G. Sanclemente, V. Ruiz-Cañas, J.M. Miranda, A.P. Ferrín, P.A. Ramirez, G.N. Hernandez
Actas Dermosifiliogr 2018;109:218-29
Abstract - Full text - PDF
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Σάββατο 14 Απριλίου 2018
Photodynamic Therapy Interventions in Facial Photodamage: A Systematic Review
A Scoping Review Protocol to Explore the Use of Interleukin-1-Targeting Drugs for the Treatment of Dermatological Diseases: Indications, Mechanism of Action, Efficacy, and Safety
Abstract
Introduction
The interleukin (IL)-1 pathway has been identified as being involved in inflammatory and neoplastic skin diseases such as psoriasis, atopic dermatitis, neutrophilic dermatosis, melanoma, and squamous cell carcinoma. Drugs developed to target the IL-1 pathway are currently used to treat these pathologies, and although they are becoming more selective, they are not exempt from adverse events and high costs. Integrating the best research evidence with clinical experience and patient needs has been shown to improve care, health, and cost outcomes. This is because evidence-based guidelines rank interventions according to cost-effectiveness. However, evidence on this topic is scarce for several reasons. First, although randomized clinical trials currently provide the best evidence, they are not always available. Second, there are no secondary scientific studies that summarize the use of IL-1-targeting agents in dermatology. We therefore sought to develop an a priori protocol for broadly reviewing the available evidence on the use of IL-1-targeting drugs in the treatment of dermatological diseases.
Methods
We used the latest methodology to perform a scoping review as described in the Joanna Briggs Institute manual.
Results/Discussion
Developing and applying a methodology for evidence synthesis promotes reproducibility and increases the validity of secondary scientific investigations, making it the optimal strategy for scientifically synthesizing a broad field such as the indications for and the mechanisms of action, efficacies, safety, and costs of IL-1-targeting drugs in the treatment of dermatological diseases. Quantitative synthesis facilitates the detection of knowledge gaps and the identification of new questions that can be addressed through systematic reviews. We present an a priori protocol for exploring the available evidence on this topic.
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Translation and Cross-Cultural Adaptation of Health Assessment Tools
Gorlin Syndrome
Dupilumab for the Treatment of Atopic Dermatitis
Sclerodermatous Chronic Graft-versus-Host Disease Treated With Imatinib: A Dermatological Perspective
A 12-Day Course of Imiquimod 5% for the Treatment of Actinic Keratosis: Effectiveness and Local Reactions
Reconstructive methods in Mohs micrographic surgery in Uruguay: A bidirectional descriptive cohort analysis
Zika Virus: Cutaneous Manifestations in 3 Patients
Color Doppler Ultrasound Study of Glomuvenous Malformations with its Clinical and Histologic Correlations
Bilateral Annular Plaques on the Hands and Forearms
Fast-growing Tumor of the Eyelid
Immediate Lymph Node Dissection on Detection of Sentinel Lymph Node Involvement Does Not Increase Survival in Cutaneous Melanoma
Linear Palmoplantar Keratoderma
Solitary Filiform Papule in the Left Nasal Vestibule
Ultrasound-Guided, Minimally Invasive Resection of a Digital Glomus Tumor
Our Experience With Strain Elastography in 2 Cases of Suspected Malignant Subcutaneous Lesions
Allergen component analysis as a tool in the diagnosis and management of occupational allergy
Publication date: Available online 9 April 2018
Source:Molecular Immunology
Author(s): Monika Raulf
We are now in the epoch of "molecular allergology" and numerous clinically relevant allergenic molecules are available improving the performance of in vitro allergen tests and allergen detection methods. This review is focusing on characterized occupational allergens and their implementation into the in vitro diagnosis for occupational allergy and in allergen detection methods.More than 400 occupational agents are identified and documented as being 'respiratory sensitizers', but currently only a limited number of them are characterized on the molecular level and available for routine diagnosis as native or recombinant allergens. One exception, however, is natural rubber latex (NRL) from Hevea brasiliensis still remaining an important occupational allergen source. Characterization of 15 NRL allergens led to the development of assays for the determination of allergen content of NRL materials and the implementation of component-resolved diagnosis (CRD) for specific IgE antibody measurement. Microarray or singleplex using recombinant or native allergens are reliable tools for NRL allergy diagnosis. In addition, NRL allergy is an excellent model for improving extract-based specific IgE measurement by amplification of NRL extract preparation with stable recombinant major allergen rHev b 5. Despite the many efforts to characterize the occupationally relevant wheat allergens for baker's asthma, the most frequently occurring forms of occupational asthma, the results are highly diverse. Wheat sensitization profiles of bakers showed great interindividual variability and no wheat allergen could be classified as the major allergen. For diagnosis of baker's asthma, a whole wheat extract is still the best option for specific IgE determination. But single wheat allergens might help to discriminate between wheat-induced food allergy, grass pollen allergy and baker's asthma. For workplace-related allergens like coffee, wood, soybean, seafood and moulds allergens are characterized and few of them are available, but their relevance for occupational sensitization routes should be verified in the further studies.
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Life Experience of Patients With Unilateral Vocal Fold Paralysis.
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Life Experience of Patients With Unilateral Vocal Fold Paralysis.
JAMA Otolaryngol Head Neck Surg. 2018 Apr 05;:
Authors: Francis DO, Sherman AE, Hovis KL, Bonnet K, Schlundt D, Garrett CG, Davies L
Abstract
Importance: Clinicians and patients benefit when they have a clear understanding of how medical conditions influence patients' life experiences. Patients' perspectives on life with unilateral vocal fold paralysis have not been well described.
Objective: To promote patient-centered care by characterizing the patient experiences of living with unilateral vocal fold paralysis.
Design, Setting, and Participants: This study used mixed methods: surveys using the voice and dysphagia handicap indexes (VHI and DHI) and semistructured interviews with adults with unilateral vocal cord paralysis recruited from a tertiary voice center. Recorded interviews were transcribed, coded using a hierarchical coding system, and analyzed using an iterative inductive-deductive approach.
Main Outcomes and Measures: Symptom domains of the patient experience.
Results: In 36 patients (26 [72%] were female, and the median age and interquartile range [IQR] were 63 years [48-68 years]; median interview duration, 42 minutes), median VHI and DHI scores were 96 (IQR, 77-108) and 55.5 (IQR, 35-89) at the time of interviews, respectively. Frustration, isolation, fear, and altered self-identity were primary themes permeating patients' experiences. Frustrations related to limitations in communication, employment, and the medical system. Sources of fear included a loss of control, fear of further dysfunction or permanent disability, concern for health consequences (eg, aspiration pneumonia), and/or an inability to call for help in emergency situations. These experiences were modified by the following factors: resilience, self-efficacy, perceived sense of control, and social support systems.
Conclusions and Relevance: Effects of unilateral vocal fold paralysis extend beyond impaired voice and other somatic symptoms. Awareness of the extent to which these patients experience frustration, isolation, fear, and altered self-identity is important. A patient-centered approach to optimizing unilateral vocal fold paralysis treatment is enhanced by an understanding of both the physical dimension of this condition and how patients cope with the considerable emotional and social consequences. Recognizing the psychosocial dimensions of disease allows clinicians to communicate more effectively, be more empathetic, and to better personalize treatment plans, which may lead to improved patient care and patient satisfaction.
PMID: 29621392 [PubMed - as supplied by publisher]
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Survival Outcomes for Patients With T3N0M0 Squamous Cell Carcinoma of the Glottic Larynx-Reply.
| Related Articles |
Survival Outcomes for Patients With T3N0M0 Squamous Cell Carcinoma of the Glottic Larynx-Reply.
JAMA Otolaryngol Head Neck Surg. 2018 Apr 05;:
Authors: Witek ME, Hartig GK, Harari PM
PMID: 29621382 [PubMed - as supplied by publisher]
https://ift.tt/2JoLs93
Thyroidosis Mistaken for Thyroid Cancer.
| Related Articles |
Thyroidosis Mistaken for Thyroid Cancer.
JAMA Otolaryngol Head Neck Surg. 2018 Apr 05;:
Authors: Crawford AR, Martinez-Lage M, Kim CS
PMID: 29621377 [PubMed - as supplied by publisher]
https://ift.tt/2Jq76Kf
Auricular Swelling After Mild Trauma.
| Related Articles |
Auricular Swelling After Mild Trauma.
JAMA Otolaryngol Head Neck Surg. 2018 Apr 05;:
Authors: Sakano H, Mhoyan A, Cueva RA
PMID: 29621371 [PubMed - as supplied by publisher]
https://ift.tt/2H45Ii8
Survival Outcomes for Patients With T3N0M0 Squamous Cell Carcinoma of the Glottic Larynx.
| Related Articles |
Survival Outcomes for Patients With T3N0M0 Squamous Cell Carcinoma of the Glottic Larynx.
JAMA Otolaryngol Head Neck Surg. 2018 Apr 05;:
Authors: D'Ascanio L, Piazza F
PMID: 29621368 [PubMed - as supplied by publisher]
https://ift.tt/2IyKTby
A Child's Complaint of "Throat Freeze"-Not Brain Freeze-and Experiences With Zenker Diverticulum.
| Related Articles |
A Child's Complaint of "Throat Freeze"-Not Brain Freeze-and Experiences With Zenker Diverticulum.
JAMA Otolaryngol Head Neck Surg. 2018 Apr 05;:
Authors: Wiebe DJ
PMID: 29621364 [PubMed - as supplied by publisher]
https://ift.tt/2JNjZ0T
Fehlerquelle Datenschutzerklärung
Die meisten Praxis-Websites von Haus- und Fachärzten erfüllen nicht die gesetzlichen Anforderungen. Das legt eine aktuelle Studie nahe, in der 400 Homepages von Ärzten untersucht wurden. Sie zeigt, wo am häufigsten Fehler passieren.
https://ift.tt/2EMPrZu
Patientenwünsche ablehnen ist hohe Diplomatenkunst
Wenn Ärzte medizinisch nicht gerechtfertigte Wünsche und Forderungen ihrer Patienten ablehnen, bleibt dies mitunter nicht ohne Folgen: Die Enttäuschten sind mit der Behandlung unzufrieden — und kommunizieren dies auch per Mundpropaganda. Mit ein wenig diplomatischem Geschick lassen sich Frustrationen aber oft vermeiden.
https://ift.tt/2IX9Iy5
Neue Pflichten für Praxischefs
Das neue Mutterschutzgesetz ist zum 1. Januar in Kraft getreten. Es gibt einige Detailänderungen, die Praxisinhaber kennen sollten, sonst droht Ärger — inklusive Bußgeldern.
https://ift.tt/2qxs55R
Stressfaktor Nummer eins: die Bürokratie
Fast die Hälfte sowohl der leitenden Klinikärzte wie auch der Praxischefs identifiziert die Dokumentationsanforderungen als Hauptursache für Stress im Versorgungsalltag.
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Ärzte sollten Arztsitz gegen MVZ-Pleite absichern
In einem medizinischen Versorgungszentrum tätige Ärzte sollten überlegen, eine Klausel zur Insolvenz ihrer Einrichtung in den Arbeitsvertrag einzubringen. Im Ernstfall hat das Vorteile für den Erhalt des Arztsitzes, wie ein BSG-Urteil nahelegt.
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Fortgeschrittene Kopf-Hals-Tumoren: Aufgeteilte Chemotherapie effektiv?
Weniger Toxizität bei gleicher Wirksamkeit durch eine Splittung der Induktionschemotherapie? Den Daten einer Phase-II-Studie zufolge scheint diese Strategie aufzugehen. Patienten mit lokal fortgeschrittenen resezierbaren oralen und oropharyngealen Tumoren hatten vor der Operation die TPF-Chemotherapie in zwei Fraktionen pro Zyklus erhalten.
https://ift.tt/2qxrWzl
Globusgefühl: Für den Kloß im Hals gibt’s meistens einen Grund
Viele Patienten, die von einem Globusgefühl im Hals berichten, haben Angst, es könne sich um Krebs handeln. Dies bestätigt sich zwar meistens nicht, aber bei genauer Ursachenforschung lassen sich doch häufig andere klinische Befunde erheben.
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Verschenken Sie kein Geld
Ärztliche Befundberichte und Briefe sind im gesamten Behandlungsfall nicht neben den üblichen Pauschalen berechnungsfähig. Somit gilt in vielen Praxen der Grundsatz, dass Briefe und Befundberichte prinzipiell nicht berechnungsfähig sind. Ein fataler Irrtum.
https://ift.tt/2IYssgr
Speicheldrüsenkarzinome: Therapiefindung per Molekulardiagnostik
Das genetische Tumorprofil bietet bei rezidivierten Speicheldrüsenkarzinomen neben der Histologie wichtige Informationen zum Tumortyp und eröffnet neue Wege für den Einsatz von zielgerichteten Therapien. Dies zeigen Ergebnisse einer aktuellen Untersuchung.
https://ift.tt/2ELmmOj
Milben-Rhinitis: SLIT bei Jugendlichen wirksam
Was bringt die sublinguale spezifische Immuntherapie gegen Hausstaubmilben bei Jugendlichen mit einer entsprechenden allergischen Rhinitis? Die gepoolte Auswertung zweier großer Phase-III-Studien gibt Antworten.
https://ift.tt/2EMmfC9
Nocebo — der böse Bruder des Placebos
Wenn die Chemotherapie bereits bei Anblick des Infusionsbeutels Übelkeit auslöst oder ein Biosimilar schlechter wirkt als das Original, ist vielleicht der Nocebo-Effekt schuld. Was das ist und wie Sie vorbeugen — eine Übersicht.
https://ift.tt/2qwESp3
3 training scenarios for suctioning the upper airway
Sponsored by Bound Tree Medical By Tim Nowak for EMS1 BrandFocus Gurgling … one of the sounds an EMS provider may hear upon approaching their patient that immediately sets them into a mode of airway management. What caused this patient to have an airway obstruction" Was it trauma" Intoxication" How about a reaction of some sort" Case 1: Trauma You're dispatched to a motorcycle accident ...
https://ift.tt/2v1CGKX
3 takeaways on how EMS providers train to use supraglottic airways
By Sarah Calams, EMS1 Associate Editor Supraglottic airways are a valuable airway management tool. Which methods of training do you use to refresh your knowledge of and ability to use supraglottic airways" Furthermore, how often do you complete refresher training" We asked these questions, along with six others, in a survey to help us gain a better understanding of how EMS providers train to use supraglottic ...
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Neue klinische Anwendungen der Laser-Doppler-Vibrometrie in der Otologie
Zusammenfassung
Hintergrund
Für die Untersuchung der Mittelohrmechanik ist eine Messmethode erforderlich, die Vibrationsbewegungen im Nanometerbereich zu messen vermag, ohne dabei den Schwingungsvorgang zu beeinflussen. Zahlreiche Messverfahren kamen zur Anwendung, bis sich die Laser-Doppler-Vibrometrie (LDV) als Standardverfahren in der Ohrforschung etablierte.
Ziel der Arbeit
Ziel war die Darstellung der klinischen Anwendungsmöglichkeiten eines LDV-Systems in der Otologie.
Material und Methoden
Verwendet wurde ein kommerzielles Ein-Punkt-Vibrometer. Der Lasermesskopf wurde sowohl in Verbindung mit einem Operationsmikroskop verwendet als auch als handgeführtes Messgerät zur Messung direkt im Gehörgang. Hierbei kam eine selbstentwickelte Vorsatzeinheit unter Verwendung einer elastischen Linse zur Anwendung. Schwingungsmessungen des Mittelohrs erfolgten im Felsenbeinmodell sowie intra- und postoperativ an Patienten im Zuge der Implantation einer Vibrant Soundbridge (VSB, Fa. MED-EL GmbH, Innsbruck, Österreich).
Ergebnisse
Verschiedene pathologische Mittelohrveränderungen zeigen eine unterschiedliche Frequenzantwort des Umbos. Die LDV kann für eine intraoperative objektive Ankopplungsüberprüfung des Floating Mass Transducer (FMT, Fa. MED-EL) an die Ossikelkette bei der Implantation einer Vibrant Soundbridge verwendet werden. Postoperativ kann die Methode hilfreich sein, falls eine Verschlechterung der Soundbridge-Verstärkungsleistung bemerkt wird. Gemessen wird eine Veränderung der Transferfunktion des Umbos, hervorgerufen z. B. durch eine Vernarbung des Mittelohrs oder eine Dislokation des FMT.
Schlussfolgerung
Die LDV bietet sich für viele klinische Fragestellungen in der Otologie an. Durch die hohen Kosten für ein LDV-System und den verhältnismäßig großen apparativen Aufwand sowie einen breiten Korridor zur Interpretation der Messergebnisse hat es die Methode jedoch (noch) nicht geschafft, sich im klinischen Alltag zu etablieren.
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Das angeborene Immunsystem beim Oropharynxkarzinom
Zusammenfassung
Klinisch und biologisch können Plattenepithelkarzinome des Oropharynx („oropharyngeal squamous cell carcinoma", OPSCC), die mit humanen Papillomaviren (HPV) assoziiert sind, als eine eigene Tumorentität im Kopf-Hals-Bereich betrachtet werden. Bisher hat dies außerhalb klinischer Studien keinen Einfluss auf Therapiekonzepte. Der natürliche Replikationszyklus von HPV findet „räumlich getrennt" von zytotoxischen Immunzellen in der Epidermis statt. Dendritische (Langerhans‑)Zellen finden sich jedoch häufig in dieser oberen Hautschicht. Ihre Fähigkeit Antigene zu prozessieren, zu migrieren und schließlich T‑Zellen zu aktivieren, wird durch die Aktivität der viralen Onkoproteine (E5–E7) inhibiert. Die Repression einer funktionellen HLA-I(Human-Leukocyte-Antigen-I)-Expression auf der Oberfläche von Epithelzellen ist hierbei wichtig. Eine entsprechende Aktivierung von natürlichen Killer(NK)-Zellen („Missing-Self-Erkennung") unterbleibt jedoch, da diese in der Epidermis normalerweise fehlen. Genomweite Untersuchungen zeigen spezifische Signaturen bei HPV-assoziierten OPSCC, die distinkt sind von HPV-negativen Tumoren. Dabei sind Gene des HLA-I-Systems bei HPV-assoziierten OPSCC vermehrt von genetischen Veränderungen betroffen. Eigene Daten deuten darauf hin, dass HPV-assoziierte OPSCC häufiger durch CD56-positive (CD56+-)NK-Zellen infiltriert sind, was mit dem Verlust der HLA-I-Oberflächenexpression bei der HPV-assoziierten Karzinogenese zusammenhängen könnte. Bei Patienten mit OPSCC korrelieren CD56+-Zellen mit einem günstigeren Verlauf nach konventioneller Therapie. Die vorliegenden Daten zeigen, dass HPV-assoziierte OPSCC für künftige immunmodulatorische Therapiekonzepte geeignet sein könnten und der Immunstatus für die Planung klinischer Studien bedeutsam ist.
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Lärminduzierte Neurodegeneration der zentralen Hörbahn
Zusammenfassung
Hintergrund
Ein Lärmtrauma induziert zentralnervöse Pathologien, die zur Generierung von Hör- und Wahrnehmungsstörungen führen.
Fragestellung
Sind degenerative Prozesse in der zentralen Hörbahn eine direkte Auswirkung der Überstimulation oder eine Folge akustischer Deprivation?
Material und Methode
Bestimmung von Zelltodmechanismen im Mausmodell eines lärminduzierten Hörverlusts zu verschiedenen Zeitpunkten nach einfacher oder wiederholter Lärmexposition.
Ergebnisse
Eine einmalige Lärmexposition (3 h, 115 dB SPL, 5–20 kHz) induziert akute (≤1 Tag) und längerfristige (Beobachtungszeitraum 14 Tage) Degeneration insbesondere in subkortikalen Strukturen. Nach einem wiederholten Lärmtrauma treten v. a. pathologische Veränderungen im auditorischen Thalamus und Kortex auf.
Schlussfolgerung
Lärm hat direkte Auswirkungen auf basale Strukturen der zentralen Hörbahn, eine Protektion kortikaler Areale erfolgt möglicherweise aufgrund inhibitorischer neuronaler Projektionen. Degenerative Mechanismen in höheren Strukturen des vorgeschädigten Systems deuten auf eine zunehmende Beeinträchtigung komplexer Verarbeitung akustischer Informationen.
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Successful Utilization of Mechanical Thrombectomy in a Presentation of Pediatric Acute Ischemic Stroke
Guidelines regarding the management of acute ischemic stroke (AIS) in the pediatric population using mechanical recanalization procedures are lacking. We present a case of a 14-year-old male diagnosed in the Emergency Department with an acute onset stroke who underwent successful mechanical clot removal by interventional radiology.
https://ift.tt/2qxQcS4
Same Phenotype in Children with Growth Hormone Deficiency and Resistance
By definition, about 2.5% of children show a short stature due to several causes. Two clinical conditions are characterized by serum IGF-I low levels, idiopathic GH deficiency (IGHD), and GH insensitivity (GHI), and the phenotypic appearance of these patients may be very similar. We studied two children with short stature and similar phenotypes. The first case showed frontal bossing, doll face, acromicria, and truncal obesity, with a GH peak
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Evaluating Diagnostic Accuracy of Noninvasive Tests in Assessment of Significant Liver Fibrosis in Chronic Hepatitis C Egyptian Patients
Viral Immunology, Ahead of Print.
https://ift.tt/2EMGsaB
Identification of Hub Genes and Pathways in Zika Virus Infection Using RNA-Seq Data: A Network-Based Computational Approach
Viral Immunology, Ahead of Print.
https://ift.tt/2JLZSAr
Deregulated TNF-Alpha Levels Along with HPV Genotype 16 Infection Are Associated with Pathogenesis of Cervical Neoplasia in Northeast Indian Patients
Viral Immunology, Ahead of Print.
https://ift.tt/2IYnkZJ
Comparison of Lipid Accumulation Product Index with Body Mass Index and Waist Circumference as a Predictor of Metabolic Syndrome in Indian Population
Metabolic Syndrome and Related Disorders, Ahead of Print.
https://ift.tt/2ELGy2x
The Effects of a Community-Based Lifestyle Intervention on Metabolic Syndrome and Its Components in Adolescents: Findings of a Decade Follow-Up
Metabolic Syndrome and Related Disorders, Ahead of Print.
https://ift.tt/2JMJb82
Metabolic Syndrome and Vitamin D Levels in Patients with Obstructive Sleep Apnea Syndrome
Metabolic Syndrome and Related Disorders, Ahead of Print.
https://ift.tt/2ELGoIt
Cortical Processing Related to Intensity of a Modulated Noise Stimulus—a Functional Near-Infrared Study
Abstract
Sound intensity is a key feature of auditory signals. A profound understanding of cortical processing of this feature is therefore highly desirable. This study investigates whether cortical functional near-infrared spectroscopy (fNIRS) signals reflect sound intensity changes and where on the brain cortex maximal intensity-dependent activations are located. The fNIRS technique is particularly suitable for this kind of hearing study, as it runs silently. Twenty-three normal hearing subjects were included and actively participated in a counterbalanced block design task. Four intensity levels of a modulated noise stimulus with long-term spectrum and modulation characteristics similar to speech were applied, evenly spaced from 15 to 90 dB SPL. Signals from auditory processing cortical fields were derived from a montage of 16 optodes on each side of the head. Results showed that fNIRS responses originating from auditory processing areas are highly dependent on sound intensity level: higher stimulation levels led to higher concentration changes. Caudal and rostral channels showed different waveform morphologies, reflecting specific cortical signal processing of the stimulus. Channels overlying the supramarginal and caudal superior temporal gyrus evoked a phasic response, whereas channels over Broca's area showed a broad tonic pattern. This data set can serve as a foundation for future auditory fNIRS research to develop the technique as a hearing assessment tool in the normal hearing and hearing-impaired populations.
https://ift.tt/2GJruYR
Transcription and microRNA Profiling of Cultured Human Tympanic Membrane Epidermal Keratinocytes
Abstract
The human tympanic membrane (TM) has a thin outer epidermal layer which plays an important role in TM homeostasis and ear health. The specialised cells of the TM epidermis have a different physiology compared to normal skin epidermal keratinocytes, displaying a dynamic and constitutive migration that maintains a clear TM surface and assists in regeneration. Here, we characterise and compare molecular phenotypes in keratinocyte cultures from TM and normal skin. TM keratinocytes were isolated by enzymatic digestion and cultured in vitro. We compared global mRNA and microRNA expression of the cultured cells with that of human epidermal keratinocyte cultures. Genes with either relatively higher or lower expression were analysed further using the biostatistical tools g:Profiler and Ingenuity Pathway Analysis. Approximately 500 genes were found differentially expressed. Gene ontology enrichment and Ingenuity analyses identified cellular migration and closely related biological processes to be the most significant functions of the genes highly expressed in the TM keratinocytes. The genes of low expression showed a marked difference in homeobox (HOX) genes of clusters A and C, giving the TM keratinocytes a strikingly low HOX gene expression profile. An in vitro scratch wound assay showed a more individualised cell movement in cells from the tympanic membrane than normal epidermal keratinocytes. We identified 10 microRNAs with differential expression, several of which can also be linked to regulation of cell migration and expression of HOX genes. Our data provides clues to understanding the specific physiological properties of TM keratinocytes, including candidate genes for constitutive migration, and may thus help focus further research.
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The Association Between Cochlear and Retrocochlear Disorders with Tinnitus with Normal Hearing Thresholds
Abstract
Tinnitus is the perception of hearing the sound without any sound stimulus. It is a symptom of abnormality in a form of conductive disorder when it comes from the outer ear canal and middle ear. A tinnitus complaint has a normal hearing threshold but it has been not fully recognized its causes. Thus, an objective evaluation is needed to locate the abnormality by using OAE and BERA test. To analyze the association of TEOAE, DPOAE, and BERA to locate cochlear and retrocochlear disorders in tinnitus patients with normal hearing threshold. The study was conducted from August to November 2010 until the number of samples was fulfilled in Outpatient Clinic and Audiology Unit in Department of Otolaryngology-Head and Neck Surgery, Dr. Soetomo General Hospital Surabaya. The inclusion criteria in this study included: patients aged 20–50 years old, hearing threshold of ≤ 25 dB, type A tympanogram. The comparison and the association test of TEOAE, DPOAE and BERA in tinnitus group were: TEOAE–BERA analysis result using Mc Nemar obtained p = 0.006, Kappa p = 0.047, likelihood ratio p = 0.066, and the result of DPOAE–BERA analysis using Mc Nemar obtained p = 0.008, Kappa p = 0.439, likelihood ratio p = 0.336. There was a difference in the results of DPOAE examination between tinnitus patients with normal hearing threshold and the control group. There was no difference in TEOAE and BERA test results between tinnitus patients with normal hearing threshold and the control group. This indicates an abnormality in the cochlear.
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Management of Mandible Fracture by Plating and Wiring: An Otolaryngologist Perspective at Teritiary Care Center
Abstract
The facial area is one of the most frequently injured parts of the body (Abiose in Br J Oral Maxillofac Surg 24(1):319, 1986; Adi et al. in Br J Oral Maxillofac Surg 28(3):1949, 1990; Allan and Daly in Int J Oral Maxillofac Surg 19(5):26871, 1990), and the mandible is one of the most commonly fractured maxillofacial bones (1990; Azevedo et al. in J Trauma 45(6):10847, 1998; Bremerich et al. in Acta Stomatol Belg 93:511, 1996). Mandible is the only mobile bone of the skeleton, and hence vulnerable to fracture. This is a retrospective study of 50 mandibular fracture cases managed at the Department of ENT, Govt. Medical College Bhavnagar during the 2 years period from 2014 to 2016. Maximum subjects were in age group 21–30 years with a male preponderance. Road traffic accident is the main cause followed by falls and assault. Symphysis is the most common site of Mandibular fracture. Mandible fracture is a common entity in Road traffic accidents. Multiple fractures are seen in 40% of mandibular fracture cases. The results were equally good in patients requiring only MMF (Maxillo Mandibular Fixation) and inpatients requiring MMF and Plating, during the follow up up to 8 weeks. Physiotherapy was advised for all the post op patients after 2 months.
https://ift.tt/2GPjK3C
Conventional Tracheostomy Versus Percutaneous Tracheostomy: A Retrospective Study
Abstract
Objectives Emergency Tracheostomy is a life saving surgical procedure. With the advent of newer instruments and equipments in the critical care units, there is marked improvement in the quality of care of the critically ill patients and such patients are able to survive for a longer period. Elective tracheostomy is being done in those patients who needs positive pressure ventilation, for a longer duration. Objectives of our study are to compare conventional tracheostomy (CT) to percutaneous tracheostomy (PcT) and to identify the strategy with the lowest frequency of potentially life threatening events. Study Design Retrospective comparative study. Patients Included 30 patients who met inclusion criteria. Study Settings Tertiary care centre (medical college). Results 15 patients underwent CT and 15 underwent PcT. Blood loss, mean operation time and complications were compared. Blood loss and operation time was lesser in CT compared to PcT. There were no reported complications in both the techniques. Conclusion In our study CT took lesser time with lesser blood loss and without any complications. But statistically, this difference was not significant. Thus person with refined skill in the technique is of utmost importance in deciding the choice of a technique.
https://ift.tt/2qfoAkv
Reflux Finding Score (RFS) a Quantitative Guide for Diagnosis and Treatment of Laryngopharyngeal Reflux
Abstract
The study was under taken to know the prevalence of reflux signs in an individuals with throat complaints on the basis of reflux finding score (RFS) and quantitatively assess the effect of treatment. A cross-sectional study was done to evaluate the presence of laryngo-pharyngeal reflux signs in patients visiting ENT clinic with throat or voice problems in central India. There were 80 patients included in the study from 2017 to 2018 individuals. They were questioned regarding their symptoms. Their pharyngeal findings on rigid 70° laryngoscopy were viewed and RFS was made. The patients were reviewed at monthly intervals. Laryngopharyngeal reflux changes were seen in 36 of the 80 patients (45%). The reflux was graded as per the reflux finding score. The score ranged from 7 to maximum of 17 out of 26 in the patients with LPRD. Majority of the patients the score decreased with lifestyle changes and pantaprazole twice daily. There was poor response in 5% (4) patients, who were then advised to undergo upper gastro intestinal endoscopy for further assessment. Laryngopharyngeal reflux has become a very common entity in urban lifestyle. On careful examination the signs can be picked and assessed with the RFS, which is a very useful tool to grade and reassess patient on subsequent follow up.
https://ift.tt/2GQ3P5j
Vagal Paragangliomas: From Reducing Morbidity to Improving Quality of Life
Abstract
Vagal paragangliomas are rare tumors. Advances in the imaging have aided the diagnosis and assessment of this disease. Surgery is the mainstay of the treatment however radiotherapy has been tried in the selected cases. Surgery is associated with some mortality but with a lot of morbidity in view of cranial nerve deficit. The necessity to prevent additional cranial nerve deficits needs thorough preoperative evaluation and influences the therapeutic approach. This study involves the retrograde evaluation of five patients of vagal paraganglioma histopathologically confirmed, all the patients were operated via trancervical approach. Preoperatively three of five had 9, 11 and 12th cranial nerve involvement, one had horner's syndrome. Postoperative vocal rehabilitation was done in all the patient by medialisation thyroplasty Issiki type 1. Though vagal paragangliomas are associated with mortality and morbidity. Surgical treatment should aim at reducing mortality. Vagal nerve morbidity can be taken care as a planned and staged procedure mainly involving restoring voice as rest of concerns are taken care by compensation from opposite nerves.
https://ift.tt/2HfQKD6
Transcutaneous Columellar Strut for Correcting Caudal Nasal Septal Deviation
Abstract
Correction of caudal septal deviation is a challenging issue because of its significant role in tip support mechanisms. Some interventions especially aggressive resection of caudal septum to correct deviation, may compromise external nasal valve, tip ptosis and persistence of nasal obstruction. Many surgical techniques have been suggested to correct this type of nasal septal deviation. This study presents a technique to correct caudal septal deviation without weakening of tip support mechanisms. To evaluate the efficacy of insertion of a transcutaneous columellar strut during correction of caudal septal deviation. The study was performed in patients complaining from nasal obstruction with caudal septal deviation. After intranasal incision and elevation of mucoperichondrial flap, Caudal septum released from anterior nasal spine (ANS) and a band of cartilage removed from inferior and caudal part of septum and septum again fixed to ANS. Through a vertical transcutaneous incision, a cartilaginous strut is placed in columella, between medial crurae. Preoperative and postoperative NOSE score determined and photographs were taken. In 14 patients we performed this technique, the postoperative NOSE score showed significant improvement, (p = 0.001). Nasal breathing improved in all patients without any complication or tip ptosis or worsening of nasal appearance. This septoplasty technique along with placement of transcolumellar strut, is an easy, efficient and complication free method for simultaneously correction of caudal deviation of nasal septum, reinforcing external nasal valve and prevents tip ptosis.
https://ift.tt/2Es1fQK
Microscopic Versus Endoscopic Myringoplasty: A comparative study
Abstract
To compare the results of myringoplasty by using operating microscope (postaural) with that of myringoplasty by using endoscope (permeatal). Our study was conducted in Department of ENT of in Chirayu Medical College and Hospital. Total 60 patients of age group 18–60 were taken for study having chronic otitis media or trauma with central perforation. Patients were randomly selected microscopic or endoscopic myringoplasty. 30 patients for Microscopic Myringoplasty and 30 patients for endoscopic Myringoplasty were selected. Out of total 60 patients 35 were females and the 25 were males, 27 were in the age group 15–30 and 23 were in age group 31–45 and only 10 in the age group of 46–60. 18–30 age group cohort was predominant. The average time taken for endoscopic myringoplasty was 65.5 ± 3.45 min and for microscopic myringoplasty 85.7 ± 3.42 min. 26 were having Large central perforation (LCP), of which 13 underwent microscopic and 13 underwent endoscopic myringoplasty. The graft was taken up in situ in 22 patients while 4 patients had small residual central perforation. Out of these four residual perforations 3 were done by endoscopy and 1 by microscopy. 19 (of 60) were having Medium size central perforation (MCP), 10 were operated with endoscope and 9 with microscope. 15 (60) were having Small central perforation (SCP), 7 done with endoscope and 8 with microscope. In all patient graft take up was well. Large central perforation present in maximum patient and had least graft uptake as compared to MCP and SCP. Out of the 30 these endoscopic myringoplasty 27 patients had good graft uptake and 3 had small central residual perforation after 3 months. Out of the 30 microscopic myringoplasty 29 patients had good graft uptake and 1 patient had small central residual perforation after 3 months. In our study pre operative and post operative Air Bone Gaps (ABGs) were 22.05 ± 2.04 and 9.05 ± 1.36 db respectively in endoscopic myringoplasty and 21.81 ± 1.85 and 8.55 ± 1.44 db respectively in microscopic myringoplasty. Microscopic myringoplasty has greater success rate in larger perforations that is LCP and MCP and equal result in SCP. Advantage of microscope is depth perception and both hands are free for procedure which is limitation of endoscopic myringoplasty (need to use endoscope holder). Advantage of endoscopic permeatal myringoplasty is superior visualization, least tissue trauma and better cosmetic outcome, almost equal graft uptake and hearing outcome with less operative time. Endoscope system is portable, so convenient for surgeon where microscope is not available. Also endoscope is a less costly armamentarium. Our study shows better result in myringoplasty can be achieved if both methods of surgery are used in combination.
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Prevalence of Oral Candidiasis in Indian HIV Sero-Positive Patients with CD4 + Cell Count Correlation
Abstract
The objective of this study was to investigate the prevalence of oral candidiasis in human immunodeficiency virus/acquired immunodeficiency syndrome patients in India. A descriptive cross-sectional study. To compare the occurrence of candidiasis with the levels of CD4+ (cluster of differentiation) cell counts. A total of 100 patients infected with HIV were included. Oral lesions were observed, only patients with oral candidiasis were studied and classified. Standard methods were used for collection of oral specimens, culturing and identifying Candida species. Potential correlations between the presence and severity of oral lesions and CD4+ cells counts were analysed. Candidiasis was detected in 20% of the patients with an mean CD4+ count being 188. All the patients were on highly active antiretroviral therapy except one. There was pseudomembranous candidiasis in 9, erythematous type in 3, angular chelitis in 2, chronic hyperplastic in 4, and median rhomboid glossitis in 2. Candidiasis is an indicator of low CD4+ cell count but may be seen at different levels of the disease. In HIV sero-positive patients it is an indicator of falling CD4+ cell count generally below 200, indicating onset of AIDS. Many a times the patient does not have specific complaints but, it is picked up only on examination. Hence oral cavity examination should be a must in seropositive patients at every clinical follow up.
https://ift.tt/2uY5O60
Glossopharyngeal Nerve Block with Long Acting Local Anaesthetic Agent (Bupivacaine) and It’s Effect on Early Post-operative Period in Adult Tonsillectomy: A Prospective Study
Abstract
We evaluated the benefit of glossopharyngeal nerve block with long acting local anaesthetic like bupivacaine. It was a randomized prospective study. Sixty-four patients were selected and divided into two groups. Group A received bilateral nerve block and Group B received no block. Pain score using Visual Analog Scale (0–100 mm) was assessed at 30 min, 2, 6 and 12 h. In the immediate post operative period pain scores of Group A at rest and swallowing was significantly lower than Group B (p < 0.001 and p < 0.01). Glossopharyngeal nerve block is an important method of reducing post-tonsillectomy pain.
https://ift.tt/2Hg332p
Correlation Between Objective Evaluation Result of Nasal Congestion and Life Quality in Patients with Acute Rhinosinusitis
Abstract
Rhinosinusitis is an inflammatory process involving the nasal mucosa and paranasal sinuses. Rhinitis and sinusitis generally occur simultaneously and thus the current terminology used is rhinosinusitis. The blind nose can negatively affect the overall quality of life including the physical or emotional condition of the sufferer and disruption to work or school (reduced productivity and difficulty in concentrating). To analyse correlation between objective evaluation results of nasal congestion through NIPF and life quality based on sinonasal outcome Test-20 score in patients with acute rhinosinusitis. The study was conducted at Otolaryngology Outpatient Clinic at Dr. Soetomo General Hospital Surabaya. The time of study began in July 2011 until the minimum sample size was met. The sample of the study was patients diagnosed with acute rhinosinusitis treated at Otolaryngology Outpatient Clinic at Dr. Soetomo General Hospital Surabaya and meet the research criteria. Based on statistical analysis with Spearman rank correlation test, correlation between NIPF value and SNOT-20 score on 16 samples got correlation coefficient—0.310 and p = 0.243. The scatter diagram showed the NIPF value variables and the SNOT-20 scores being scattered in uneven spots and erratic patterns. This indicated that an objective evaluation of nasal congestion based on NIPF and subjective assessment of quality of life based on SNOT-20 score was not obtained correlation (p > 0.05). The results of the objective nasal obstruction examination based on Nasal Inspiratory Peak Flow have no correlation with subjective subjective assessment of quality of life based on Sino-Nasal Outcome Test-20 score in patients with acute rhinosinusitis.
https://ift.tt/2uSgRxp
Xanthelasma Palpebrarum: More than Meets the Eye
Abstract
Xanthelasma palpebrarum (XP) is the most common form of cutaneous xanthomata, and is important aesthetically, because of its close relation to the eyes, as well as medically for its association with cardiovascular disease (CVD). To provide avant-garde review discussing the various aspects of XP, including its aetio-pathogenesis and various treatment modalities. A structured Pubmed and Medline were searched for relevant articles. The finding of recent research has strongly espoused the link between XP and CVD, and mechanisms have been suggested for its formation. The new technologies have led to a multitude of treatment options for XP. XP is a multi-faceted entity; other than simple treatment of the cosmetic aspect of the disease, one must be cognizant of its cardiovascular implications.
https://ift.tt/2Es1eMG
Assessment of Histopathological Grade and Ki-67 Expression in Tobacco and Non-tobacco Habitual Buccal Mucosa Cancer
Abstract
Although there are various risk factors in the literature, the established primary risk factor for oral cancer is tobacco and betal-nut chewing habits. It is believed that pathogenesis of oral cancer depends on the aetiology. To assess the histopathological grade and Ki-67 expression in tobacco (smoking/smokeless) and non-tobacco (betal nut/pan masala) habitual buccal mucosa cancer. The cross-sectional study was carried out in Regional cancer centre, Tamilnadu. Proliferative marker, Ki-67 expression was determined by immunohistochemistry using biotin-streptavidin method. The study includes 117 buccal mucosa cancer patients (61 male and 56 female). According to WHO grading system, high frequency observed with well differentiated squamous cell carcinoma 48 (41%) followed by moderate 46 (39.3%) and poorly differentiated 23 (19.7%). The cut-off value 50% was used to categorize Ki-67 expression into low and high labelling index (LI); 96 (82%) buccal mucosa cancer and 4 (3.4%) adjacent normal mucosa patients showed high Ki-67 expression. The present study showed highly significant association of histopathological tumor grade and Ki-67 expression by Chi square and paired t test p < 0.05. All the patients were grouped as tobacco 87 (74.4%) and non-tobacco habitual 30 (25.6%) in 3:1, respectively. Further, the risk habits identified with significant differences of tumor grade (p = 0.028) and Ki-67 at p < 0.05. Thus, the study revealed that the nature of cell differentiation and proliferation was strongly related to consumption of carcinogen in both tobacco and non-tobacco form. Therefore, histopathological grade and Ki-67 could be used as a reliable biomarker to understand the biological behaviour of risk habits which might helpful for further treatment therapeutics.
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Hautkrebsscreening und Behandlungskosten
Zusammenfassung
Hintergrund
Organtransplantierte Patienten unterliegen einem bis zu 250-fach erhöhten Hautkrebsrisiko. Mit der vorliegenden Arbeit wurden die Inanspruchnahme des Hautkrebsscreenings und die Kosten der Hautkrebsbehandlung unter den organtransplantierten Versicherten der AOK Bremen/Bremerhaven ermittelt und der Bedarf an Hautkrebspräventionsschulungen abgeleitet.
Methodik
Es wurden die Anzahl organtransplantierter Menschen (ICD Code Z94.0-4) mit und ohne Hautkrebsanamnese (ICD Code C43/C44), die Inanspruchnahme von dermatologischen Leistungen, die Kosten für Behandlungen mit der Diagnose Z94.0-4 ohne bzw. mit C43/C44-Codierung ausgewertet. Die Analysen wurden für die Jahre 2009 bis 2014 mithilfe der AOK-Abrechnungssysteme durchgeführt.
Ergebnisse
Zwischen 2009 und 2014 wurden 231 organtransplantierte Versicherte erfasst. Bis Mitte 2014 erkrankten 20 % dieser Versicherten an Hautkrebs, die mittlere Inzidenz lag bei 2,76 % pro Jahr. Im Mittel gingen 43 % mindestens 1‑mal pro Jahr zum Hautarzt. Ein Hautkrebsscreening erhielten durchschnittlich nur 15 % pro Jahr. Bei 29 % der organtransplantierten Menschen ohne Hautkrebsanamnese wurde die Haut weder von einem Hautarzt noch im Rahmen eines hausärztlichen Hautkrebsscreenings untersucht. Es wurden 17 stationäre Fälle organtransplantierter Personen mit der Hauptdiagnose C43/C44 ermittelt. Durch diese entstanden Kosten in Höhe von 54.707 € (im Mittel ca. 3200 € pro Fall).
Schlussfolgerungen
Die erhöhte Hautkrebsinzidenz und die damit verbundenen Behandlungskosten weisen auf einen Bedarf an Hautkrebspräventionsschulungen hin.
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Phlebologische Notfälle
Zusammenfassung
Hintergrund
Tiefe und oberflächliche Venenthrombosen sowie Varizenblutungen sind phlebologische Notfälle. Bei Venenthrombosen ist das Risiko für kurz- und langfristige Morbidität und Mortalität erhöht. Die Varizenblutung birgt die Gefahr massiver Blutverluste. Eine rasche und adäquate Therapie dieser Erkrankungen ist daher essenziell.
Ziel der Arbeit
Ziel unserer Arbeit war es, einen Überblick über diese phlebologischen Notfälle zu geben.
Material und Methoden
Basierend auf den aktuellen Leitlinien und ergänzt durch eine themenspezifische Literaturrecherche in PubMed fassen wir die für die klinische Praxis wichtigsten Aspekte zusammen.
Ergebnisse
Bei einer tiefen Venenthrombose sind eine therapeutische Antikoagulation und Kompressionstherapie über mindestens 3 bis 6 Monate indiziert. Eine kürzere Therapiedauer geht mit einer deutlich erhöhten Rezidivrate einher. Bei oberflächlicher Venenthrombose stellen Mobilisation, Kühlung und Kompression sowie bei Schmerzen nichtsteroidale Antiphlogistika die Basistherapie dar. Länge des Thrombus und Abstand des proximalen Thrombusteils zum tiefen Venensystem sowie Vorliegen von Risikofaktoren sind entscheidend für die Indikation zur Antikoagulation und deren Dosierung. Die Varizenblutung ist eine Komplikation der fortgeschrittenen Varikose und kann meist mit einfachen Maßnahmen wie Hochlagerung des Beins und Kompression beherrscht werden.
Fazit
Bei oberflächlicher und tiefer Venenthrombose sind die frühe Diagnostik und Therapie essenziell, um akut Komplikationen wie Lungenembolie und Thrombuswachstum und Spätkomplikationen wie das postthrombotische Syndrom mit sekundärer Varikose und Ulcus cruris zu vermeiden. Zur Rezidivprophylaxe ist bei Varikophlebitis und Varizenblutung im Verlauf eine Sanierung der Varikose indiziert.
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Rhinophym
Zusammenfassung
Das Rhinophym ist eine kosmetisch stark beeinträchtigende Maximalvariante der Rosazea. Es existieren zahlreiche operative Therapieoptionen. Aufgrund der ausgedehnten Wundfläche entstehen Ausfallzeiten und Begleiterscheinungen. Wir schildern kasuistisch die erfolgreiche Volumenreduktion und Entzündungshemmung mittels systemischem niedrig dosiertem Isotretinoin und diskutieren die Vor- und Nachteile der unterschiedlichen Therapieoptionen.
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Informationsangebote für Melanompatienten und ihre Bekanntheit unter Betroffenen
Zusammenfassung
Hintergrund
Für Melanompatienten (MP) in Deutschland sind verschiedene krankheitsspezifische Informations- und Beratungsangebote kommerzieller und nichtkommerzieller Anbieter verfügbar. Jedoch ist wenig darüber bekannt, inwiefern sie von den Betroffenen wahr- und angenommen werden.
Material und Methode
Zwischen Juli und Oktober 2016 wurden an 27 zertifizierten deutschen Hauttumorzentren insgesamt 529 MP mithilfe eines standardisierten Fragenbogens zu Bekanntheit von und Zufriedenheit mit 12 ausgewählten Informations- und Beratungsangeboten (aus dem Print‑, Online- und telefonischen Bereich) befragt. Die Angebote wurden durch renommierte Anbieter aus dem (dermato)onkologischen Fachbereich empfohlen.
Ergebnisse
Unter den abgefragten Angeboten waren den meisten MP die Broschüren der Die Blauen Ratgeber – Hautkrebs (43 %), die Patientenleitlinie Melanom (24 %) sowie die Internetdomain www.hautkrebs-screening.de (23 %) bekannt. Diese wurden auch dem Informationsbedürfnis der Mehrheit ihrer Nutzer (65–80 %) gerecht. Broschüren kommerzieller Anbieter waren 8–16 % der Teilnehmer bekannt und für 42–56 % der Nutzer zufriedenstellend. Mit 14 bzw. 11 % waren der Krebsinformationsdienst oder das INFONETZ Krebs, als hauptsächlich telefonische Beratungsangebote, dem MP weniger geläufig. Die wenigsten MP waren über die Hautkrebs- bzw. Melanombroschüren der Österreichischen Krebshilfe und der Krebsliga Schweiz (je 2 %) im Bilde.
Schlussfolgerung
Die vergleichsweise hohe Bekanntheit und gute Akzeptanz von Broschüren vordergründig nichtkommerzieller Anbietern lassen annehmen, dass diese stärker an MP vermittelt bzw. eher von den Betroffenen angenommen und genutzt werden.
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Arzneimittelassoziierte Angioödeme
Zusammenfassung
Bei Angioödemen können pathophysiologisch histamin- und bradykininmediierte Formen unterschieden werden. Angiotensin-converting-enzyme(ACE)-Hemmer-induzierte Angioödeme sind der Prototyp arzneimittelassoziierter, bradykininmediierter Angioödeme. Als Ursache wird ein verminderter Bradykininabbau durch die Hemmung des ACE angenommen. In diesem Fall kommt anderen Bradykinin degradierenden Enzymen eine größere Bedeutung zu. Wenn auch diese z. B. durch genetische Varianten oder äußere Faktoren in ihrer Wirkung vermindert sind, kann die Hemmung des ACE möglicherweise nicht ausreichend kompensiert werden. Auch für andere Arzneimittel wurde über ein erhöhtes Angioödemrisiko bei alleiniger Anwendung oder insbesondere in Kombination mit ACE-Hemmern berichtet. Ursächlich wurde ebenfalls ein Zusammenhang mit dem Abbau von Bradykinin vermutet. Dabei könnten bei den Angioödemen, die bei gleichzeitiger Anwendung von ACE-Hemmern mit anderen Arzneimitteln auftreten, additive Effekte in Bezug auf den Bradykininabbau eine Rolle spielen.
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Type 3 Thyroplasty for a Patient with Female-to-Male Gender Identity Disorder
Objective. In most cases, about the voice of the patient with female-to-male/gender identity disorder (FTM/GID), hormone therapy makes the voice low-pitched. In success cases, there is no need for phonosurgery. However, hormone therapy is not effective in some cases. We perform type 3 thyroplasty in these cases. Method. Hormone therapy was started in 2008 but did not lower the speaking fundamental frequencies (SFFs). We therefore performed TP3 under local anesthesia. Results. In our case, the SFF at the first visit was 146 Hz. The postoperative SFF was 110 Hz. Conclusions. TP3 was performed under local anesthesia in a patient with FTM/GID in whom hormone therapy proved ineffective. With successful conversion to a lower-pitched voice, the patient could begin to live daily life as a male. QOL improved significantly with TP3. If hormone therapy proves ineffective, TP3 may be selected as an optional treatment and appears to show few surgical complications and was, in this case, a very effective treatment.
https://ift.tt/2ExOuUJ
Maxillary Swing Approach for Removal of Palatal Carcinoma: A Modified Procedure
Introduction. We report a modification of the maxillary swing approach to remove a palatal tumor while preserving the anterior alveolar area. Methods. Case report using clinical records. Results. The patient was a 54-year-old male. TNM grade was T4bN0M0, and invasion to the base of the pterygoid process was seen. Two courses of induction chemotherapy were administered prior to the operation. Because there was no evidence of anterior maxillary invasion, the maxillary swing approach was chosen. The left anterior maxilla was cut and swung laterally, preserving the blood supply. After removal of the palatal tumor, the maxilla was repositioned and the defect was restored with an anterior lateral thigh flap. Postoperative course was typical, and facial appearance, speech, and masticatory function were satisfactory. Conclusions. This technique is particularly useful for preserving appearance as well as speech and mastication.
https://ift.tt/2GCOGUK
Recombinant outer membrane protein 25c from Brucella abortus induces Th1 and Th2 mediated protection against Brucella abortus infection in mouse model
Source:Molecular Immunology, Volume 99
Author(s): Soumya Paul, Bhavani V. Peddayelachagiri, Sowmya Nagaraj, Joseph J. Kingston, Harsh V. Batra
Development of a safe and efficacious vaccine for brucellosis is a long standing challenge for scientists. Recognizing potential antigens towards developing vaccine candidate is crucial. Omp25c, a porin protein of Brucella, is a paralog of two previously identified promising vaccine candidates namely, Omp25 and Omp31, with notable sequence identity. Also, Omp25c is conserved in all major Brucella species. This highlights the possibility of employing this protein in multivalent subunit vaccine based approach of Brucella management. In this study, we were interested in examining the immunogenicity and protective efficacy of Omp25c against Brucella infections. Recombinant unlipidated form of this antigen (rOmp25c) produced, upon intraperitoneal immunization in BALB/c mice along with Freund's adjuvant, was confirmed to be highly immunogenic; leading to high IgG antibody titers during the study duration. The IgG2a/IgG2b ratio of anti-rOmp25c antibodies revealed elicitation of Th2 based humoral immunity. Lymphocyte proliferation study divulged induction of specific memory response and secretion of both Th1-type (IFN-γ, GM-CSF and TNF-α) and Th2-type cytokine (IL-5) from restimulated splenocytes of rOmp25c immunized mice. CD4 T-cell subpopulation was comparatively increased than total B cell subpopulation in case of immunized mice, indicating the induction of strong cell-mediated (Th1 biased) immunity than humoral (Th2) immunity. The collective Th1 plus Th2 immune response specific to rOmp25c could be the reason for protection against Brucella challenge observed in mice groups that was comparable with S19 vaccine strain. Thus, the study encourages rOmp25c as a potent candidate vaccine against brucellosis.
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Editorial Board
Source:Molecular Immunology, Volume 97
https://ift.tt/2JNm2SX
Distinguishing allergens from non-allergenic homologues using Physical–Chemical Property (PCP) motifs
Source:Molecular Immunology, Volume 99
Author(s): Wenzhe Lu, Surendra S. Negi, Catherine H. Schein, Soheila J. Maleki, Barry K. Hurlburt, Werner Braun
Quantitative guidelines to distinguish allergenic proteins from related, but non-allergenic ones are urgently needed for regulatory agencies, biotech companies and physicians. In a previous study, we found that allergenic proteins populate a relatively small number of protein families, as characterized by the Pfam database. However, these families also contain non-allergenic proteins, meaning that allergenic determinants must lie within more discrete regions of the sequence. Thus, new methods are needed to discriminate allergenic proteins within those families. Physical–Chemical Properties (PCP)-motifs specific for allergens within a Pfam class were determined for 17 highly populated protein domains. A novel scoring method based on PCP-motifs that characterize known allergenic proteins within these families was developed, and validated for those domains. The motif scores distinguished sequences of allergens from a large selection of 80,000 randomly selected non-allergenic sequences. The motif scores for the birch pollen allergen (Bet v 1) family, which also contains related fruit and nut allergens, correlated better than global sequence similarities with clinically observed cross-reactivities among those allergens. Further, we demonstrated that the average scores of allergen specific motifs for allergenic profilins are significantly different from the scores of non-allergenic profilins. Several of the selective motifs coincide with experimentally determined IgE epitopes of allergenic profilins. The motifs also discriminated allergenic pectate lyases, including Jun a 1 from mountain cedar pollen, from similar proteins in the human microbiome, which can be assumed to be non-allergens. The latter lacked key motifs characteristic of the known allergens, some of which correlate with known IgE binding sites.
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TEIPP antigens for T-cell based immunotherapy of immune-edited HLA class Ilow cancers
Publication date: Available online 4 April 2018
Source:Molecular Immunology
Author(s): Koen A. Marijt, Elien M. Doorduijn, Thorbald van Hall
T-cell based immunotherapies through checkpoint blockade or adoptive transfer are effective treatments for a wide range of cancers like melanomas and lung carcinomas that harbor a high mutational load. The HLA class I and class II (HLA-I and HLA-II) presented neoantigens arise from genetic mutations in the cancerous cells and are ideal non-self targets for the T cell-based treatments. Although some cancer patients responded with complete regression, many others are irresponsive to checkpoint blockade treatments, or relapse after initial success. One of the mechanisms by which tumors evade T cell recognition is by acquiring deficiencies in the HLA-I antigen-processing pathway, leading to downregulation of HLA-I molecules at the cell surface and thereby creating an 'invisible' tumor phenotype. Interestingly, an alternative antigen repertoire arises on these HLA-Ilow cancer cells. We refer to this alternative antigen repertoire as TEIPP: T cell epitopes associated with impaired peptide processing. TEIPP antigens are curious non-mutated peptides from housekeeping proteins that are not presented in homeostasis. In this review, for the first time we recapitulate all our published work on TEIPP antigens, including our recent understanding of the CD8 T cell repertoire. We are convinced that TEIPP-directed T cells will be valuable resources to target immune-edited tumors that have acquired resistance to checkpoint blockade therapy.
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JH6 downstream intronic sequence is dispensable for RNA polymerase II accumulation and somatic hypermutation of the variable gene in Ramos cells
Source:Molecular Immunology, Volume 97
Author(s): Diana P. Castiblanco, Darrell D. Norton, Robert W. Maul, Patricia J. Gearhart
Activation-induced deaminase (AID) introduces nucleotide substitutions within the variable region of immunoglobulin genes to promote antibody diversity. This activity, which is limited to 1.5 kb downstream of the variable gene promoter, mutates both the coding exon and downstream intronic sequences. We recently reported that RNA polymerase II accumulates in these regions during transcription in mice. This build-up directly correlates with the area that is accessible to AID, and manipulation of RNA polymerase II levels alters the mutation frequency. To address whether the intronic DNA sequence by itself can regulate RNA polymerase II accumulation and promote mutagenesis, we deleted 613 bp of DNA downstream of the JH6 intron in the human Ramos B cell line. The loss of this sequence did not alter polymerase abundance or mutagenesis in the variable gene, suggesting that most of the intronic sequence is dispensable for somatic hypermutation.
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Structural insights into the evolution feature of a bony fish CD8αα homodimer
Source:Molecular Immunology, Volume 97
Author(s): Junya Wang, Nianzhi Zhang, Zhenbao Wang, Wu Yanan, Lijie Zhang, Chun Xia
The CD8αα homodimer structures of endotherms demonstrate that despite distinct diversity at the amino acid sequence level, a few conserved key amino acids ensure common structural features. The structure of CD8αα in ancient ectotherms, such as lower bony fish, remains unclear. In this study, the high-resolution structure of the grass carp (Ctenopharyngodon idella) CD8αα (Ctid-CD8αα) homodimer was determined using the single-wavelength anomalous diffraction (SAD) method. The structure of Ctid-CD8αα shows distinct differences from the known CD8αα structures of endotherms, including a distinct topological structure with shorter back β sheets. The configuration and distribution of the hydrophobic core are different from those in endotherms. Interestingly, mutation of the key amino acid F32S, which is very common in fish and lies in the CDR loop region, leads to the absence of the typical cavity that binds to an epitope-MHC I (p/MHC I) in endotherms, yet Ctid-CD8αα can still specifically bind the grass carp peptide-Ctid-UAA-β2m (p/UAA-β2m). Our results indicate that during the evolutionary process, CD8αα has undergone dramatic changes that affect its dimeric structure and may use a new strategy to interact with p/MHC I.
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Corrigendum to “Rapid induction of expression by LPS is accompanied by favorable chromatin and rapid binding of c-Jun” [Mol. Immunol. 95 (2018) 99–106]
Source:Molecular Immunology, Volume 97
Author(s): Kelly Maurer, Swathi Ramen, Lihua Shi, Li Song, Kathleen E. Sullivan
https://ift.tt/2GXsEQx
Allergen component analysis as a tool in the diagnosis and management of occupational allergy
Source:Molecular Immunology
Author(s): Monika Raulf
We are now in the epoch of "molecular allergology" and numerous clinically relevant allergenic molecules are available improving the performance of in vitro allergen tests and allergen detection methods. This review is focusing on characterized occupational allergens and their implementation into the in vitro diagnosis for occupational allergy and in allergen detection methods.More than 400 occupational agents are identified and documented as being 'respiratory sensitizers', but currently only a limited number of them are characterized on the molecular level and available for routine diagnosis as native or recombinant allergens. One exception, however, is natural rubber latex (NRL) from Hevea brasiliensis still remaining an important occupational allergen source. Characterization of 15 NRL allergens led to the development of assays for the determination of allergen content of NRL materials and the implementation of component-resolved diagnosis (CRD) for specific IgE antibody measurement. Microarray or singleplex using recombinant or native allergens are reliable tools for NRL allergy diagnosis. In addition, NRL allergy is an excellent model for improving extract-based specific IgE measurement by amplification of NRL extract preparation with stable recombinant major allergen rHev b 5. Despite the many efforts to characterize the occupationally relevant wheat allergens for baker's asthma, the most frequently occurring forms of occupational asthma, the results are highly diverse. Wheat sensitization profiles of bakers showed great interindividual variability and no wheat allergen could be classified as the major allergen. For diagnosis of baker's asthma, a whole wheat extract is still the best option for specific IgE determination. But single wheat allergens might help to discriminate between wheat-induced food allergy, grass pollen allergy and baker's asthma. For workplace-related allergens like coffee, wood, soybean, seafood and moulds allergens are characterized and few of them are available, but their relevance for occupational sensitization routes should be verified in the further studies.
https://ift.tt/2qzEFAH
Production of spliced peptides by the proteasome
Source:Molecular Immunology
Author(s): Nathalie Vigneron, Vincent Stroobant, Violette Ferrari, Joanna Abi Habib, Benoit J. Van den Eynde
CD8+ cytolytic T lymphocytes are essential players of anti-tumor immune responses. On tumors, they recognize peptides of about 8-to-10 amino acids that generally result from the degradation of cellular proteins by the proteasome. Until a decade ago, these peptides were thought to solely correspond to linear fragments of proteins that were liberated after the hydrolysis of the peptide bonds located at their extremities. However, several examples of peptides containing two fragments originally distant in the protein sequence challenged this concept and demonstrated that proteasome could also splice peptides together by creating a new peptide bond between two distant fragments. Unexpectedly, peptide splicing emerges as an essential way to increase the peptide repertoire diversity as these spliced peptides were shown to represent up to 25% of the peptides presented on a cell by MHC class I. Here, we review the different steps that led to the discovery of peptide splicing by the proteasome as well as the lightening offered by the recent progresses of mass spectrometry and bioinformatics in the analysis of the spliced peptide repertoire.
https://ift.tt/2GWlyfc
Antigen processing and presentation in HIV infection
Source:Molecular Immunology
Author(s): Julie Boucau, Sylvie Le Gall
The presentation of virus-derived peptides by MHC molecules constitutes the earliest signals for immune recognition by T cells. In HIV infection, immune responses elicited during infection do not enable to clear infection and correlates of immune protection are not well defined. Here we review features of antigen processing and presentation specific to HIV, analyze how HIV has adapted to the antigen processing machinery and discuss how advances in biochemical and computational protein degradation analyses and in immunopeptidome definition may help identify targets for efficient immune clearance and vaccine immunogen design.
https://ift.tt/2qzECVx
Rab22a: A novel regulator of immune functions
Source:Molecular Immunology
Author(s): Luis S. Mayorga, Ignacio Cebrian
Dendritic cells (DCs) trigger CD8 + T cell responses after the internalization of exogenous antigens in a process called cross-presentation. Multiple intracellular transport events within the endocytic and secretory routes take place in order to accomplish this fundamental immunological process. The endomembrane system can be envisioned as a complex network of membrane domains coordinately working in the fusion of organelles, the budding of vesicles and tubules, and modifying the molecular composition of the limiting membranes. In this context of tightly regulated and dynamic endomembrane transport, small GTPases of the Rab family display a pivotal role by organizing membrane microdomains and defining specific identities to the different intracellular compartments. In this review, we synthesize and update the current knowledge about Rab22a, which has been involved in several immune functions. In this way, we analyze the intracellular localization of Rab22a and its important role in the endocytic recycling, including its relevance during MHC-I trafficking, antigen cross-presentation by DCs and the formation of T cell conjugates. We also describe how different pathogenic microorganisms hijack Rab22a functions to achieve efficient infection and intracellular survival strategies. Furthermore, we examine the oncogenic properties of Rab22a and how its expression determines the progression of many tumors. In summary, we highlight the role of Rab22a as a key effector of the intracellular trafficking that could be exploited in future therapies to modulate the immune system.
https://ift.tt/2H0zQf7
Dysfunction of antigen processing and presentation by dendritic cells in cancer
Source:Molecular Immunology
Author(s): Joanna Bandola-Simon, Paul A. Roche
The ability to mount an effective anti-tumor immune response requires coordinate control of CD4 T cell and CD8 T cell function by antigen presenting cells (APCs). Unfortunately, tumors create an immunosuppressive microenvironment that helps protect tumor cells from immune recognition. In many cases this defect can be traced back to a failure of APCs (most importantly dendritic cells (DCs)) to recognize, process, and present tumor antigens to T cells. In this review, we will summarize work addressing the role of different DC subsets in anti-tumor immunity and the various mechanisms used by tumor cells to suppress the ability of APCs to stimulate potent anti-tumor T cell responses.
https://ift.tt/2qzEANp
Role of genetic variations on MHC class I antigen-processing genes in human cancer and viral-mediated diseases
Source:Molecular Immunology
Author(s): Valerio D'Alicandro, Paolo Romania, Ombretta Melaiu, Doriana Fruci
Cytotoxic T lymphocytes constantly monitor peptide-MHC class I complexes on the cell surface to eliminate transformed and virally infected cells expressing peptides derived from abnormal proteins. The generation of antigenic peptides and their loading on MHC class I molecules is a multistep process involving different molecules that constitute the so-called antigen processing and presentation machinery (APM). To avoid immune-mediated elimination, human tumors and pathogens have adopted different strategies including loss of MHC class I expression and dysregulation of APM genes and proteins. Here, we summarize recent knowledge on genetic variations in APM genes and their association with cancer development and viral-mediated diseases.
https://ift.tt/2GXsGI9
WHO/IUIS Allergen Nomenclature: Providing a common language
Source:Molecular Immunology
Author(s): Anna Pomés, Janet M. Davies, Gabriele Gadermaier, Christiane Hilger, Thomas Holzhauser, Jonas Lidholm, Andreas L. Lopata, Geoffrey A. Mueller, Andreas Nandy, Christian Radauer, Sanny K. Chan, Uta Jappe, Jörg Kleine-Tebbe, Wayne R. Thomas, Martin D. Chapman, Marianne van Hage, Ronald van Ree, Stefan Vieths, Monika Raulf, Richard E. Goodman
A systematic nomenclature for allergens originated in the early 1980s, when few protein allergens had been described. A group of scientists led by Dr. David G. Marsh developed a nomenclature based on the Linnaean taxonomy, and further established the World Health Organization/International Union of Immunological Societies (WHO/IUIS) Allergen Nomenclature Sub-Committee in 1986. Its stated aim was to standardize the names given to the antigens (allergens) that caused IgE-mediated allergies in humans. The Sub-Committee first published a revised list of allergen names in 1986, which continued to grow with rare publications until 1994. Between 1994 and 2007 the database was a text table online, then converted to a more readily updated website. The allergen list became the Allergen Nomenclature database (www.allergen.org), which currently includes approximately 880 proteins from a wide variety of sources. The Sub-Committee includes experts on clinical and molecular allergology. They review submissions of allergen candidates, using evidence-based criteria developed by the Sub-Committee. The review process assesses the biochemical analysis and the proof of allergenicity submitted, and aims to assign allergen names prior to publication. The Sub-Committee maintains and revises the database, and addresses continuous challenges as new "omics" technologies provide increasing data about potential new allergens. Most journals publishing information on new allergens require an official allergen name, which involves submission of confidential data to the WHO/IUIS Allergen Nomenclature Sub-Committee, sufficient to demonstrate binding of IgE from allergic subjects to the purified protein.
https://ift.tt/2qzEy8f
What you should not miss from the systematic reviews and meta-analyses on allergen-specific immunotherapy in 2017
Purpose of review Allergen immunotherapy (AIT) is a well recognized and extensively studied therapeutic intervention for some allergic diseases. Every year new systematic reviews and meta-analysis provide the most powerful source of evidence to orient decision making on prevention or efficacy of AIT. We here discuss systematic reviews and meta-analyses on AIT (published January 2017 to February 2018). Recent findings We identified 4 systematic reviews and 10 meta-analyses. Subcutaneous and sublingual AIT (SCIT/SLIT) significantly reduced the development of asthma in children–adolescents with moderate/severe allergic rhinitis, but evidence for a short-term, preventive effect for new allergic sensitizations was nonconclusive. SCIT/SLIT proved to significantly improve symptom and medication scores versus placebo or active comparators in respiratory allergy, with various effect sizes. Oral immunotherapy for IgE-mediated food allergy resulted in substantial benefit in desensitization rates. Data on venom AIT and latex AIT, although limited in quantity and quality, respectively, suggest a large and discrete beneficial effect. Summary Although current evidence extracted from meta-analyses and systematic reviews support AIT as an effective, relatively safe, and well tolerated alternative for some allergic diseases, heterogeneity and some methodological inconsistencies represent matters of concern as they may affect the validity and applicability of their results, especially in the context of individual, real-life settings. Correspondence to Désirée Larenas-Linnemann, MD, Hospital Medica Sur, Torre 2-602, Colonia Toriello-Guerra, Delegación Tlalpan, 14050 Mexico city, Mexico. Tel: +52 1 55 85095950; fax: +52 55 51712248; e-mail: marlar1@prodigy.net.mx Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2Jpvlbr
https://ift.tt/2Jpvlbr
How to actively treat food allergy
Purpose of review In the last years, food allergy treatment is moving away from food avoidance to interventional treatments. We review here the recent developments on immunotherapy with food allergens. Recent findings Oral immunotherapy remains the best studied form of food immunotherapy. In 2017, further evidence has been added to its efficacy. Its mechanisms of action are under scrutiny. To reduce its side effects, studies have been dedicated to the simultaneous use of biologics, in particular omalizumab. Among the other forms of food immunotherapy that are being developed, the epicutaneous application of food allergens is promising. Summary The immunologic trajectories of the development of food tolerance may be intercepted by different forms of food immunotherapy. Research efforts aim to make these therapies feasible at the clinical level. Correspondence to Valentina Pecora, MD, PhD, Allergy Department, Pediatric Hospital Bambino Gesù – Piazza di Sant'Onofrio 4, Vatican City, Rome 00100, Italy. Tel: +39 46 6859 4777; fax: +39 46 6859 2020; e-mail: valentina.pecora@opbg.net Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2EuhLQ4
https://ift.tt/2EuhLQ4
How to cope with food allergy symptoms?
Purpose of review Food allergy symptoms may involve a wide variety of organs (skin, gastrointestinal tract, and eyes) and systems (respiratory, circulatory, and neurological). They are often associated. Their severity ranges from mild to potentially life-threatening reactions and the presentation from acute to chronic. Recent findings Food allergies have been the focus of multiple studies, position papers, and guidelines in recent years. They have defined an approach in classifying symptoms as mild to anaphylactic, distinguishing objective from subjective symptoms, and describing their heterogeneity, specific phenotypes or syndromes (e.g., lipid transfer protein syndrome or pollen food syndrome). Cofactors can also influence food allergy reactions. Symptoms of non-IgE-gastrointestinal food allergies, illustrated by eosinophilic esophagitis and food-protein-induced enterocolitis syndrome, are also now better understood and defined. Improvement in the knowledge of food allergy symptoms is crucial for correct diagnosis and a personalized treatment approach. Summary Through a better description and understanding of symptoms, the diversity of food allergies is now better known. The next step is to harmonize symptom assessment not only for clinicians but also for patients, researchers, and public health stakeholders, to describe food allergy phenotypes and their underlying mechanisms and endotypes, to develop targeted management. Correspondence to Antoine Deschildre, Pneumologie et Allergologie Pédiatriques, Hôpital Jeanne de Flandre, CHRU de Lille, Avenue Avinée, 59037 Lille Cedex, France. Tel: +33 320445072; e-mail: antoine.deschildre@chru-lille.fr Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2Ii5Szh
https://ift.tt/2Ii5Szh
Oral food challenge using different target doses and time intervals between doses
Purpose of review The oral food challenge (OFC) is a specific and vital tool used in clinical practice to identify the level of tolerance a person exhibits toward certain foods while diagnosing food-related allergies. OFC methods differ among countries. The aim of this review is to evaluate different target doses and determine the time interval between doses used for OFC. Recent findings We analyzed recent articles on target doses and time between doses, and noted that some papers reported low target doses and less time between doses. A low-dose OFC appears to be a useful strategy; a time interval of 15 min between doses is short and that of at least 1 h is appropriate. Summary Low-dose OFCs appear to be well tolerated and effective to avoid complete elimination of the consumption of foods causing allergies. For the safety of the OFC method, the time interval between doses should be more than 30 min. Correspondence to Noriyuki Yanagida, Department of Pediatrics, Sagamihara National Hospital, 18-1, Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392, Japan. Tel: +81 42 742 8311; fax: +81 42 742 5314; e-mail: n-yanagida@sagamihara-hosp.gr.jp Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2H2ry2Q
https://ift.tt/2H2ry2Q
A Woman with Black Beads in Her Stomach: Severe Gastric Ulceration Caused by Yttrium-90 Radioembolization
Radioembolization (RE) is a selective internal radiation therapy (SIRT) delivering targeted, high-dose, intra-arterial radiation directly to the vascular supply of liver tumors. Complications can occur due to aberrant deposition or migration of radiation microspheres into nontarget locations, including normal hepatic parenchyma, lungs, pancreas, and upper gastrointestinal (UGI) tract. We report a case of gastric ulcers due to yttrium-90 (90Y) seed migration to the stomach to alert clinicians to this rare cause of gastric injury. A 57-year-old woman with stage IV breast cancer with liver and lung metastases presented to the hospital with 2 months of worsening nausea and vomiting. Two months prior, she had received SIRT with 90Y microspheres without complications. Upper GI endoscopy showed diffuse gastritis and extensive antral ulceration. Biopsies revealed black, spherical foreign bodies, consistent with 90Y microspheres, documenting radiation injury. Radiation-induced UGI ulceration is caused by direct radiation injury from beta-radiation. Delay in diagnosis may be due to the nonspecificity of symptoms and temporal delay of symptom onset from SIRT, which was 2 months in our patient. Also, complaints may be attributed erroneously to adjuvant chemotherapy or widespread metastatic disease. Clinicians must consider radiation-associated toxicity in any SIRT-treated patient developing abdominal symptoms.
https://ift.tt/2EMljxi
How to manage food dependent exercise induced anaphylaxis (FDEIA)
Purpose of review In recent years, the number of reports on food-dependent exercise-induced anaphylaxis (FDEIA) has been increasing. This review aims to describe the standard management of FDEIA including provocation tests and identify the issues that remain unclear. Recent findings Provocation tests with aspirin for FDEIA enable us to confirm the definitive diagnosis and to make differential diagnosis. In some cases, FDEIA symptoms can be induced by aspirin and the causative food without exercise. Exercise may only be an augmenting factor of FDEIA, similar to aspirin or alcohol. Summary The mechanisms of FDEIA development remain unclear. It has been suggested that in FDEIA, exercise lowers the threshold of a food allergy. Further research is needed to elucidate the mechanism of FDEIA and to establish strategies for effective disease management. Correspondence to Tomoyuki Asaumi, Department of Pediatrics, Sagamihara National Hospital, 18-1, Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392, Japan. Tel: +81 42 742 8311; fax: +81 42 742 5314; e-mail: ocean19oranges@yahoo.co.jp Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2JtMMr7
https://ift.tt/2JtMMr7
Programme scientifique du 31e Congrès de l’ADF
Source:Annales de Dermatologie et de Vénéréologie
https://ift.tt/2HC0Ez9
Traitement des toxidermies graves
Publication date: Available online 13 April 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): S. Ingen-Housz-Oro, T.-A. Duong, N. de Prost, A. Colin, L. Fardet, B. Lebrun-Vignes, A. Barbaud, O. Chosidow, P. Wolkenstein
https://ift.tt/2GZj1Nb
Localisation cutanée de la maladie de Rosai Dorfmann
Publication date: Available online 11 April 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): R. Doghri, Y. Houcine, M. Driss, R. Sellami, L. Charfi, K. Mrad
https://ift.tt/2HC11K3
Syndrome d’Iso Kikuchi : onychodystrophie congénitale des index ou syndrome COIF
Publication date: Available online 10 April 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-M. L'Orphelin, C. Picard, J. Andre, B. Richert, A. Dompmartin
https://ift.tt/2GYXCDT
Pelade sous ipilimumab
Publication date: Available online 10 April 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M. Amini-Adle, S. Dalle
https://ift.tt/2HC0CY3
Cutaneous presentation of adult T-cell leukemia/lymphoma (ATLL). Single-center study on 37 patients in metropolitan France between 1996 and 2016
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Hurabielle, M. Battistella, C. Ram-Wolff, C. Fite, V. Meignin, J. Rivet, M.-D. Vignon-Pennamen, T. de Risi-Pugliese, E. Raffoux, B. Arnulf, E. Oksenhendler, F. Sicre de Fontbrune, R. Peffault de Latour, G. Socié, J.-D. Bouaziz, C. Lebbé, A. Bensussan, M. Bagot
IntroductionAdult T-cell leukemia/lymphoma (ATLL) is a hematological malignancy associated with chronic HTLV-1 infection.AimTo describe skin lesions in ATLL.MethodsA descriptive, retrospective study between 1996 and 2016, including all patients diagnosed with ATLL at Saint-Louis Hospital (Paris, France).ResultsThirty-seven ATLL patients were included. Fifteen patients (41%) had a cutaneous localization of the disease, which was present from the beginning of the disease for two thirds of them. ATLL types in patients with cutaneous localization of the disease were as follows: lymphoma, n=5, chronic, n=4, smoldering, n=4, acute, n=2. Half the patients had 2 or more cutaneous manifestations. The cutaneous localizations observed were as follows: nodulotumoral (n=8), plaques (n=7), multipapular (n=6), macular (n=4), purpuric (n=2). Among the 15 patients with cutaneous localization, median overall survival was significantly shorter in the acute and lymphoma types compared to the smoldering and chronic types (8.7 months vs. 79 months, P=0.003).DiscussionATLL is a hematologic malignancy with variable expression that is diagnosed only very rarely in metropolitan France, but that should be sought in patients from countries with high HTLV-1 prevalence in the event of a chronic eruption with patches, papules, plaques and/or tumors. The chronic and smoldering types are relatively indolent, whereas the acute and lymphoma forms have a poor prognosis.
https://ift.tt/2H1EVj9
Éditorial
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J. Vulliet
https://ift.tt/2HC0Azp
Statuts de l’Association des dermatologues francophones (ADF)
Source:Annales de Dermatologie et de Vénéréologie
https://ift.tt/2GY7ON3
Barrière épidermique
Source:Annales de Dermatologie et de Vénéréologie
Author(s): R. Abdayem, M. Haftek
La peau joue le rôle d'interface entre l'organisme et son milieu environnant. L'épiderme, la couche la plus superficielle de la peau, assure essentiellement cette fonction de protection interactive. La barrière épidermique peut être sous-divisée en trois systèmes de défense : la barrière photoprotectrice ; la barrière immunitaire ; la barrière physique et chimique de la couche cornée. Afin de se protéger des rayonnements ultraviolets nocifs, l'épiderme dispose de facteurs d'absorption tels la mélanine, produite par les mélanocytes, et l'acide urocanique – un produit de dégradation de la filaggrine. Le système épidermique de défense immunitaire comprend un versant inné, rapide mais non spécifique, et la réponse adaptative, systémique et spécifique d'antigène, initiée par les cellules de Langerhans. Le produit de la différenciation terminale des kératinocytes épidermiques, le stratum corneum, assure la fonction essentielle de barrière physique et chimique de perméabilité. Cette couche cornée est constituée de cornéocytes, dotés d'enveloppes cornifiées et liés entre eux par des cornéodesmosomes, et de la matrice extracellulaire lipidique organisée en feuillets. La barrière épidermique, en constant renouvellement, se caractérise par une très grande capacité d'adaptation aux conditions changeantes de l'environnement.The skin acts as an interface between the body and its surrounding environment. The epidermis, the surface layer of the skin, is chiefly responsible for this interactive protective function. The epidermal barrier may be subdivided into three defensive systems: the photoprotective barrier, the immune barrier, and the physical and chemical barrier of the stratum corneum or horny layer. To protect against harmful ultraviolet radiation, the epidermis has absorption factors such as melanin, produced by melanocytes, and urocanic acid, which is a degradation product of filaggrin. The epidermal immune defence system comprises an innate component, which is rapid but non-specific, together with adaptive response, which is systemic and antigen-specific, initiated by Langerhans cells. The stratum corneum, derived from terminal differentiation of epidermal keratinocytes, plays a key role as a physical and chemical permeability barrier. This horny layer is made up of corneocytes, covered with horny envelopes and linked to one another by corneodesmosomes and by extracellular matrix sheets. The epidermal barrier, which is constantly being renewed, is characterised by its extremely great capacity of adaptation to changing conditions in the environment.
https://ift.tt/2Hzb7eC
Item 152 – UE 6 Infections cutanéo-muqueuses bactériennes et mycosiques
Source:Annales de Dermatologie et de Vénéréologie
Author(s): CEDEF
https://ift.tt/2GXZrkI
Item 158 – UE 6 Infections sexuellement transmissibles (IST)
Source:Annales de Dermatologie et de Vénéréologie
Author(s): CEDEF
https://ift.tt/2HzZBjf
Item 299 – UE 9 Tumeurs cutanées épithéliales et mélaniques
Source:Annales de Dermatologie et de Vénéréologie
Author(s): CEDEF
https://ift.tt/2H1PVNx
Item 164 – UE 6 Infections à herpès virus du sujet immunocompétent
Source:Annales de Dermatologie et de Vénéréologie
Author(s): CEDEF
https://ift.tt/2HC0wj9
Läsionale Therapieoptionen beim maligen Melanom
Zusammenfassung
Hintergrund
In den letzten Jahren kam es bezüglich der systemischen Therapie des metastasierten malignen Melanoms durch die Einführung der Immuncheckpointinhibitoren und die Möglichkeit der zielgerichteten Therapie mit BRAF- und MEK-Inhibitoren zu einer revolutionären Entwicklung. Problematisch können allerdings die Nebenwirkungen der Therapien sein, und zudem ist man noch weit davon entfernt, allen Patienten ein Benefit mit diesen Therapien zu bescheren. Viele Melanompatienten entwickeln im metastasierten Stadium kutane, subkutane oder Lymphknotenmetastasen, die einer lokalen oder intraläsionalen Therapie zugänglich sind.
Material und Methode
Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zum Thema „Läsionale Therapie beim malignen Melanom".
Ergebnisse und Schlussfolgerung
Auch im Bereich der läsionalen Therapie des metatasierten malignen Melanoms konnten Fortschritte mit neuen Therapiestrategien erreicht werden. Von besonderem Interesse sind hier die oftmals aktuell in klinischen Studien getesteten Kombinationstherapien, die unter Umständen die Möglichkeit der Resistenzüberwindung gegenüber einer Checkpointinhibitor-Monotherapie ermöglichen.
https://ift.tt/2HBHLfU
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