Ces « spins » qui twistent les articles

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): O. Laccourreye, H. Maisonneuve




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Lésions de l’œsophage provoquées par l’ingestion de pile bouton chez l’enfant : analyse des causes et proposition de mesures préventives

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): J.J. Lahmar, C. Célérier, E.N. Garabédian, V. Couloigner, N. Leboulanger, F. Denoyelle
ButsÉtudier les cas récents de lésion œsophagienne chez l'enfant par ingestion de piles boutons pris en charge aux urgences ORL pédiatriques d'Île-de-France, pour proposer des mesures préventives adaptées.Matériel et méthodesNous avons réalisé une étude descriptive, rétrospective et monocentrique. Les patients inclus étaient tous les enfants, âgés de moins de 15 ans, pris en charge aux urgences d'ORL pédiatrique entre janvier 2008 et avril 2014 pour l'ingestion et le blocage dans l'œsophage de pile bouton ayant nécessité une extraction en urgence.RésultatsVingt-deux garçons et 4 filles ont été inclus. L'âge médian était de 25 mois. Vingt-cinq piles sur 26 avaient un diamètre de 20mm ou plus. La durée médiane de présence des piles dans l'œsophage était de 7 heures 30 (2 à 72h). Le taux de complications était de 23 %. Le coût d'hospitalisation allait de 10 260 à 110 520€, avec un coût moyen de 38 751€. La provenance des piles était connue dans 23 cas sur 26 : télécommande sans compartiment vissé (42,3 %), paquet neuf ouvert (15,4 %), jouet pour enfant (15,3 %), appareil photo (7,7 %), montre (un cas) et appareil auditif sans compartiment vissé (un cas).ConclusionLes lésions œsophagiennes par ingestion de piles bouton chez l'enfant sont dues presque toujours à des piles de plus de 20mm provenant en majorité d'appareils au compartiment mal protégé ou de piles non conditionnées individuellement. Ces lésions sont sources de complications graves une fois sur 4 et leur prise en charge a un coût de santé élevé. Une législation imposant des compartiments vissés pour les appareils concernés et des emballages blisters individuels des piles aurait évité plus de 76,9 % des ingestions.



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Myringoplastie avec utilisation de colle au cyanoacrylate et sans comblement d’oreille moyenne par Gelfoam©

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): L. Yang, L. JianMin, C. Yan, Z. Qing, R. XiaoYong, S. Ying
ObjectifsBien que de nombreuses méthodes aient été décrites pour essayer de stabiliser le greffon lors d'une myringoplastie, on ne peut éviter de placer du Gelfoam^© dans la caisse ; ceci peut entraîner une obstruction tubaire voire une atteinte de l'oreille interne. L'usage d'une colle tissulaire lors d'une myringoplastie connaît un regain d'intérêt car elle permet de stabiliser le greffon et d'améliorer sa prise. Le but de cette étude prospective était d'étudier les résultats des myringoplasties réalisées pour perforation tympanique subtotale, avec utilisation de colle au cyanoacrylate et sans mise en place d'un produit de comblement dans l'oreille moyenne.MéthodesEntre mars 2014 et novembre 2015, 71 patients présentant une perforation tympanique subtotale ont été opérés, aléatoirement et prospectivement répartis en deux groupes : le groupe colle et le groupe témoin. Deux techniques de stabilisation du greffon ont été utilisées : soit par colle au cyanoacrylate (groupe colle), soit par comblement de l'oreille moyenne au Gelfoam^© (groupe témoin). Toutes les interventions ont été réalisées par le même opérateur.RésultatsÀ 6 mois de l'intervention, la prise de greffe était de 87 % dans le groupe colle et de 89 % dans le groupe témoin. Dans les deux groupes, une amélioration significative de l'audition par rapport au préopératoire a été mise en évidence (p<0,05 dans les deux cas). Il n'y avait pas de différence entre le taux de prise de greffe, celui de complications, et les résultats audiométriques entre les deux groupes.ConclusionLa colle au cyanoacrylate est un outil utile pour stabiliser le greffon dans les myringoplasties pour perforation subtotale, et peut se substituer au comblement de la caisse par Gelfoam^©.



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Facteurs pronostiques des métastases intra-parotidiennes des carcinomes épidermoïdes cutanés de la face

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): C. Bobin, P. Ingrand, B. Dréno, E. Rio, O. Malard, F. Espitalier
ContexteLes carcinomes épidermoïdes cutanés (CEC) se développent sur l'extrémité céphalique dans 80 % des cas. Les métastases intra-parotidiennes (MIP) sont rares, mais leur traitement associant chirurgie et radiothérapie est lourd et leur pronostic est sombre.Matériel et méthodesLes cas de parotidectomies pour MIP d'un CEC de la face entre 2005 et 2015 ont été rétrospectivement étudiés. Les données épidémiologiques, carcinologiques et thérapeutiques ont été évaluées. Les survies globale et spécifique ont été calculées suivant la méthode de Kaplan–Meier. Le test du Logrank et le modèle de Cox ont été utilisés pour rechercher les facteurs pronostiques des MIP.ObjectifsL'objectif principal était d'identifier les facteurs influençant la survie des patients présentant une MIP d'un CEC de la face.RésultatsTrente-cinq patients ont été inclus. Le délai d'apparition des MIP était en moyenne de 13 mois. La survie globale à 1 an, 2 ans et 5 ans était respectivement de 57 %, 50 % et 35 %, la survie spécifique respectivement de 70 %, 66 % et 59 %. Les facteurs pronostiques indépendants des MIP étaient l'immunodépression, l'âge au traitement, les marges non saines de la tumeur cutanée, l'envahissement macroscopique du nerf facial et la présence d'adénopathies cervicales métastatiques.ConclusionCette étude confirme l'association de nombreux facteurs pronostiques indépendants au stade métastatique ganglionnaire intra-parotidien, liés à la population, à la tumeur cutanée primitive et à la MIP. L'obtention d'une exérèse complète de la tumeur cutanée initiale est une règle absolue, afin de diminuer le risque de survenue des MIP. Une surveillance radioclinique accrue doit permettre le diagnostic précoce de ces métastases.



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Évaluation à moyen terme de la fonction de la trompe auditive après dilatation par ballonnet

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): D. Schmitt, M. Akkari, T. Mura, M. Mondain, A. Uziel, F. Venail
Il n'existe à ce jour aucun traitement consensuel des dysfonctions tubaires par obstruction. En cas d'échec de traitements médicamenteux et pressionnels bien conduits, certains auteurs proposent la dilatation tubaire par ballonnet comme alternative thérapeutique. Le but était d'évaluer l'efficacité et l'innocuité de la dilatation tubaire par ballonnet dans cette population.Materiels et méthodesCette étude rétrospective monocentrique rapporte les résultats évalués cliniquement et par tubomanométrie, ainsi que les complications et la satisfaction des sujets traités consécutivement par dilatation tubaire de juin 2012 à février 2015. L'indication opératoire était portée sur des signes cliniques et paracliniques de dysfonction tubaire obstructive en échec de traitement médical bien conduit.RésultatsQuarante-cinq gestes ont été réalisés chez 38 sujets. L'amélioration des symptômes cliniques a été évaluée à 88 %, 80 % et 80 % à respectivement 2 mois, 6 mois, et à plus d'un an. On observait également une amélioration de la fonction évaluée par tubomanométrie dans 81 % des cas. Le geste était bien toléré, et uniquement 4 % de complications mineures ont été retrouvées.ConclusionsL'efficacité, la tolérance et la sécurité retrouvées sont comparables à celles observées dans la littérature, bien qu'il s'agisse de patients étant tous en échec de 1^re ligne de traitement. On note une normalisation de la fonction tubaire dans un peu plus d'un tiers des cas. Malgré ces résultats encourageants, la place et l'efficacité réelle de ce traitement reste à évaluer dans le cadre d'études prospectives de plus fort niveau de preuve.



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Editorial Board

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2





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La chirurgie de rattrapage dans les récidives de carcinomes épidermoïdes du larynx et de l’hypopharynx : étude rétrospective de 2005 à 2013

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): K. Pujo, P. Philouze, A. Scalabre, P. Céruse, M. Poupart, G. Buiret
ObjectifLa chirurgie en terrain irradié, dite de rattrapage, est l'option thérapeutique de référence en cas de récidive locorégionale des cancers du larynx et de l'hypopharynx. Néanmoins ses résultats carcinologiques et fonctionnels modérés nécessitent de pouvoir sélectionner les patients candidats à cette chirurgie. L'objectif principal de ce travail était de déterminer les facteurs pronostiques préopératoires associés à la survie. Les objectifs secondaires étaient l'étude de la survie globale et sans récidive à 5 ans, du taux de complications locorégionales et générales et des résultats fonctionnels en termes d'alimentation et de sevrage de trachéotomie.Patients et méthodeIl s'agit d'une étude rétrospective multicentrique sur 52 patients ayant présenté une récidive de carcinome épidermoïde laryngé ou hypopharyngé en terrain irradié et ayant eu une chirurgie de rattrapage entre 2005 et 2013.RésultatsLes facteurs associés à une meilleure survie globale à 3 ans en analyse univariée étaient la localisation laryngée de la tumeur initiale (p=0,001), la localisation laryngée de la récidive (p=0,026), les tumeurs classées rT1, rT2, rT3 par rapport aux tumeurs rT4 (p=0,007), un antécédent de chimiothérapie (p=0,036) et la réalisation d'un curage cervical au cours de la chirurgie de rattrapage (p=0,005). Ce dernier est confirmé à l'analyse multivariée. La survie globale à 5 ans était de 36,0 % [27,6 %–44,4 %]. La durée médiane de survie globale estimée était de 23,04 mois (IC 95 % [19,44–26,64]). La survie sans récidive à 5 ans était de 23,5 % [16,0 %–31,0 %]. La durée médiane de survie sans récidive estimée était de 8,04 mois (IC 95 % [2,04–14,04]).ConclusionLa chirurgie de rattrapage des cancers du larynx et de l'hypopharynx est difficile avec des survies modestes. La localisation laryngée de la tumeur initiale et de la récidive, son volume et son extension modérés (inférieure à T4), un traitement préalable par chimiothérapie, ainsi que la possibilité de réaliser un curage lors de la chirurgie de rattrapage sont corrélés à une meilleure survie globale et sans récidive, permettant une meilleure sélection des patients pouvant en bénéficier.



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Facteurs de risque cardiovasculaire et facteurs de gravité chez les patients hospitalisés pour épistaxis spontanée

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): N. André, N. Klopp-Dutote, A. Biet-Hornstein, V. Strunski, C. Page
ObjectifsÉvaluer le rôle des facteurs de risque « cardiovasculaire », de la prise de médicaments altérant la crase sanguine et les signes de gravité chez des patients hospitalisés pour épistaxis spontanée.Matériel et méthodesIl s'agissait d'une étude monocentrique, rétrospective, réalisée sur 7 ans dans un centre hospitalier universitaire, ayant inclus 205 patients hospitalisés pour épistaxis spontanée. Ont été notés par patient : les facteurs de « risque cardiovasculaire » (maladie ou antécédent « cardiovasculaire » à risque hémorragique ou thromboembolique, hypertension artérielle, diabète sucré, dyslipidémie), la prise de médicaments modifiant la crase sanguine ; les mesure de la pression artérielle et le taux minimal d'hémoglobinémie au cours de l'hospitalisation. Les patients ont été séparés en deux groupes : épistaxis « graves » et « non graves ».RésultatsIl n'existait pas de différence significative entre les groupes de patients concernant l'âge moyen, le sex-ratio, la présence d'un antécédent d'hypertension artérielle et le nombre de facteurs de « risque cardiovasculaire ». Les patients avec une épistaxis grave avaient des mesures de pression artérielle significativement plus basse que dans le groupe non grave. L'hémoglobinémie était significativement inférieure dans le groupe des épistaxis graves. Il existait un lien entre le nombre de facteurs de risque « cardiovasculaire » par patient et la probabilité d'une transfusion sanguine.ConclusionsLes rôles réels de ces différents facteurs présumés dans la survenue d'une épistaxis spontanée restent encore à élucider, de même que les facteurs de gravité.



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Localisation intra-labyrinthique d’une tumeur sporadique du sac endolymphatique

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): C. Lucas, J.-C. Leclère, E. Mornet, R. Marianowski
IntroductionLes tumeurs du sac endolymphatique sont des tumeurs bénignes, invasives d'évolution lente, envahissant l'os temporal, se manifestant par une surdité unilatérale. Elles peuvent être sporadiques ou s'intégrer dans un syndrome de von Hippel-Lindau (VHL).Résumé du casNous rapportons le cas d'une tumeur développée dans l'utricule dont l'aspect histologique et immunohistochimique correspond à une tumeur du sac endolymphatique, chez un patient indemne de VHL.DiscussionLes tumeurs du sac endolymphatique sont des lésions lysant l'os temporal, situées dans la partie postérieure de l'os pétreux. D'après deux études concernant des patients atteints de von Hippel-Lindau, les tumeurs du sac endolymphatique seraient développées aux dépens du canal endolymphatique. Notre observation d'un développement intra-labyrinthique d'une tumeur du sac endolymphatique sporadique est en faveur de cette hypothèse pour les formes sporadiques et plaide pour une labyrinthectomie associée au geste d'exérèse tumorale afin d'éviter les récidives.



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La pharyngo-laryngoplastie par voie endoscopique : à propos d’un cas

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): A. Baguan, C.A. Righini, P.F. Castellanos, I. Atallah
IntroductionToute thérapeutique permettant la décanulation des malades trachéotomisés et dépendants de leur canule leur apporte un confort et permet pour ceux-ci et permet en outre de réduire les coûts de santé publique.Résumé du cas cliniqueNous exposons le cas d'un patient de 70 ans trachéotomisé dans les suites d'une radiothérapie pour un cancer du larynx en rémission depuis 13 ans avec des échecs de décanulation. Il présentait une sténose pharyngolaryngée. Une pharyngo-laryngoplastie par voie endoscopique a été réalisée en adoptant les techniques reconnues de la microchirurgie reconstructrice au laser par voie transorale. Des sutures par voie endoscopique ont été réalisées et sécurisées par des clips afin de remodeler le pharyngo-larynx et d'éviter la récidive des synéchies. La chirurgie a permis la décanulation définitive de ce patient.DiscussionLa chirurgie endoscopique pharyngo-laryngée a été initialement développée pour la résection des tumeurs à des stades localisés. Plus récemment, la microchirurgie reconstructrice au laser par voie transorale a été développée. Elle présente un intérêt fonctionnel permettant une reconstruction pharyngolaryngée destinée à traiter les séquelles de la chirurgie ou/et de la radiothérapie des cancers des voies aérodigestives supérieures. Elle permet de reconstruire les voies aériennes supérieures restaurant une respiration buccale chez les patients trachéotomisés favorisant leur décanulation.



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Lymphome de la zone marginale de localisation méningée : le piège du méningiome

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): A. Villeneuve, F. Rubin, P. Bonfils
ObjectifPrésenter un cas de lymphome de la zone marginale de type MALT de la méninge temporale dans lequel un diagnostic initial de méningiome temporal avait été initialement porté.ObservationPatiente de 60 ans immunocompétente suivie depuis plus de 10 ans pour un méningiome en plaque temporal (ou ostéoméningiome) responsable de vertiges et d'hypoacousie mixte. L'apparition d'une adénopathie cervicale a conduit à mettre en évidence une progression importante de la lésion intracrânienne et à poser le diagnostic de lymphome de la zone marginale grâce à l'examen histologique de l'adénopathie cervicale. Le traitement par 6 cures de Rituximab et Bendamustine a permis une rémission complète de l'atteinte cervicale et de l'atteinte intracrânienne, confirmant qu'il s'agissait d'un lymphome dural temporal.ConclusionLe lymphome dural primitif doit faire partie du diagnostic différentiel du méningiome, la surveillance au long terme permettant de redresser le diagnostic.



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Comment utiliser à moindre coût l’impression 3D comme aide à la reconstruction mandibulaire ?

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): A. Dupret-Bories, S. Vergez, T. Meresse, F. Brouillet, G. Bertrand
L'impression en 3 dimensions est en plein essor dans le domaine médical. Cette technologie accroît les possibilités de traitement personnalisé pour les patients tout en abaissant les coûts de fabrication. Dans le cadre des reconstructions de mandibule par lambeau libre de fibula, des sociétés proposent, à l'heure actuelle, des guides de coupe obtenus par moulage à partir de scanner. Outre les délais de réalisation importants i.e. minimum 21jours, ces guides sont vendus à des coûts prohibitifs (2000 à 6000 euros). Conjointement avec le CNRS, des étudiants ingénieurs, une société biomédicale, les auteurs ont mis au point des guides de coupe et des fantômes de mandibule imprimés en 3 dimensions, livrables en 7jours et à moindre coût. La nouveauté de ce projet réside dans la rapidité d'élaboration des produits et la réduction importante de leur prix. Les auteurs proposent de décrire dans cette note technique la chaîne logistique de réalisation des fantômes et des guides de coupe ainsi que les résultats apportés. L'objectif est de permettre dans un avenir proche l'accès à cette technologie pour tous les patients.



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La chirurgie endoscopique de la fente olfactive

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): R. Jankowski, C. Rumeau, P. Gallet, D.T. Nguyen, A. Russel, B. Toussaint
La fente olfactive est le siège électif de tumeurs spécifiques (hamartome épithélial respiratoire adénomatoïde, adénocarcinome intestinal, neuroblastome olfactif, papillome inversé, glomangiopéricytome, …). Elle est aussi le site de rhinoliquorrhées particulières appelées cribri-liquorrhées. En conséquence la chirurgie de la fente olfactive se doit d'être pensée en tant que chirurgie spécifique, complémentaire de la chirurgie des masses latérales de l'ethmoïde et de celle de la fosse cérébrale antérieure. Les tumeurs développées à partir de la fente olfactive peuvent être réséquées selon cinq procédés chirurgicaux différents : mucosectomie de fente olfactive, résection partielle de fente olfactive, résection totale de fente olfactive, résection cranio-ethmoïdale endoscopique unilatérale, et résection cranio-ethmoïdale endoscopique bilatérale. Le diagnostic et la fermeture des cribri-liquorrhées (rhinoliquorrhée prouvée dont l'origine au niveau de la lame criblée est affirmée au cours d'une endoscopie des fentes olfactives sous anesthésie générale chez un patient dont l'imagerie n'a pas permis de localiser le site de la brèche) complète ce nouvel arsenal chirurgical.



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L’organe oublié

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): L.-M. Roussel, C. Escalard, M. Hitier




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Une tumeur cervicale inusitée

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): A. Gaudreau, A. Belisle, T. Ayad




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Physiologie de l’ostium des sinus paranasaux : observations endoscopiques

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): R. Jankowski, C. Rumeau




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The burden of allergic rhinitis and allergic rhinoconjunctivitis on adolescents: a literature review

To evaluate the literature regarding the burden of allergic rhinitis (AR) and allergic rhinoconjunctivitis (ARC) in adolescents (10-19 years).

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CORRECTION

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Effect of changing postoperative pain management on bleeding rates in tonsillectomy patients

To review rates of post-tonsillectomy hemorrhage (PTH) at a quaternary medical center, including the impact of narcotic versus nonsteroidal anti-inflammatory drug (NSAID) postoperative pain management.

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A boy presenting with chronic ear drainage and associated middle ear mass

11-year old male presented to the clinic with a chronically draining ear and associated hearing loss. He was treated two months ago by his pediatrician for otitis media with amoxicillin but continued to have drainage. He underwent an audiogram which showed a left sided maximal conductive hearing loss. He had no history of ear tubes or surgery. He passed his newborn hearing screen and subsequent audiograms until recently.

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In whom does horizontal canal BPPV recur?

The objective of this study is to examine the rate of horizontal canal BPPV recurrence of the same type and search for predisposing factors.

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A boy presenting with chronic ear drainage and associated middle ear mass

Publication date: Available online 4 April 2018
Source:American Journal of Otolaryngology
Author(s): Kaelen Black, Jonathan Murnick, Brian K. Reilly




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Pollen and spore monitoring in the world

Ambient air quality monitoring is a governmental duty that is widely carried out in order to detect non-biological ("chemical") components in ambient air, such as particles of 

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Comparison of the computer–aided articulation therapy application with printed material in children with speech sound disorders

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Rana Dural, Özlem Ünal–Logacev
ObjectivesThe aim of the present study was to develop an iPad application for computer–aided articulation therapy called the Turkish Articulation Therapy Application (TARTU), and make comparisons between the efficacy of TARTU and printed material.MethodA single subject research design, adapted alternating treatments model, was used for this purpose. The study was carried out with 2 children, at the age of 5; 1 and 5; 11, both of whom have a speech sound disorder. The comparison between TARTU and printed material effectiveness was compared for three target sounds (/k/, /ʃ/ and /l/). 12 therapy sessions were carried out three times a week using the behavioural approach. One participant received therapy targeting the sound /k/ using TARTU, while printed material used for the sound /ʃ/. The targeted sounds were switched for the second participant. Sound /l/ was left without any intervention.ResultThe target sound met the criterion with TARTU in one participant, and with printed material in the other participant.ConclusionThe presentation type of the materials did not play an important role in the success of the therapy on the participants.



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Association of Hidradenitis Suppurativa With T Helper 1/T Helper 17 Phenotypes

This case series uses semantic map analysis to assess the association of hidradenitis suppurativa with T helper 1/T helper 17 phenotypes.

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Task Shifting in Dermatology—A Call to Action

To the Editor In response to the Evidence Synopsis by Brown et al on the practice of task shifting, we would like to highlight how task shifting is currently being successfully implemented in health programs in India, with emphasis on National Leprosy Eradication Program.

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Indoor Tanners as a Priority Population for Skin Cancer Screening

The study by Heckman et al published in this issue of JAMA Dermatology makes a significant contribution to our understanding of skin cancer screening for indoor tanners. The literature contains only a handful of studies that examined skin screening prevalence and factors that may be associated with this practice among indoor tanners. The National Health Interview Survey (NHIS), a national probability survey of the US adult population, collects data on skin screening and indoor tanning and provides a valuable opportunity to examine potential factors associated with these practices in a large sample. Results of previous studies of skin screening and indoor tanning using NHIS data have been mixed, possibly because of differences in methods and sampling. One study of 2010 NHIS data found a positive association between indoor tanning in the past year and ever having had a skin examination, whereas another study of a subsample of the 2015 NHIS data found no association.

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Prevalence of Delusional Infestation—A Population-Based Study

This population-based study reports the prevalence of delusional infestation in Olmsted County, Minnesota.

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Atorvastatin in Combination With Narrowband UV-B in Adult Patients With Active Vitiligo

This randomized clinical trial evaluates the use of atorvastatin combined with narrowband UV-B therapy vs narrowband UV-B therapy alone in adult patients with active vitiligo.

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Task Shifting in Dermatology—A Call to Action—Reply

In Reply We greatly appreciate the response by Bishnoi et al to "Task Shifting in Dermatology: A Call to Action." Their group's use of task shifting for early diagnosis of leprosy throughout remote areas of India is highly commendable. They emphasize that the challenges of task shifting include both the need for well-resourced training centers and "meticulous strategies." As outlined in their letter, task shifting involves training of an available workforce to meet previously unmet needs in the health care system, which may include community and individual education, diagnosis, referral to tertiary care centers, or treatment. We propose task shifting as a potential means to meet dermatologic needs specifically in lower- and middle-income countries. Worldwide, there exists an inequitable dermatologic treatment gap, and dermatologic disease is the fourth leading cause of morbidity globally. What is lacking are large-scale trials assessing the efficacy of (1) training of these health care workers and (2) implementation of task-shifting interventions, specifically in areas of dermatology diagnosis, triage, and treatment. Assessment of efficacy in the dermatologic setting is necessary prior to scaling up task-shifting interventions. The field of psychiatry has demonstrated through large randomized clinical trials in lower- and middle-income countries that community health care providers can effectively implement psychological therapies for diseases such as depression and alcoholism, and we propose that task shifting in dermatology be similarly systematically assessed.

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Skin Cancer Screening Among Indoor Tanners and Nontanners

This survey study of 30 352 participants investigates the association between indoor tanning and skin cancer screening.

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Tumour lysis in newborn: spontaneous or secondary to antenatal steroids?

Malignancies are rare in the early neonatal period. Common congenital tumours include malignant teratoma and neuroblastomas. Tumour lysis syndrome is a serious condition usually seen after commencement of chemotherapy for a malignancy. Rare case reports of spontaneous tumour lysis have been reported though not in the newborn period. We report here an instance of tumour lysis syndrome in a newborn with congenital rhabdoid tumour, where the cause was either spontaneous or related to antenatal steroid exposure.

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Surprising cause of a hoarse voice

Description 

A 78-year-old woman presented to our otorhinolaryngology clinic with a 5-year history of gradually progressive, worsening dysphonia, associated with some recent weight loss. She denied any dysphagia, odynophagia, otalgia, dyspnoea or neck lumps. She had a significant cardiovascular history and was a non-smoker with no alcohol intake. Using the grade–roughness–breathiness–asthenicity–strain scale, the patient scored a 2/3 for grade and breathiness, 1/3 for roughness and 3/3 for strain. On examination, there was a large left-sided posterior pharyngeal wall swelling occluding most of the oropharynx (figure 1). It was firm, non-pulsatile and non-tender, with a normal overlying mucosal appearance. Flexible nasoendoscopy demonstrated that this swelling extended from the level of the soft palate to just below the level of the epiglottis, with laryngeal displacement to the right. However, there was no airway compression, and the patient had normal, mobile true vocal cords bilaterally. Videolaryngostroboscopy was not possible with...

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The burden of allergic rhinitis and allergic rhinoconjunctivitis on adolescents: a literature review

Publication date: Available online 4 April 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Michael S. Blaiss, Eva Hammerby, Susan Robinson, Tessa Kennedy-Martin, Sarah Buchs
ObjectiveTo evaluate the literature regarding the burden of allergic rhinitis (AR) and allergic rhinoconjunctivitis (ARC) in adolescents (10-19 years).Data SourcesSearches were performed in MEDLINE, Embase, Health Technology Assessment Database, and National Health Service Economic Evaluation Database for studies evaluating concepts of symptoms, quality of life (QOL), daily activities, sleep, examination performance, school absenteeism and presenteeism, and treatment burden in adolescents with AR or ARC.Study SelectionsEnglish-language journal articles indexed in the last 15 years describing non-interventional population-based studies. Records were assessed by 2 independent reviewers.ResultsA total of 27 articles were identified; outcomes evaluated were: symptoms (n=6 studies), QOL (n=9), daily activities (n=5), emotional aspects (n=3), sleep (n=6), education (n=7), and treatment burden (n=2). AR symptoms rated most bothersome were rhinorrhea, nasal congestion, and itchy eyes. QOL was worse in adolescents with AR versus controls regardless of QOL instrument used. Nasal symptoms and nasal obstruction were more likely to be associated with poor QOL in adolescents than in adults or younger children, respectively. Daily functioning and sleep were also negatively impacted by AR. In addition, a detrimental effect on absenteeism, school productivity, and academic performance was reported.ConclusionAlthough AR and ARC are sometimes perceived as trivial conditions, this review indicates that their impact on adolescent life is negative and far-reaching. It is critical that clinicians gain a greater understanding of the unique burden of AR and ARC in adolescents to ensure they receive prompt and appropriate care and treatment in order to improve clinical and academic outcomes.



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Cementum Regeneration Using Stem Cells in the Dog Model: A Systematic Review

Publication date: Available online 3 April 2018
Source:Archives of Oral Biology
Author(s): Jacqueline Crossman, Maryam Elyasi, Tarek El-Bialy, Carlos Flores Mir
ObjectiveRestoring lost tissues of the periodontium, such as cementum, is essential in reducing the risk of tooth loss due to periodontitis and/or severe root resorption. Stem cell therapy is a regenerative strategy in cementum regeneration. This systematic review aimed to analyze the effect of various stem cells and their transplantation method on cementum regeneration in the dog model.MethodsElectronic databases were searched, in addition to performing hand searches and a gray literature search. Titles and abstracts were searched according to the inclusion criteria and full texts were selected to be included in this systematic review. Data was extracted from each article and risk of bias was assessed for individual studies.ResultsMost studies reported that the treatment using a variety of stem cells resulted in significantly greater cementum regeneration.ConclusionsBecause of variations in additional factors included in each study and varied risk of bias among those studies, the effect of each type of stem cell on cementum regeneration in dogs is difficult to clarify. Additional information needs to be obtained from each study in order to further analyze the individual effect of stem cells on cementum regeneration in dogs.



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Esclerosis múltiple: ventaja izquierda para la lateralidad auditiva en pruebas dicóticas de procesamiento auditivo central y relación de pruebas psicoacústicas con examen de discapacidad-EDEM

Publication date: Available online 3 April 2018
Source:Acta Otorrinolaringológica Española
Author(s): Yolanda Rebeca Peñaloza López, Xóchitl Daisy Orozco Peña, Santiago Jesús Pérez Ruiz
ObjetivoEvaluar los trastornos en procesos centrales de la audición, en pacientes con esclerosis múltiple, enfatizando en lateralidad auditiva mediante la aplicación de pruebas psicoacústicas e identificar la relación de estas con funciones de la Escala de Discapacidad en Esclerosis Múltiple(EDEM).MétodoEn 26 individuos con esclerosis múltiple y 26 controles se aplicaron escala de depresión (HADS), EDEM y 9 pruebas psicoacústicas para estudiar trastornos en los procesos centrales de la audición. Se efectuaron pruebas de correlación entre EDEM y pruebas psicoacústicas.ResultadosSiete de 9 pruebas psicoacústicas fueron diferentes significativamente (p<0,05); derecha o izquierda (14/19 exploraciones) respecto al grupo control. En dígitos dicóticos la izquierda mostró ventaja de aciertos respecto al predominio usual de dígitos dicóticos en la derecha. Hubo correlación significativa en 5 pruebas psicoacústicas y funciones específicas de la Escala de Discapacidad en Esclerosis Múltiple.ConclusiónConviene investigar la ventaja del oído izquierdo detectada como expresión de influencias deficientes del cuerpo calloso y de atención en esclerosis múltiple. Hay correlación entre pruebas psicoacústicas con funciones específicas de EDEM.ObjectiveTo evaluate the central auditory processing disorders in patients with multiple sclerosis, emphasizing auditory laterality by applying psychoacoustic tests and to identify their relationship with the Multiple Sclerosis Disability Scale (EDSS) functions.MethodDepression scales (HADS), EDSS, and 9 psychoacoustic tests to study CAPD were applied to 26 individuals with multiple sclerosis and 26 controls. Correlation tests were performed between the EDSS and psychoacoustic tests.ResultsSeven out of 9 psychoacoustic tests were significantly different (P<.05); right or left (14/19 explorations) with respect to control. In dichotic digits there was a left-ear advantage compared to the usual predominance of RDD. There was significant correlation in five psychoacoustic tests and the specific functions of EDSS.ConclusionThe left-ear advantage detected and interpreted as an expression of deficient influences of the corpus callosum and attention in multiple sclerosis should be investigated. There was a correlation between psychoacoustic tests and specific EDSS functions.



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Infectious complications in head and neck surgery: Porto Oncology Centre retrospective analysis

Publication date: Available online 3 April 2018
Source:Acta Otorrinolaringológica Española
Author(s): Miguel Sá Breda, Joaquim Castro Silva, Eurico Monteiro
ObjectiveTo analyze the impact of infectious complications and microbiology in the postoperative period after major oncologic neck surgeries.MethodsA retrospective study conducted in an oncology center, including all the consecutive patients who developed infectious complications after major neck cancer surgery, from October 2012 to May 2016 (44 months). Among other data, we collected TNM stage, ASA score, body mass index, comorbidities and habits, pre and postoperative hemoglobin levels, albumin serum levels, pre-surgical treatments, length of inpatient stay, isolated microbiological agents and the recorded complications and mortality rate.ResultsIn the studied period, 761 major neck surgeries were performed. Of these, 96 patients had complications (12.6%). Pharyngocutaneous fistula (PCF) was the most frequent complication (56%) and nosocomial pneumonia was the most common systemic complication (23%). Pseudomonas aeruginosa was the principal microorganism of the 26 species isolated (15%). 12 deaths were registered. Using multiple linear regression we concluded that flap/cutaneous necrosis and PCF were complications with statistical significance that prolonged inpatient stay. The same complications had significant relative risk for more than 30 days of hospitalization.ConclusionThe postoperative period is critical for the successful treatment of head and neck oncology patients. PCF and flap/cutaneous necrosis were the principal complications which worsened the outcomes during this critical period. The early recognition and treatment of these complications is crucial.



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Cirugía de rescate en las recidivas locales del carcinoma de nasofaringe

Publication date: Available online 3 April 2018
Source:Acta Otorrinolaringológica Española
Author(s): María Cecilia Salom, Fernando López, Esteban Pacheco, Gabriela Muñoz, Patricia García-Cabo, Laura Fernández, Vanessa Suárez, José Luis Llorente
Introducción y objetivosLa quimiorradioterapia es el tratamiento de elección del carcinoma de nasofaringe. Las recurrencias locales son una de las principales causas de mortalidad en estos pacientes: el rescate quirúrgico o la reirradiación son el tratamiento de elección, según la disponibilidad. El objetivo fue evaluar y comparar los resultados de la cirugía de rescate en el tratamiento de las recidivas locales de los carcinomas nasofaríngeos mediante abordajes abiertos vs. endoscópicos.MétodosVeinte pacientes con recidivas locales de carcinomas nasofaríngeos fueron intervenidos quirúrgicamente: 12 pacientes fueron intervenidos mediante cirugía abierta y 8 mediante un abordaje endoscópico endonasal transpterigoideo. Un paciente fue estadiado como rT1; 3 como rT2; 2 como rT3 y 6 como rT4 en el grupo de abordajes abiertos; en la serie endoscópica, 2 pacientes fueron rT1, 5 fueron rT2 y uno fue rT3.ResultadosEn 3 de los pacientes (25%) intervenidos mediante cirugía abierta (un rT4, un rT3 y un rT2) no se logró una resección macroscópica completa). En el grupo endoscópico la resección fue completa en todos los pacientes. La tasa de complicaciones en el grupo intervenido mediante abordajes abiertos fue del 92% (5 complicaciones leves, 5 complicaciones moderadas y una complicación grave) y en el grupo intervenido mediante endoscopia fue del 100% (7 sufrieron complicaciones leves y un paciente una complicación grave). La supervivencia a los 3 y 5 años fue del 53 y del 42% en el abordaje abierto y del 100 y del 75% en el abordaje endoscópico, respectivamente.ConclusionesLos abordajes endoscópicos disminuyen la morbilidad asociada a los abordajes abiertos y permiten obtener un control oncológico favorable.Introduction and objectivesChemoradiotherapy is the treatment of choice for nasopharyngeal carcinoma. Local recurrences are one of the leading causes of death in these patients, and surgical salvage the treatment of choice. Our goal was to evaluate and compare the results of salvage surgery in the treatment of local recurrence of nasopharyngeal carcinomas comparing endoscopic to open approaches.MethodsTwenty patients with local recurrence of nasopharyngeal carcinomas underwent surgery: 12 patients underwent open surgery and 8 endoscopic endonasal transpterygoid nasopharyngectomy. One patient was classified as rT1; 3 as rT2;2 as rT3; and 6 as rT4 in the group of open approaches; in the endoscopic series, 2 patients were rT1, 5 rT2 and one rT3.ResultsIn 3 patients (25%) operated by an open approach (one rT4, one rT3 and one rT2) a complete gross resection was not achieved. Gross total resection was achieved in patients operated by endoscopic surgery. The complication rate in the group operated by an open approach was 92% (5 minor complications, 5 moderate complications, and one serious complication) and in the group that underwent endoscopic surgery all patients had some complication (7 had minor complications and one patient developed a severe complication). Survival at 3 and 5 years was 53% and 42% with the open approach and 100% and 50% with the endoscopic approach, respectively.ConclusionsEndoscopic approaches decrease the morbidity associated with open approaches and allow for favourable oncological control.



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Fenómeno de vacío intervertebral: una causa de abombamiento de la pared faríngea

Publication date: Available online 4 April 2018
Source:Acta Otorrinolaringológica Española
Author(s): Luis Gorospe, Rosa María Gómez-García, Juan Martínez San Millán




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Effects of Branched-Chain Amino Acid Supplementation on Spontaneous Seizures and Neuronal Viability in a Model of Mesial Temporal Lobe Epilepsy

Background: The essential branched-chain amino acids (BCAAs) leucine, isoleucine, and valine have recently emerged as a potential novel treatment for medically refractory epilepsy. Blood-derived BCAAs can readily enter the brain, where they contribute to glutamate biosynthesis and may either suppress or trigger acute seizures. However, the effects of BCAAs on chronic (ie, spontaneous recurrent) seizures and epilepsy-associated neuron loss are incompletely understood. Materials and Methods: Sixteen rats with mesial temporal lobe epilepsy were randomized into 2 groups that could drink, ad libitum, either a 4% solution of BCAAs in water (n=8) or pure water (n=8). The frequency and relative percent of convulsive and nonconvulsive spontaneous seizures were monitored for a period of 21 days, and the brains were then harvested for immunohistochemical analysis. Results: Although the frequency of convulsive and nonconvulsive spontaneous recurrent seizures over a 3-week drinking/monitoring period were not different between the groups, there were differences in the relative percent of convulsive seizures in the first and third week of treatment. Moreover, the BCAA-treated rats had over 25% fewer neurons in the dentate hilus of the hippocampus compared with water-treated controls. Conclusions: Acute BCAA supplementation reduces seizure propagation, whereas chronic oral supplementation with BCAAs worsens seizure propagation and causes neuron loss in rodents with mesial temporal lobe epilepsy. These findings raise the question of whether such supplementation has a similar effect in humans. T.E. and R.D. are supported by grants from the National Institutes of Health (NIH): NINDS R01 NS070824. S.E.G. is supported by grants from the Foundation for Anesthesia Education and Research (FAER) and the NIH: T32 GM086287. This work was also made possible by a grant from the National Center for Advancing Translational Sciences (NCATS; UL1 TR000142), a component of the NIH and the NIH Roadmap for Medical Research. The authors have no conflicts of interest to disclose. Address correspondence to: Tore Eid, MD, PhD, Department of Laboratory Medicine, 330 Cedar St., P.O. Box 208035, Yale School of Medicine, New Haven, CT 06520 (e-mail: tore.eid@yale.edu). Received November 28, 2017 Accepted February 23, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Endoscopic management of maxillary sinus inverted papilloma attachment sites to minimize disease recurrence

Inverted papillomas (IPs) are benign neoplasms, most commonly arising from the mucosal lining of the maxillary sinus. IPs can have single or multifocal sites of attachment. Although pedicle location is an impo...

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In-office laryngeal procedures (IOLP) in Canada: current safety practices and procedural care

The advent of chip tip technology combined with advanced endoscopy has revolutionized the field of laryngology in the past decade. Procedures such as transnasal esophagoscopy, site-specific steroid injections,...

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Critical view of anaphylaxis epidemiology: open questions and new perspectives

In contrast to the majority of allergic or hypersensitivity conditions, worldwide anaphylaxis epidemiological data remain sparse with low accuracy, which hampers comparable morbidity statistics. Data can diffe...

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Interferon-α2b-induced STAT3 suppression in myeloid-derived suppressor cells in mycosis fungoides

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A Prospective Study of Predicting Prognosis and Recurrence of Thyroid Cancer Via New Biomarkers, Urinary Exosomal Thyroglobulin and Galectin-3

Condition:   Thyroid Cancer
Intervention:  
Sponsor:   National Taiwan University Hospital
Not yet recruiting

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Incidence, Risk Factors, and Outcomes of Clostridium difficile Infections in Kidney Transplant Recipients

Background Kidney transplant recipients (KTR) may be at increased risk for Clostridium difficile infections (CDI) but risk factors and outcomes in this population have not been well studied. Methods An observational cohort study was conducted to determine the incidence, risk factors, and outcomes of CDI in KTR. A total of 1,816 KTR transplanted between 2000 and 2013 at Toronto General Hospital were included. Sixty-eight patients developed CDI. Controls were selected at a 4:1 ratio using risk-set sampling and risk factors were explored using conditional logistic regression models. The impact of CDI on graft outcomes was evaluated using Cox proportional hazards models. Results The incidence rate of CDI was 0.64 cases/100 person-years. Independent predictors of CDI included antibiotic use (OR 2.88 [95%CI: 1.35, 6.15]), increased duration of hospitalization posttransplant (OR 1.04 [95%CI: 1.02, 1.06]), receiving a deceased donor kidney (OR 2.98 [95%CI: 1.47, 6.05]), and a history of biopsy-proven acute rejection (OR 5.82 [95%CI: 2.22, 15.26]). In the Cox proportional hazards model, CDI was found to be an independent risk factor for the subsequent development of biopsy-proven acute rejection (HR 2.18 [95% CI: 1.34, 3.55]). Conclusions Our results confirm that transplant-specific factors place KTR at a higher risk for CDI. CDI may increase the risk of adverse outcomes such as biopsy-proven acute rejection. These findings emphasize the importance of preventive strategies to reduce the morbidity associated with CDI in KTR. Address correspondence to: S. Joseph Kim, MD, PhD, MHS, FRCPC, Toronto General Hospital, University Health Network, 585 University Avenue, 11-PMB-129, Toronto, Ontario, Canada M5G 2N2. Email: joseph.kim@uhn.ca. Office: 416-340-3228. Fax: 416-340-4701 AUTHORSHIP Research design: G. Li, Trac, Husain, Famure, Y. Li, Kim Writing the paper: G. Li, Trac, Husain, Famure, Kim Performance of the research: G. Li, Trac, Husain, Famure, Kim Contributed analytic tools: G. Li, Trac, Y. Li, Kim Participated in data analysis: G. Li, Trac, Husain, Famure, Y. Li, Kim DISCLOSURE The authors have no conflicts of interest to disclose as it relates to this work. FUNDING No external funding was acquired to support this research. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Reduced access to liver transplantation in women: role of height, MELD exception scores and renal function underestimation

Background Sex-based disparities in liver transplantation (LT) are incompletely understood. We assessed the role of height, MELD, MELD-Na and exception points in the disparate access to LT. Methods Adults waitlisted for LT at Organ Procurement and Transplantation Network (OPTN) between 2002 and 2013 were included. Covariates associated with likelihood of LT were analyzed by Cox proportional model. In a separate cohort of waitlisted adults with glomerular filtration rate (GFR) measurement by iothalamate clearance (n=611), we determined the number of creatinine-derived MELD points in men vs women, across all ranges of GFR. The impact of correcting the MELD score deficit in women on LT was modeled. Results Among 90,720 OPTN registrants, women had higher mortality than men (4 years after listing: 22% vs 18%, p

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Long-term outcomes of ABO-incompatible pediatric living donor liver transplantation

Background ABO-incompatible (ABOi) living donor liver transplantation (LDLT) have been performed to compensate for donor shortage. To date, few studies have reported detailed B cell desensitization protocols and long-term outcomes of ABOi pediatric LDLT. Methods Twenty-nine pediatric ABOi LDLT recipients were retrospectively analyzed. We compared the clinical outcomes between ABOi (n = 29) and non-ABOi (n = 131) pediatric LDLT recipients. Furthermore, we evaluated the safety and efficacy of our rituximab-based regimen for ABOi pediatric LDLT (2 ≤ age

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Meeting Report of the 13th Congress of the International Society of Vascularized Composite Allotransplantation

The International Society of Vascularized Composite Allotransplantation (ISVCA) held its 13th congress "Defining Success" in October 2017 in Salzburg, Austria. A total of 122 delegates from 22 countries representing 5 continents attended the conference. The theme strived to provide pathways to accomplish best possible outcomes in this unique and multifaceted field of transplantation. 'Ignite talks', a new feature introduced for the first time at the Salzburg meeting served as key elements for productive discussions on both congress days. The "ignitors" had been selected as experts from Europe, the Americas and Asia in VCA and neighbouring disciplines and provided a global perspective of their topic. Posttransplant treatment regimens, including the most burdensome side effects of immunosuppressants in addition to novel and future therapeutic options were discussed in depth. An additional ethics symposium summarized and advanced topics that had been discussed during the first international workshop on bioethical challenges in reconstructive transplantation held earlier in 2017. Correspondence Annemarie Weissenbacher, MD, Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford, Old Road, Oxford, OX3 7LE, United Kingdom. Tel.: +447481147692. E-mail: annemarie.weissenbacher@nds.ox.ac.uk Authorship AW: local organising chair and chair of the SPC for the ISVCA congress, wrote the meeting report; LC, EM, PP, GB, PJF, VG, CK, JK, LSL, GV, SS: SPC members, participated in editing the meeting report Disclosure The authors declare no conflicts of interest. The authors have no funding to disclose. Funding No funding received. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Pancreas Transplantation from pediatric donors: a single center experience

Background Pancreas allografts from pediatric donors are considered less suitable due to the increased risk of surgical complications and reduced islet cell mass that may compromise function. Methods All pancreatic transplants, procured from donors 60kg. Analysis of patient and graft survival was done between the groups, and subsequently between the pediatric cohort and the adult-donor control group. Results Sixty-three pediatric-donor pancreas transplants were performed. The mean donor age and weight were of 12.10±4.13 years and 47.8±21.3kg. Excellent metabolic control was achieved in 59 (93.65%) patients at the time of discharge and at a mean 5 year follow up, with the average hemoglobin A1c of 5.30 ±0.61% and blood glucose level of 102.75±20.70 mg/dL in those with a functioning graft. Nine graft losses were registered, of which one (1.6%) was due to arterial thrombosis. Eight (12.7%) patients experienced rejection. Overall graft survival and patient survival were of 85.7% and 92.1%, respectively, at a median follow up of 37.07 months (min 0.19 – max 119.57). No differences amongst the 3 groups were identified. Long term patient and allograft survival was comparable to that of the adult-donor pancreatic transplants. Conclusion Pediatric-donor pancreas demonstrated excellent short-term outcomes with no surgical complications and promising long-term outcomes despite the smaller islet mass. Pancreata from pediatric donors should not be marginalized and can offset worsening organ shortage. Corresponding Author: Mario Spaggiari, MD, Department of Surgery, University of Illinois at Chicago, 840 South Wood Street, Clinical Sciences Building, Suite 522, Chicago, Illinois 60612. Telephone: 312-996-6771. Fax: 312-413-3483. mspaggia@uic.edu Authorship: Mario Spaggiari participated in study design, statistical analysis, and writing. The author declares no conflict of interest. Caterina Di Bella participated in study design, statistical analysis, and writing. The author declares no conflict of interest. Pierpaolo Di Cocco participated in study design, statistical analysis and writing. The author declares no conflict of interest. Maya Campara participated in writing and critical review. The author declares no conflict of interest. Kelly Galen participated in writing and critical review. The author declares no conflict of interest Federico Gheza participated in data analysis and critical review. The author declares no conflict of interest. Jose Oberholzer participated in critical review and study design. The author declares no conflict of interest. Enrico Benedetti participated in critical review and study design. The author declares no conflict of interest. Ivo G. Tzvetanov participated in critical review and study design. The author declares no conflict of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Tofacitinib halts progression of graft dysfunction in a rat model of mixed cellular and humoral rejection

Background The progression from acute to chronic antibody-mediated rejection in kidney transplant recipients is usually not prevented by current therapeutic options. Here, we investigated whether the use of tofacinitib, a Janus kinase 3 inhibitor, was capable of preventing the progression of allograft dysfunction in a Fisher-to-Lewis rat model of kidney transplantation. Methods Rats were treated from the third week after transplantation in order to allow the development of rejection. Treatment was based on cyclosporin A, rapamycin or tofacitinib. Renal function was assessed at 1, 4, 8 and 12 weeks after transplantation while rat survival, histological lesions and infiltrating lymphocytes were analyzed at 12 weeks. Results Tofacitinib prolonged graft survival, preserved tubular and glomerular structures and reduced humoral damage characterized by C4d deposition. Tofacitinib was able to reduce donor-specific antibodies. In addition, T and NK cell graft infiltration was reduced in tofacitinib treated rats. Although rapamycin treated rats also showed prolonged graft survival, glomerular structures were more affected. Moreover, only tofacitinib treatment reduced the presence of T, B and NK cells in splenic parenchyma. Conclusions Tofacitinib is able to reduce the immune response generated in a rat model of kidney graft rejection, providing prolonged graft and recipient survival, better graft function and less histological lesions. CORRESPONDING AUTHOR Fritz Diekmann, MD, Hospital Clínic de Barcelona, Department of Nephrology and Renal Transplantation, Villarroel 170 (Escala 12 – Planta 5). E-08036 Barcelona, Spain. Tel.: +34-932275444. Fax: +34-934546033. fdiekman@clinic.ub.es Authorship Jordi Rovira: participated in research design, performance of research, data analysis and writing of the paper. María J Ramírez-Bajo: participated in data analysis, performance of research. Elisenda Banon-Maneus: participated in data analysis, performance of research. Marta Lazo-Rodríguez: participated in data analysis, performance of research. Daniel Moya-Rull: participated in data analysis, performance of research. Natalia Hierro-Garcia: participated in data analysis, performance of research. Valeria Tubita: participated in data analysis, performance of research. Gastón J Piñeiro: participated in data analysis, performance of research. Ignacio Revuelta: participated in data analysis, performance of research. Pedro Ventura-Aguiar: participated in data analysis, performance of research. David Cucchiari: participated in data analysis, critical revision of the manuscript for important intellectual content. Federico Oppenheimer: critical revision of the manuscript for important intellectual content. Mercè Brunet: participated in data analysis, critical revision of the manuscript for important intellectual content. Josep M Campistol: critical revision of the manuscript for important intellectual content. Fritz Diekmann: participated in research design, data analysis and writing of the paper. Disclosure The authors declare no conflicts of interest. Funding This study has been funded by the project PI11/01112 and Redes Tematicas De Investigacion Cooperativa En Salud, REDINREN (RD12/0021/0028 and RD16/0009/0023) both co-funded by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER) "Una manera de hacer Europa". CERCA Programme/Generalitat de Catalunya. This work was developed at the Centre de Recerca Biomèdica Cellex, Barcelona, Spain. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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IL-17-producing-ST2+ILC2 plays a pathogenic role in lung inflammation

Publication date: Available online 3 April 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Ting Cai, Jinxin Qiu, Yan Ji, Wenjing Li, Zhaoyun Ding, Caixia Suo, Jiali Chang, Jingjing Wang, Rui He, Youcun Qian, Xiaohuan Guo, Liang Zhou, Huiming Sheng, Lei Shen, Ju Qiu
BackgroundIL-17 plays a pathogenic role in asthma. ST2⁻iILC2s (inflammatory group 2 innate lymphoid cells) driven by IL-25 can produce IL-17, while ST2⁺nILC2s (natural ILC2s) produce few IL-17.ObjectiveWe characterized the ST2⁺IL-17⁺ILC2s during lung inflammation and determined the pathogenesis and molecular regulation of ST2⁺IL-17⁺ILC2s.MethodsLung inflammation was induced by papain or IL-33. IL-17 production by lung ILC2s from wild-type, Rag1^−/−, Rorc^gfp/gfp and Ahr^−/− mice was examined by flow cytometry. Bone marrow transfer experiment was performed to evaluate hematopoietic MyD88 signaling in regulating IL-17 production by ILC2s. mRNA expression of IL-17 was analyzed in purified naïve ILC2s treated with IL-33, leukotrienes and inhibitors for NFAT, p38, JNK or NF-κB. The pathogenesis of IL-17⁺ILC2s was determined by transferring wild-type or Il17^−/−ILC2s to Rag2^−/−Il2rg^−/− mice which were further induced lung inflammation. Finally, the expression of 106 ILC2 signature genes was compared between ST2⁺IL-17⁺ILC2s and ST2⁺IL-17⁻ILC2s.ResultsPapain or IL-33 treatment boosted IL-17 production from ST2⁺ILC2s (we name them as ILC217), but not ST2⁻ILC2s. Ahr, but not RORγt, facilitated the production of IL-17 by ILC217s. Hematopoietic compartment of MyD88 signaling is essential for the induction of ILC217s. IL-33 works in synergy with leukotrienes, which signal through NFAT activation, to promote IL-17 in ILC217s. Il17^−/− ILC2s were less pathogenic in lung inflammation. ILC217s concomitantly expressed IL-5 and IL-13 but expressed few GM-CSF.ConclusionDuring lung inflammation, IL-33 and leukotrienes synergistically induce ILC217s. ILC217s are highly pathogenic and unexpected source for IL-17 in lung inflammation.

Teaser

During lung inflammation, IL-33 and leukotrienes synergistically boost endogenous production of IL-17 from tissue-resident ST2⁺ILC2s. IL-17-producing ST2⁺ILC2s are highly pathogenic by recruiting leukocytes to airways and may be involved in severe forms of asthma.


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Global Supply and Demand of Opioids for Pain Management

Abstract

Purpose of Review

The goal of this review is to evaluate the global supply and demand of opioids used for pain management and discuss how it relates to the utilization of opioids around the world. The purpose of the review is also to determine the factors that contribute to inappropriate pain management.

Recent Findings

The total global production of opium for opioid manufacturing is enough to supply the growing global demands. However, licit opioids are only consumed by 20% of the world population. Most people throughout the world had no access to opioid analgesics for pain relief in case of need. Opioid misuse and abuse is not only a phenomena plague by the USA but globally across many countries.

Summary

Many countries have a lack of availability of opioids, contributing factors being strict government regulations limiting access, lack of knowledge of the efficacy of opioid analgesics in treating acute and chronic pain and palliative care, and the stigma that opioids are highly addictive. For the countries in which opioids are readily available and prescribed heavily, diversion, misuse, abuse, and the resurgence of heroin have become problems leading to morbidity and mortality. It is pertinent to find a balance between having opioids accessible to patients in need, with ensuring that opioids are regulated along with other illicit drugs to decrease abuse potential.

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The Evidence for the Role of Nutraceuticals in the Management of Pediatric Migraine: a Review

Abstract

Purpose of Review

Nutraceuticals are a form of complementary and alternative medicine that is commonly used by children and adolescents with migraine. In this review, observational studies, randomized controlled trials, systematic reviews, and meta-analyses on the efficacy and safety of single compound nutraceuticals for the management of migraine in children and adolescents were identified through a literature search of MEDLINE, Embase, and EBM Reviews—Cochrane Central Register of Controlled Trials.

Recent Findings

Twenty-one studies were reviewed, of which 11 were observational studies, 7 were randomized controlled trials, and 3 were systematic reviews. Six different nutraceuticals were included in the review: vitamin D, riboflavin, coenzyme Q10, magnesium, butterbur, and polyunsaturated fatty acids. All but three of the studies assessed the role of nutraceuticals in migraine prevention, while three studies evaluated the role of intravenous magnesium for acute migraine management. Overall, the quality and size of the studies were limited.

Summary

Due to low quality evidence and limited studies, no definite conclusions can be drawn on the efficacy of nutraceuticals for the treatment of pediatric migraine. Future studies are warranted in order to establish evidence upon which to define the role of nutraceuticals in this patient population.

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America’s Opioid Epidemic: a Comprehensive Review and Look into the Rising Crisis

Abstract

Purpose of Review

In the USA, there has been a sharp increase in heroin, prescription opiate, and illicitly manufactured fentanyl abuse with overdoses tripling since the 1990s. Several states have been deemed as "high-burden" abuse states where there is a greater proportion of synthetic opiate use. During the same period that prescription limitations were initially implemented throughout the country, the fentanyl epidemic started nationwide.

Recent Findings

In the setting of data demonstrating an almost fourfold increase in overdose deaths from 1999 to 2008, states began restricting access to Food and Drug Agency (FDA) approved opioid medications. Another factor further exacerbating the opioid crises is that the cost of all formulations of naloxone has increased significantly over the past several years.

Summary

In order to combat the opioid epidemic, stricter prescribing practices and prescription-monitoring programs have been instituted. Also, improvements in abuse-deterrent strategies for all opioid preparations can play an important role by increasing the safety of these medications and is a major focus of the FDA.

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Is Migraine Primarily a Metaboloendocrine Disorder?

Abstract

Purpose of the Review

The goals of this review are to evaluate recent studies regarding comorbidity between migraine and different metabolic and endocrine disorders and to discuss the role of insulin resistance as a common pathogenetic mechanism of these diseases.

Recent Findings

Recently, several studies showed that migraine is associated with insulin resistance, a condition in which a normal amount of insulin induces a suboptimal physiological response. All the clinical studies that used the oral glucose tolerance test to examine insulin sensitivity found that, after glucose load, there is in migraine patients a significant increase of both plasmatic insulin and glucose concentrations in comparison with controls. On the contrary, no association was found between migraine and type 2 diabetes, while type 1 diabetes seems to have a protective effect in the disease. Obesity and hypertension were shown to be risk factors for both episodic and chronic migraine. Metabolic syndrome has been recently associated mainly with migraine with aura and is now considered a risk factor also for medication overuse headache. Finally, a bidirectional association between migraine and hypothyroidism has been recently demonstrated, suggesting that common genetic or autoimmune mechanisms underlie both diseases.

Summary

Recent studies showed that insulin receptor signaling and the related physiological responses are altered in migraine and may have a relevant pathogenic role in the disease. Further studies are warranted in order to better elucidate mechanisms underlying insulin resistance in migraine in order to develop new therapeutic strategies for this debilitating disease.

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Evidence-Based Non-Pharmacological Therapies for Fibromyalgia

Abstract

Purpose of Review

Fibromyalgia (FM) is the second most common rheumatologic pain disorder after osteoarthritis with a multisystem presentation. While the treatment of FM in a clinical setting incorporates both pharmacologic and non-pharmacologic modalities, the present investigation reviews evolving literature on cognitive behavioral and complementary medical therapies. The recent medical literature on FM was reviewed between 2012 and 2017 via MEDLINE and the Cochrane Central Registry of Controlled Trials, with an emphasis on randomized controlled trials, meta-analyses, and evidence-based treatment guidelines.

Recent Findings

Cognitive behavioral therapy continues to play a significant role in the non-medical therapy of FM. It is especially helpful in high catastrophizing patients as evidenced by recent studies that note changes in the brain on functional magnetic resonance imaging. Mindfulness meditation can be helpful in improving pain symptoms and pain perception. No particular diet is found to have a meaningful impact in FM; however, various diets including low fermentable oligo- di –monosaccharides and polyols diet, gluten free, and hypocaloric may be helpful in ameliorating gastrointestinal distress in select patient populations. Current literature does not support the routine use of acupuncture for improving pain or quality of life in FM; however, given its benign side effect profile, it should not be discouraged.

Summary

Goals for symptom management and pain control should be set early, and patient engagement remains critical in the management of this complex pain presentation. While low quality evidence exists for most non-pharmacologic treatment modalities for FM, CBT and mindfulness meditation show promise for future investigation.

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New Advances in Acute Postoperative Pain Management

Abstract

Purpose of Review

Postoperative pain remains one of the most common challenges following inpatient and outpatient surgeries. With our advances in modern medicine, pain following surgical procedures still remains a challenge, though significant accomplishments have been made over the past few decades. This article highlights some of the promising new advances and approaches in postoperative pain management.

Recent Findings

Over the last decade, Enhanced Recovery after Surgery (ERAS) pathways and protocols are becoming the benchmark standards for enhancing postoperative recovery. Multimodal analgesia (MMA) is an essential component of such care. Further, in the wake of serious and persistent concern on the opioid epidemic in the USA, there has been a recent renewal of interest in non-opioid alternatives or adjuncts in controlling postoperative pain, often in the context of MMA. Intravenous (IV) acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), magnesium, ketamine, dexmedetomidine, liposomal bupivacaine, and newer neuraxial and peripheral regional techniques as well as patient-controlled modalities are gaining importance. Gabapentinoids have become popular but recent meta-analytic reviews have cast doubt on their routine use in perioperative settings. Among opioids, sublingual sufentanil, IV oxycodone, and iontophoretic transdermal fentanyl hold promise. Acupuncture and transcutaneous electrical nerve stimulation may be useful as adjuncts in MMA packages. Genetic testing, derivatives of herbal preparations, and an extended role of acute pain services may emerge as potential areas of importance in the future. There are, however, critical gaps in good quality evidence in many of the practice guideline recommendations.

Summary

In the era of opioid epidemic, several lines of evidence have emerged to support non-opioid-based drugs and approaches along with a few newer opioid formulations for postoperative pain management, although more research is needed to find the right balance of efficacy and safety.

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