in isolated model sensory neurons of LAs on responses to the algogenic and sensitizing peptide, bradykinin (BK). Methods ND/7 sensory neurons were stimulated by different concentrations of BK in the presence or absence of LAs, with transient increases in intracellular calcium (Δ[Ca+2]in) detected fluorometrically in fields of cells. Equilibrium saturable binding of radiolabeled BK also was conducted on the same type of cells, with and without LA. Results Responses to low BK (5 nM) were inhibited by lidocaine at 1 mM (approximately 35% inhibition) and 10 mM (approximately 70% inhibition), whereas responses to high BK (100 nM) were unaffected by 1 mM yet inhibited (approximately 75%) by 10 mM lidocaine. Bupivacaine (1 and 2 mM) did not reduce peak Δ[Ca+2]in (using 5 nM BK). Lidocaine's quaternary derivative, QX-314 (10 mM), also was ineffective on peak Ca+2 (5 nM BK). Saturation binding of BK showed that lidocaine lowered the binding capacity (Bmax) without changing the KD, consistent with noncompetitive inhibition. Conclusions At subclinical concentrations, lidocaine suppresses BK's activation of model sensory neurons. This effect adds to the known analgesic mechanisms of LAs and likely contributes to the reduction of postincisional pain. Accepted for publication November 1, 2017. Address correspondence to: Gary R. Strichartz, PhD, Pain Research Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, MRB611, 75 Francis St, Boston, MA 02115 (e-mail: gstrichartz@partners.org). Funding for this work was provided in part by the US Public Health Service, National Institutes of Health, from grants NIGMS R01-GM35647 and NIH/NCI R01-CA080153. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

http://ift.tt/2DGIk4p

Anatomical Study of the Innervation of Anterior Knee Joint Capsule: Implication for Image-Guided Intervention

Background and Objectives The knee joint is the most common site of osteoarthritis. While joint replacement is considered an ultimate solution, radiofrequency denervation may be contemplated in some cases. Radiofrequency ablation requires precise localization of the articular branches innervating the joint capsule. The objective of this cadaveric study was to determine the source, course, relationships, and frequency of articular branches innervating the anterior knee joint capsule. Methods Fifteen knees were meticulously dissected. The number and origin of the articular branches were recorded, and their distribution defined by quadrants. Their relationships to anatomical landmarks were identified. Results The articular branches terminated in 1 of the 4 quadrants with minimal overlap. In all specimens, the superolateral quadrant was innervated by the nerve to vastus lateralis, nerve to vastus intermedius, superior lateral genicular and common fibular nerves; inferolateral by the inferior lateral genicular and recurrent fibular nerves; superomedial by the nerve to vastus medialis, nerve to vastus intermedius and superior medial genicular nerve; and inferomedial by the inferior medial genicular nerve. In 3 specimens, the inferomedial quadrant also received innervation from the infrapatellar branch of saphenous nerve. All articular branches except the nerves to vastus lateralis and medialis course at the periosteal level. Conclusions The frequency map of the articular branches provides an anatomical basis for the development of new clinical protocols for knee radiofrequency denervation and perioperative pain management. Accepted for publication January 15, 2018. Address correspondence to: Philip W.H. Peng, MBBS, Department of Anesthesia, University of Toronto, 399 Bathurst St, McL 2-405 Toronto, Ontario, Canada M5T 2S8 (e-mail: philip.peng@uhn.ca). The authors declare no conflict of interest. Funding was provided through Merit Award in Research, Department of Anesthesia, University of Toronto (to P.W.H.P.) and Physicians' Service Incorporated Foundation award (to P.W.H.P. and K.L.). Interim data from this work were presented at the 2017 Annual Meeting of American Association of Clinical Anatomists in Minneapolis, MN, on July 17 to 21, 2017; at the 2017 World Academy of Pain Medicine Ultrasonography Annual Meeting and Workshop in Miami, FL, on January 13 to 15, 2017; and at the 2017 Study in Multidisciplinary Pain Research—International Symposium of Ultrasound in Regional Anesthesia Congress in Florence, Italy, on March 29 to April 1, 2017. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

http://ift.tt/2GQkvdA

Interfascial Plane Blocks: Back to Basics

Ultrasound-guided interfascial plane blocks are a recent development in modern regional anesthesia research and practice and represent a new route of transmission for local anesthetic to various anatomic locations, but much more research is warranted. Before becoming overtaken with enthusiasm for these new techniques, a deeper understanding of fascial tissue anatomy and structure, as well as precise targets for needle placement, is required. Many factors may influence the ultimate spread and quality of resulting interfascial plane blocks, and these must be understood in order to best integrate these techniques into contemporary perioperative pain management protocols. Accepted for publication October 29, 2017. Address correspondence to: Hesham Elsharkawy, MD, MBA, MSc, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Ave, E-31 Cleveland, OH 44195 (e-mail: elsharh@ccf.org). No external funding and no competing interests were declared. H.E. has received unrestricted educational funding from PAJUNK (Norcross, GA) and is consultant for PACIRA (Troy Hills, NJ). A.P. has received honoraria from GE Healthcare, Pittsburgh, PA, for teaching. E.R.M. has received unrestricted educational program funding from Halyard Health (Alpharetta, GA). These companies had no input into any aspect of the present project design or manuscript preparation. Permission to use images was obtained from the Cleveland Clinic Department of Art Photography. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

http://ift.tt/2u7nqMb

Study Finds the Emergency Department Can Play a Key Role in Identifying Undiagnosed HIV Cases in Low Resource Settings

South Africa has the worst epidemic of HIV in the world. According to the Joint United Nations Programme on HIV/AIDS, 19 percent of the global number of people living with HIV are in South Africa. Many people in South Africa and around the globe do not even know they have HIV.

http://ift.tt/2u64Q7n

Transmission of hepatitis E virus with plasma exchange in kidney-transplant recipients: a retrospective cohort study

Background: After observing a case of plasma exchange-mediated HEV infections in a kidney transplant recipient, we investigated the relationship between plasma exchange and HEV infection after kidney transplantation. Methods: A cohort of 263 patients who underwent kidney transplantation from January 1, 2011 through December 31, 2012 was screened for HEV markers, including anti-HEV IgG and IgM antibodies and HEV RNA, on 3 consecutive blood samples: 1 before, 1 a mean (SD) of 9.5 (9) months and 1 a mean (SD) of 18.2 (6.6) months after transplantation, respectively. Transfusional investigation was performed in patients with detectable HEV RNA. We explored the relationships between plasma exchange, posttransplantation transaminase elevation and HEV markers acquisition. Results: Overall, 24 (9.1%) patients had acquired HEV markers on the first posttransplantation sample, including 2 patients with detectable HEV RNA, and 7 (2.3%) patients had long-term persistent HEV markers on the second posttransplantation sample, including 3 patients with detectable HEV RNA without detectable anti-HEV antibodies. Plasma exchange was an independent risk factor for the acquisition of posttransplantation and long-term persistent HEV markers. Pathogen-reduced plasma-borne transmission of HEV was demonstrated. Plasma exchange and long-term persistent HEV markers were risk factors of posttransplantation transaminase elevation. Conclusion: Plasma exchange, including with pathogen-reduced plasma, is a risk factor for posttransplantation HEV infection and transaminase elevation. Screening for HEV RNA should be carried out in kidney transplant recipients treated with plasma exchange. Corresponding author: Vincent Mallet, MD, PhD, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Hépatologie, 27 rue du Faubourg Saint Jacques, 75014 Paris, France; e-mail, vincent.mallet@aphp.fr Role of the funding source The Agence Nationale de la Recherche (ANR) paid for the serological tests. Vincent Mallet is funded by la fondation ARC pour la Recherche sur le Cancer. The Renal Transplant Unit at Necker Hospital belongs to the Fondation Centaure and the Transplantex group, which supports the French network for transplantation research. Conflicts of interest: none Authors Contributions: Conception and design: V. Mallet Analysis and interpretation of the data: V. Mallet, R. Sberro-Soussan, AM Roque-Afonso, L Hauser Drafting of the article: V. Mallet, AM Roque-Afonso, S Pol Critical revision of the article for important intellectual content: V. Mallet, R Sberro-Soussan, AM Roque-Afonso, S Pol Provision of study materials or patients: V Mallet, R Sberro-Soussan, AM Roque-Afonso, A Vallet-Pichard, B Deau, A Portal, ML Chaix, L Hauser, A Beylouné, A Mercadier, J Izopet, C Legendre, S Pol. Final approval of the article: V Mallet, R Sberro-Soussan, AM Roque-Afonso, A Vallet-Pichard, B Deau, A Portal, ML Chaix, L Hauser, A Beylouné, A Mercadier, J Izopet, C Legendre, S Pol Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2G8M3No

Organ Transplantation in the Czech Republic

No abstract available

http://ift.tt/2ptkjbS

Hypothermic Machine Preservation Benefits Deceased Donor Kidneys with Short Cold Ischaemic Times

No abstract available

http://ift.tt/2GebjBY

E-xchange: Hepatitis E and the risk of plasma products for organ transplant recipients

No abstract available

http://ift.tt/2G1yXOv

Facial soft tissue changes after nonsurgical rapid maxillary expansion: a systematic review and meta-analysis

Abstract

Background

The present systematic review and meta-analysis aimed to test the hypothesis that no facial soft tissue changes occur after nonsurgical rapid maxillary expansion (RME), in order to provide a reference for orthodontists.

Methods

PubMed, EMBASE, Cochrane Library, OVID, MEDLINE, CINAHL, Scopus, and ScienceDirect databases were electronically and manually searched up to December 2017, and randomized controlled, clinical controlled trials, cohort studies and retrospective studies where soft tissue changes were measured before and after nonsurgical RME were identified. Study appraisal and synthesis were performed by two reviewers who completed the study selection and quality assessment procedures independently and in duplicate. Data from the involved studies were pooled using Revman 5.3.

Results

A total of 1762 articles were identified after the removal of duplicates. After selection and quality assessment, 15 studies met the inclusion criteria for the systematic review, and 13 articles were ultimately included in the meta-analysis. The quality of the involved studies was relatively moderate. Pre-expansion, postexpansion, and postretention data were pooled. The nasal width, alar base width, and distances from the lower lips to the E line showed significant changes after expansion. Moreover, after retention, the nasal width, mouth width, upper philtrum width, and distance from the lower lip to the E line showed significant increases relative to the baseline values. Limitations of the present study included the moderate quality of the included studies and the fact that the results were based on short-term observations of patients in the growth phase.

Conclusion

Our findings suggest that RME results in a significantly increased nasal width, mouth width, upper philtrum width, and distance from the lower lip to the E line after the retention phase. However, the clinical importance of these findings is questionable.

http://ift.tt/2GNJfDb

How to manage food allergy in nursery or school

Purpose of review The aim of this review is to describe effective management strategies in nursery or school based upon research findings. Recent findings The prevalence of food allergy and number of emergency department visits for food-related anaphylaxis are increasing in children and adolescents. As there is currently no cure, the most effective strategy to decrease allergic reactions is food allergen avoidance. However, allergic reactions are inevitable in both food allergic children as well as in first-time reactors. Misconceptions exist on the safety of products with advisory labels and questions remain on whether school-wide bans decrease the risk of allergic reactions in school. Recent legislation has prompted schools to consider requiring unassigned epinephrine autoinjectors to better manage those who have allergic reactions in nursery or school. Summary A collective effort is required to keep children with food allergies safe at school. Families, healthcare providers, and school personnel should be informed on food allergen avoidance strategies, symptoms consistent with allergic reactions and anaphylaxis, how to respond to allergic reactions, and the impact the diagnosis of food allergy may have on quality of life for affected children and their families. Correspondence to Julie Wang, MD, Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, One Gustave L. Levy Place, Box 1198, New York, NY 10029, USA. Tel: +1 212 241 5548; e-mail: julie.wang@mssm.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2DJn8L4

Nonspecific immunomodulators for recurrent respiratory tract infections, wheezing and asthma in children: a systematic review of mechanistic and clinical evidence

Purpose of review To provide an overview of the mechanistic and clinical evidence for the use of nonspecific immunomodulators in paediatric respiratory tract infection (RTI) and wheezing/asthma prophylaxis. Recent findings Nonspecific immunomodulators have a long history of empirical use for the prevention of RTIs in vulnerable populations, such as children. The past decade has seen an increase in both the number and quality of studies providing mechanistic and clinical evidence for the prophylactic potential of nonspecific immunomodulators against both respiratory infections and wheezing/asthma in the paediatric population. Orally administered immunomodulators result in the mounting of innate and adaptive immune responses to infection in the respiratory mucosa and anti-inflammatory effects in proinflammatory environments. Clinical data reflect these mechanistic effects in reductions in the recurrence of respiratory infections and wheezing events in high-risk paediatric populations. A new generation of clinical studies is currently underway with the power to position the nonspecific bacterial lysate immunomodulator OM-85 as a potential antiasthma prophylactic. Summary An established mechanistic and clinical role for prophylaxis against paediatric respiratory infections by nonspecific immunomodulators exists. Clinical trials underway promise to provide high-quality data to establish whether a similar role exists in wheezing/asthma prevention. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/OBJ4xP Correspondence to Dr Wojciech Feleszko, Department of Pediatric Respiratory Diseases and Allergy, ul. Zwirki i Wigury 63A, 02-091 Warsaw, Poland. Tel: +48 317 94 19; e-mail: wojciech.feleszko@kliniczny.pl Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-allergy.com). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2FQd5tJ

Endotypes in allergic diseases

Purpose of review The precision medicine concept is both appealing and challenging. We review here the recent findings in the endotype-driven approach for major allergic diseases. Recent findings Stratified medicine for different allergic diseases can identify patients who are more likely to benefit or experience an adverse reaction in response to a given therapy and anticipate their long-term outcome and vital risk. In addition, this approach potentially facilitates drug development and prevention strategies. Summary The endotype-driven approach in allergic diseases has tremendous potential, but there are notable barriers in reaching the new world of precision medicine. Multidimensional endotyping integrating visible properties with multiple biomarkers is recommended for both type 2 and nontype 2 allergic diseases to provide evidence that a certain pathway is the key driver for a given patient. Significant healthcare system changes are required to achieve the expected targets. Correspondence to Ioana Agache, Faculty of Medicine, Transylvania University, Theramed Healthcare, Pictor Ion Andreescu 2A, 50051, Brasov, Romania. Tel: +40 728 878386; e-mail: ibrumaru@unitbv.ro Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2HPQ5Hz

Food allergy trends at the crossing among socio-economics, history and geography

Purpose of review The epidemiology of food allergy did inspire theories on the reasons for the recent surge of the disease. We offer here a reasoned review on the relationships between the trajectories of human development and the trend of the food allergy epidemics. Recent findings The exponential trend of the frequency of food allergy paralleled the explosive acceleration of the human development over the last few decades. Dietary factors have been indicated as responsible for these trends and targeted for potential preventive strategies. Other socio-economic factors have been related to this evolution: solar exposure, climate changes, structure of societies, reproductive choices and societal inequalities. Summary The epidemiologic associations of food allergy suggest different causal theories. Future prevention strategies may be predicated not only on dietary interventions, but on wider programmes aimed to restore a human ecology promoting food tolerance. Correspondence to Alessandro Fiocchi, MD, Director of Allergy, Pediatric Hospital Bambino Gesù, Piazza di Sant'Onofrio 4, Rome 00100, Vatican City, Italy. Tel: +39 046 6859 4777; fax: +39 046 6859 2020; e-mail: allerg@tin.it Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2pt7M8w

Precision medicine in the area of work-related asthma

No abstract available

http://ift.tt/2ICn4k1

Management of irreducible unilateral facet joint dislocations in subaxial cervical spine: two case reports and a review of the literature

Skeletal and soft tissue damage are often associated with unilateral facet dislocations, which undoubtedly lead to instability of the spine and further increase difficulties in cervical reduction. This type of...

http://ift.tt/2GNWfc3

Treatment, outcomes, and demographics in sinonasal sarcoma: a systematic review of the literature

Abstract

Background

Sarcomas comprise a diverse group of soft tissue mesenchymal malignancies. The sinuses and nasal region are a relatively rare site of sarcomas.

Methods

Retrospective review of the literature on sinonasal sarcomas from 1987-2017. Data were analyzed for demographics, treatment type, stage, and histopathologic type. Kaplan-Meier analysis was used to assess and compare survival.

Results

A total of 198 cases of sinonasal sarcoma were identified and analyzed. The median age at diagnosis was 39 years. Overall 5-, 10-, and 20-year survival was 61.3%, 58.9%, and 49.1%, respectively, and disease-free 5-, 10-, and 20-year survival was 53.2%, 49.1%, and 38.3%, respectively. Lymph node metastasis was present at diagnosis in 3.0% of cases, and distant metastasis was present in 3.5% of cases. On univariate analysis T stage, overall stage, treatment type, histopathologic subtype, and presence of distant metastasis significantly affected survival. On multivariate analysis overall stage alone significantly predicted overall survival. Open vs. endoscopic surgery, total radiation dose, and presence of neck metastasis did not significantly affect survival. Combined modality treatment was associated with higher survival rates than single modality therapy.

Conclusions

Sinonasal sarcoma is a relatively rare malignancy. Lower T and overall stage, lack of distant metastasis, and multimodality therapy were associated with improved survival. Certain histopathologic subtypes were associated with poorer survival.

http://ift.tt/2HRSXUk

Agent-Specific Learning Signals for Self-Other Distinction During Mentalising

Ereira, SPA; Dolan, R; Kurth-Nelson, Z; (2018) Agent-Specific Learning Signals for Self-Other Distinction During Mentalising. PLoS Biology (In press).

http://ift.tt/2IFotGv

Transformative Agroecology: Foundations in agri-cultural practice, agrarian social thought and sociological theory

Woodgate, GR; Sevilla Guzman, E; (2015) Transformative Agroecology: Foundations in agri-cultural practice, agrarian social thought and sociological theory. In: Mendez, E and Bacon, C and Cohen, R and Gliessman, SR, (eds.) Agroecology: A Transdisciplinary, Participatory and Action-oriented Approach. (pp. 37-54). CRC Press: Boca Raton, FL, USA.

http://ift.tt/2pxOY8b

Response to letter commenting on published paper: Adding abiraterone to androgen deprivation therapy in men with metastatic hormone-sensitive prostate cancer: A systematic review and meta-analysis

Rydzewska, LHM; Burdett, S; Vale, CL; Parmar, MKB; Tierney, JF; (2018) Response to letter commenting on published paper: Adding abiraterone to androgen deprivation therapy in men with metastatic hormone-sensitive prostate cancer: A systematic review and meta-analysis. European Journal of Cancer 10.1016/j.ejca.2018.02.002 . (In press).

http://ift.tt/2IGrZQW

Insular Celtic population structure and genomic footprints of migration

Byrne, RP; Martiniano, R; Cassidy, LM; Carrigan, M; Hellenthal, G; Hardiman, O; Bradley, DG; Byrne, RP; Martiniano, R; Cassidy, LM; Carrigan, M; Hellenthal, G; Hardiman, O; Bradley, DG; McLaughli, RL; - view fewer (2018) Insular Celtic population structure and genomic footprints of migration. PLoS Genetics , 14 (1) , Article e1007152. 10.1371/journal.pgen.1007152 . Green open access

http://ift.tt/2FXFgCP

The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science.

Holmes, EA; Ghaderi, A; Harmer, CJ; Ramchandani, PG; Cuijpers, P; Morrison, AP; Roiser, JP; ... Craske, MG; + view all Holmes, EA; Ghaderi, A; Harmer, CJ; Ramchandani, PG; Cuijpers, P; Morrison, AP; Roiser, JP; Bockting, CLH; O'Connor, RC; Shafran, R; Moulds, ML; Craske, MG; - view fewer (2018) The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science. Lancet Psychiatry , 5 (3) pp. 237-286. 10.1016/S2215-0366(17)30513-8 .

http://ift.tt/2IDWDu6

Wellness interventions for anesthesiologists

Purpose of review The review examines the different preventive measures that have been found to be useful to abolish or decrease the negative effects of burnout and increase resilience in anesthesiologists. Recent findings Studies in anesthesiology cite autonomy, control of the work environment, professional relationships, leadership, and organizational justice as the most important factors in job satisfaction. Factors such as difficulty in balancing personal and professional life, poor attention to wellness, work alcoholism, and genetic factors increase an individual's susceptibility to burnout. Exposure to chronic or repeated stress instigates a spectrum of autonomic, endocrine, immunologic, and behavioral responses that activate the sympathetic-adrenal-medullary and hypothalamic-pituitary-adrenal axis. Investigating the difference in psychobiologic reactivity, as well as defining the psychological symptoms that are characteristic to individuals vulnerable to stress-induced illness, would enable scientists to better look into the modalities to eradicate the negative effects. Recent studies have shown that a combination of individual and structural changes in institutions can increase resilience in physicians. Summary Burnout is a pathological syndrome that is triggered by constant levels of high stress. A combination of individual efforts as well as structural interventions can help to increase wellbeing in physicians. Correspondence to Haleh Saadat, MD, FAAP, Clinical Associate Professor, Department of Anesthesiology, Frank H Netter, MD, School of Medicine, Quinnipiac University, 70 Bassett Rd, North Haven, CT 06473, USA. E-mail: Hsaadat@Quinnipiac.edu, Haleh.saadat@gmail.com Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2FPF2lo

Protective ventilation during anaesthesia reduces major postoperative complications after lung cancer surgery: A double-blind randomised controlled trial

BACKGROUND Thoracic surgery for lung resection is associated with a high incidence of postoperative pulmonary complications. Controlled ventilation with a large tidal volume has been documented to be a risk factor for postoperative respiratory complications after major abdominal surgery, whereas the use of low tidal volumes and positive end-expiratory pressure (PEEP) has a protective effect. OBJECTIVE To evaluate the effects of ventilation with low tidal volume and PEEP on major complications after thoracic surgery. DESIGN A prospective, double-blind, randomised controlled study. SETTING A multicentre trial from December 2008 to October 2011. PATIENTS A total of 346 patients undergoing lobectomy or pneumonectomy for lung cancer. MAIN OUTCOME MEASURES The primary outcome was the occurrence of major postoperative complications (pneumonia, acute lung injury, acute respiratory distress syndrome, pulmonary embolism, shock, myocardial infarction or death) within 30 days after surgery. INTERVENTIONS Patients were randomly assigned to receive either lung-protective ventilation (LPV group) [tidal volume 5 ml kg−1 ideal body weight + PEEP between 5 and 8 cmH2O] or nonprotective ventilation (control group) (tidal volume 10 ml kg−1 ideal body weight without PEEP) during anaesthesia. RESULTS The trial was stopped prematurely because of an insufficient inclusion rate. Major postoperative complications occurred in 23/172 patients in the LPV group (13.4%) vs. 38/171 (22.2%) in the control group (odds ratio 0.54, 95% confidence interval, 0.31 to 0.95, P = 0.03). The incidence of other complications (supraventricular cardiac arrhythmia, bronchial obstruction, pulmonary atelectasis, hypercapnia, bronchial fistula and persistent air leak) was also lower in the LPV group (37.2 vs. 49.4%, odds ratio 0.60, 95% confidence interval, 0.39 to 0.92, P = 0.02).The duration of hospital stay was shorter in the LPV group, 11 [interquartile range, 9 to 15] days vs. 12 [9 to 16] days, P = 0.048. CONCLUSION Compared with high tidal volume and no PEEP, LPV combining low tidal volume and PEEP during anaesthesia for lung cancer surgery seems to improve postoperative outcomes. TRIALS REGISTRATION ClinicalTrials.gov number: NCT00805077. Correspondence to Dr Emmanuel Marret, MD, PhD, Department of Anaesthesia and Intensive Care Medicine, American Hospital of Paris, 63 Bd Victor Hugo, Neuilly-sur-Seine, Paris, France E-mail: drmarret@gmail.com © 2018 European Society of Anaesthesiology

http://ift.tt/2FXrAI4

Hypogammaglobulinemia Observed One Year after Rituximab Treatment for Idiopathic Thrombocytopenic Purpura

We present the case of a 19-year-old female with severe hypogammaglobulinemia after having had treatment with rituximab for idiopathic thrombocytopenic purpura requiring intravenous immunoglobulins. She was admitted with the diagnosis of left-sided pneumonia with parapneumonic effusion. The patient was treated with piperacillin/tazobactam after having a poor response to co-amoxiclav. The patient had been tested for immunoglobulin levels, and the levels were very low. She has a history of ITP for which she received steroids. She also received rituximab for the same on four separate occasions, and the last one was about 1 year ago.

http://ift.tt/2GcWRtV

Congenital Aural Atresia prevalence in the Argentinian population

Publication date: Available online 20 March 2018
Source:Acta Otorrinolaringológica Española
Author(s): Mario Emilio Zernotti, Carlos A. Curet, Susana Cortasa, Mario Chiaraviglio, Maria Fernanda Di Gregorio
IntroductionCongenital Aural Atresia (CAA) or microtia is a malformation that results in esthetic and functional problems. There is little information on prevalence, considering that Latin American is the most affected region in the world.ObjectiveTo determine the prevalence of microtia, considering the different ethnical structure of the population.MethodsA retrospective analysis was performed of the clinical reports of newborn infants (public hospitals) in three different regions.ResultsThe incidence of CAA in Argentina was 1 case per 7500 new births (i.e. 1.3/10,000). Marked differences were found per geographical area. The means were calculated per year by bilateral parametric estimation, according to the ethnical origins of the population. In the Caucasoid area: 02.47/10,000 (±1.2), in the Mestizo area: 03.99/10,000 (±0.0) and finally in the Amerindian area: 20.93/10,000 (±0.1).ConclusionThis study shows different incidences according to the demographic features of the population from 1.90/10,000 to 20.9/10,000. This data indicates that CAA is associated with a genetic problem (ethnic differences).



http://ift.tt/2FN2cZo

How to manage food allergy in nursery or school

Purpose of review The aim of this review is to describe effective management strategies in nursery or school based upon research findings. Recent findings The prevalence of food allergy and number of emergency department visits for food-related anaphylaxis are increasing in children and adolescents. As there is currently no cure, the most effective strategy to decrease allergic reactions is food allergen avoidance. However, allergic reactions are inevitable in both food allergic children as well as in first-time reactors. Misconceptions exist on the safety of products with advisory labels and questions remain on whether school-wide bans decrease the risk of allergic reactions in school. Recent legislation has prompted schools to consider requiring unassigned epinephrine autoinjectors to better manage those who have allergic reactions in nursery or school. Summary A collective effort is required to keep children with food allergies safe at school. Families, healthcare providers, and school personnel should be informed on food allergen avoidance strategies, symptoms consistent with allergic reactions and anaphylaxis, how to respond to allergic reactions, and the impact the diagnosis of food allergy may have on quality of life for affected children and their families. Correspondence to Julie Wang, MD, Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, One Gustave L. Levy Place, Box 1198, New York, NY 10029, USA. Tel: +1 212 241 5548; e-mail: julie.wang@mssm.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2DJn8L4

Nonspecific immunomodulators for recurrent respiratory tract infections, wheezing and asthma in children: a systematic review of mechanistic and clinical evidence

Purpose of review To provide an overview of the mechanistic and clinical evidence for the use of nonspecific immunomodulators in paediatric respiratory tract infection (RTI) and wheezing/asthma prophylaxis. Recent findings Nonspecific immunomodulators have a long history of empirical use for the prevention of RTIs in vulnerable populations, such as children. The past decade has seen an increase in both the number and quality of studies providing mechanistic and clinical evidence for the prophylactic potential of nonspecific immunomodulators against both respiratory infections and wheezing/asthma in the paediatric population. Orally administered immunomodulators result in the mounting of innate and adaptive immune responses to infection in the respiratory mucosa and anti-inflammatory effects in proinflammatory environments. Clinical data reflect these mechanistic effects in reductions in the recurrence of respiratory infections and wheezing events in high-risk paediatric populations. A new generation of clinical studies is currently underway with the power to position the nonspecific bacterial lysate immunomodulator OM-85 as a potential antiasthma prophylactic. Summary An established mechanistic and clinical role for prophylaxis against paediatric respiratory infections by nonspecific immunomodulators exists. Clinical trials underway promise to provide high-quality data to establish whether a similar role exists in wheezing/asthma prevention. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/OBJ4xP Correspondence to Dr Wojciech Feleszko, Department of Pediatric Respiratory Diseases and Allergy, ul. Zwirki i Wigury 63A, 02-091 Warsaw, Poland. Tel: +48 317 94 19; e-mail: wojciech.feleszko@kliniczny.pl Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-allergy.com). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2FQd5tJ

Endotypes in allergic diseases

Purpose of review The precision medicine concept is both appealing and challenging. We review here the recent findings in the endotype-driven approach for major allergic diseases. Recent findings Stratified medicine for different allergic diseases can identify patients who are more likely to benefit or experience an adverse reaction in response to a given therapy and anticipate their long-term outcome and vital risk. In addition, this approach potentially facilitates drug development and prevention strategies. Summary The endotype-driven approach in allergic diseases has tremendous potential, but there are notable barriers in reaching the new world of precision medicine. Multidimensional endotyping integrating visible properties with multiple biomarkers is recommended for both type 2 and nontype 2 allergic diseases to provide evidence that a certain pathway is the key driver for a given patient. Significant healthcare system changes are required to achieve the expected targets. Correspondence to Ioana Agache, Faculty of Medicine, Transylvania University, Theramed Healthcare, Pictor Ion Andreescu 2A, 50051, Brasov, Romania. Tel: +40 728 878386; e-mail: ibrumaru@unitbv.ro Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2HPQ5Hz

Food allergy trends at the crossing among socio-economics, history and geography

Purpose of review The epidemiology of food allergy did inspire theories on the reasons for the recent surge of the disease. We offer here a reasoned review on the relationships between the trajectories of human development and the trend of the food allergy epidemics. Recent findings The exponential trend of the frequency of food allergy paralleled the explosive acceleration of the human development over the last few decades. Dietary factors have been indicated as responsible for these trends and targeted for potential preventive strategies. Other socio-economic factors have been related to this evolution: solar exposure, climate changes, structure of societies, reproductive choices and societal inequalities. Summary The epidemiologic associations of food allergy suggest different causal theories. Future prevention strategies may be predicated not only on dietary interventions, but on wider programmes aimed to restore a human ecology promoting food tolerance. Correspondence to Alessandro Fiocchi, MD, Director of Allergy, Pediatric Hospital Bambino Gesù, Piazza di Sant'Onofrio 4, Rome 00100, Vatican City, Italy. Tel: +39 046 6859 4777; fax: +39 046 6859 2020; e-mail: allerg@tin.it Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2pt7M8w

Precision medicine in the area of work-related asthma

No abstract available

http://ift.tt/2ICn4k1

SJL-1, a C-type lectin, acts as a surface defense molecule in Japanese sea cucumber, Apostichopus japonicus

Publication date: May 2018
Source:Molecular Immunology, Volume 97
Author(s): Keisuke Ono, Takuya Alan Suzuki, Youichi Toyoshima, Tomoya Suzuki, Shigeyuki Tsutsui, Tomoyuki Odaka, Toshiaki Miyadai, Osamu Nakamura
The surface defense molecules of aquatic invertebrates against infectious microorganisms have remained largely unexplored. In the present study, hemagglutinins were isolated from an extract of body surface layer of Japanese sea cucumber, Apostichopus japonicus, by affinity chromatography with fixed rabbit erythrocyte membranes. The N-terminal sequence of a 15-kDa agglutinin was almost identical with that of SJL-1, a C-type lectin formerly identified in this species. Because cDNA sequence and tissue distribution of SJL-1 have not been reported, we performed cDNA sequencing, gene expression analysis, and western blotting and immunohistochemical evaluation with anti-recombinant SJL-1 (rSJL-1) antibodies. The hemagglutinin gene was transcribed mainly in the integument, tentacles, and respiratory tree. Western blotting revealed that SJL-I is present in a body surface rinse, indicating that SJL-1 is secreted onto the body surface. SJL-1-positive cells scattered beneath the outermost layer of the integument were detected by immunohistochemistry. Furthermore, rSJL-1 agglutinated Gram-positive and Gram-negative bacteria, and yeast. These results indicate that SJL-1 acts as a surface defense molecule in A. japonicus.



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Relative antibacterial functions of complement and NETs: NETs trap and complement effectively kills bacteria

Publication date: May 2018
Source:Molecular Immunology, Volume 97
Author(s): Louiza Azzouz, Ahmed Cherry, Magdalena Riedl, Meraj Khan, Fred G. Pluthero, Walter H.A. Kahr, Nades Palaniyar, Christoph Licht
Neutrophil extracellular traps (NETs) are web-like DNA structures released by activated neutrophils. These structures are decorated with antimicrobial proteins, and considered to trap and kill bacteria extracellularly. However, the exact functions of NETs remain elusive, and contradictory observations have been made with NETs functioning as an antimicrobial or a pathogentrapping mechanism. There is a disconnect in the interpretation of the involvement of other major immune mechanisms, such as the complement system, as effectors of the function of NETs. We have recently shown that NETs activate complement.In this study, we aimed to elucidate the relative antimicrobial roles of NETs in the absence and presence of complement. Using primary human neutrophils, human serum (normal, heat inactivated, and C5-depleted), P. aeruginosa (at multiplicity of infection, MOI, of 1 or 10), S. aureus (MOI of 1), colony-counting assays and confocal microscopy, we demonstrate that most bacteria trapped by NETs remain viable, indicating that NETs have limited bactericidal properties. By contrast, complement effectively killed bacteria, but NETs decreased the bactericidal ability of complement and degrading NETs by DNases restored complement-mediated killing. Experiments with conditions allowing for specific pathway activation showed that the complement classical and lectin, but not the alternative, pathway lead to bacterial killing. NETs under static conditions showed limited killing of bacteria while NETs under dynamic conditions showed enhanced bacteria trapping and reduced killing. Furthermore, NETs incubated with normal human serum depleted complement and reduced the hemolytic capacity of the serum.This report, for the first time, clarifies the relative bactericidal contributions of NETs and complement. We propose that – while NETs can ensnare bacteria such as P. aeruginosa – complement is necessary for efficient bacterial killing.



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Editorial Board

Publication date: April 2018
Source:Molecular Immunology, Volume 96





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Expression of complement receptor 3 (CR3) and regulatory protein CD46 on dendritic cells of antiretroviral naïve and treated HIV-1 infected individuals: Correlation with immune activation status

Publication date: April 2018
Source:Molecular Immunology, Volume 96
Author(s): Nitesh Mishra, Madhav Mohata, Heena Aggarwal, Omkar Chaudhary, Bimal Kumar Das, Sanjeev Sinha, Anjali Hazarika, Kalpana Luthra
During infection and budding, human immunodeficiency virus-1 (HIV-1) acquires regulators of Complement Activation (RCAs) along with the host cell membrane on the viral envelope. Activation of host complement system results in opsonization of virus by complement fragments, however the virus evades complement mediated lysis (CoML) by virtue of the RCAs on the viral envelope. The RCAs on HIV-1 envelope process complement protein C3 into various fragments that promote viral entry and infection of cells through different complement receptors. Complement opsonized HIV-1 has been shown in vitro to infect dendritic cells (DCs) in a CR3 dependent manner, although the role of CR3 and CD46 in natural HIV-1 infection is not clear. Surface expression of CR3 and CD46 on DC subsets of 30 antiretroviral naïve, 31 treated (cART) HIV-1 infected individuals and 30 seronegative controls was measured by flow cytometry and plasma levels of cytokines and complement activity (C3c levels) were quantitated by sandwich ELISA. Significantly lower surface expression of CR3 and CD46 was observed on DC subsets in naïve and treated HIV-1 infected individuals compared to controls. Significantly higher complement activation and plasma levels of IL-4, IL-8, IL-10 and IFN-γ were observed in treatment naïve HIV-1 infected individuals than controls. Significantly lower plasma levels of IL-4, IL-6, IL-8 and IL-10 were observed in treated vs. naïve HIV-1 infected individuals. Our findings suggest that alterations in expression of CR3 and CD46 on DCs along with complement activity could be factors that influence viral persistence and HIV-1 disease progression and need to be further evaluated.



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Hypoxia induced EMT: A review on the mechanism of tumor progression and metastasis in OSCC

Publication date: May 2018
Source:Oral Oncology, Volume 80
Author(s): Joel P. Joseph, M.K. Harishankar, Aruthra Arumugam Pillai, Arikketh Devi
Hypoxia, a condition of low oxygen tension in tissues, has emerged as a crucial factor in tumor pathophysiology. Hypoxic microenvironment gives rise to altered cellular metabolism and triggers varied molecular responses. These responses promote tumor progression and confer radiation resistance and chemo resistance to tumors. The predominant molecules that are associated with hypoxia research are the hypoxia inducible factors (HIFs). HIFs are known to regulate a large group of genes that are involved in cell survival, proliferation, motility, metabolism, pH regulation, extracellular matrix function, inflammatory cell recruitment and angiogenesis by inducing the expression of their downstream target genes. The process of epithelial to mesenchymal transition (EMT) has been associated with metastasis in cancer. Reports also suggest that hypoxia triggers EMT in several types of cancer including breast cancer, prostate cancer and oral cancer. Oral cancer is a predominant cancer in Central and South East Asia. However, in the recent times, the incidence rates of oral cancer have been increasing in Northern and Eastern Europe as well. This review articulates the role of hypoxia and the associated factors like HIFs in inducing EMT in oral cancer (OSCC).



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Low grade parotid mucoepidermoid carcinoma with tumour associated lymphoid proliferation (“Warthin-like”) and CRTC1-MAML2 fusion transcript: Definitive diagnosis with molecular investigation only

Publication date: Available online 21 March 2018
Source:Oral Oncology
Author(s): Iolia Akaev, Chit Cheng Yeoh, Peter A. Brennan, Siavash Rahimi




http://ift.tt/2IGlKwj

Onkologische Chirurgie 4.0

Zusammenfassung

Hintergrund

Die Fortschritte in der Digitalisierung und der Informationsverarbeitung nehmen auch Einfluss auf die interventionelle Medizin. Sich dieser Entwicklung anzupassen, wird eine zentrale Herausforderung der modernen (onkologischen) Chirurgie sein, um weiterhin optimierte Therapieverfahren anbieten zu können.

Ziel und Schlussfolgerung

Im Hinblick auf die technologische Entwicklung innerhalb und auch außerhalb der Medizin schlagen die Autoren eine „Chirurgie 4.0" vor, die ein besonderes Augenmerk auf die Sammlung, Aufbereitung und Analyse von perioperativen Daten legt, um durch intelligente Assistenzsysteme die Eingriffe effizienter und sicherer zu machen. Hierzu werden – bezogen auf die 3 operativen Phasen Planung, Durchführung und Nachbehandlung – die Bedeutung der Datengenerierung, Analyse und Interpretation und die möglichen Anwendungen für kontextsensitive mechatronische oder softwarebasierte Unterstützungssysteme dargestellt.

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Therapie des rezidivierten und refraktären multiplen Myeloms

Zusammenfassung

Hintergrund

Die Rezidivbehandlung beim multiplen Myelom (MM) ist durch Zulassung vieler neuer Substanzen komplexer geworden.

Ziel

Es sollen aktuelle Therapieoptionen für das rezidivierte und refraktäre MM (RRMM) dargestellt werden.

Material und Methoden

Nach aktueller Literaturrecherche internationaler Studien- bzw. Übersichtsartikel werden Antimyelomtherapien beim RRMM beschrieben.

Ergebnisse und Schlussfolgerungen

Aufgrund des deutlich verlängerten Überlebens von MM-Patienten erleiden nahezu alle ein oder mehrere Rezidive während ihres Krankheitsverlaufs. Zahlreiche neue zugelassene Substanzen im Rezidiv sowie zahlreiche Substanzen in klinischen Studien haben die Prognose beim RRMM erheblich verbessert, lassen die Therapiewahl aber auch komplexer ausfallen. Zu berücksichtigen sind hierbei patienten-, krankheits- und therapiespezifische Faktoren. Interdisziplinäre Tumorboards zur Planung eines bestmöglichen therapeutischen Vorgehens sind dabei hilfreich. Zahlreiche neue zugelassene Substanzen, die im Rezidiv auch bei intensiv vorbehandelten Patienten eingesetzt werden, umfassen neue immunmodulatorische Substanzen wie Pomalidomid, neue Proteasomeninhibitoren wie Carfilzomib und Ixazomib, Antikörper wie Daratumumab und Elotuzumab sowie den Histondeacetylase(HDAC)-Inhibitor Panobinostat. Die autologe Stammzelltransplantation (SZT) spielt in der Rezidivsituation bei genügend fitten Patienten ebenfalls eine Rolle, insbesondere, um eine tiefe Remission zu induzieren oder – nach bereits durchgeführter erster SZT und bei mindestens 18 Monaten Remissionsinduktion – um eine länger anhaltende Remission erneut zu erreichen. Neben der Antimyelomtherapie ist auch die Supportivtherapie essenziel und umfasst u. a. die suffiziente Schmerztherapie, die Vermeidung bzw. Behandlung von Osteolysen oder Frakturen und von Infektkomplikationen.

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Cardiac output Optimisation following Liver Transplant (COLT) trial: study protocol for a feasibility randomised controlled trial

Froghi, F; Koti, R; Gurusamy, K; Mallett, S; Thorburn, D; Selves, L; James, S; ... Davidson, B; + view all Froghi, F; Koti, R; Gurusamy, K; Mallett, S; Thorburn, D; Selves, L; James, S; Singh, J; Pinto, M; Eastgate, C; McNeil, M; Filipe, H; Jichi, F; Schofield, N; Martin, D; Davidson, B; - view fewer (2018) Cardiac output Optimisation following Liver Transplant (COLT) trial: study protocol for a feasibility randomised controlled trial. Trials , 19 (1) , Article 170. 10.1186/s13063-018-2488-8 . Green open access

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Evaluation of prospective motion correction of high-resolution 3D-T2-FLAIR acquisitions in epilepsy patients

Vos, SB; Micallef, C; Barkhof, F; Hill, A; Winston, GP; Ourselin, S; Duncan, JS; (2018) Evaluation of prospective motion correction of high-resolution 3D-T2-FLAIR acquisitions in epilepsy patients. Journal of Neuroradiology 10.1016/j.neurad.2018.02.007 . (In press). Green open access

http://ift.tt/2DIQTeT

Progressive neurodegeneration following spinal cord injury: Implications for clinical trials

Ziegler, G; Grabher, P; Thompson, A; Altmann, D; Hupp, M; Ashburner, J; Friston, K; ... Freund, P; + view all Ziegler, G; Grabher, P; Thompson, A; Altmann, D; Hupp, M; Ashburner, J; Friston, K; Weiskopf, N; Curt, A; Freund, P; - view fewer (2018) Progressive neurodegeneration following spinal cord injury: Implications for clinical trials. Neurology 10.1212/WNL.0000000000005258 . (In press). Green open access

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TBX22-Associated Syndrome

Stanier, PM; Seselgyte, R; Moore, GE; Pauws, E; (2018) TBX22-Associated Syndrome. Reference Module in Biomedical Sciences (In press).

http://ift.tt/2FR8pDA

Prognostic impact of the absence of biallelic deletion at theTRGlocus for pediatric patients with T-cell acute lymphoblastic leukemia treated on the MRC UKALL2003 trial

Farah, N; Kirkwood, AA; Rahman, S; Leon, T; Jenkinson, S; Gale, RE; Patrick, K; ... Mansour, MR; + view all Farah, N; Kirkwood, AA; Rahman, S; Leon, T; Jenkinson, S; Gale, RE; Patrick, K; Hancock, J; Samarasinghe, S; Linch, DC; Moorman, AV; Goulden, N; Vora, A; Mansour, MR; - view fewer (2018) Prognostic impact of the absence of biallelic deletion at theTRGlocus for pediatric patients with T-cell acute lymphoblastic leukemia treated on the MRC UKALL2003 trial. Haematologica , Article 185801. 10.3324/haematol.2017.185801 . (In press). Green open access

http://ift.tt/2DJbNL4

Age-related functional changes in domain-specific medial temporal lobe pathways

Berron, D; Neumann, K; Maass, A; Schütze, H; Fliessbach, K; Kiven, V; Jessen, F; ... Düzel, E; + view all Berron, D; Neumann, K; Maass, A; Schütze, H; Fliessbach, K; Kiven, V; Jessen, F; Sauvage, M; Kumaran, D; Düzel, E; - view fewer (2018) Age-related functional changes in domain-specific medial temporal lobe pathways. Neurobiology of Aging , 65 pp. 86-97. 10.1016/j.neurobiolaging.2017.12.030 . Green open access

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Heuristics as Bayesian inference under extreme priors

Parpart, P; Jones, M; Love, BC; (2018) Heuristics as Bayesian inference under extreme priors. Cognitive Psychology , 102 pp. 127-144. 10.1016/j.cogpsych.2017.11.006 . Green open access

http://ift.tt/2HSmL34

Urinary biomarker for the detection of recurrence following non-muscle invasive bladder cancer: are we there yet?

Tan, WS; Tan, WP; (2018) Urinary biomarker for the detection of recurrence following non-muscle invasive bladder cancer: are we there yet? [Editorial comment]. Translational Andrology and Urology , 7 , Article Supplementary. 10.21037/tau.2017.12.18 .

http://ift.tt/2FOPwkI

Severe Eosinophilic Colitis Caused By Neuropathic Agents in a Patient with Chronic Fatigue Syndrome and Functional Abdominal Pain: Case Report and Review of the Literature

Fragkos, K; Barragry, J; Fernando, CS; Novelli, M; Begent, J; Zárate-Lopez, N; (2018) Severe Eosinophilic Colitis Caused By Neuropathic Agents in a Patient with Chronic Fatigue Syndrome and Functional Abdominal Pain: Case Report and Review of the Literature. Zeitschrift für Gastroenterologie (In press).

http://ift.tt/2DIRcq3

Eavesdropping Whilst You're Shopping: Balancing Personalisation and Privacy in Connected Retail Spaces

Mavroudis, V; Veale, M; (2018) Eavesdropping Whilst You're Shopping: Balancing Personalisation and Privacy in Connected Retail Spaces. In: (Proceedings) Living in the Internet of Things: A PETRAS, IoTUK & IET Conference, Forum & Exhibition, 28 - 29 March 2018, London, UK. (In press).

http://ift.tt/2FRU7mg

Students’ science attitudes, beliefs, and context: associations with science and chemistry aspirations

Mujtaba, T; Sheldrake, R; Reiss, M; Simon, S; (2018) Students' science attitudes, beliefs, and context: associations with science and chemistry aspirations. International Journal of Science Education 10.1080/09500693.2018.1433896 . (In press).

http://ift.tt/2HQ3EXE

Eesti Heal ja Meie Aeg: Esimese maailmasõja aegne laagrikirjandus eesti sõjavangidele Saksamaal

Kuldkepp, M; (2018) Eesti Heal ja Meie Aeg: Esimese maailmasõja aegne laagrikirjandus eesti sõjavangidele Saksamaal. Akadeemia (In press).

http://ift.tt/2FRU3mw

A genetic modifier suggests that endurance exercise exacerbates Huntington's disease

Corrochano, S; Blanco, G; Williams, D; Wettstein, J; Simon, M; Kumar, S; Moir, L; ... Acevedo-Arozena, A; + view all Corrochano, S; Blanco, G; Williams, D; Wettstein, J; Simon, M; Kumar, S; Moir, L; Agnew, T; Stewart, M; Landman, A; Kotiadis, VN; Duchen, MR; Wackerhage, H; Rubinsztein, DC; Brown, SDM; Acevedo-Arozena, A; - view fewer (2018) A genetic modifier suggests that endurance exercise exacerbates Huntington's disease. Human Molecular Genetics 10.1093/hmg/ddy077 . (In press). Green open access

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Imminent extinction in the wild of the world’s largest amphibian

Turvey, ST; Chen, S; Tapley, B; Wei, G; Xie, F; Yan, F; Yang, J; ... Cunningham, AA; + view all Turvey, ST; Chen, S; Tapley, B; Wei, G; Xie, F; Yan, F; Yang, J; Liang, Z; Tian, H; Wu, M; Okada, S; Wang, J; Lü, J; Zhou, F; Papworth, SK; Redbond, J; Brown, T; Che, J; Cunningham, AA; - view fewer (2018) Imminent extinction in the wild of the world's largest amphibian. Current Biology (In press). Green open access

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Phase II study of the dual EGFR/HER3 inhibitor duligotuzumab (MEHD7945A) vs. cetuximab in combination with FOLFIRI in RAS wild-type metastatic colorectal cancer

Hill, AG; Findlay, M; Burge, M; Jackson, C; García Alfonso, P; Samuel, L; Ganju, V; ... Tabernero, J; + view all Hill, AG; Findlay, M; Burge, M; Jackson, C; García Alfonso, P; Samuel, L; Ganju, V; Karthaus, M; Amatu, A; Jeffery, M; Di Bartolomeo, M; Bridgewater, J; Coveler, AL; Hidalgo, M; Kapp, AV; Sufan, R; McCall, B; Hanley, W; Penuel, E; Pirzkall, A; Tabernero, J; - view fewer (2018) Phase II study of the dual EGFR/HER3 inhibitor duligotuzumab (MEHD7945A) vs. cetuximab in combination with FOLFIRI in RAS wild-type metastatic colorectal cancer. Clinical Cancer Research 10.1158/1078-0432.CCR-17-0646 . (In press).

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Rap1, canoe and Mbt cooperate with Bazooka to promotezonula adherensassembly in the fly photoreceptor

Walther, RF; Burki, M; Pinal, N; Rogerson, C; Pichaud, F; (2018) Rap1, canoe and Mbt cooperate with Bazooka to promotezonula adherensassembly in the fly photoreceptor. Journal of Cell Science 10.1242/jcs.207779 . (In press). Green open access

http://ift.tt/2HNFMUz

Behold the bubbly ocean

Czerski, H; (2017) Behold the bubbly ocean. Physics World , 30 (11) pp. 34-38. 10.1088/2058-7058/30/11/32 .

http://ift.tt/2FSESK4

Weight management programmes: Re-analysis of a systematic review to identify pathways to effectiveness

Melendez-Torres, GJ; Sutcliffe, K; Burchett, HED; Rees, R; Richardson, M; Thomas, J; (2018) Weight management programmes: Re-analysis of a systematic review to identify pathways to effectiveness. Health Expectations 10.1111/hex.12667 . (In press). Green open access

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Psychological treatments for depression and anxiety in dementia and mild cognitive impairment

Orgeta, V; Qazi, A; Spector, AE; Orrell, M; (2014) Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database of Systematic Reviews (1) , Article CD009125. 10.1002/14651858.CD009125.pub2 . Green open access

http://ift.tt/2FQAwTE

Toward omnidirectional and automated imaging system for measuring oceanic whitecap coverage

Al-Lashi, RS; (2016) Toward omnidirectional and automated imaging system for measuring oceanic whitecap coverage. Journal of the Optical Society of America A , 33 (8) pp. 1589-1597. 10.1364/JOSAA.33.001589 . Green open access

http://ift.tt/2DJqRrW

Cardiovascular Disease Outcomes Related to Early Stage Renal Impairment Following Liver Transplantation

Background In the general population, even mild renal disease is associated with increased cardiovascular (CV) complications. Whether this is true in liver transplant recipients (LTR) is unknown. Methods This was a retrospective cohort study of 671 LTR (2002-2012) from a large urban tertiary care center and 37,322 LTR using Vizient hospitalization data linked to the United Network for Organ Sharing. The MDRD4 equation estimated GFR (eGFR). Outcomes were 1-year CV complications (death/hospitalization from myocardial infarction, heart failure, atrial fibrillation, cardiac arrest, pulmonary embolism or stroke) and mortality. Latent mixture modeling identified trajectories in eGFR in the first LT year in the 671 patients. Results Mean(SD) eGFR was 72.1(45.7) ml/min/1.73m2. Six distinct eGFR trajectories were identified in the local cohort (n=671): qualitatively Normal-Slow Decrease (4% of cohort), Normal-Rapid Decrease (4%), Mild-Stable (18%), Mild-Slow Decrease (35%), Moderate-Stable (30%), and Severe-Stable (9%). In multivariable analyses adjusted for confounders and baseline eGFR, the greatest odds of 1-year CV complications were in the Normal-Rapid Decrease group (OR, 95% CI: 10.6, 3.0-36.9). Among the national cohort, each 5-unit lower eGFR at LT was associated with a 2% and 5% higher hazard of all-cause and CV-mortality, respectively (p

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The Impact of Renal Insufficiency Following Liver Transplantation

No abstract available

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Goal-Directed Management of Coagulation: The right treatment, the right patient, the right time

No abstract available

http://ift.tt/2IGWkPa

Solid Organ Transplantation in Patients with Preexisting Malignancies in Remission: A Propensity Score Matched Cohort Study

Background Solid organ transplant recipients (SOTR) with pretransplant malignancies (PTM) have worse overall survival (OS) compared to recipients without history of malignancy. However, it is unknown whether the increased risk of mortality is due to recurrent cancer-related deaths. Methods All SOTR in Ontario between 1991 and 2010 were identified and matched 1:2 to recipients without PTM using a propensity score. OS was compared using the Kaplan-Meier estimator and Cox proportional hazard models. For cancer-specific mortality and cancer recurrence, cause-specific hazard models were used and the cumulative incidence was plotted. Results Recipients with PTM had a worse OS compared to recipients without PTM (median OS: 10.3 versus 13.4 years). Recipients with PTM were not only at increased risk of cancer-specific mortality (CSHR:1.85 [95%CI: 1.20, 2.86]) but also at increased risk of noncancer death (CSHR:1.29 [95%CI: 1.08, 1.54]). Compared to recipients without PTM, recipients with high-risk PTM had higher all-cause mortality (HR:1.81 [95%CI: 1.47, 2.23]). Recipients with low-risk PTM were not at increased risk (HR:1.06 [95%CI: 0.86, 1.31]). Conclusion Recipients with PTM are at increased risk of all-cause mortality compared to recipients without PTM. This increased risk was noted for both cancer-specific and noncancer mortality. However, only those with high-risk PTM had worse outcomes. Corresponding Author: Dr. Nancy Baxter, MD, PhD, Division of General Surgery, St. Michael's Hospital, 040-16 Cardinal Carter Wing, 30 Bond Street, Toronto, ON, M5B 1W8 Canada | BaxterN@smh.ca Funding source: This study was funded by a Canadian Institutes of Health Research (CIHR) Operating Grant (Funding Reference No. 115164) and CIHR Foundation Grant (Funding Reference No. 148470). The funding sources had no role in the design or conduct of the study; collection, management, analysis or interpretation of the data; or preparation, review or approval of the manuscript. Disclaimers: There are no conflicts of interest to disclose. This work was presented as an oral presentation (Abstract number: 822) at the 2016 American Transplant Congress, Boston, MA, June 11-25, 2016. Authorship: Sergio A. Acuna, hypothesis generation and study design, data acquisition, statistical analysis, interpretation of findings, writing of the manuscript, and approval of the final draft. Rinku Sutradhar, study design, interpretation of findings, and approval of the final draft. S. Joseph Kim, study design, interpretation of findings, and approval of the final draft. Nancy N. Baxter, hypothesis generation and research design, interpretation of findings, writing of the manuscript, and approval of the final draft. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Preexisting Cancer in Transplant Candidates: Time for a Change in Practice?

No abstract available

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The Bronchial Arterial Circulation in Lung Transplantation: Bedside to Bench to Bedside, and Beyond

Chronic allograft dysfunction (CLAD) remains a major complication, causing the poor survival after lung transplantation. Although strenuous efforts have been made at preventing CLAD, surgical approaches for lung transplantation have not been updated over the last 2 decades. The bronchial artery, which supplies oxygenated blood to the airways and constitutes a functional microvasculature, has occasionally been revascularized during transplants, but this technique did not gain popularity and is not standard in current lung transplantation protocols, despite the fact that a small number of studies have shown beneficial effects of bronchial artery revascularization (BAR) on limiting CLAD. Also, recent basic and clinical evidence has demonstrated the relationship between microvasculature damage and CLAD. Thus, the protection of the bronchial circulation and microvasculature in lung grafts may be a key factor to overcome CLAD. This review revisits the history of BAR, discusses the role of the bronchial circulation in lung transplantation, and advocates for novel bronchial-arterial-circulation-sparing (BACS) approaches as a future direction for overcoming CLAD. While there are some already published review articles summarizing the surgical techniques and their possible contribution to outcomes in lung transplantation, to the best of our knowledge, this review is the first to elaborate on bronchial circulation that will contribute to prevent CLAD from both scientific and clinical perspectives: from bedside to bench to bedside, and beyond. *Address for Correspondence: Norihisa Shigemura, MD, PhD. Surgical Director of Lung Transplantation and Lung Failure, Temple University Hospital, 3401 N Broad Street, Parkinson Pavilion, Suite 301, Zone C, Philadelphia, PA 19140. E-mail address: Norihisa.Shigemura@tuhs.temple.edu Authorship Shinya Tane (ST): shinyatane@gmail.com Kentaro Noda (KN): nodak@upmc.edu Participated in review design: NS, ST. Participated in data collection: NS, ST and KN. Participated in the writing of the paper: NS, ST. Funding Sources: N/A Competing interests: All the authors declare no conflict of interests. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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EXTRACORPOREAL PHOTOPHERESIS FOR BRONCHIOLITIS OBLITERANS SYNDROME AFTER LUNG TRANSPLANTATION

Background Lung transplantation is a therapeutic option for select patients with end-stage lung disease. However, successful lung transplantation is hampered by chronic lung allograft dysfunction (CLAD), in particular bronchiolitis obliterans syndrome (BOS). Although there is no approved or standard treatment for BOS, which may have several distinct phenotypes, extracorporeal photopheresis (ECP) has shown promising results in patients who develop BOS refractory to azithromycin treatment. Methods We reviewed all relevant clinical data indexed on PubMed from 1987 to 2017 to evaluate the role of ECP in patients with BOS. Results 7 small studies investigated the immunomodulatory effects of ECP in patients after solid organ transplant and 12 studies reported clinical data specific to ECP therapy for BOS. Studies indicate that ECP triggers an apoptotic cellular cascade that exerts various immunomodulatory effects mediated via increases in anti-inflammatory cytokines, a decrease in pro-inflammatory cytokines, and an increase in tolerogenic regulatory T cells. Clinical evidence derived from relatively small single-center studies suggests that ECP therapy is associated with improvement or stabilization in lung function and sustainable, statistically significant, decreases in the rate of lung function decline in patients with BOS. Additionally, when adverse event data were reported, ECP was generally well-tolerated. None of the comparative studies were randomized. Conclusions Immunomodulation mediated via ECP is a rational therapeutic option that may improve clinical outcomes in patients with BOS, particularly in the context of in-depth patient phenotyping as part of a stratified approach to treatment; good quality randomized controlled trials are needed to confirm observational findings. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Author correspondence: Paul Corris, MBBS, FRCP, Institute of Cellular Medicine, Newcastle University and The Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, United Kingdom. Business Phone: +44 (0) 191 213 7462. E-mail: paul.corris@ncl.ac.uk AUTHORSHIP Ramsey Hachem participated in the design of the review search strategy, and in the interpretation, critical review and writing of this paper Paul Corris participated in the design of the review search strategy, and in the interpretation, critical review and writing of this paper CONFLICT OF INTEREST AND FUNDING SOURCES PC: No disclosures of relevance, RH: Grant support from Therakos, Inc., a Mallinckrodt Pharmaceuticals company. Financial support for medical editorial assistance was provided by Therakos, Inc., a Mallinckrodt Pharmaceuticals company. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Syndecan-1 shedding inhibition to protect against ischemic acute kidney injury through HGF target signaling pathway

Background The hepatocyte growth factor (HGF) target pathway plays pivotal renoprotective roles after acute kidney injury (AKI). Syndecan-1 serves as the co-receptor for HGF. Shedding of syndecan-1 is involved in various pathological processes. Thus, we hypothesized that IRI induced syndecan-1 shedding and inhibiting syndecan-1 shedding would protect against kidney injury by potentiating activation of the HGF receptor c-Met. Methods Expression of syndecan-1 and its sheddases were observed in kidneys of sham and I/R mice. To inhibit syndecan-1 shedding, mice were injected with the sheddase inhibitor GM6001 prior to I/R surgery, and then, renal inflammation, tubular apoptosis and activation of the c-Met/AKT/GSK-3β pathway were analysed. In vitro, HK-2 cells were pretreated with GM6001 under hypoxia/reperfusion (H/R) conditions. The apoptosis and viability of cells and expression of c-Met/AKT/GSK-3β pathway components were evaluated. The relationship was further confirmed by treatment with SU11274, a specific inhibitor of phospho-c-Met. Results Shedding of syndecan-1 was induced after IRI both in vivo and in vitro. GM6001 pretreatment suppressed syndecan-1 shedding, and alleviated renal inflammation and tubular apoptosis, and upregulated phosphorylation of the c-Met/AKT/GSK-3β pathway. In vitro, pretreatment with GM6001 also decreased H/R-induced cell apoptosis and promoted activation of the c-Met pathway. In addition, the cytoprotective role of GM6001 was attenuated by suppressing c-Met phosphorylation with SU11274. Conclusion Our findings suggest that inhibiting I/R-induced syndecan-1 shedding protected against ischaemic acute kidney injury by potentiating the c-Met/AKT/GSK-3β pathway. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. # Co-first authors, these authors contributed equally to this work. Corresponding author: Jianzhou Zou and Jie Teng, Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, PR China. Fax: +86-021-64038038. Telephone: +86-021-64041990. Email: zou.jianzhou@zs-hospital.sh.cn and teng.jie@zs-hospital.sh.cn Author Contributions Z.L. and N.S. conceived the study, performed the experiment, generated figures and wrote the manuscript. B.S., X.X., J.H., Y.N. performed the experiment and collected data. Y.F., Y.S and Y.D. searched literature and analyzed data. X.D. revised the manuscript. J.Z. and T.J. desigend the study, interpreted data and revised the manuscript. Conflict of interest All the authors declared no conflicts of interest. Fundings This work was funded by National Natural Science Foundation of China (81500048, 81430015 and 81670614), Talent Development Program of Zhongshan Hospital-Outstanding Backbone Project (2017ZSGG19) and Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Science and Technology Commission (14DZ2260200). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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