The objectivity of Subjective Bayesianism

Abstract

Subjective Bayesianism is a major school of uncertain reasoning and statistical inference. It is often criticized for a lack of objectivity: (i) it opens the door to the influence of values and biases, (ii) evidence judgments can vary substantially between scientists, (iii) it is not suited for informing policy decisions. My paper rebuts these concerns by connecting the debates on scientific objectivity and statistical method. First, I show that the above concerns arise equally for standard frequentist inference with null hypothesis significance tests (NHST). Second, the criticisms are based on specific senses of objectivity with unclear epistemic value. Third, I show that Subjective Bayesianism promotes other, epistemically relevant senses of scientific objectivity—most notably by increasing the transparency of scientific reasoning.

https://ift.tt/2pMY3ef

Influence of reactive oxygen species on de novo acquisition of resistance to bactericidal antibiotics [PublishAheadOfPrint]

The radical-based theory proposes that three major classes of bactericidal antibiotics, beta-lactams, quinolones, and aminoglycosides, have in common the downstream formation of lethal levels of reactive oxygen species (ROS) as part of the killing mechanism. If bactericidal antibiotics exhibit a common mechanism, it is to be expected that the acquisition of resistance against these drugs has some shared traits as well. Indeed, cells made resistant to one bactericidal antibiotic became more rapidly resistant to another. This effect was absent after induced resistance to a bacteriostatic drug. De novo acquisition of resistance to one bactericidal antibiotic provided partial protection to killing by bactericidals from a different class. This protective effect was observed in short-term experiments. No protective effect was detected during 24 hour exposures, suggesting that cross-resistance did not occur. In the wild-type, exposure to bactericidal antibiotics increased intracellular ROS levels. This increase in ROS levels was not observed when strains resistant to these drugs were exposed to the same concentrations. These results indicate that de novo acquisition of resistance against the bactericidal drugs tested involves a common cellular response that provides protection against ROS accumulation upon exposure to this type of antibiotics. Possibly a central mechanism or at least a few common elements within the separate mechanisms play a role during acquisition of antibiotic resistance.

https://ift.tt/2GcpXpY

Novel Ciprofloxacin-Modifying Enzyme (CrpP) Encoded by the Pseudomonas aeruginosa pUM505 Plasmid [PublishAheadOfPrint]

The pUM505 plasmid, isolated from a clinical Pseudomonas aeruginosa isolate, confers resistance to ciprofloxacin (CIP) when transferred into the standard P. aeruginosa PAO1 strain. CIP is an antibiotic of the quinolone family that is used to treat P. aeruginosa infections. In silico analysis, performed to identify CIP-resistance genes, revealed that the 65-amino acid product encoded by the orf131 gene in pUM505 displays 40% amino acid identity to the Mycobacterium smegmatis aminoglycoside phosphotransferase (an enzyme that phosphorylates and inactivates aminoglycoside antibiotics). We cloned orf131 (renamed as crpP for ciprofloxacin-resistance protein plasmid-encoded) into the pUCP20 shuttle vector. The resulting recombinant plasmid, pUC-crpP, conferred resistance to CIP in the Escherichia coli J53-3 strain, suggesting that the product of this gene encodes a protein involved in CIP resistance. Using a coupled enzymatic analysis, we determined that the activity of CrpP on CIP is ATP-dependent, while little activity was detected towards norfloxacin, suggesting that CIP may undergo phosphorylation. Using a recombinant His-tagged CrpP protein and liquid chromatography--tandem mass spectrometry, we also showed that CIP was phosphorylated prior to its degradation. Thus, our findings demonstrate that CrpP, encoded on the pUM505 plasmid, represents a new mechanism of CIP-resistance in P. aeruginosa, which involves phosphorylation of the antibiotic.

https://ift.tt/2IXBjA8

PHARMACOKINETICS OF INTRAVENOUS POSACONAZOLE IN CRITICALLY ILL PATIENTS [PublishAheadOfPrint]

To date, there is no information on the IV posaconazole pharmacokinetics in ICU patients. This prospective observational study aimed to describe the pharmacokinetics of a single dose of IV posaconazole in critically ill patients. Patients with no history of allergy to triazole antifungals and requiring systemic antifungal therapy were enrolled if aged ≥ 18 years, central venous access was available, were not pregnant, and didn't receive prior posaconazole or drugs interacting with posaconazole. A single dose of 300 mg posaconazole was administered over 90 minutes. Total plasma concentrations were measured from serial plasma samples collected over 48 h, using a validated chromatographic method. The pharmacokinetic data set was analyzed by non-compartmental methods. Eight patients (7 male) were enrolled; median (interquartile range, IQR) age 46 years (40-51), weight 68 kg (65-82) and albumin concentration 20 g/L (18-24). Median (IQR) pharmacokinetic parameter estimates were Cmax, 1,702 ng/mL (1,352-2,141); AUC_0-, 17,932 ng*h/mL (13,823 — 27, 905); CL, 16.8 L/h (11.1-21.7); and Vd, 529.1 L (352.2 — 720.6). The Vd and CL were greater than two fold and AUC_0- was 39% of values reported for heathy volunteers. The AUC_0- was only 52% of the steady-state AUC_0-24 reported for hematology patients. The median of estimated average steady-steady state concentrations was 747 ng/mL (IQR, 576 -1,163), which is within but close to the lower end of previously recommended therapeutic range of 500 to 2,500 ng/mL. In conclusion, we observed different pharmacokinetics of intravenous posaconazole in this cohort of critically ill patients compared to healthy volunteers and hematology patients.

https://ift.tt/2pHIALo

Determination of the dynamically-linked indices of fosfomycin for Pseudomonas aeruginosa in the Hollow Fiber Infection Model (HFIM) [PublishAheadOfPrint]

Fosfomycin is the only expoxide antimicrobial and is currently under development in the United States as an intravenously administered product. We were interested in identifying the exposure indices most closely linked to the ability to kill bacterial cells and to suppress amplification of less-susceptible subpopulations. We employed the Hollow Fiber Infection model for this investigation and studied wild-type Pseudomonas aeruginosa PAO1. Because of anticipated rapid resistance emergence, we shortened study duration to 24 hours but sampled the system more intensively. Doses and schedules of 12 and 18 g/day and daily, 8 hourly administration and continuous infusion were studied at each daily dose. We measured fosfomycin concentrations (by LC/MS/MS), total bacterial burden and less-susceptible burden. We applied a mathematical model to all the data simultaneously. There was rapid emergence of resistance in all doses and schedules. Prior to the resistance emergence, an initial kill of 2-3 Log₁₀(CFU/ml) was observed. The model demonstrated that AUC/MIC Ratio was linked to total bacterial kill, while Time > MIC (equivalently C_min/MIC ratio) was linked to resistance suppression. These findings were also seen in other investigations with Enterobacteriaceae (in vitro systems) and P. aeruginosa (murine system). We conclude that for serious high bacterial burden infections, fosfomycin may be of value as a new therapeutic and may be optimized by administering the agent as a continuous or prolonged infusion or by a short dosing interval. For indications such as Ventilator-Associated Bacterial Pneumonia, it may be prudent to administer fosfomycin as part of a combination regimen.

https://ift.tt/2IVIJDU

Dextromethorphan Attenuates NADPH Oxidase-regulated GSK-3{beta} and NF-{kappa}B Activation and Reduces Nitric Oxide Production in Group A Streptococcal Infection [PublishAheadOfPrint]

Group A streptococcus (GAS) is an important human pathogen that causes a wide spectrum of diseases, including necrotizing fasciitis and streptococcal toxic shock syndrome. Dextromethorphan (DM), an antitussive drug, has been demonstrated to efficiently reduce inflammatory responses thereby contributing to an increased survival rate of GAS-infected mice. However, the anti-inflammatory mechanisms underlying DM treatment in GAS infection remain unclear. DM is known to exert neuroprotective effects through a NADPH oxidase-dependent regulated process. In the present study, membrane translocation of NADPH oxidase subunit p47^phox and subsequent reactive oxygen species (ROS) generation induced by GAS infection were significantly inhibited via DM treatment in RAW264.7 murine macrophage cells. Further determination of proinflammatory mediators revealed that DM effectively suppressed inducible nitric oxide synthase (iNOS) expression, NO, TNF-α and IL-6 generation in GAS-infected RAW264.7 cells as well as in air-pouch-infiltrating cells from GAS/DM-treated mice. GAS infection caused AKT dephosphorylation, glycogen synthase kinase-3β (GSK-3β) activation, and subsequent NF-B nuclear translocation, which were also markedly inhibited by treatment with DM and NADPH oxidase inhibitor, diphenylene iodonium. These results suggest that DM attenuates GAS infection-induced overactive inflammation by inhibiting NADPH oxidase-mediated ROS production that leads to down-regulation of the GSK-3β/NF-B/NO signaling pathway.

https://ift.tt/2pIQC6I

Survival in Patients with Candida glabrata Bloodstream Infections is Associated with Fluconazole Dose [PublishAheadOfPrint]

Robust pharmacodynamic indices that align fluconazole dose or exposure with outcome in invasive candidiasis due to C. glabrata remain elusive. The purpose of this retrospective, multicenter study was to evaluate a cohort of 127 patients with C. glabrata fungemia treated with fluconazole using adjusted analyses to identify risk factors for 28-day mortality. No significant correlations were found between fluconazole AUC, AUC:MIC, or MIC and survival. However, on multivariable logistic regression, higher average fluconazole dose (odds ratio (OR) 1.006, 95% confidence interval (CI), 1.001-1.010, p=0.008), average fluconazole dose ≥ 400 mg (OR 3.965, 95% CI 1.509-10.418, p=0.005), and higher fluconazole dose on day 1 of therapy (OR 1.007, 95% CI 1.002-1.011, p=0.002) were found to be independent predictors of 28-day survival. Additionally, the presence of a central venous catheter at the time of infection was found to be a significant risk factor for mortality. In conclusion, we found fluconazole dose to be an independent predictor for 28-day survival in patients with C. glabrata fungemia, with doses ≥ 400mg/day associated with 28-day survival approaching 90%. These data inform the use and efficacy of fluconazole in the treatment of this serious infection. Aggressive dosing appears necessary when using fluconazole for the treatment of C. glabrata fungemia, irrespective of MIC.

https://ift.tt/2IXBj36

Molecular characterization of OXA-198 carbapenemase producing Pseudomonas aeruginosa clinical isolates [PublishAheadOfPrint]

Carbapenemase-producing Pseudomonadaceae have increasingly been reported worldwide, with an ever-increasing heterogeneity of carbapenem resistance mechanisms depending on the bacterial species and its geographical location. OXA-198 is a plasmid-encoded class D β-lactamase involved in carbapenem-resistance in one Pseudomonas aeruginosa isolate from Belgium. In the setting of a multicentre survey of carbapenem-resistance in P. aeruginosa in Belgian hospitals in 2013, three additional OXA-198 producing P. aeruginosa originating from patients hospitalized at one hospital were detected. To reveal the molecular mechanism underlying the reduced susceptibility to carbapenems, MICs, whole genome sequencing (WGS) and PCR reactions to confirm the genetic organization were performed. The plasmid harboring bla_OXA-198 gene was characterized alongside with the genetic relatedness of the four P. aeruginosa isolates. The bla_OXA-198 gene was harbored on a class 1 integron carried itself by a ca. 49-kb IncP-type plasmid proposed as IncP11. The same plasmid was present in all four P. aeruginosa isolates. MLST typing revealed that they all belonged to ST-446 and SNP analysis revealed only a few differences between these isolates. This report describes the structure of a 49-kb plasmid harbouring the bla_OXA-198 gene and the first description of OXA-198 producing P. aeruginosa isolates associated with a hospital-associated cluster episode.

https://ift.tt/2Gf9n99

Pharmacokinetics and Pharmacodynamics of Fosfomycin and its Activity against ESBL-, Plasmid-mediated AmpC- and Carbapenemase-Producing Escherichia coli in a Murine Urinary Tract Infection Model [PublishAheadOfPrint]

Fosfomycin has become an attractive treatment alternative for urinary tract infections (UTIs) due to increasing multidrug-resistance (MDR) in Escherichia coli. In this study, we evaluated the pharmacokinetic and pharmacodynamic (PK/PD) indices of fosfomycin and its in vivo activity in an experimental murine model of ascending UTI. Subcutaneous administration of fosfomycin showed that the mean peak plasma concentrations of fosfomycin were 36, 280, and 750 mg/L following administration of a single dose of 0.75, 7.5, and 30 mg/mouse, respectively, with an elimination half-life of 28 min; and urine peak concentrations of 1100, 33400, and 70000 mg/L expected to sustain above the MIC of the test strain (NU14, 1 mg/L) for 5, 8 and 9.5 h, respectively. The optimal PK/PD indices for reducing urine colony counts (CFU/ml) were determined to be AUC/MIC_0-72h and C_max/MIC based on the dose-dependent bloodstream PK and evaluation of six dosing regimens. With a dosing regimen of 15 mg/mouse twice (q36h), fosfomycin significantly reduced the CFU/ml in urine of susceptible strains, including clinical MDR strains, except for one clinical strain (p = 0.062). A variable degree of reduction was observed in the bladder and kidneys. No significant reduction in CFU/ml were observed with the resistant strains. In conclusion, fosfomycin shows concentration-dependent in vivo activity and the results suggest that fosfomycin is an effective alternative to carbapenems in treating MDR E. coli in uncomplicated UTIs. The data for effectiveness on the MDR isolates along with PK/PD modeling should facilitate further development of improved recommendations for clinical use.

https://ift.tt/2IT6OuW

Chemotherapy with Phage Lysins Reduces Pneumococcal Colonization of the Respiratory Tract [PublishAheadOfPrint]

Bacteriophage-encoded lytic enzymes, also named lysins, or enzybiotics, are efficient agents to kill bacterial pathogens. Colonization of the respiratory tract by Streptococcus pneumoniae is a prerequisite for the establishment of the infection process. Hence, we have evaluated the antibacterial activity of three different lysins against pneumococcal colonization using human nasopharyngeal and lung epithelial cells as well as a mouse model of nasopharyngeal colonization. The lysins tested were the wild type Cpl-1, the engineered Cpl-7S, and the chimera Cpl-711. Moreover, we have included amoxicillin as a comparator antibiotic. Human epithelial cells were infected with three different multidrug-resistant clinical isolates of S. pneumoniae followed by a single dose of the corresponding lysin. The antimicrobial activity of these lysins was also evaluated using a mouse nasopharyngeal carriage model. Exposure of infected epithelial cells to Cpl-7S did not result in the killing of any of the pneumococcal strains investigated. However, treatment with Cpl-1 or Cpl-711 increased the killing of S. pneumoniae adhered to both types of human epithelial cells with Cpl-711 being more effective than Cpl-1, at sub-inhibitory concentrations. In addition, treatment with amoxicillin had no effect reducing the carrier state whereas mice treated by the intranasal route with Cpl-711 showed significantly reduced nasopharyngeal colonization with no detection of bacterial load in 20-40% of the mice. This study indicates that Cpl-1 and Cpl-711 lysins might be promising antimicrobial candidates for therapy against pneumococcal colonization.

https://ift.tt/2pKdfHX

Clinical and Microbiological Characteristics of Candida guilliermondii and Candida fermentati [PublishAheadOfPrint]

The 46 clinical isolates of Candida guilliermondii and Candida famata were re-identified genetically, resulting in 27 C. guilliermondii and 12 Candida fermentati strains. The majority of C. guilliermondii, but no C. fermentati, were isolated from blood cultures. C. fermentati was more sensitive to antifungals, hydrogen peroxide and killing by murine macrophages than C. guilliermondii. The C. guilliermondii isolates were echinocandin susceptible in vitro but resistant to micafungin in a murine model of invasive candidiasis.

https://ift.tt/2IVIt7U

Combination of amphotericin B and terbinafine against melanized fungi associated with chromoblastomycosis [PublishAheadOfPrint]

Our in vitro studies showed that combination of amphotericin B and terbinafine had synergistic effects against the majority of melanized fungi associated with chromoblastomycosis (CBM) and similar infections, including Cladophialophora carrionii, C. arxii, Exophiala dermatitidis, E. spinifera, Fonsecaea monophora, F. nubica, F. pedrosoi, and Phialophora verrucosa. This combination could provide an option for treatment of severe or unresponsive cases of CBM, particularly in cases due to species of Fonsecaea and Cladophialophora.

https://ift.tt/2GcpUdM

Genetic Relationships among Multidrug-Resistant Salmonella enterica Serovar Typhimurium Strains from Humans and Animals [PublishAheadOfPrint]

We identified 20—22 resistance genes, carried in four incompatibility groups of plasmid, in each of five genetically closely-related Salmonella enterica serovar Typhimurium strains recovered from humans, pigs, and chicken. The genes conferred resistance to aminoglycosides, chloramphenicol, sulfonamides, trimethoprim, tetracycline, fluoroquinolones, extended-spectrum cephalosporins and cefoxitin, and azithromycin. This study demonstrates the transmission of multidrug-resistant Salmonella strains among humans and food animals and may be the first identification of mphA in azithromycin-resistant Salmonella strains in Taiwan.

https://ift.tt/2IVInNA

Profiling of PDR1 and MSH2 in Candida glabrata Bloodstream Isolates from a Multi-Center Study in China [PublishAheadOfPrint]

Among 158 Candida glabrata bloodstream isolates collected from multicenter in China, resistance to fluconazole were seen in 8.9% of isolates. Three isolates (1.9%) were resistant to all echinocandins. MLST ST7 (65.8%) was the most common type and followed by ST3 (7.6%). PDR1 polymorphisms were associated with acquisition of fluconazole resistance in C. glabrata isolates, while MSH2 polymorphisms were associated with the STs and microsatellite genotypes, irrespective of fluconazole resistance.

https://ift.tt/2GfcLkc

Antifungal prophylaxis with Posaconazole delayed-release tablet and oral suspension in a Real-life setting: plasma levels, efficacy and tolerability [PublishAheadOfPrint]

We continuously determined Posaconazole plasma concentrations (PPCs) in 61 patients with hematological malignancies receiving Posaconazole (PCZ) delayed-release tablet (DRT) (48 patients, median duration of intake 92 days) and PCZ oral solution (OS) (13 patients, median duration of intake 124 days). PCZ DRT and OS antifungal prophylaxis was efficient and well tolerated. Thirty-four of 48 patients (71%) receiving DRT always had PPCs >0.7 mg/L, while 14 of 48 patients (29%) had at least one PPC ≤0.7 mg/L. In patients receiving OS 4 of 13 patients (31%) always had PPCs >0.7 mg/L, 6 of 13 patients (46%) had at least one PPC ≤0.7 mg/L, and 3 (23%) patients never reached a PPC of 0.7 mg/L. In patients with at least one determined PPCs the mean proportion of all PPCs >0.7 mg/L was 91% for PCZ DRT versus 52% for PCZ OS (p=0.001). In per sample analysis PPCs in patients receiving DRT were significantly more likely to be >0.7 mg/L when compared to PPCs in patients receiving OS [lsqb]91.4% (297/325) of PPCs >0.7 mg/L in DRT versus 70.3% (85/121) in OS; p<0.001[rsqb]. PCZ DRT has higher proportions of PPCs >0.7 mg/L compared to OS, both in per patient and in per sample analysis. Two patients (3%) had side effects during PCZ prophylaxis and one (2%) had fungal breakthrough infection. TDM enables to detect extended periods of PPCs ≤0.7 mg/L (e.g., due to non-adherence or GHVD), which may be associated also with loss of protective intracellular PCZ concentrations regardless of PCZ formulation.

https://ift.tt/2ITbuBf

Reply to: Cutaneous squamous cell carcinoma progression during imiquimod treatment

https://ift.tt/2uljo30

Successful treatment of severe psoriasis relapse with Secukinumab(IL17 A inhibitor) after abrupt Brodalumab (IL17 receptor inhibitor) discontinuation: A retrospective study evaluating long term efficacy and safety

https://ift.tt/2G8vYba

Cochlear implant function in a patient with Jervell and Lange-Nielsen syndrome after defibrillation by countershock

Jervell and Lange-Nielsen syndrome (JLNS), a rare autosomal recessive congenital QT prolongation syndrome, is characterized by cardiac arrhythmias, syncopal episodes, and profound deafness. A cochlear implant (CI) for patients with JLNS is expected to result in hearing improvement. Sometimes, defibrillation is required if a patient experiences lethal arrhythmia. In this paper, we report a pediatric patient with JLNS who received defibrillation after CI surgery in his right ear at the age of 2 years.

https://ift.tt/2I5i0n8

Barriers to medication adherence in asthma: the importance of culture and context

Significant disparities exist in asthma outcomes. Racial and ethnic minorities have lower controller medication adherence, which may contribute to differences in asthma morbidity between minority and non-minority groups. The objective of this review is to identify individual, patient-provider communication, and systems issues that contribute to this pattern of medication underuse and to discuss potential strategies for intervention.

https://ift.tt/2utWIOf

Occupational exposure and asthma

Key Messages – 18-02-0119

https://ift.tt/2GxmvK6

Stage IV Melanoma of Unknown Primary: A Population-Based Study in the United States from 1973 to 2014

Melanoma of unknown primary (MUP) is incompletely described on a population level.

https://ift.tt/2GeXLmo

Trichologic response of platelet-rich plasma in androgenetic alopecia is maintained during combination therapy

https://ift.tt/2IXg0i6

Low conversion rate of Quantiferon-TB Gold screening tests in patients treated with tumor necrosis factor inhibitors: A retrospective cohort study identifying an important practice gap

https://ift.tt/2GhhaTy

Melanoma staging: Varying precision and terminal digit clustering in Breslow thickness data is evident in a population based study

Errors in Breslow thickness reporting can give misclassification of T category, an important classifier in melanoma staging.

https://ift.tt/2IVtJGe

Risk of skin cancer in HIV-infected patients: a Danish nationwide cohort study

The risk of skin cancer in HIV-infected patients has not been extensively studied.

https://ift.tt/2pMK3Am

Drug survival of apremilast for psoriasis in a real-world setting

https://ift.tt/2ISrzHa

Non-malignant late cutaneous changes after allogeneic hematopoietic stem cell transplant in children

There are limited pediatric data on non-malignant cutaneous changes, including autoimmune conditions and permanent alopecia, after hematopoietic stem cell transplantation (HSCT).

https://ift.tt/2GenjQK

Oncological and Functional Evaluation of Open Conservation Surgery for Hypopharyngeal Cancer with/without Reconstruction

Objectives. Oncological and functional results of open conservation surgery for hypopharyngeal cancer have been desired. Methods. We performed a chart review of 33 patients with hypopharyngeal cancer who underwent open conservation surgery. Oncological and functional results were evaluated in surgery with primary closure (Group A) and surgery with reconstruction (Group B). Postoperative functions were evaluated by interval to resumption of oral intake, Functional Outcome Swallowing Scale (FOSS) and Communication Scale (CS). Results. Five-year disease-specific and overall cumulative survival rates by Kaplan-Meier method for all cases were 95.7% and 82.3%, respectively. Duration from surgery to full oral intake was 12 days in Group A and 14 days in Group B. FOSS rates were 83.3 in Group A and 95.5 in Group B. CS was 0 in both groups. Conclusion. Oncological and functional results of open conservation surgery were comparable to those with transoral surgery and chemo/radiotherapy. Our technique represents a reliable treatment for hypopharyngeal cancer.

https://ift.tt/2G9vdij

Evaluation of gap filling skills and reading mistakes of cochlear implanted and normally hearing students

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Hülya Çizmeci, Ayça Çiprut
ObjectiveThis study aimed to (1) evaluate the gap filling skills and reading mistakes of students with cochlear implants, and to (2) compare their results with those of their normal-hearing peers. The effects of implantation age and total time of cochlear implant use were analyzed in relation to the subjects' reading skills development.MethodsThe study included 19 students who underwent cochlear implantation and 20 students with normal hearing, who were enrolled at the 6th to 8th grades. The subjects' ages ranged between 12 and 14 years old. Their reading skills were evaluated by using the Informal Reading Inventory.ResultsA significant relationship were found between implanted and normal-hearing students in terms of the percentages of reading error and the percentages of gap filling scores. The average order of the reading errors of students using cochlear implants was higher than that of normal-hearing students. As for the gap filling, the performances of implanted students in the passage are lower than those of their normal-hearing peers. No significant relationship was found between the variables tested in terms of age and duration of implantation on the reading performances of implanted students.ConclusionEven if they were early implanted, there were significant differences in the reading performances of implanted students compared with those of their normal-hearing peers in older classes.



https://ift.tt/2unwzAk

Tuberculosis induced autoimmune haemolytic anaemia: a systematic review to find out common clinical presentations, investigation findings and the treatment options

Tuberculosis induced autoimmune haemolytic anaemia is a rare entity. The aim of this study was to explore its common presentations, investigation findings and treatment options through a systematic review of p...

https://ift.tt/2GtrHhW

A Pediatric Case of Relapsing-Remitting Multiple Sclerosis Onset following Varicella Zoster Ophthalmicus with Optic Neuritis

Some epidemiological studies have implied a pathogenetic association between varicella zoster virus (VZV) and multiple sclerosis (MS); this, however, remains controversial. The present report describes a case involving an immunocompetent 10-year-old girl who developed relapsing-remitting MS following the prolonged reactivation of VZV inside the first branch of the trigeminal nerve, exhibiting herpes zoster ophthalmicus with severe optic neuritis. Symptoms related to herpes zoster ophthalmicus and MS appeared consecutively in the 10-week period after the appearance of vesicles. This suggests that the onset of MS was triggered by some mechanism involving VZV reactivation in the first branch of the trigeminal nerve. To the best of our knowledge, this report is the first to describe a relationship between the onset of MS and herpes zoster ophthalmicus. Early diagnosis and aggressive antiviral therapy are important in cases of herpes zoster ophthalmicus to prevent the possible development of MS as well as visual impairment as sequela.

https://ift.tt/2G8OZul

Airborne protein concentration: a key metric for type 1 allergy risk assessment—in home measurement challenges and considerations

Exposure to airborne proteins can be associated with the development of immediate, IgE-mediated respiratory allergies, with genetic, epigenetic and environmental factors also playing a role in determining the ...

https://ift.tt/2ukt4ux

Submental liposuction for the management of lymphedema following head and neck cancer treatment: a randomized controlled trial

Patients who have undergone treatment for head and neck cancer are at risk for neck lymphedema, which can severely affect quality of life. Liposuction has been used successfully in cancer patients who suffer f...

https://ift.tt/2G7Dnrj

Role of neurogenic inflammation in local communication in the visceral mucosa

Abstract

Intense research has focused on the involvement of the nervous system in regard to cellular mechanisms underlying neurogenic inflammation in the pelvic viscera. Evidence supports the neural release of inflammatory factors, trophic factors, and neuropeptides in the initiation of inflammation. However, more recently, non-neuronal cells including epithelia, endothelial, mast cells, and paraneurons are likely important participants in nervous system functions. For example, the urinary bladder urothelial cells are emerging as key elements in the detection and transmission of both physiological and nociceptive stimuli in the lower urinary tract. There is mounting evidence that these cells are involved in sensory mechanisms and can release mediators. Further, localization of afferent nerves next to the urothelium suggests these cells may be targets for transmitters released from bladder nerves and that chemicals released by urothelial cells may alter afferent excitability. Modifications of this type of communication in a number of pathological conditions can result in altered release of epithelial-derived mediators, which can activate local sensory nerves. Taken together, these and other findings highlighted in this review suggest that neurogenic inflammation involves complex anatomical and physiological interactions among a number of cell types in the bladder wall. The specific factors and pathways that mediate inflammatory responses in both acute and chronic conditions are not well understood and need to be further examined. Elucidation of mechanisms impacting on these pathways may provide insights into the pathology of various types of disorders involving the pelvic viscera.

https://ift.tt/2pEuZp0

A Very Rare Case of Hypereosinophilic Syndrome Secondary to Natural Killer/T-Cell Lymphoma

Hypereosinophilic syndrome (HES) is a systemic disease characterized by an increased peripheral blood eosinophil count accompanied by systemic organ dysfunction. HES is classified into idiopathic HES, primary (neoplastic) HES (HESN), and secondary (reactive) HES (HESR). In this case report, a patient who developed peripheral blood eosinophilia and granulation tissue in the pharynx and paranasal sinus, which was initially diagnosed as chronic eosinophilic leukemia (CEL), categorized as HESN, but was eventually identified after the patient had died as natural killer/T-cell (NK/T) lymphoma, nasal type (ENKL), categorized as HESR, is presented. ENKL-induced HES is very rare but must be considered.

https://ift.tt/2Gb3zkP

An exploratory study of the factors related to mouth breathing syndrome in primary school children

Publication date: Available online 26 March 2018
Source:Archives of Oral Biology
Author(s): Issei Saitoh, Emi Inada, Yasutaka Kaihara, Yukiko Nogami, Daisuke Murakami, Naoko Kubota, Kaoru Sakurai, Yoshito Shirazawa, Tadashi Sawami, Miyuki Goto, Maki Nosou, Katsuyuki Kozai, Haruaki Hayasaki, Youichi Yamasaki
ObjectiveMouth breathing syndrome (MBS) is defined as a set of signs and symptoms that may be completely or incompletely present in subjects who, for various reasons, replace the correct pattern of nasal breathing with an oral or mixed pattern. It is important to identify the relevant factors affecting MBS in order to diagnose its cause since breathing obstructions can result from multiple factors. The purpose of this study is to clarify the relevant factors and the interrelationships between factors affecting MBS among children.DesignWe surveyed 380 elementary school children from 6 to 12 years in age. The questionnaire consisted of 44 questions regarding their daily health conditions and lifestyle habits and was completed by the children's guardians. A factor analysis was performed to classify closely related questions into their respective factors and to examine the strength of the correlation between the newly revealed factors.ResultsTwenty-six out of the 44 questions were selected, and they were classified into seven factors. Factors 1 to 7 were defined as "incompetent lip seal", "diseases of the nose and throat", "eating and drinking habits", "bad breath", "problem with swallowing and chewing", "condition of teeth and gums", and "dry lips", respectively. There were also correlations between these factors themselves.ConclusionMBS was categorized according to 7 major factors. Because Factor 1 was defined as "incompetent lip seal", which was representative of the physical appearance of mouth breathers and correlated with other factors, we suggested that MBS should consist of 7 factors in total.



https://ift.tt/2pIuZEk

Spectral components in electromyograms from four regions of the human masseter, in natural dentate and edentulous subjects with removable prostheses and implants.

Publication date: Available online 26 March 2018
Source:Archives of Oral Biology
Author(s): Rodrigo A. Guzmán-Venegas, Felipe H. Palma, Jorge L. Biotti P, Francisco J. Berral de la Rosa
ObjectiveTo compare the frequency or spectral components between different regions of the superficial masseter in young natural dentate and total edentulous older adults rehabilitated with removable prostheses and fixed-implant support. A secondary objective was to compare these components between the three groups.Design21 young natural dentate and 28 edentulous (14 with removable prostheses and 14 with fixed-implant support) were assessed. High-density surface electromyography (sEMG) was recorded in four portions of the superficial masseter during submaximal isometric bites. Spectral components were obtained through a spectral analysis of the sEMG signals. An analysis of mixed models was used to compare the spectral components.ResultsIn all groups, the spectral components of the anterior portion were lower than in the posterior region (p < 0.05). Both edentulous groups showed lower spectral components and median frequency slope than the natural dentate group (p < 0.05). The removable prostheses group showed the greatest differences with natural dentate group.ConclusionsThere were significant differences in the spectral components recorded in the different regions of the superficial masseter. The lower spectral components and fatigability of older adults rehabilitated with prostheses could be a cause of a greater loss of type II fibers, especially in the removable prostheses group.



https://ift.tt/2pLEbY7

Increased Vascular Permeability in the Bone Marrow Microenvironment Contributes to Disease Progression and Drug Response in Acute Myeloid Leukemia.

Passaro, D; Di Tullio, A; Abarrategi, A; Rouault-Pierre, K; Foster, K; Ariza-McNaughton, L; Montaner, B; ... Bonnet, D; + view all Passaro, D; Di Tullio, A; Abarrategi, A; Rouault-Pierre, K; Foster, K; Ariza-McNaughton, L; Montaner, B; Chakravarty, P; Bhaw, L; Diana, G; Lassailly, F; Gribben, J; Bonnet, D; - view fewer (2017) Increased Vascular Permeability in the Bone Marrow Microenvironment Contributes to Disease Progression and Drug Response in Acute Myeloid Leukemia. Cancer Cell , 32 (3) 324-341.e6. 10.1016/j.ccell.2017.08.001 . Green open access

https://ift.tt/2DWCID4

Exploring whether (and how) self-reflection can improve practice as a teacher educator

Fragkos, KC; (2018) Exploring whether (and how) self-reflection can improve practice as a teacher educator. AMEE MedEdPublish 10.15694/mep.2018.0000067.1 . Green open access

https://ift.tt/2GpAIZv

Context dependence of female reproductive competition in wild chacma baboons

Baniel, A; Cowlishaw, G; Huchard, E; (2018) Context dependence of female reproductive competition in wild chacma baboons. Animal Behaviour (In press).

https://ift.tt/2DWKm0a

Central Coherence in Eating Disorders: A Synthesis of Studies Using the Rey Osterrieth Complex Figure Test

Lang, K; Roberts, M; Harrison, A; Lopez, C; Goddard, E; Khondoker, M; Treasure, J; Lang, K; Roberts, M; Harrison, A; Lopez, C; Goddard, E; Khondoker, M; Treasure, J; Tchanturia, K; - view fewer (2016) Central Coherence in Eating Disorders: A Synthesis of Studies Using the Rey Osterrieth Complex Figure Test. PLoS ONE , 11 (11) , Article e0165467. 10.1371/journal.pone.0165467 . Green open access

https://ift.tt/2GsXkbC

Archaeometallurgy in Colombia: Recent Developments

Martinon-Torres, M; Uribe-Villegas, MA; Saenz-Samper, J; Lobo Guerrero Arenas, J; (2017) Archaeometallurgy in Colombia: Recent Developments. Archaeology International , 20 pp. 80-84. 10.5334/ai.354 . Green open access

https://ift.tt/2GbH5w0

Preclinical modeling of myelodysplastic syndromes

Rouault-Pierre, K; Mian, SA; Goulard, M; Abarrategi, A; Di Tulio, A; Smith, AE; Mohamedali, A; ... Bonnet, D; + view all Rouault-Pierre, K; Mian, SA; Goulard, M; Abarrategi, A; Di Tulio, A; Smith, AE; Mohamedali, A; Best, S; Nloga, A-M; Kulasekararaj, AG; Ades, L; Chomienne, C; Fenaux, P; Dosquet, C; Mufti, GJ; Bonnet, D; - view fewer (2017) Preclinical modeling of myelodysplastic syndromes. Leukemia , 31 (12) pp. 2702-2708. 10.1038/leu.2017.172 . Green open access

https://ift.tt/2GvbPM8

Continuous-wave room-temperature diamond maser

Breeze, J; Salvadori, E; Sathian, J; Alford, N; Kay, CWM; (2018) Continuous-wave room-temperature diamond maser. Nature , 555 (7697) pp. 493-496. 10.1038/nature25970 .

https://ift.tt/2DTZw6A

Adaptive Streaming in Interactive Multiview Video Systems

Zhang, X; Toni, L; Frossard, P; Zhao, Y; Lin, C; (2018) Adaptive Streaming in Interactive Multiview Video Systems. IEEE Transactions on Circuits and Systems for Video Technology (In press).

https://ift.tt/2GsXkIE

Effect of donepezil on transcranial magnetic stimulation parameters in Alzheimer's disease

Hwang, YT; Rocchi, L; Hammond, P; Hardy, CJ; Warren, JD; Ridha, BH; Rothwell, J; Hwang, YT; Rocchi, L; Hammond, P; Hardy, CJ; Warren, JD; Ridha, BH; Rothwell, J; Rossor, MN; - view fewer (2018) Effect of donepezil on transcranial magnetic stimulation parameters in Alzheimer's disease. Alzheimer's & Dementia: Translational Research & Clinical Interventions , 4 pp. 103-107. 10.1016/j.trci.2018.02.001 . Green open access

https://ift.tt/2GbH3Eo

3D patient imaging and retrieval analysis help understand the clinical importance of rotation in knee replacements.

Cerquiglini, A; Henckel, J; Hothi, H; Rotigliano, N; Hirschmann, MT; Hart, AJ; (2018) 3D patient imaging and retrieval analysis help understand the clinical importance of rotation in knee replacements. Knee Surg Sports Traumatol Arthrosc 10.1007/s00167-018-4891-9 . (In press). Green open access

https://ift.tt/2GvBJz2

Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries.

GlobalSurg Collaborative, ; (2016) Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries. BMJ Glob Health , 1 (4) , Article e000091. 10.1136/bmjgh-2016-000091 . Green open access

https://ift.tt/2GeKRF3

Towards a More Particularist View of Rights’ Stringency

Rumbold, B; (2018) Towards a More Particularist View of Rights' Stringency. Res Publica 10.1007/s11158-018-9396-3 . (In press). Green open access

https://ift.tt/2GrmUNX

Association of nursery and early school attendance with later health behaviours, biomedical risk factors, and mortality: evidence from four decades of follow-up of participants in the 1958 birth cohort study.

Batty, GD; Ploubidis, GB; Goodman, A; Bann, D; (2018) Association of nursery and early school attendance with later health behaviours, biomedical risk factors, and mortality: evidence from four decades of follow-up of participants in the 1958 birth cohort study. J Epidemiol Community Health 10.1136/jech-2018-210667 . (In press). Green open access

https://ift.tt/2DUWUoY

Toward a Theory of Everything

Knight, C; Lewis, JD; (2016) Toward a Theory of Everything. In: Power, C and Finnegan, M and Callan, H, (eds.) Human Origins: Contributions from Social Anthropology. Berghahn: New York / Oxford.

https://ift.tt/2Grmp6x

Lepidosaurian diversity in the Mesozoic-Palaeogene: the potential roles of sampling biases and environmental drivers

Cleary, T; Benson, R; Evans, SE; Barrett, P; (2018) Lepidosaurian diversity in the Mesozoic-Palaeogene: the potential roles of sampling biases and environmental drivers. Royal Society Open Science , 5 , Article 171830. 10.1098/rsos.171830 . Green open access

https://ift.tt/2DVSkXx

Rotation-free online handwritten character recognition using dyadic path signature features, hanging normalization, and deep neural network

Ni, H; Weixin, Y; Lianwen, J; Terry, L; (2017) Rotation-free online handwritten character recognition using dyadic path signature features, hanging normalization, and deep neural network. In: Proceedings of the 2016 23rd International Conference on Pattern Recognition (ICPR). (pp. pp. 4083-4088). IEEE Green open access

https://ift.tt/2GrlWRP

Minimally symptomatic cerebral amyloid angiopathy-related inflammation: three descriptive case reports

Banerjee, G; Alvares, D; Bowen, J; Adams, ME; Werring, DJ; (2018) Minimally symptomatic cerebral amyloid angiopathy-related inflammation: three descriptive case reports. Journal of Neurology, Neurosurgery, and Psychiatry 10.1136/jnnp-2017-317347 . (In press). Green open access

https://ift.tt/2GbH0Ze

The metaplastic mosaic of Barrett's oesophagus

Biswas, S; Quante, M; Leedham, S; Jansen, M; (2018) The metaplastic mosaic of Barrett's oesophagus. Virchows Archiv , 472 (1) pp. 43-54. 10.1007/s00428-018-2317-1 . Green open access

https://ift.tt/2GvbLvS

An Exploration of Social Functioning in Young People with Eating Disorders: A Qualitative Study

Patel, K; Tchanturia, K; Harrison, A; (2016) An Exploration of Social Functioning in Young People with Eating Disorders: A Qualitative Study. PLOS ONE , 11 (7) , Article e0159910. 10.1371/journal.pone.0159910 . Green open access

https://ift.tt/2Gdp3tc

Diagnostic double strike in the emergency room - two cases of complete pancreatic ruptures due to bicycle handlebar injuries on two consecutive days

Pancreatic injuries are rare in cases of blunt abdominal trauma and therefore easily misdiagnosed at time of hospital admission. They are associated with a significantly elevated morbidity and lethality. Bicyc...

https://ift.tt/2GbvtZW

Management of a giant retroperitoneal leiomyoma: a case report

Leiomyomas are benign tumors observed mainly in adult women. The retroperitoneum is a rare location for leiomyomas; almost 100 cases have been reported. Because retroperitoneal leiomyomas are paucisymptomatic ...

https://ift.tt/2pG4y26

Kickballs, Chicken and 3-D Models Help Johns Hopkins Surgeons Prepare for Complex Fetal Surgeries

By combining high-tech 3-D printing technology with everyday items such as a kickball and pieces of chicken breast, surgeons at Johns Hopkins report they have devised an innovative way to "rehearse" a complex minimally invasive surgical repair of open lesions on fetal spinal cords inside the womb.
 

https://ift.tt/2IStLOV

Acute Suppurative Thyroiditis in an Intravenous Drug User with a Preexisting Goiter

Acute suppurative thyroiditis (AST) is an uncommon, potentially life-threatening cause of a rapidly enlarging neck mass. It may present similarly to subacute thyroiditis, a relatively benign and self-limiting condition. We report a case of AST in an adult intravenous (IV) drug user with a preexisting goiter who presented with a left forearm abscess that grew methicillin-sensitive Staphylococcus aureus. In this particular case, clinical suspicion for AST was high. As a result, early IV antibiotic therapy was initiated, and this led to rapid clinical improvement furthermore preventing airway compromise. To our knowledge, this is the first case of AST in the literature resulting from likely hematogenous spread in the setting of IV drug use and a preexisting goiter. Overall, this case highlights the importance of assessing risk factors for AST in patients whose presentations may seem more typical of subacute thyroiditis. Such an approach will lead to timely diagnosis and treatment to avoid potentially devastating consequences.

https://ift.tt/2I3gDoS

Cochlear Implantation in Charcot-Marie-Tooth Disease: Case Report and Review of the Literature

Introduction. Charcot-Marie-Tooth (CMT) disease is a peripheral hereditary neuropathy associated with motor and sensory impairment and can result in profound sensorineural hearing loss (SNHL). Currently, the role of cochlear implantation in the setting of CMT and other progressive peripheral neurodegenerative disorders is not well established. Methods. Case report and review of the English literature. Results. A 70-year-old male with CMT was referred for evaluation of progressive asymmetric SNHL and reported a 15-year duration of deafness involving the left ear. Audiometric testing confirmed profound SNHL in the left ear, while the right ear exhibited moderate-to-severe SNHL. Left-sided cochlear implantation was performed using a conventional length lateral wall electrode. Intraoperative device testing found normal impedance levels throughout the array; however, electrically evoked auditory potentials were absent on all electrodes. Upon initial activation 3 weeks after surgery, the patient reported excellent access to sound in the cochlear implant-only condition. He has made good progress at each subsequent visit; speech perception testing after seven months showed improvement from 0% to 32% on AzBio sentence and 53% on CNC phoneme testing in the cochlear implant-only condition. Conclusion. We report the third case of cochlear implantation in a patient with CMT. SNHL in CMT is hypothesized to result from disruption of synchronous activity of the cochlear nerve. In patients with CMT, cochlear implantation may reconstitute synchronous neural activity by way of supraphysiological electrical stimulation. Our results corroborate two earlier reports that cochlear implantation is a viable option for rehabilitation of SNHL in this unique subset of patients.

https://ift.tt/2GuYB1C

Children with sickle cell anemia with normal TCD and without silent infarcts have a low incidence of new strokes

Jordan, LC; Williams, DOR; Rodeghier, MJ; Covert, B; Ponisio, MR; Casella, JF; McKinstry, RC; ... DeBaun, MR; + view all Jordan, LC; Williams, DOR; Rodeghier, MJ; Covert, B; Ponisio, MR; Casella, JF; McKinstry, RC; Noetzel, MJ; Kirkham, FJ; Meier, ER; Fuh, B; McNaull, M; Sarnaik, S; Majumdar, S; McCavit, TL; DeBaun, MR; - view fewer (2018) Children with sickle cell anemia with normal TCD and without silent infarcts have a low incidence of new strokes. American Journal of Hematology 10.1002/ajh.25085 . (In press).

https://ift.tt/2IV6gVp

Getting the best outcomes from epilepsy surgery

Vakharia, VN; Duncan, JS; Witt, J-A; Elger, CE; Staba, R; Engel, J; (2018) Getting the best outcomes from epilepsy surgery. Annals of Neurology 10.1002/ana.25205 . (In press).

https://ift.tt/2ujI4ca

Characterization of Pax3 and Sox10 transgenic Xenopus laevis embryos as tools to study neural crest development

Alkobtawi, M; Ray, H; Barriga, EH; Moreno, M; Kerney, R; Monsoro-Burq, A-H; Saint-Jeannet, J-P; Alkobtawi, M; Ray, H; Barriga, EH; Moreno, M; Kerney, R; Monsoro-Burq, A-H; Saint-Jeannet, J-P; Mayor, R; - view fewer (2018) Characterization of Pax3 and Sox10 transgenic Xenopus laevis embryos as tools to study neural crest development. Developmental Biology 10.1016/j.ydbio.2018.02.020 . (In press).

https://ift.tt/2IPtoVk

Association of branched-chain amino acids and other circulating metabolites with risk of incident dementia and Alzheimer's disease: A prospective study in eight cohorts

Tynkkynen, J; Chouraki, V; van der Lee, SJ; Hernesniemi, J; Yang, Q; Li, S; Beiser, A; ... Salomaa, V; + view all Tynkkynen, J; Chouraki, V; van der Lee, SJ; Hernesniemi, J; Yang, Q; Li, S; Beiser, A; Larson, MG; Sääksjärvi, K; Shipley, MJ; Singh-Manoux, A; Gerszten, RE; Wang, TJ; Havulinna, AS; Würtz, P; Fischer, K; Demirkan, A; Ikram, MA; Amin, N; Lehtimäki, T; Kähönen, M; Perola, M; Metspalu, A; Kangas, AJ; Soininen, P; Ala-Korpela, M; Vasan, RS; Kivimäki, M; van Duijn, CM; Seshadri, S; Salomaa, V; - view fewer (2018) Association of branched-chain amino acids and other circulating metabolites with risk of incident dementia and Alzheimer's disease: A prospective study in eight cohorts. Alzheimer's & Dementia 10.1016/j.jalz.2018.01.003 . (In press).

https://ift.tt/2ugpRMI

Review of Young and Free: [Post]colonial Ontologies of Childhood, Memory and History in Australia, written by Joanne Faulkner

Alderson, P; (2018) Review of Young and Free: [Post]colonial Ontologies of Childhood, Memory and History in Australia, written by Joanne Faulkner. International Journal of Children's Rights , 26 pp. 183-185. 10.1163/15718182-02601008 .

https://ift.tt/2IPt1tU

Cascading Effects and Escalations in Wide Area Power Failures: A Summary for Emergency Planners

Pescaroli, G; Turner, S; Gould, T; Alexander, DE; Wicks, RT; (2017) Cascading Effects and Escalations in Wide Area Power Failures: A Summary for Emergency Planners. [Pamphlet]. (UCL IRDR and London Resilience Special Report 2017-01 ). UCL Institute for Risk and Disaster Reduction: London, UK. Green open access

https://ift.tt/2uphjTQ

Regulating Content on Social Media

Tan, C; (2018) Regulating Content on Social Media. [Book]. UCL Press: London, UK. Green open access

https://ift.tt/2pFg91u

Association of body mass index with chronic pain prevalence: a large population-based cross-sectional study in Japan

Abstract

Purpose

The aim of this study was to examine the association between body mass index and chronic pain.

Methods

The outcome was chronic pain prevalence by body mass index (BMI). BMIs of less than 18.5, 18.5–25.0, 25.0–30.0, and 30.0 or over kg/m² were defined as underweight, normal weight, overweight, and obese.

Subjects

We used data from 4993 participants (2464 men and 2529 women aged 20–79 years) of the Pain Associated Cross-sectional Epidemiological survey in Japan. Sex-stratified multivariable-adjusted odds ratios were calculated with 95% confidence intervals using a logistic regression model including age, smoking, exercise, sleep time, monthly household expenditure, and presence of severe depression. We analyzed all ages and age subgroups, 20–49 and 50–79 years.

Results

The prevalence of chronic pain was higher among underweight, overweight, and obese male respondents than those reporting normal weight, with multivariable odds ratios of 1.52 (1.03–2.25), 1.55 (1.26–1.91), and 1.71 (1.12–2.60). According to underweight, only older men showed higher prevalence of chronic pain than normal weight men with odd ratios, 2.19 (1.14–4.20). Being overweight and obese were also associated with chronic pain in women; multivariable odds ratios were 1.48 (1.14–1.93) and 2.09 (1.20–3.64). Being underweight was not associated with chronic pain.

Conclusion

There was a U-shaped association between BMI and chronic pain prevalence among men ≥ 50 years, and a dose–response association among women. Our finding suggests that underweight should be considered in older men suffering chronic pain.

https://ift.tt/2pEZlb4

Epidemiological Features and Management of Oral Cancer Patients: Experience from a Single Private Comprehensive Cancer Care Center in the State of Odisha

Abstract

Oral cancer is the most common cancer in India. Challenges in the management of oral cancer patients in India include, delay in the presentation with high volume of advanced disease to be handled, affordability of patients and lack economical support especially in the non-governmental institutions and lack of awareness among patients and their relatives. Present study, a retrospective analysis of a prospectively maintained data, portrays the epidemiological features and management of patients with oral cancer presented to a private comprehensive cancer care hospital in the state of Odisha, India. A total of 1049 patients were considered for the analyses, managed between January 2014 and December 2016. Among 1049 patients, 20% (n, 215) were females and 80% (n, 834) were males. Mean age among the present cohort of patients was 50 years with age group 40–55 years being most common. All the patients underwent resection with curative intent and a 1 cm gross resection margins with or without bone and skin. Margin negative resection could be achieved in 82% of patients. Nodal involvement was seen in 36% of patients in the final histopathological assessment. Management of oral cancer patients is a major oncological and reconstructive challenge in India due to the advanced nature of disease at presentation. Inspite of socioeconomic constraints, these patients can be managed even in a private cancer centers with optimum outcomes. This is possible through coordinated team efforts.

https://ift.tt/2GbWXP7

Prevalence of Otitis Media with Effusion in Children with Hearing Loss

Abstract

Otitis media is an inflammation of the middle ear cleft, with or without intact tympanic membrane. Otitis media is known to be one of the most common childhood infections. Middle ear effusions have been recognized to grab increasing attention because of the problems they pose in both the diagnosis and the treatment, and because of the fear that effusion is the cause of learning difficulties, irreversible middle ear disease, or both. To study prevalence of otitis media with effusion in children with hearing loss. Materials and methods: This prospective study was conducted on children with hearing loss ageing between 3 and 15 years presenting to ENT OPD of GURU GOBIND SINGH MEDICAL COLLEGE FARIDKOT with complaint of hearing loss from January 2015 to June 2016. Total of 125 children were taken in study. Detailed history and complete ENT examination was done along with pure tone audiometery and impedence audiometery. Most common complaints of patient were otalgia on ototscopic examination majority of patients had congested tympanic membranes. Otitis media with effusion was most common cause of hearing loss. Majority of children diagnosed with otitis media with effusion were in age group of 6–8 years of age. Patients with mild hearing loss due to otitis media with effusion, on pure tone audiometery was more as compared to moderate hearing loss. B type of tympanogram was found in majority of cases. The potential of otitis media with effusion to cause a series of sequels and complications such as tympanosclerosis, retraction pockets, adhesive otitis media and hearing or speech impairment makes the disease an important public health problem. To prevent delayed diagnosis which leads to development of this disease, parents must be informed about the preventable risk factors and symptoms for the development of otitis media with effusion.

https://ift.tt/2IP6b5E

Rezidiviertes oder refraktäres klassisches Hodgkin-Lymphom

Zusammenfassung

Hintergrund

Das klassische Hodgkin-Lymphom ist mit risikoadaptierter Erstlinientherapie in den meisten Fällen heilbar. Neben der Reduktion möglicher therapieassoziierter Früh- und Langzeitschädigungen stellt v. a. die Therapie von Patienten mit rezidivierter oder primär refraktärer Erkrankung (r/r HL) eine klinische Herausforderung dar.

Methoden

Dieser Übersichtsartikel fasst die aktuell verfügbaren Daten zu Sicherheit und Effektivität verschiedener Therapieansätze beim r/r HL zusammen und gibt Handlungsempfehlungen für verschiedene klinische Situationen.

Ergebnisse

Bis zu 50 % der für eine intensivierte Therapie geeigneten Patienten erreichen nach einer Hochdosischemotherapie mit autologer Stammzelltransplantation (ASZT) eine langfristige Remission. Mehrfach rezidivierte, refraktäre, ältere oder multimorbide Patienten hatten bis vor einigen Jahren bei größtenteils palliativen Therapieoptionen eine schlechte Prognose. Das Anti-CD30-Antikörper-Wirkstoffkonjugat Brentuximab Vedotin (BV) ermöglicht eine zielgerichtete Therapie mit hohen Ansprechraten sowie teilweise dauerhaften kompletten Remissionen und ist nach ASZT oder zwei vorangegangen Therapien für das r/r HL zugelassen. Zuletzt wurden die beiden Anti-PD-1-Antikörper Nivolumab und Pembrolizumab als Immuncheckpointinhibitoren auch bei Patienten mit intensiv vorbehandeltem r/r HL untersucht. Beide Substanzen zeigten bei sehr guter Verträglichkeit deutlich höhere Ansprechraten als bei anderen malignen Erkrankungen und lange Remissionen. Nivolumab und Pembrolizumab wurden daher kürzlich für das r/r HL nach vorausgegangener Therapie mit BV zugelassen. Zudem zeigten weitere zielgerichtete Substanzen wie AFM13, Everolimus, Panobinostat oder Mocetinostat sowie auch Lenalidomid oder Bendamustin Aktivität bei intensiv behandelten Patienten.

https://ift.tt/2up17lw

Therapiealgorithmus für Patienten mit Hodgkin-Lymphom

https://ift.tt/2G60DGd

Tumorassoziierte Fatigue beim Hodgkin-Lymphom

Zusammenfassung

Hintergrund

Da heutzutage die meisten Hodgkin-Patienten geheilt werden können, ist die Nachsorge der überwiegend jungen Langzeitüberlebenden in den Mittelpunkt gerückt. Zu den häufigsten Beeinträchtigungen zählt die tumorassoziierte Fatigue („cancer-related fatigue", CrF).

Fragestellung

Dieser Artikel gibt einen Überblick über die Häufigkeit, Entwicklung und den Verlauf von CrF beim Hodgkin-Lymphom (HL), deren langfristige Folgen für die soziale Reintegration sowie über bestehende therapeutische Optionen.

Material und Methoden

Mittels systematischer und manueller Literaturrecherche wurden relevante Publikationen sowie im Rahmen aktueller Studien getestete neue Therapieansätze für CrF zusammengefasst.

Ergebnisse

CrF ist bereits zum Zeitpunkt der Diagnosestellung vorhanden, wobei das Ausmaß der Fatigue mit fortschreitendem Stadium zunimmt. Unter laufender Therapie kommt es unabhängig vom Stadium und der erhaltenen Therapie zu einem starken Anstieg der Fatigue auf ein nahezu identisch hohes Niveau. Wichtigster prognostischer Faktor für den Verlauf und den Schweregrad der Langzeit-Fatigue ist die Baseline-Fatigue. Die Therapieintensität hingegen nimmt auf das Ausmaß und den Verlauf der Fatigue keinen Einfluss. In allen Stadien konnten mehrere Subgruppen mit unterschiedlichen Fatigue-Verläufen identifiziert werden. Patienten mit schwerer Fatigue bei Diagnosestellung müssen auch mit dauerhafter, schwerer Fatigue rechnen. In den anderen Subgruppen konnten hingegen teils wesentliche Verbesserungen beobachtet werden. Neben der Einschränkung der Lebensqualität hat das Leiden an Fatigue auch relevante sozioökonomische Folgen. Die Zahl der Überlebenden mit Fatigue, die sich nach 5 Jahren in einem festen Beschäftigungsverhältnis oder in Ausbildung befinden, ist fast 30 % niedriger verglichen mit Überlebenden ohne Fatigue. Mit körperlichen Trainingsprogrammen sowie verhaltenstherapeutischen Maßnahmen konnten bislang gute Erfolge in der Therapie von CrF erzielt werden.

Schlussfolgerungen

Der Leidensdruck der Betroffenen ist hoch. Weitere randomisierte, klinische Studien sind erforderlich, um die Therapieoptionen und somit das Outcome der Patienten zu verbessern.

https://ift.tt/2G5QusZ

Positronenemissionstomographie beim Hodgkin-Lymphom

Zusammenfassung

Hintergrund

Die FDG-PET (Fluordesoxyglucose-Positronenemissionstomographie) ist eine Standarduntersuchung in der Bestimmung des Stadiums und des Therapieansprechens des Hodgkin-Lymphoms geworden.

Ergebnisse

Im initialen Staging erlaubt die PET eine sichere Stadienzuordnung und bei unauffälligem osteomedullärem Befund den Verzicht auf die Knochenmarkbiopsie. Der prädiktive Wert der FDG-PET während und nach der Chemotherapie bietet weiteren, deutlichen Zugewinn an Information. PET-gesteuerte Therapieregime wurden eingeführt, die die PET schon nach 2 Zyklen Chemotherapie zur weiteren Therapiestratifizierung einsetzen. Sowohl Protokolle, die eine Intensivierung der Therapie aufgrund einer positiven PET nutzen, als auch die Deeskalation der Therapie wegen einer unauffälligen, negativen PET haben Erfolge gezeigt. So kann z. B. bei negativer FDG-PET nach 2 Zyklen effektiver Chemotherapie für fortgeschrittene Stadien die Therapie von üblicherweise 6 auf insgesamt nur 4 Zyklen verkürzt werden. Nach Chemotherapie kann in fortgeschrittenen Stadien bei negativer FDG-PET außerdem ohne Verlust an Therapiesicherheit auf eine ergänzende Bestrahlung verzichtet werden.

Ausblick

Für frühe und mittlere Stadien ist die Möglichkeit des Verzichts auf die Bestrahlung noch nicht gezeigt, jedoch werden belastbare Daten erwartet. Robuste und reproduzierbare Beurteilungskriterien für die PET sind heute Standard bei der Interpretation der Untersuchung, sowohl in wissenschaftlichen Studien als auch in der täglichen klinischen Routine. Die sog. 5‑Punkte-Deauville-Skala ist derzeitiger Standard zur visuellen Analyse. Die Konsequenzen aus der jeweiligen Zuordnung berücksichtigen dabei sowohl die vorangegangene als auch die folgende Behandlung.

https://ift.tt/2umZrsF

Therapie des Hodgkin-Lymphoms in frühen und intermediären Stadien

Zusammenfassung

Hintergrund

In frühen und intermediären Stadien des Hodgkin-Lymphoms (HL) kann die überwiegende Zahl der Patienten durch eine risikoadaptierte Chemo- und Strahlentherapie (RT) geheilt werden. Allerdings trägt die therapieassoziierte Langzeittoxizität wesentlich zu Morbidität und Mortalität bei. Aktuelle Studien haben daher zum Ziel, die therapieassoziierte Toxizität unter Erhalt bzw. weiterer Verbesserung der erreichten Tumorkontrolle zu reduzieren.

Ziel

Ziel war die Entwicklung einer Therapieleitlinie für die frühen und intermediären Stadien des HL auf der Grundlage aktueller Studiendaten.

Methoden

Es erfolgte eine Analyse der Tumorkontrolle, des Gesamtüberlebens und der verfügbaren Toxizitätsdaten in aktuellen randomisierten Studien, Metaanalysen und relevanten retrospektiven Auswertungen.

Ergebnisse und Schlussfolgerung

In den frühen Stadien sind 2 Zyklen ABVD (Adriamycin, Bleomycin, Vinblastin, Dacarbazin) und 20 Gy Involved-Site-RT (IS-RT) aufgrund der hervorragenden Überlebensdaten (HD10) und der Etablierung des kleineres Bestrahlungsfelds der IS-RT Therapiestandard. In den intermediären Stadien kann mit 4 Zyklen ABVD und 30 Gy IF-RT (Involved-Field-RT) ein progressionsfreies Überleben (PFS) von bis zu 83 % erzielt werden. Eine signifikante Verbesserung der Tumorkontrolle wurde bei höherer Akuttoxizität mit 2 Zyklen BEACOPP_eskaliert (Bleomycin, Etoposid, Doxorubicin, Cyclophosphamid, Vincristin, Procarbazin, Prednison) und 2 Zyklen ABVD („2 + 2"; HD14) erreicht. Die in H10 angewandte ^18FFDG-PET-basierte Applikation von 2 Zyklen BEACOPP_eskaliert bei nach 2 Zyklen ABVD PET-positiven Patienten könnte bei einem signifikanten Teil der Patienten bei vergleichsweise gutem PFS die Therapieintensität reduzieren. Es bedarf jedoch weiterer Daten zur Etablierung dieses Ansatzes. Daher werden aktuell „2 + 2" + 30 Gy IS-RT bei Patienten bis 60 Jahre als Standard empfohlen. Die verfügbaren Daten unterstützen die Rolle der RT in der erzielten Tumorkontrolle. Eine ^18FFDG-PET-basierte RT kann als individueller Therapieansatz angewandt werden.

https://ift.tt/2uhlXTH

Neue Entwicklungen in der Therapie des fortgeschrittenen klassischen Hodgkin-Lymphoms

Zusammenfassung

Hintergrund

Das Gesamtüberleben von Patienten mit fortgeschrittenem Hodgkin-Lymphom (HL), die mit dem aktuellen Standard der Deutschen Hodgkin Studiengruppe (DHSG), bestehend aus der Interim-Positronen-Emissionstomographie(PET)-gesteuerten Gabe von 4 bis 6 Zyklen BEACOPP_eskaliert (Bleomycin, Etoposid, Doxorubicin, Cyclophosphamid, Vincristin, Procarbazin und Prednison in eskalierter Dosierung) plus Bestrahlung Positronen-Emissionstomographie-positiver Reste, behandelt werden, liegt bei mehr als 95 %. Es ist dennoch nötig, die Toxizität der Therapie weiter zu minimieren, ohne dabei Einbußen in der Effektivität zu erleiden. Langfristiges Ziel ist also die Reduktion von Nebenwirkungen bei gleichbleibend gutem Therapieerfolg.

Ziel

Ziel des vorliegenden Artikels ist es, eine Zusammenfassung über die gegenwärtigen Standardtherapien sowie neue Entwicklungen in der Behandlung des fortgeschrittenen HL zu geben.

Material und Methode

Mittels systematischer und manueller Literaturrecherche wurden relevante Publikationen sowie im Rahmen derzeit laufender Studien getestete neue Therapieansätze zusammengefasst.

Ergebnisse

Vergleiche von BEACOPP_eskaliert und ABVD (Doxorubicin, Bleomycin, Vinblastin, Dacarbazin) zeigen einen signifikanten und klinisch bedeutenden Überlebensvorteil für BEACOPP_eskaliert sowohl im Sinne des progressionsfreien Überlebens (PFS) als auch des Gesamtüberlebens (OS). Die Interim-PET-gesteuerte Gabe von 4−6 Zyklen BEACOPP_eskaliert ist sicher und hoch effektiv. Dennoch ist eine weitere Optimierung der Therapie, z. B. durch die Implementierung zielgerichteter Substanzen wie Brentuximab Vedotin, möglich. Daher wird derzeit eine BEACOPP-Variante namens BrECADD (Brentuximab Vedotin, Etoposid, Cyclophosphamid, Doxorubicin, Dacarbazin, Dexamethason) im Rahmen der HD21-Studie randomisiert mit herkömmlichem BEACOPP_eskaliert verglichen. Zuvor wurde im Rahmen einer Phase-II-Studie gezeigt, dass BrECADD bei Patienten mit fortgeschrittenem HL sicher angewendet werden kann.

Schlussfolgerungen

Langfristiges Ziel in der Behandlung des HL ist die Reduktion der Toxizität der Therapie ohne Verschlechterung der Tumorkontrolle und des lymphomspezifischen Outcomes. Dies kann möglicherweise durch die Implementierung zielgerichteter Substanzen in die Erstlinientherapie erreicht werden. Daher wird momentan die Brentuximab Vedotin enthaltende BEACOPP-Variante BrECADD im Rahmen der HD21-Studie randomisiert gegen konventionelles BEACOPP_eskaliert getestet.

https://ift.tt/2G60wdL

Submental liposuction for the management of lymphedema following head and neck cancer treatment: a randomized controlled trial

Abstract

Background

Patients who have undergone treatment for head and neck cancer are at risk for neck lymphedema, which can severely affect quality of life. Liposuction has been used successfully in cancer patients who suffer from post-treatment limb lymphedema. The purpose of our study was to review the outcomes of head and neck cancer patients at our center who have undergone submental liposuction for post-treatment lymphedema and compare their subsequent results with a control group.

Methods

All head and neck cancer patients at an oncology center in tertiary hospital setting who complained to their attending surgeon or radiation oncologist regarding cervical lymphedema secondary to head and neck cancer treatment, and had been disease-free for a minimum of one year, with no previous facial plastic surgical procedures were eligible for inclusion into the study. Study design was a non-blinded randomized controlled trial. Twenty patients were randomized into a treatment arm (underwent submental liposuction n = 10) and control arm (n = 10). Both groups of patients completed two surveys (Modified Blepharoplasty Outcome Evaluation and the validated Derriford Appearance Scale) on initial office visit after consenting for the trial. The treatment group then completed the surveys 6 months post-operatively while the control group filled the surveys 6 months after the initial assessment but had no intervention. Mann-Whitney U tests were performed to compare the responses of those that did and did not receive liposuction.

Results

Our study demonstrated a statistically significant improvement in patients' self-perception of appearance and statistically significant subjective scoring of appearance following submental liposuction.

Conclusions

Submental liposuction is an effective and safe procedure to improves the quality of life for head and neck cancer patients suffering from post-treatment lymphedema.

https://ift.tt/2IOmtM1

Can Medullary Thyroid Carcinoma Arise in Thyroglossal Duct Cysts? A Search for Parafollicular C-cells in 41 Resected Cases

Abstract

Thyroglossal duct cysts (TGDCs) are present in ~7% of adults and develop from the midline migratory tract between the foramen cecum and anatomic location of the thyroid. Thyroid tissue can be identified in 2/3 of TGDCs, and up to 1% develop associated malignancy, 90% of which are papillary thyroid carcinoma. Cases of follicular and anaplastic carcinoma have been documented, but there are no reports of medullary thyroid carcinoma arising in a TGDC. This is presumably due to the distinct embryologic origin of parafollicular C-cells, from which medullary carcinoma arises. The goal of this study is to determine whether parafollicular C-cells are present in TGDCs. H&E sections from 41 TGDC cases were examined for thyroid tissue, thyroglossal duct remnants, ultimobranchial remnants, and parafollicular C-cells. Immunohistochemistry was performed for TTF-1 and calcitonin. Eighty three percent (34/41) of cases contained thyroid tissue on H&E and by TTF-1. No cases (0/41) had ultimobranchial remnants or parafollicular C-cells on H&E or with calcitonin. One case of papillary carcinoma in a TGDC was identified. These cases illustrate that although TGDCs often contain thyroid tissue, parafollicular C-cells are absent. Therefore, unlike other thyroid neoplasms, there is no evidence to support the possibility of medullary carcinoma arising in a TGDC.

https://ift.tt/2DVIViK

Epidemiological Features and Management of Oral Cancer Patients: Experience from a Single Private Comprehensive Cancer Care Center in the State of Odisha

Abstract

Oral cancer is the most common cancer in India. Challenges in the management of oral cancer patients in India include, delay in the presentation with high volume of advanced disease to be handled, affordability of patients and lack economical support especially in the non-governmental institutions and lack of awareness among patients and their relatives. Present study, a retrospective analysis of a prospectively maintained data, portrays the epidemiological features and management of patients with oral cancer presented to a private comprehensive cancer care hospital in the state of Odisha, India. A total of 1049 patients were considered for the analyses, managed between January 2014 and December 2016. Among 1049 patients, 20% (n, 215) were females and 80% (n, 834) were males. Mean age among the present cohort of patients was 50 years with age group 40–55 years being most common. All the patients underwent resection with curative intent and a 1 cm gross resection margins with or without bone and skin. Margin negative resection could be achieved in 82% of patients. Nodal involvement was seen in 36% of patients in the final histopathological assessment. Management of oral cancer patients is a major oncological and reconstructive challenge in India due to the advanced nature of disease at presentation. Inspite of socioeconomic constraints, these patients can be managed even in a private cancer centers with optimum outcomes. This is possible through coordinated team efforts.

https://ift.tt/2GbWXP7

Prevalence of Otitis Media with Effusion in Children with Hearing Loss

Abstract

Otitis media is an inflammation of the middle ear cleft, with or without intact tympanic membrane. Otitis media is known to be one of the most common childhood infections. Middle ear effusions have been recognized to grab increasing attention because of the problems they pose in both the diagnosis and the treatment, and because of the fear that effusion is the cause of learning difficulties, irreversible middle ear disease, or both. To study prevalence of otitis media with effusion in children with hearing loss. Materials and methods: This prospective study was conducted on children with hearing loss ageing between 3 and 15 years presenting to ENT OPD of GURU GOBIND SINGH MEDICAL COLLEGE FARIDKOT with complaint of hearing loss from January 2015 to June 2016. Total of 125 children were taken in study. Detailed history and complete ENT examination was done along with pure tone audiometery and impedence audiometery. Most common complaints of patient were otalgia on ototscopic examination majority of patients had congested tympanic membranes. Otitis media with effusion was most common cause of hearing loss. Majority of children diagnosed with otitis media with effusion were in age group of 6–8 years of age. Patients with mild hearing loss due to otitis media with effusion, on pure tone audiometery was more as compared to moderate hearing loss. B type of tympanogram was found in majority of cases. The potential of otitis media with effusion to cause a series of sequels and complications such as tympanosclerosis, retraction pockets, adhesive otitis media and hearing or speech impairment makes the disease an important public health problem. To prevent delayed diagnosis which leads to development of this disease, parents must be informed about the preventable risk factors and symptoms for the development of otitis media with effusion.

https://ift.tt/2IP6b5E

Nasopharyngeal Angiofibroma: A Clinical, Histopathological and Immunohistochemical Study of 42 Cases with Emphasis on Stromal Features

Abstract

Nasopharyngeal angiofibroma is a benign but aggressive tumor of unknown etiology, typically occurring in adolescent males. It is described as a rare neoplasm; however, the prevalence seems to have geographic differences. All cases referred to our head and neck clinical and pathology service were reviewed. Most of the patients presented at an advanced stage. The clinical and radiographic features are presented and discussed. Histologically, the tumor shows a highly vascular fibrous proliferation with characteristic plump, angulated and stellate cells, categorized as fibroblasts. Immunohistochemistry was performed on 42 cases to further elucidate the nature of these cells. The stromal cells expressed vimentin and factor XIIIa, the latter expressed most commonly in the giant stellate cells. Inflammation was almost exclusively present in peripheral subepithelial areas. Mast cells were abundant, even in the absence of other inflammatory cells. Lymphatics were observed principally in peripheral regions. Proliferating cells (Ki-67 reactive) were restricted to endothelial cells.

https://ift.tt/2Gry4SN

Can Medullary Thyroid Carcinoma Arise in Thyroglossal Duct Cysts? A Search for Parafollicular C-cells in 41 Resected Cases

Abstract

Thyroglossal duct cysts (TGDCs) are present in ~7% of adults and develop from the midline migratory tract between the foramen cecum and anatomic location of the thyroid. Thyroid tissue can be identified in 2/3 of TGDCs, and up to 1% develop associated malignancy, 90% of which are papillary thyroid carcinoma. Cases of follicular and anaplastic carcinoma have been documented, but there are no reports of medullary thyroid carcinoma arising in a TGDC. This is presumably due to the distinct embryologic origin of parafollicular C-cells, from which medullary carcinoma arises. The goal of this study is to determine whether parafollicular C-cells are present in TGDCs. H&E sections from 41 TGDC cases were examined for thyroid tissue, thyroglossal duct remnants, ultimobranchial remnants, and parafollicular C-cells. Immunohistochemistry was performed for TTF-1 and calcitonin. Eighty three percent (34/41) of cases contained thyroid tissue on H&E and by TTF-1. No cases (0/41) had ultimobranchial remnants or parafollicular C-cells on H&E or with calcitonin. One case of papillary carcinoma in a TGDC was identified. These cases illustrate that although TGDCs often contain thyroid tissue, parafollicular C-cells are absent. Therefore, unlike other thyroid neoplasms, there is no evidence to support the possibility of medullary carcinoma arising in a TGDC.

https://ift.tt/2DVIViK

Nasopharyngeal Angiofibroma: A Clinical, Histopathological and Immunohistochemical Study of 42 Cases with Emphasis on Stromal Features

Abstract

Nasopharyngeal angiofibroma is a benign but aggressive tumor of unknown etiology, typically occurring in adolescent males. It is described as a rare neoplasm; however, the prevalence seems to have geographic differences. All cases referred to our head and neck clinical and pathology service were reviewed. Most of the patients presented at an advanced stage. The clinical and radiographic features are presented and discussed. Histologically, the tumor shows a highly vascular fibrous proliferation with characteristic plump, angulated and stellate cells, categorized as fibroblasts. Immunohistochemistry was performed on 42 cases to further elucidate the nature of these cells. The stromal cells expressed vimentin and factor XIIIa, the latter expressed most commonly in the giant stellate cells. Inflammation was almost exclusively present in peripheral subepithelial areas. Mast cells were abundant, even in the absence of other inflammatory cells. Lymphatics were observed principally in peripheral regions. Proliferating cells (Ki-67 reactive) were restricted to endothelial cells.

https://ift.tt/2Gry4SN

Idiopathic omental infarction: One for conservative or surgical management?

Abstract

Idiopathic omental infarction (IOI) is a rare cause of right-sided abdominal pain, mimicking serious surgical pathology. It occurs in <4 in 1000 cases of appendicitis. IOI can be a challenge to diagnose, as features may mimic appendicitis, and therefore in young patients, may only be discovered on laparoscopy. CT features can be diagnostic, but due to its rarity the diagnosis may be unclear. The literature supports both conservative management and surgical management (to expedite symptom resolution). We present a case of IOI and discuss our management and learning from the case. We discuss the utility of CT radiology, conservative management and the benefits of non-resection management, even at laparoscopy.

https://ift.tt/2DVs9jG

Laparoscopic resection of a giant retroperitoneal melanotic schwannoma

Abstract

Background

Retroperitoneal schwannomas are extremely rare, as they account for only 3% of retroperitoneal tumors. Clinical symptoms are nonspecific and of late onset, meaning that these tumors are diagnosed at an advanced stage. Surgical resection is required for histological diagnosis and to prevent possible malignant transformation. Celioscopy offers numerous benefits, reducing postoperative pain and speeding up the patient's return to autonomy, but it can pose a real challenge due to the size of these lesions.

Case presentation

We report a case of laparoscopic resection of a very large right-sided retroperitoneal schwannoma, with a particular histological form.

Conclusion

Surgical resection in a single unit remains the golden rule, and a laparoscopy can be proposed when the diagnosis is beyond doubt. The large size of the retroperitoneal melanotic schwannomas, a common feature, increases surgical difficulties but is not a contraindication to this approach.

https://ift.tt/2Gsp1Be

Brown bowel syndrome, an unusual cause of sigmoid volvulus

Abstract

We report a case of a 79-year-old gentleman who presented to the emergency department with a 5-day history of abdominal pain, constipation, a progressively distending abdomen and new onset feculent vomiting on a background of a recent endoscopic decompression of a sigmoid volvulus. Investigations confirmed the presence of a recurrent sigmoid volvulus. Attempts to reduce this endoscopically failed and laparotomy with sub-total colectomy and ileostomy formation was performed. Histology from the resected specimen identified a distinct pathology, namely intestinal lipofuscinosis also known as brown bowel syndrome. Brown bowel syndrome is a recognized but rare complication of chronic long term malnutrition. It may present in a myriad of ways including atonia and, rarely, massive colonic dilatation, as in our case.

https://ift.tt/2I2vMqw

Can Medullary Thyroid Carcinoma Arise in Thyroglossal Duct Cysts? A Search for Parafollicular C-cells in 41 Resected Cases

Abstract

Thyroglossal duct cysts (TGDCs) are present in ~7% of adults and develop from the midline migratory tract between the foramen cecum and anatomic location of the thyroid. Thyroid tissue can be identified in 2/3 of TGDCs, and up to 1% develop associated malignancy, 90% of which are papillary thyroid carcinoma. Cases of follicular and anaplastic carcinoma have been documented, but there are no reports of medullary thyroid carcinoma arising in a TGDC. This is presumably due to the distinct embryologic origin of parafollicular C-cells, from which medullary carcinoma arises. The goal of this study is to determine whether parafollicular C-cells are present in TGDCs. H&E sections from 41 TGDC cases were examined for thyroid tissue, thyroglossal duct remnants, ultimobranchial remnants, and parafollicular C-cells. Immunohistochemistry was performed for TTF-1 and calcitonin. Eighty three percent (34/41) of cases contained thyroid tissue on H&E and by TTF-1. No cases (0/41) had ultimobranchial remnants or parafollicular C-cells on H&E or with calcitonin. One case of papillary carcinoma in a TGDC was identified. These cases illustrate that although TGDCs often contain thyroid tissue, parafollicular C-cells are absent. Therefore, unlike other thyroid neoplasms, there is no evidence to support the possibility of medullary carcinoma arising in a TGDC.

https://ift.tt/2DVIViK

Nasopharyngeal Angiofibroma: A Clinical, Histopathological and Immunohistochemical Study of 42 Cases with Emphasis on Stromal Features

Abstract

Nasopharyngeal angiofibroma is a benign but aggressive tumor of unknown etiology, typically occurring in adolescent males. It is described as a rare neoplasm; however, the prevalence seems to have geographic differences. All cases referred to our head and neck clinical and pathology service were reviewed. Most of the patients presented at an advanced stage. The clinical and radiographic features are presented and discussed. Histologically, the tumor shows a highly vascular fibrous proliferation with characteristic plump, angulated and stellate cells, categorized as fibroblasts. Immunohistochemistry was performed on 42 cases to further elucidate the nature of these cells. The stromal cells expressed vimentin and factor XIIIa, the latter expressed most commonly in the giant stellate cells. Inflammation was almost exclusively present in peripheral subepithelial areas. Mast cells were abundant, even in the absence of other inflammatory cells. Lymphatics were observed principally in peripheral regions. Proliferating cells (Ki-67 reactive) were restricted to endothelial cells.

https://ift.tt/2Gry4SN

Development of a droplet digital PCR assay for population analysis of aflatoxigenic and atoxigenic Aspergillus flavus mixtures in soil

Abstract

Aflatoxin B₁ is a potent hepatotoxin and carcinogen that poses a serious safety hazard to both humans and animals. Aspergillus flavus is the most common aflatoxin-producing species on corn, cotton, peanuts, and tree nuts. Application of atoxigenic strains to compete against aflatoxigenic strains of A. flavus has emerged as one of the most practical strategies for ameliorating aflatoxin contamination in food. Genes directly involved in aflatoxin biosynthesis are clustered on an 82-kb region of the genome. Three atoxigenic strains (CA12, M34, and AF123) were each paired with each of four aflatoxigenic strains (CA28, CA42, CA90, and M52), inoculated into soil and incubated at 28 °C for 2 weeks and 1 month. TaqMan probes, omtA-FAM, and norA-HEX were designed for developing a droplet digital PCR (ddPCR) assay to analyze the soil population of mixtures of A. flavus strains. DNA was extracted from each soil sample and used for ddPCR assays. The data indicated that competition between atoxigenic and aflatoxigenic was strain dependent. Variation in competitive ability among different strains of A. flavus influenced the population reduction of the aflatoxigenic strain by the atoxigenic strain. Higher ratios of atoxigenic to aflatoxigenic strains increased soil population of atoxigenic strains. This is the first study to demonstrate the utility of ddPCR to quantify mixtures of both atoxigenic and aflatoxigenic A. flavus strains in soil and allows for rapid and accurate determination of population sizes of atoxigenic and aflatoxigenic strains. This method eliminates the need for isolation and identification of individual fungal isolates from experimental soil samples.

https://ift.tt/2Gc021I