Αρχειοθήκη ιστολογίου

Τετάρτη 25 Απριλίου 2018

A Clinical Study of Effect of Hyperpyrexia on Otoacoustic Emissions in Children

Abstract

Various degrees of sensory neural hearing loss can be seen in the progression of some hereditary periodic fever syndromes. Otoacoustic emission testing can help to establish the inner ear involvement at an early period of a periodic fever with a risk of hearing loss (Abdul Kadir et al. in J Int Adv Otol 9(2.79):08–11, 2014). Sensorineural hearing loss is the common most complication of bacterial meningitis in childhood (Richardson in Pediatrics 102(6):1364–1368, 1998). When present from birth, or acquired in the pre-school years, hearing loss of any degree, even mild hearing loss, interferes with speech and language development. In addition to obvious communication deficits, the consequences of hearing loss in children and adults include psychosocial problems, such as frustration, irritability, anxiety, the tendency to withdraw from social interactions, and even depression (Dhar and Hall in Otoacoustic emissions: principles, procedures, and protocols, Plural Publishing, San Diego, 2011). OAE are acoustic signals emitted from cochlea to the middle ear and into the external ear where they are recorded. Evoked OAE are undetectable when deafness is above 30–35 dB Sound pressure level (Biswas in Clinical audio-vestibulometry for otologists and neurologists, Bhalani Publishing House, Mumbai, 1995). OAEs permit early detection of inner ear abnormalities associated with a wide variety of diseases and disorders, including Alport syndrome etc. With early detection, the serious consequences of hearing loss can sometimes be prevented. With proper identification and diagnosis of hearing impairment, timely and effective management for the same can be taken. Data for this study was collected from children (5–14 years) attending the Department of Otorhinolaryngology and Paediatrics Out-patient departments in P.E.S.I.M.S.R, Kuppam. Among the study population 43 (57.3%) were male and 32 (42.7%) were females showing the slight male preponderance. study was done on children with temperature > 1000 F, children with temperature were screened with OAE, and OAE was recorded in same children once fever has subsided and results were compared. This is a new study where we compared same group of children with fever and once fever has subsided. In most other studies, study group was compared to the healthy control group. In our study, children with fever having abnormal FDP values at f1were 9, they reverted back to base line once fever has subsided. This shows that there is no much damage to inner ear at lower frequencies. Almost 47 abnormal FDP values at f2 reverted back to normal. At higher frequencies (f3 and f4), there is no much change in abnormal FDPs with fever and after fever has subsided, this shows that there is more damage to inner ear at higher frequencies. This study demonstrated that hyperpyrexia causes hearing loss in children with fever probably due to cochlear involvement. We conclude that OAE can be used as a screening tool in detecting hearing loss among children because the technique is simple, reproducible, not expensive, not time consuming also effectively narrows down the children with high chances of hearing loss thereby effectively improves the chances of early diagnosis and hence children can be rehabilitated early, making a marked change in their future.



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Novel compound heterozygous variants in the XPC gene identified in a Chinese xeroderma pigmentosum group C patient with ovarian teratoma

The Journal of Dermatology, EarlyView.


https://ift.tt/2Kgmysv

Sweet's syndrome with laryngoparalysis due to laryngitis

The Journal of Dermatology, EarlyView.


https://ift.tt/2Jrq5D7

Interleukin‐33 is expressed in the lesional epidermis in herpes virus infection but not in verruca vulgaris

The Journal of Dermatology, EarlyView.


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Mild dystrophic epidermolysis bullosa associated with homozygous gene mutation c.6216+5G>T in type VII collagen ultrastructurally suggestive of the decreased number of anchoring fibrils

The Journal of Dermatology, EarlyView.


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Frontal sinus schwannoma

Publication date: Available online 25 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): J. Petersen, L. Gilain, A. Coutu, N. Saroul
IntroductionNasal sinus schwannomas are rare tumors, particularly in the frontal sinus.Case reportThe authors report the case of a woman with left frontal sinus schwannoma discovered in a context of frontal sinusitis with orbital and ocular complications. The surgical procedure consisted of endonasal tumor resection and external drainage.DiscussionThe pathogenesis of frontal sinus schwannomas remains unclear. These tumors can present with a wide range of clinical and radiological signs, making them difficult to diagnosis. Surgical resection of these tumors is also complex.



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A review of the mechanisms of action of dimethylfumarate in the treatment of psoriasis

Experimental Dermatology, EarlyView.


https://ift.tt/2FhqKEY

A Clinical Study of Effect of Hyperpyrexia on Otoacoustic Emissions in Children

Abstract

Various degrees of sensory neural hearing loss can be seen in the progression of some hereditary periodic fever syndromes. Otoacoustic emission testing can help to establish the inner ear involvement at an early period of a periodic fever with a risk of hearing loss (Abdul Kadir et al. in J Int Adv Otol 9(2.79):08–11, 2014). Sensorineural hearing loss is the common most complication of bacterial meningitis in childhood (Richardson in Pediatrics 102(6):1364–1368, 1998). When present from birth, or acquired in the pre-school years, hearing loss of any degree, even mild hearing loss, interferes with speech and language development. In addition to obvious communication deficits, the consequences of hearing loss in children and adults include psychosocial problems, such as frustration, irritability, anxiety, the tendency to withdraw from social interactions, and even depression (Dhar and Hall in Otoacoustic emissions: principles, procedures, and protocols, Plural Publishing, San Diego, 2011). OAE are acoustic signals emitted from cochlea to the middle ear and into the external ear where they are recorded. Evoked OAE are undetectable when deafness is above 30–35 dB Sound pressure level (Biswas in Clinical audio-vestibulometry for otologists and neurologists, Bhalani Publishing House, Mumbai, 1995). OAEs permit early detection of inner ear abnormalities associated with a wide variety of diseases and disorders, including Alport syndrome etc. With early detection, the serious consequences of hearing loss can sometimes be prevented. With proper identification and diagnosis of hearing impairment, timely and effective management for the same can be taken. Data for this study was collected from children (5–14 years) attending the Department of Otorhinolaryngology and Paediatrics Out-patient departments in P.E.S.I.M.S.R, Kuppam. Among the study population 43 (57.3%) were male and 32 (42.7%) were females showing the slight male preponderance. study was done on children with temperature > 1000 F, children with temperature were screened with OAE, and OAE was recorded in same children once fever has subsided and results were compared. This is a new study where we compared same group of children with fever and once fever has subsided. In most other studies, study group was compared to the healthy control group. In our study, children with fever having abnormal FDP values at f1were 9, they reverted back to base line once fever has subsided. This shows that there is no much damage to inner ear at lower frequencies. Almost 47 abnormal FDP values at f2 reverted back to normal. At higher frequencies (f3 and f4), there is no much change in abnormal FDPs with fever and after fever has subsided, this shows that there is more damage to inner ear at higher frequencies. This study demonstrated that hyperpyrexia causes hearing loss in children with fever probably due to cochlear involvement. We conclude that OAE can be used as a screening tool in detecting hearing loss among children because the technique is simple, reproducible, not expensive, not time consuming also effectively narrows down the children with high chances of hearing loss thereby effectively improves the chances of early diagnosis and hence children can be rehabilitated early, making a marked change in their future.



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Unexpected Response Profiles Seen in Hepatitis C Virus-Infected Patients Treated with Sofosbuvir Plus Ribavirin: Five Case Reports

Viral Immunology, Ahead of Print.


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Issue Information

The Journal of Dermatology, Volume 45, Issue 5, Page i, 513-514, May 2018.


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Issue Information

The Journal of Dermatology, Volume 45, Issue 5, Page 630-630, May 2018.


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Simple method for estimating cutaneous neurofibromas in patients with neurofibromatosis 1

The Journal of Dermatology, Volume 45, Issue 5, Page 626-627, May 2018.


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Erythema induratum of Bazin: Epidemiological, clinical and laboratorial profile of 54 patients

The Journal of Dermatology, Volume 45, Issue 5, Page 628-629, May 2018.


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A sustainable model for cochlear implantation in the developing world: perspectives from the Indian subcontinent

Purpose of review The overall prevalence of deafness in India is 0.2%, but the prevalence in the southern state of Tamil Nadu is much higher (around 0.6%) because of consanguinity. Especially in India, establishing cochlear implantation as a treatment modality for hearing loss has been a daunting task, but in the last decade, the cochlear implantation program has emerged as an unqualified success in many states, with over 20 000 cochlear implantations done till date. Several states are sponsoring free implants to children under the age of 6 years and below poverty line. Recent findings Nearly 3000 cochlear implantations have been performed in Tamil Nadu under the Chief Minister's Comprehensive Health Insurance Scheme, with the goal to have a 'deafness free Tamil Nadu' by 2025. This scheme covers nearly 40 million people in rural areas. Valuable lessons have been learnt from this social experiment. One of the cornerstones of this scheme is the method to deliver habilitation via satellite centers in rural areas at the doorstep of the patient. The outcomes in peripheral centers were found to be statistically similar to those in the main center and correlated well with duration of habilitation. Summary Opening up satellite centers for habilitation across the state of Tamil Nadu has greatly helped to improve the attendance and outcomes. The Indian model has been hugely successful and has helped start similar cochlear implantation programs in neighboring countries such as Nepal, Sri Lanka and Bangladesh. Correspondence to Prof. Mohan Kameswaran, Department of Neurotology and Auditory Implants, Madras ENT Research Foundation, No. 1, First Cross Street, Off. Second Main Road, Raja Annamalai Puram, Chennai 600028, Tamil Nadu, India. Tel: +91 44 24311411x412x413x414x415; fax: +91 4424311416; e-mail: merfmk30@yahoo.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A sustainable model for cochlear implantation in the developing world: perspectives from the Indian subcontinent

Purpose of review The overall prevalence of deafness in India is 0.2%, but the prevalence in the southern state of Tamil Nadu is much higher (around 0.6%) because of consanguinity. Especially in India, establishing cochlear implantation as a treatment modality for hearing loss has been a daunting task, but in the last decade, the cochlear implantation program has emerged as an unqualified success in many states, with over 20 000 cochlear implantations done till date. Several states are sponsoring free implants to children under the age of 6 years and below poverty line. Recent findings Nearly 3000 cochlear implantations have been performed in Tamil Nadu under the Chief Minister's Comprehensive Health Insurance Scheme, with the goal to have a 'deafness free Tamil Nadu' by 2025. This scheme covers nearly 40 million people in rural areas. Valuable lessons have been learnt from this social experiment. One of the cornerstones of this scheme is the method to deliver habilitation via satellite centers in rural areas at the doorstep of the patient. The outcomes in peripheral centers were found to be statistically similar to those in the main center and correlated well with duration of habilitation. Summary Opening up satellite centers for habilitation across the state of Tamil Nadu has greatly helped to improve the attendance and outcomes. The Indian model has been hugely successful and has helped start similar cochlear implantation programs in neighboring countries such as Nepal, Sri Lanka and Bangladesh. Correspondence to Prof. Mohan Kameswaran, Department of Neurotology and Auditory Implants, Madras ENT Research Foundation, No. 1, First Cross Street, Off. Second Main Road, Raja Annamalai Puram, Chennai 600028, Tamil Nadu, India. Tel: +91 44 24311411x412x413x414x415; fax: +91 4424311416; e-mail: merfmk30@yahoo.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Intralesional bleomycin injection vs microneedling‐assisted topical bleomycin spraying in treatment of plantar warts

Journal of Cosmetic Dermatology, EarlyView.


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Physical properties of a novel small‐particle hyaluronic acid filler: In vitro, in vivo, and clinical studies

Journal of Cosmetic Dermatology, EarlyView.


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Early intervention in scar management and cutaneous burns with autologous platelet‐rich plasma

Journal of Cosmetic Dermatology, EarlyView.


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Comparative study of the efficacy of Platelet‐rich plasma combined with carboxytherapy vs its use with fractional carbon dioxide laser in atrophic acne scars

Journal of Cosmetic Dermatology, EarlyView.


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Teledermatology and teledermatopathology as educational tools for international dermatology: a virtual grand rounds pilot curriculum

International Journal of Dermatology, EarlyView.


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Diffuse eruptive ulcerated plaques

International Journal of Dermatology, EarlyView.


https://ift.tt/2r14ERN

Comparative study of β‐catenin and CD44 immunoexpression in oral lichen planus and squamous cell carcinoma

International Journal of Dermatology, EarlyView.


https://ift.tt/2HrnwVb

Bullous pemphigoid induced by dipeptidyl peptidase‐4 inhibitors. Eight cases with clinical and immunological characterization

International Journal of Dermatology, EarlyView.


https://ift.tt/2r0FIdo

Brunsting‐Perry pemphigoid: a case with antigen identification

International Journal of Dermatology, EarlyView.


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Atopic labial pigmentation: a new diagnostic feature in Asian patients with atopic dermatitis

International Journal of Dermatology, EarlyView.


https://ift.tt/2r0H8Vj

Rare manifestations of spinal tuberculosis in the Robert J. Terry Anatomical Skeletal Collection (National Museum of Natural History, Smithsonian Institution, Washington, DC, USA)

International Journal of Osteoarchaeology, EarlyView.


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Animal husbandry strategies in Eastern Zhou China: An isotopic study on faunal remains from the Central Plains

International Journal of Osteoarchaeology, EarlyView.


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The fragility of statistically significant findings from randomized trials in head and neck surgery

The Laryngoscope, EarlyView.


https://ift.tt/2r0Fy5F

President's address: Integrity, unity, and our common sense of purpose with the ALA

The Laryngoscope, EarlyView.


https://ift.tt/2Hrw926

Cutaneous Langerhans cell histiocytosis presenting with hypopigmented lesions: Report of two cases and review of literature

Pediatric Dermatology, EarlyView.


https://ift.tt/2I21LYY

Expression of cutaneous immunity markers during infant skin maturation

Pediatric Dermatology, EarlyView.


https://ift.tt/2HsqnZP

Mycophenolate mofetil to treat mid‐dermal elastolysis

Pediatric Dermatology, EarlyView.


https://ift.tt/2HYhmJ5

Utility of routine electrocardiographic screening before initiation of propranolol for infantile hemangiomas

Pediatric Dermatology, EarlyView.


https://ift.tt/2Hs19Lg

Very long‐term Voice Handicap Index Voice Outcomes after Montgomery Thyroplasty: A cross‐sectional study

Clinical Otolaryngology, EarlyView.


https://ift.tt/2HxlUp6

Patient‘s perspective on long‐term complications after superficial parotidectomy for benign lesions: Prospective analysis of a 2‐year follow‐up

Clinical Otolaryngology, EarlyView.


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A “golden age” in skull base and rhinology research

International Forum of Allergy &Rhinology, Volume 8, Issue 5, Page 561-562, May 2018.


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Issue Information

International Forum of Allergy &Rhinology, Volume 8, Issue 5, Page 555-557, May 2018.


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Immunohistochemical analysis of epigenetic factors to differentiate malignant peripheral nerve sheath tumor from benign neurofibroma in a patient with mosaic neurofibromatosis type 1: H3 lysine 27 trimethylation stain and enhancer of zeste homolog 2 stain

The Journal of Dermatology, EarlyView.


https://ift.tt/2r0h5NH

Case of probable spontaneous regression of Merkel cell carcinoma combined with squamous cell carcinoma without surgical intervention

The Journal of Dermatology, EarlyView.


https://ift.tt/2HucvCE

Diagnostic criteria, severity classification and guidelines of systemic sclerosis

The Journal of Dermatology, EarlyView.


https://ift.tt/2r2Aw8H

Diagnostic criteria, severity classification and guidelines of localized scleroderma

The Journal of Dermatology, EarlyView.


https://ift.tt/2HqC1IS

Regulatory T cells in autoimmune skin diseases

Experimental Dermatology, EarlyView.


https://ift.tt/2qYuKEY

Image‐guided chemical and thermal ablations for thyroid disease: Review of efficacy and complications

Head &Neck, EarlyView.


https://ift.tt/2FkgETS

External laryngeal nerve landmarks revisited

Head &Neck, EarlyView.


https://ift.tt/2Kh0tKv

Reirradiation of head and neck cancer using modern highly conformal techniques

Head &Neck, EarlyView.


https://ift.tt/2FhrN7L

Frequencies and malignancy rates of 6‐tiered Bethesda categories of thyroid nodules according to ultrasound assessment and nodule size

Head &Neck, EarlyView.


https://ift.tt/2KdiCJa

Daily allergic multimorbidity in rhinitis using mobile technology: A novel concept of the MASK study

Allergy, EarlyView.


https://ift.tt/2Jti0hx

Dermoscopy and reflectance confocal microscopy for monitoring the treatment of actinic cheilitis with ingenol mebutate gel: Report of three cases

Dermatologic Therapy, EarlyView.


https://ift.tt/2FkfCY0

Unlocking the mystery of persistent skin ulcers in a young man and successful treatment with a simple regimen

Dermatologic Therapy, EarlyView.


https://ift.tt/2KdGvQR

Long‐term remission induced by secukinumab in a 13‐year‐old boy having recalcitrant chronic erythrodermic psoriasis

Dermatologic Therapy, EarlyView.


https://ift.tt/2Fgdhgw

Efficacy of long‐term intralesional triamcinolone in Morbihan's disease and its possible association with mast cell infiltration

Dermatologic Therapy, EarlyView.


https://ift.tt/2KdhncY

Kaposiform haemangioendothelioma: clinical features, complications and risk factors for Kasabach–Merritt phenomenon

British Journal of Dermatology, EarlyView.


https://ift.tt/2Ka6ZTr

Mortality risk after clinical management of recurrent and metastatic adenoid cystic carcinoma

Management of locoregional recurrence (LRR) and distant metastasis (DM) in adenoid cystic carcinoma (ACC) is guided by limited data. We investigated mortality risks in patients diagnosed and treated for recurr...

https://ift.tt/2KgE548

Association between the age of solid food introduction and eczema: A systematic review and a meta‐analysis

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2qYC4Rh

Autoimmune Disease or Drug Hypersensitivity Reaction?

The case of a 51-year-old man with eosinophilic myocarditis was simpler than it seemed.
Medscape Rheumatology

https://ift.tt/2HnlsNY

Pecs II block for intractable postherpetic neuralgia



https://ift.tt/2FelRMF

Temporal Modulation Detection Depends on Sharpness of Spatial Tuning

Abstract

Prior research has shown that in electrical hearing, cochlear implant (CI) users' speech recognition performance is related in part to their ability to detect temporal modulation (i.e., modulation sensitivity). Previous studies have also shown better speech recognition when selectively stimulating sites with good modulation sensitivity rather than all stimulation sites. Site selection based on channel interaction measures, such as those using imaging or psychophysical estimates of spread of neural excitation, has also been shown to improve speech recognition. This led to the question of whether temporal modulation sensitivity and spatial selectivity of neural excitation are two related variables. In the present study, CI users' modulation sensitivity was compared for sites with relatively broad or narrow neural excitation patterns. This was achieved by measuring temporal modulation detection thresholds (MDTs) at stimulation sites that were significantly different in their sharpness of the psychophysical spatial tuning curves (PTCs) and measuring MDTs at the same sites in monopolar (MP) and bipolar (BP) stimulation modes. Nine postlingually deafened subjects implanted with Cochlear Nucleus® device took part in the study. Results showed a significant correlation between the sharpness of PTCs and MDTs, indicating that modulation detection benefits from a more spatially restricted neural activation pattern. There was a significant interaction between stimulation site and mode. That is, using BP stimulation only improved MDTs at stimulation sites with broad PTCs but had no effect or sometimes a detrimental effect on MDTs at stimulation sites with sharp PTCs. This interaction could suggest that a criterion number of nerve fibers is needed to achieve optimal temporal resolution, and, to achieve optimized speech recognition outcomes, individualized selection of site-specific current focusing strategies may be necessary. These results also suggest that the removal of stimulation sites measured with poor MDTs might improve both temporal and spectral resolution.



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Staphylococcus epidermidis meningitis in the absence of a neurosurgical device secondary to catheter-related bloodstream infection: a case report and review of the literature

Staphylococcus epidermidis can cause nosocomial meningitis in the presence of prosthetic devices. We describe a case of Staphylococcus epidermidis meningitis in a patient with neutropenia who had no intracranial ...

https://ift.tt/2HLgnym

Carvedilol for Treatment of Red Vulva Syndrome

This case report describes 2 patients with red vulva syndrome treated with carvedilol.

https://ift.tt/2FfOKIB

Effectiveness of Low Doses of Hyaluronidase to Remove Hyaluronic Acid Filler Nodules

This parallel-group, randomized clinical trial assesses the effectiveness and dose-related effect of small quantities of hyaluronidase vs saline to treat hyaluronic acid filler nodules in healthy women.

https://ift.tt/2KbXMKa

2018 Update of Hyaluronidase Use in Aesthetic Dermatology

Hyaluronidase has become an essential tool in cosmetic dermatology as an eraser of unwanted hyaluronic acid (HA) filler. The purpose of this Editorial is to update the reader on the evidence supporting the use of hyaluronidase in (1) the emergency treatment of vascular occlusion from accidental injection of HA into a blood vessel and (2) the more common case of removing small amounts of HA that are simply unwanted, which is the purpose of the study published by Alam and colleagues in this issue of JAMA Dermatology.

https://ift.tt/2Fjvj1C

Sulfur Ointment Treatment of Cutaneous Myiasis Caused by the Tumbu Fly

This case report describes a patient treated with sulfur ointment for cutaneous myiasis caused by the tumbu fly.

https://ift.tt/2KbiHwS

Framework for Caring for Older Patients With Skin Disease

This Viewpoint describes principles of geriatric science that allow for more appropriate dermatological care for the US population of patients older than 65 years.

https://ift.tt/2JmxP9q

A Man With Infiltrated Plaques on the Pretibial Area

A nondiabetic man in his late 20s presented with mildly itchy, large, ill-defined, erythematous plaques on the pretibial areas of both legs. What is your diagnosis?

https://ift.tt/2KbinOG

Temporal Modulation Detection Depends on Sharpness of Spatial Tuning

Abstract

Prior research has shown that in electrical hearing, cochlear implant (CI) users' speech recognition performance is related in part to their ability to detect temporal modulation (i.e., modulation sensitivity). Previous studies have also shown better speech recognition when selectively stimulating sites with good modulation sensitivity rather than all stimulation sites. Site selection based on channel interaction measures, such as those using imaging or psychophysical estimates of spread of neural excitation, has also been shown to improve speech recognition. This led to the question of whether temporal modulation sensitivity and spatial selectivity of neural excitation are two related variables. In the present study, CI users' modulation sensitivity was compared for sites with relatively broad or narrow neural excitation patterns. This was achieved by measuring temporal modulation detection thresholds (MDTs) at stimulation sites that were significantly different in their sharpness of the psychophysical spatial tuning curves (PTCs) and measuring MDTs at the same sites in monopolar (MP) and bipolar (BP) stimulation modes. Nine postlingually deafened subjects implanted with Cochlear Nucleus® device took part in the study. Results showed a significant correlation between the sharpness of PTCs and MDTs, indicating that modulation detection benefits from a more spatially restricted neural activation pattern. There was a significant interaction between stimulation site and mode. That is, using BP stimulation only improved MDTs at stimulation sites with broad PTCs but had no effect or sometimes a detrimental effect on MDTs at stimulation sites with sharp PTCs. This interaction could suggest that a criterion number of nerve fibers is needed to achieve optimal temporal resolution, and, to achieve optimized speech recognition outcomes, individualized selection of site-specific current focusing strategies may be necessary. These results also suggest that the removal of stimulation sites measured with poor MDTs might improve both temporal and spectral resolution.



https://ift.tt/2FfI11j

Mortality risk after clinical management of recurrent and metastatic adenoid cystic carcinoma

Abstract

Background

Management of locoregional recurrence (LRR) and distant metastasis (DM) in adenoid cystic carcinoma (ACC) is guided by limited data. We investigated mortality risks in patients diagnosed and treated for recurrent ACC.

Methods

A retrospective review of ACC patients treated from 1989 to 2016 identified 36 patients with LRR or DM. High-risk disease was defined as skull base involvement (for LRR) or International Registry of Lung Metastases Group III/IV or extrapulmonary site of metastasis (for DM). Kaplan-Meier method, log-rank tests, and Cox proportional hazards were used for time-to-event analysis.

Results

Among 20 LRR and 16 DM patients, the median times to recurrence were 51 and 50 months, respectively. The median follow-up post-recurrence was 37.5 months (interquartile range (IQR)16.5–56.5). Post-recurrence 3-year overall survival (OS) was 78.5%, 73.3% for LRR and 85.1% for DM (p = 0.62). High-risk recurrences were associated with worse 3-year OS (68.8% for high-risk and 92.3% for low-risk, χ2 = 10.4, p = 0.001).

Among LRR patients, 90% had surgery as part of their treatment. Multimodality therapy, age, and histopathologic features (size, margins, solid histology, lymphovascular or perineural invasion) were not associated with PFS or OS. High-risk LRR was the only variable associated with OS (χ2 = 5.9, p = 0.01).

Among DM patients, six were initially managed with observation and ten received surgery, RT, or systemic therapy. Upfront therapy was not associated with improved PFS or OS. High-risk DM was the only variable associated with OS (χ2 = 4.7, p = 0.03).

Conclusions

High-risk LRR and DM were associated with decreased 3-year OS. More effective therapies are needed for high-risk ACC recurrences.



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Mammakarzinom in der Schwangerschaft

Zusammenfassung

Hintergrund und Ziel der Arbeit

Brustkrebs in der Schwangerschaft ist selten. Die Tendenz ist steigend, was sicher auch dem höheren Alter der Frauen bei Eintreten der Schwangerschaft geschuldet ist. Aufgrund erschwerter und konsekutiv verzögerter Diagnostik zeigen sich vermehrt fortgeschrittene Tumorstadien mit ungünstiger Tumorbiologie, sodass eine multimodale Therapie erforderlich ist. Oft herrscht große Unsicherheit über die bestmögliche Behandlung für Mutter und Kind.

Ergebnisse und Schlussfolgerung

Der folgende Artikel gibt einen Überblick über diagnostische, lokale und systemische Therapieoptionen des schwangerschaftsassoziierten Mammakarzinoms. Insgesamt konnte gezeigt werden, dass nach Abschluss des 1. Trimenons sichere medikamentöse und operative Therapiekonzepte existieren, welche die Prognose der Mutter trotz bestehender Schwangerschaft nicht verschlechtern und die Entwicklung des Feten nicht gefährden. Schwangerschaftsassoziierter Brustkrebs stellt keine zwingende, medizinische Indikation für einen Schwangerschaftsabbruch dar.



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Perioperative considerations for airway management and drug dosing in obese children

Purpose of review Childhood obesity, a phenomenon that is increasing globally, holds substantial relevance for pediatric anesthesia. In particular, understanding the nuances of airway management and drug dosing in obese children can be daunting. Recent findings Respiratory adverse events and challenges in managing the airway may be anticipated. In addition, drug-dosing strategies for the obese child are complex and poorly understood although recent advances have clarified the optimal dosing for anesthetics in these children. Summary Theoretical knowledge, practical skills, meticulous risk stratification and optimal drug regimens are crucial to ensure the safe conduct of anesthesia for obese children. Correspondence to Dr Jerrold Lerman, MD, FRCPC, FANZCA, Department of Anesthesiology, Oishei Children's Outpatient Center, 1001 Main St, Suite K-3502, Buffalo, NY 14203, USA. Tel: +1 716 323 6570; e-mail: Jerrold.lerman@gmail.com Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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What are the risks of breast implant surgery?

As with many medical procedures, breast implant surgery has a range of risks and complications for people to be aware of beforehand. These can include pain, swelling, infection, and visual changes. In this article, we identify the risks of this surgery, along with early signs and symptoms to be aware of afterward.

https://ift.tt/2HPEIDk

Role of MDA5 and interferon-I in dendritic cells for T cell expansion by anti-tumor peptide vaccines in mice

Abstract

Cytotoxic T lymphocytes (CTLs) are effective components of the immune system capable of destroying tumor cells. Generation of CTLs using peptide vaccines is a practical approach to treat cancer. We have previously described a peptide vaccination strategy that generates vast numbers of endogenous tumor-reactive CTLs after two sequential immunizations (prime-boost) using poly-ICLC adjuvant, which stimulates endosomal toll-like receptor 3 (TLR3) and cytoplasmic melanoma differentiation antigen 5 (MDA5). Dendritic cells (DCs) play an important role not only in antigen presentation but are critical in generating costimulatory cytokines that promote CTL expansion. Poly-ICLC was shown to be more effective than poly-IC in generating type-I interferon (IFN-I) in various DC subsets, through its enhanced ability to escape the endosomal compartment and stimulate MDA5. In our system, IFN-I did not directly function as a T cell costimulatory cytokine, but enhanced CTL expansion through the induction of IL15. With palmitoylated peptide vaccines, CD8α+ DCs were essential for peptide crosspresentation. For vaccine boosts, non-professional antigen-presenting cells were able to present minimal epitope peptides, but DCs were still required for CTL expansions through the production of IFN-I mediated by poly-ICLC. Overall, these results clarify the roles of DCs, TLR3, MDA5, IFN-I and IL15 in the generation of vast and effective antitumor CTL responses using peptide and poly-IC vaccines.



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Sinus and Upper Airway Surgery in Children

Abstract

Purpose of Review

Chronic sinus and upper airway disease in children is a common health problem encountered every day. Its pathophysiology is complicated which leads to different treatment options and approaches. We seek to review the current literature and evidence to surgical treatments.

Recent Findings

Medical treatment with antibiotics and topical nasal sprays continues to be the first-line treatment. Surgical interventions include adenoidectomy, balloon catheter sinuplasty (BCS), and endoscopic sinus surgery (ESS). Each modality has proven to be safe; however, its effectiveness is widely variable.

Summary

More research with higher level of evidence is needed to help in choosing the right surgical treatment with optimal benefit.



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Früherkennung von berufsspezifischen Hauterkrankungen bei Kanalarbeitern

Zusammenfassung

Hintergrund

Hautkrankheiten betreffen 30–70 % der Weltbevölkerung mit seit Jahren kontinuierlich steigenden Inzidenzen von Hautkrebs. Zielgerichtete Präventionsstrategien inklusive frühestmöglicher Detektion von Hauterkrankungen sind daher von entscheidender Bedeutung.

Ziel der Arbeit

Es erfolgte die Untersuchung von Kanalarbeitern auf Hautkrankheiten unter Berücksichtigung ihrer berufsspezifischen Anforderungen.

Methodik

Im Rahmen eines Gesundheitstages erhoben 2 Dermatologen bei Beschäftigten der Münchner Stadtentwässerung standardisierte Ganzkörperinspektionen der Haut. Zusätzlich beantworteten alle Teilnehmer einen Fragebogen zum Risiko- und Präventionsverhalten in Bezug auf Hautkrebs und andere Hauterkrankungen.

Ergebnisse

Von 81 Beschäftigten (79 Männer, 2 Frauen, durchschnittliches Alter 45,7 ± 9,5 Jahre) litten 25 Personen (30,9 %) unter behandlungsbedürftigen Dermatosen: Die häufigsten Diagnosen waren Onychomykosen und Tinea pedis (16,1 %). Daneben wurde bei einem Beschäftigten ein Basalzellkarzinom und bei 2 weiteren wurden aktinische Keratosen gefunden; 43,5 % (30 von 81) aller Teilnehmer gaben an, früher bereits ein Hautkrebsscreening in Anspruch genommen zu haben.

Schlussfolgerung

Zur Früherkennung von berufsspezifischen Hautkrankheiten können gerade betrieblich organisierte Screeninguntersuchungen während der Arbeitszeit eine hocheffektive Maßnahme darstellen, da diese dank einer niedrigen Schwelle meist sehr hohe Teilnehmerzahlen erreichen. So legen die Ergebnisse der vorliegenden Studie den Verdacht nahe, dass Kanalarbeiter aufgrund ihrer beruflichen Exposition gehäuft an Fußpilz erkranken.



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Notfälle in der Allergologie

Zusammenfassung

Anaphylaktische Reaktionen sowie Angioödeme im Kopf-Hals-Bereich führen zu vital bedrohlichen Krankheitsbildern und bedürfen einer Notfalltherapie. Eine Anaphylaxie wird symptomorientiert behandelt. Als Erstmaßnahmen sollten eine Unterbrechung der Allergenzufuhr, eine symptombezogene Lagerung des Patienten, das Legen eines großlumigen i. v.-Zuganges und die Hinzuziehung des Notarztes erfolgen. Bei Beteiligung der Atemwege oder des Herz-Kreislauf-Systems ist intramuskuläres und ggf. inhalatives Adrenalin das Notfallmedikament der ersten Wahl. Bei Kreislaufbeteiligung sind eine forcierte Volumengabe und Sauerstoffapplikation und bei bronchialer Obstruktion auch Inhalation eines kurz wirksamen Betamimetikums wichtig. Gleichzeitig sollen supportiv Antihistaminika und Glukokortikoide verabreicht werden. Auch im Fall von lediglich Urtikaria oder Angioödem ohne Atemnot oder allergischer Reaktion mit Erbrechen, Bauchkrämpfen und Diarrhö ist eine i. v.-Therapie mit Antihistaminika und Glukokortikoiden indiziert. Angioödeme im Kopf-Hals-Bereich können mit lebensbedrohlicher Verlegung der oberen Atemwege einhergehen. Im Fall von Histamin-vermittelten Angioödemen erfolgt die Therapie wie bei Anaphylaxie mit Beteiligung der oberen Atemwege. Gibt die Anamnese Hinweise auf ein hereditäres Angioödem, das Bradykinin-vermittelt ist, oder bei unklassifiziertem Angioödem mit Therapieresistenz werden eine frühzeitige Atemwegssicherung und s. c.-Gabe des Bradykininrezeptorantagonisten Icatibant, die i. v.-Gabe von C1-Inhibitor-Konzentrat oder von frischem Gefrierplasma notwendig. Diese Therapie empfehlen wir auch bei einem ACE(„angiotensin converting enzyme")-Hemmer-induzierten schweren Angioödem. Die Indikation zur Intubation bei inspiratorischem Stridor und Ruhedyspnoe ist frühzeitig zu stellen. In allen Fällen von Anaphylaxie oder Angioödemen sollte der Patient bis zur sicheren Remission überwacht werden.



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Kompressionsverbände mit und ohne Unterpolsterung

Zusammenfassung

Hintergrund

Im Rahmen der Kompressionstherapie beugen Polsterbinden Hautschädigungen vor, steigern die Adhärenz und unterstützen den Therapieerfolg. Da vergleichende Studien fehlen, wird ihre routinemäßige Verwendung diskutiert.

Ziel der Arbeit

Diese Studie untersucht Effektivität, Tragekomfort und Auswirkungen von Kompressionsverbänden mit und ohne Unterpolsterung.

Teilnehmer und Methoden

Es erhielten 61 venengesunde Probanden an einem Bein mit Watte- oder Schaumstoffbinden unterpolsterte und am anderen Bein gleichartige, nicht unterpolsterte Kurzzugkompressionsbandagierungen. Beidseits wurde ein Ruhedruck von 50 mm Hg erzeugt. Nach 60 min wurden Ruhedruck, Hautzustand, Tragekomfort, Schmerzen und Sitz der Versorgung beurteilt.

Ergebnisse

Alle Bandagierungen hatten nach 1 h Druckverluste, 82,0 % der nicht unterpolsterten einen Druckabfall von über 9 mm Hg. Sie erzeugten Schnürfurchen (100,0 %), starke Rötungen (77,0 %) und Druckstellen (42,6 %). Den Tragekomfort empfanden 3,3 % als angenehm, bei Schaumstoffunterpolsterung 83,9 % und bei Watteunterpolsterung 73,3 %. Nicht unterpolsterte Kompressionsbandagierungen erzeugten zu 62,3 % Schmerzen von 1–3 (Numerische Rangskala 0–10).

Diskussion

Unterpolsterte Kompressionsbandagierungen halten den therapierelevanten Anlagedruck besser, erhöhen den Tragekomfort und verursachen weniger Schmerzen und Hautprobleme als nicht unterpolsterte Kompressionsbandagierungen. Diese Aspekte sind entscheidend für Adhärenz und Therapieerfolg. Nach einstündiger Anwendung am gesunden Bein zeigten sich signifikante Unterschiede. Bei mehrstündiger Anwendung und vorgeschädigtem Gewebe ist von deutlich mehr Nebenwirkungen auszugehen. Daher sind Kompressionsbandagierungen grundsätzlich zu unterpolstern.



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Fourteen candidate RR Lyrae star streams in the inner Galaxy

Mateu, C; Read, JI; Kawata, D; (2018) Fourteen candidate RR Lyrae star streams in the inner Galaxy. Monthly Notices of the Royal Astronomical Society , 474 (3) pp. 4112-4129. 10.1093/mnras/stx2937 . Green open access

https://ift.tt/2HTYBZI

PAR-Complex and Crumbs Function During Photoreceptor Morphogenesis and Retinal Degeneration

Pichaud, F; (2018) PAR-Complex and Crumbs Function During Photoreceptor Morphogenesis and Retinal Degeneration. Frontiers in Cellular Neuroscience , 12 , Article 90. 10.3389/fncel.2018.00090 . Green open access

https://ift.tt/2vIwIyZ

The Legal Frameworks that Govern Fetal Surgery in the United Kingdom, European Union and the United States

Cao, KX; Booth, A; Ourselin, S; David, AL; Ashcroft, R; (2018) The Legal Frameworks that Govern Fetal Surgery in the United Kingdom, European Union and the United States. Prenatal Diagnosis 10.1002/pd.5267 . (In press).

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Origin of chemically distinct discs in the Auriga cosmological simulations

Grand, RJJ; Bustamante, S; Gomez, FA; Kawata, D; Marinacci, F; Pakmor, R; Rix, H-W; ... Springel, V; + view all Grand, RJJ; Bustamante, S; Gomez, FA; Kawata, D; Marinacci, F; Pakmor, R; Rix, H-W; Simpson, CM; Sparre, M; Springel, V; - view fewer (2018) Origin of chemically distinct discs in the Auriga cosmological simulations. Monthly Notices of the Royal Astronomical Society , 474 (3) pp. 3629-3639. 10.1093/mnras/stx3025 . Green open access

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Tackling delirium: a crucial target for improving clinical outcomes

Asadi, H; Martin, D; McKenna, H; (2018) Tackling delirium: a crucial target for improving clinical outcomes. British Journal of Hospital Medicine , 79 (3) pp. 132-135. 10.12968/hmed.2018.79.3.132 .

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Psychometrics of the Personal Questionnaire: A Client-Generated Outcome Measure

Elliott, R; Wagner, J; Sales, CMD; Rodgers, B; Alves, P; Cafe, MJ; (2016) Psychometrics of the Personal Questionnaire: A Client-Generated Outcome Measure. Psychological Assessment , 28 (3) pp. 263-278. 10.1037/pas0000174 . Green open access

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Logical Representation and Analysis for RC-Arguments

Amgoud, L; Besnard, P; Hunter, A; (2015) Logical Representation and Analysis for RC-Arguments. In: Tsoukalas,, Lefteris and Papadopoulos, George, (eds.) Proceedings of 2015 IEEE 27th International Conference on Tools with Artificial Intelligence (ICTAI). (pp. pp. 104-110). IEEE: Salerno, Italy. Green open access

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The Influence of Built Environment and Perceived Walkability on Walking Behaviour in Taiwan

Liu, C-P; Titheridge, H; (2016) The Influence of Built Environment and Perceived Walkability on Walking Behaviour in Taiwan. In: (Proceedings) 14th World Conference on Transport Research - WCTR 2016 Shanghai. 10-15 July 2016. Green open access

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Phase 1 Dose Escalation Study of CGX1321 in Subjects With Advanced Gastrointestinal Tumors

Conditions:   Colorectal Adenocarcinoma;   Gastric Adenocarcinoma;   Pancreatic Adenocarcinoma;   Bile Duct Carcinoma;   Hepatocellular Carcinoma;   Esophageal Carcinoma;   Gastrointestinal Cancer
Intervention:   Drug: CGX1321
Sponsors:   Curegenix Inc.;   Guangzhou Curegenix Co. Ltd.
Recruiting

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Sinus and Upper Airway Surgery in Children

Abstract

Purpose of Review

Chronic sinus and upper airway disease in children is a common health problem encountered every day. Its pathophysiology is complicated which leads to different treatment options and approaches. We seek to review the current literature and evidence to surgical treatments.

Recent Findings

Medical treatment with antibiotics and topical nasal sprays continues to be the first-line treatment. Surgical interventions include adenoidectomy, balloon catheter sinuplasty (BCS), and endoscopic sinus surgery (ESS). Each modality has proven to be safe; however, its effectiveness is widely variable.

Summary

More research with higher level of evidence is needed to help in choosing the right surgical treatment with optimal benefit.



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Americans’ Bedtime Habits Affirmed in New Study

B11320335FA3F5D940EFC06AF5A0369E.jpg

A new analysis by Johns Hopkins researchers of national data gathered from physical activity monitors concludes that most Americans hit the sack later on Friday, Saturday and Sunday nights. Delayed bedtimes are especially pronounced for teens and young adults.



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Surgical Considerations in Advance Basal Cell Carcinoma, Cutaneous Squamous Cell Carcinoma, and Cutaneous Melanoma: a Head and Neck Perspective

Abstract

Purpose of Review

Skin cancers, including basal cell carcinoma, cutaneous squamous cell carcinoma, and cutaneous melanoma, are the most common cancer worldwide. The treatment of these cancers is primarily surgical, and when treated early and correctly, the prognosis is excellent. In this review, we aim to discuss the appropriate surgical management of skin cancers and associated controversies as it pertains to the head and neck.

Recent Findings

Evidences guiding treatment have expanded enormously over the past decade. Studies have drastically improved our understanding of skin cancer including risk factors for tumor recurrence and metastasis, indicated margin size of surgical excision, the role of sentinel lymph node biopsy, and the management of occult and gross regional neck metastasis.

Summary

Management of skin cancer poses a unique challenge in the head and neck region due to its proximity to anatomic sensitive areas and complex lymphatic drainage. Understanding how to efficiently manage the primary tumor site and the regional lymph nodes is paramount in minimizing locoregional recurrence and improving overall survival.



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Occurrence of ochratoxin A in Astragalus propinquus root and its transfer to decoction

Abstract

The aim of this study was to conduct a survey assessing (a) the ochratoxin A (OTA) content in different samples of Astragalus propinquus root (AR), one of the fundamental herbs in traditional Chinese medicine, and (b) the rate of OTA transfer to AR decoctions that are traditionally used to reduce general weakness and increase overall vitality. A validated method of high-performance liquid chromatography with fluorescence detection (HPLC-FLD) was used to determine OTA concentrations in AR samples and AR decoctions. The limit of quantification was 0.35 ng/g; the recovery of the HPLC method for AR samples was 82%; and the relative standard deviation (SD) of repeatability was 2.6%. All 40 tested AR samples were positive, with a mean value of 451.0 ng/g (range, 28.8–1700.0 ng/g). The transfer rate of OTA to decoctions, from a naturally contaminated and homogenized AR sample (internal reference material) with a concentration of OTA of 288.9 ng/g ± 12.3 (SD), was 83.4% ± 8.5 (SD). We believe it is necessary to continue OTA monitoring in AR and other herbal products, estimate the actual human usual intake, and perform health risk assessment.



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Americans’ Bedtime Habits in New Study

B11320335FA3F5D940EFC06AF5A0369E.jpg

A new analysis by Johns Hopkins researchers of national data gathered from physical activity monitors concludes that most Americans hit the sack later on Friday, Saturday and Sunday nights. Delayed bedtimes are especially pronounced for teens and young adults.



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Device-Related Error in Patient-Controlled Analgesia: Analysis of 82,698 Patients in a Tertiary Hospital

BACKGROUND: Patient-controlled analgesia (PCA) is one of the most popular and effective methods for managing postoperative pain. Various types of continuous infusion pumps are available for the safe and accurate administration of analgesic drugs. Here we report the causes and clinical outcomes of device-related errors in PCA. METHODS: Clinical records from January 1, 2011 to December 31, 2014 were collected by acute pain service team nurses in a 2715-bed tertiary hospital. Devices for all types of PCA, including intravenous PCA, epidural PCA, and nerve block PCA, were included for analysis. The following 4 types of infusion pumps were used during the study period: elastomeric balloon infusers, carbon dioxide-driven infusers, semielectronic disposable pumps, and electronic programmable pumps. We categorized PCA device-related errors based on the error mechanism and clinical features. RESULTS: Among 82,698 surgical patients using PCA, 610 cases (0.74%) were reported as human error, and 155 cases (0.19%) of device-related errors were noted during the 4-year study period. The most common type of device-related error was underflow, which was observed in 47 cases (30.3%). The electronic programmable pump exhibited the high incidence of errors in PCA (70 of 15,052 patients; 0.47%; 95% confidence interval, 0.36–0.59) among the 4 types of devices, and 96 of 152 (63%) patients experienced some type of adverse outcome, ranging from minor symptoms to respiratory arrest. CONCLUSIONS: The incidence of PCA device-related errors was

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Association of Neuraxial Anesthesia With Postoperative Venous Thromboembolism After Noncardiac Surgery: A Propensity-Matched Analysis of ACS-NSQIP Database

BACKGROUND: Neuraxial anesthesia improves components of the Virchow's triad (hypercoagulability, venous stasis, and endothelial injury) which are key pathogenic contributors to venous thrombosis in surgical patients. However, whether neuraxial anesthesia reduces the incidence of venous thromboembolism (VTE) remain unclear. We therefore tested the primary hypothesis that neuraxial anesthesia reduces the incidence of 30-day VTE in adults recovering from orthopedic surgery. Secondarily, we tested the hypotheses that neuraxial anesthesia reduces 30-day readmission, 30-day mortality, and the duration of postoperative hospitalization. METHODS: Inpatient orthopedic surgeries from American College of Surgeons National Surgical Quality Improvement Program database (2011–2015) in adults lasting more than 1 hour with either neuraxial or general anesthesia were included. Groups were matched 1:1 by propensity score matching for appropriate confounders. Logistic regression model was used to assess the effect of neuraxial anesthesia on 30-day VTE, 30-day mortality, and readmission, while Cox proportional hazard regression model was used to assess its effect on length of stay. RESULTS: Neuraxial anesthesia decreased odds of 30-day VTE (odds ratio 0.85, 95% confidence interval, 0.78–0.95; P = .002) corresponding to number-needed-to-treat of 500. Although there was no difference in 30-day mortality, neuraxial anesthesia reduced 30-day readmission (odds ratio 0.90, 98.3% confidence interval, 0.85–0.95; P

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Population Pharmacokinetics of Periarticular Ketorolac in Adult Patients Undergoing Total Hip or Total Knee Replacement Surgery

BACKGROUND: Ketorolac tromethamine has been used for joint infiltration by the orthopedic surgeons as a part of postoperative multimodal analgesia. The objective of this study is to investigate the pharmacokinetic properties of S (−) and R (+) enantiomers of ketorolac in adult patients undergoing total hip (THA) and knee arthroplasty (TKA). METHODS: Adult patients with normal preoperative renal function received a periarticular infiltration of 30 mg of ketorolac tromethamine along with 100 mL of 0.2% ropivacaine and 1 mg of epinephrine at the end of their THA or TKA surgery. Blood samples were taken from a venous cannula at various time points after infiltration. Pharmacokinetic modeling was performed using PMetrics 1.5.0. RESULTS: From 18 participants, 104 samples were analyzed. The peak plasma concentration for S (−) ketorolac was found to be lower than that of R (+) ketorolac, for both THA (0.19–1.22 mg/L vs 0.39–1.63 mg/L, respectively) and TKA (0.28–0.60 mg/L vs 0.48–0.88 mg/L, respectively). The clearance of the S (−) ketorolac enantiomer was higher than R (+) ketorolac (4.50 ± 2.27 vs 1.40 ± 0.694 L/h, respectively). CONCLUSIONS: Our study demonstrates that with periarticular infiltration, S (−) ketorolac was observed to have increased clearance rate and highly variable volume of distribution and lower peak plasma concentration compared to R (+) ketorolac. Accepted for publication February 28, 2018. Funding: This project was supported by research funding from the Department of Anaesthesia and Perfusion Services at the Prince Charles Hospital, Brisbane, Australia. The authors declare no conflicts of interest. Clinical trial number and registry: Australian New Zealand Clinical Trials Registry (ACTRN12613000923763). Reprints will not be available from the authors. Address correspondence to Usha Gurunathan, FANZCA, Department of Anaesthesia & Perfusion Services, The Prince Charles Hospital, Rode Rd, Chermside, QLD 4032, Australia. Address e-mail to usha.gurunathan@health.qld.gov.au. © 2018 International Anesthesia Research Society

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In-Line Filtration Reduces Postoperative Venous Peripheral Phlebitis Associated With Cannulation: A Randomized Clinical Trial

BACKGROUND: Peripheral venous cannulation is an everyday practice of care for patients undergoing anesthesia and surgery. Particles infused with intravenous fluids (eg, plastic/glass/drugs particulate) contribute to the pathogenesis of peripheral phlebitis. The aim of this study is to demonstrate the efficacy of in-line filtration in reducing the incidence of postoperative phlebitis associated with peripheral short-term vascular access. METHODS: In this controlled trial, 268 surgical patients were randomly assigned to in-line filtration and standard care (NCT03193827). The incidence of phlebitis (defined as visual infusion phlebitis [VIP] score, ≥2) within 48 hours was compared between the 2 groups, as well as the onset and severity of phlebitis and the reasons for removal of the cannula. The lifespan of venous cannulae was compared for the in-line filter and no-filter groups through a Kaplan-Meier curve. RESULTS: The incidence of phlebitis within 48 hours postoperatively was 2.2% and 26.9% (difference, 25% [95% confidence interval {CI}, 12%–36%]; odds ratio, 0.05 [0.01–0.15]), respectively, for the in-line filter and no-filter groups (P

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Integrative Pain Management Must Include Diet Considerations

No abstract available

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Essentials of Pain Medicine, 4th ed

No abstract available

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The Incidence of Transfusion-Related Acute Lung Injury at a Large, Urban Tertiary Medical Center: A Decade’s Experience

BACKGROUND: While transfusion-related acute lung injury (TRALI) remains the primary cause of transfusion-related fatalities (37%), recent reports estimate the incidence of TRALI at 0.008% per unit of plasma transfused and 0.004% per all products transfused. Because blood banks have moved toward male-predominant plasma, TRALI appears, anecdotally, to have been reduced to an extremely rare event. The purpose of this study was to estimate the current incidence of TRALI at a large, urban center known for its early and aggressive use of plasma in the setting of trauma, hemorrhagic shock, and massive transfusion. METHODS: The Blood Bank Registry of our hospital was queried for all transfused patients admitted from September 2002 through March 2013. The blood bank collected and investigated all cases of clinical acute lung injury meeting the consensus definition for TRALI, as well as potential cases for which the donor product was recalled for having a high reactivity level of human leukocyte antigen antibodies (ie, the antibodies that could cause TRALI). Clinical reactions were reviewed in conjunction with independent serological testing and classified by transfusion medicine physicians as being "probable TRALI" or of "unrelated etiology." The total number of units transfused at our facility during this time period was also obtained, allowing the incidence of TRALI to be estimated. Cases were analyzed based on demographics, outcome, blood types, observed symptoms and their duration, and type of product transfused. RESULTS: Seven cases were identified at our center for the indicated time period, with only 3 of these occurring in trauma. A total of 714,757 units of blood products were transfused between September 2002 and March 2013. The incidence of TRALI was estimated to be 1 case per 100,000 units of product for the entire study period. A broad range of patients was affected. Consistent with previous descriptions, an acute duration of symptoms (average, 1.4 days) was observed and usually resolved with supportive care. Reactions were observed predominantly in plasma products, both type specific and nontype specific. CONCLUSIONS: This study demonstrates that while TRALI still occurs, clinically meaningful cases are rare. Moreover, TRALI rates remain low despite the increasingly aggressive use of plasma and platelets in the trauma setting. Accepted for publication February 14, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to David E. Meyer, MD, MS, Department of Surgery, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 4.292, Houston, TX 77030. Address e-mail to david.e.meyer@uth.tmc.edu. © 2018 International Anesthesia Research Society

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Data Interpretation in Anesthesia: A Clinical Guide

No abstract available

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Introduction: Autoinflammatory Syndromes Special Issue—hidden mysteries in the corners of autoinflammation

This is the 18th year of ongoing research in 'autoinflammation'. Since the genetic and pathogenic characterization of the first autoinflammatory diseases—familial Mediterranean fever (FMF) and TNF-receptor associated periodic syndrome (TRAPS)—further genetic and clinical discoveries have advanced hand in hand with basic discoveries of innate-immune sensors and pathways that link danger-sensing to the production and release of key pro-inflammatory cytokines (1).

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Effects of kidney transplantation on labour market outcomes in Sweden

Background Kidney transplantation is considered a superior treatment for end stage renal disease compared to dialysis although little is known about the wider effects, especially on labour market outcomes. The objective is to estimate the treatment effect of kidney transplantation compared to dialysis on labour market outcomes, controlling for the nonrandom selection into treatment. Method The average treatment effect is estimated using an inverse-probability weighting regression adjustment approach on all patients in renal replacement therapy 1995-2012. Results Kidney transplantation is associated with a treatment advantage over dialysis on employment, labour force participation, early retirement, and labour income. The probability of being employed 1 year after treatment is 21 (CI 16-25) percentage points higher for transplantation. The positive effect increases to 38 (CI 30-46) percentage points after 5 years, mainly due to worsening outcomes on dialysis. The effect on labour income is mainly mediated through employment probability. The productivity gains of transplantation compared to dialysis amounts to €33 000 over 5 years. Conclusions Transplantation is superior to dialysis in terms of potential to return to work as well as in terms of labour income and risk of early retirement, after controlling for treatment selection. This positive effect increases over time after transplantation. Corresponding author: Johan Jarl, Box 117, 221 00 Lund, Sweden, johan.jarl@med.lu.se Authorship: All authors participated in the design of the study, interpretation of the results and write-up. JJ conducted the analyses and drafted the first version. All authors have approved the final version. Disclosure: The authors declare no conflicts of interest. The results presented in this paper have not been published previously in whole or part. Funding: Financial support from Region Skåne, Sweden (regional public health care provider), and the Government Grant for Clinical Research ("ALF") is greatly acknowledged. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Utilization and Cost Analysis of Lung Transplantation and Survival After 10 years of Adopting the Lung Allocation Score (LAS)

Background Lungs are allocated in the United States using the Lung Allocation Score (LAS). We investigated the effect of LAS trends on lung transplant-related costs, health care utilization, and mortality. Methods Utilization data from Mayo Clinic (FL and MN) from 2005-2015 were obtained from the electronic health records (N=465). Costs were categorized as 1-year post or transplant episode and standardized using 2015 Medicare reimbursement and cost-to-charge ratios. Regression analysis was used to assess the relationship of LAS to length of stay (LOS), mortality, and cost of transplant. Results The mean LAS at transplant increased from 45.7 to 58.3 during the study period, while the 1-year survival improved from 88.1% to 92.5%, (p60) at transplant is associated with increased mortality. Corresponding Author: Cesar Keller, MD, Mayo Clinic Transplant Center, 3600 San Pablo Road, Jacksonville, FL 32224, keller.cesar@mayo.edu ©2018 Mayo Foundation for Medical Education and Research Mayo Clinic does not endorse specific products or services included in this article. Authorship Participated in research design: CAK, TAG, LJW, MER, SLV, JMN Participated in writing of the paper: CAK, TAG, LJW, CCK, RCD, JMN Participated in the performance of the research: CAK, TAG, LJW, SLV, JMN Contributed new reagents or analytic tools: LJW, MER, SLV, JMN Participated in data analysis: CAK, TAG, LJW, SLV, CCK, JMN Conflicts of Interest: The authors declare no conflicts of interest. Funding: This work was supported in part by the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, an unrestricted grant by United Therapeutics and by NHLBI of the NIH under award number K23 HL 128859 (CCK principal investigator). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Descriptor Number: 16.2 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Hearing loss in pediatric temporal bone fractures: Evaluating two radiographic classification systems as prognosticators

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Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): A. Bhindi, L. Carpineta, B. Al Qassabi, S. Waissbluth, R. Ywakim, J.J. Manoukian, L.H.P. Nguyen
IntroductionTemporal bone fractures (TBF) are traditionally classified by their angle of fracture relative to the petrous ridge, and more recently by whether or not they violate the otic-capsule. This study compared rates of hearing loss (HL) and signs of otologic dysfunction among fracture types of both classification systems, within the pediatric population.MethodsPediatric patients were retrospectively characterized from a previously identified cohort of TBF patients, diagnosed from 2000 to 2014. CT scans were reviewed and TBFs were classified first as longitudinal (L), transverse (T) or mixed (M), and then as otic-capsule sparing (OCS) or otic-capsule violating (OCV). Medical records were reviewed, and rates of HL and presenting signs were compared among L, T and M fractures, and OCS and OCV fractures.ResultsForty-three patients with 47 TBFs met the inclusion criteria. Eighteen, 4 and 25 TBFs were classified as L, T and M fractures, respectively. Thirty-three and 9 were classified as OCS, and OCV, respectively. Among 24 cases of HL: 20, 3, and 1 were conductive HL (CHL), sensorineural HL (SNHL) and mixed HL, respectively. Two cases of SNHL were found among OCV fractures, with none in OCS fractures (estimated difference 0.22; 95% confidence interval 0.01–0.60). Similar rates of CHL were found across L, T and M fractures (range 36–50%), and across OCV and OCS fractures (range 42–44%). Hemotympanum was the most common presenting sign, found in 68% of TBFs and 80% of CHL cases. There were no significant differences in the incidence of signs or symptoms between fracture types.ConclusionsIn our cohort, both the traditional and otic-capsule radiographic classification systems failed to predict the incidence of CHL and other otologic signs in the pediatric population. Though OCV fractures conferred an increased risk for developing SNHL, we found a lower incidence than anticipated given violation to the bony labyrinth.



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Modeling congenital nasal pyriform aperture stenosis using computational fluid dynamics

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Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Tirth R. Patel, Chengyu Li, Jillian Krebs, Kai Zhao, Prashant Malhotra
ObjectivesCongenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of airway obstruction in the neonate. Computational airway modeling has not been done in neonates and young infants to understand the impact of stenosis on functional nasal airflow. In this study, we 1) applied computational fluid dynamics (CFD) model to the airway of a neonate with CNPAS and 2) compare airflow dynamics of a normal and CNPAS airway.MethodsThree-dimensional models of the nasal airway of a normal neonate and a neonate with CNPAS were created using computed tomography scans of the facial bones. Measured anatomic parameters included volume, surface area, and cross-sectional area. CFD simulation was then performed. Simulated flow parameters included pressure, average velocity, and resistance.ResultsThe neonate with CNPAS had a lesser volume (2.74 cm3 vs. 4.50 cm3) and surface area (18.8 cm2 vs. 45.5 cm2) than the normal airway. The CNPAS airway had a lesser bilateral cross-sectional area and average cross-sectional velocity throughout the length of the model. While there is a large pressure drop in the normal airway immediately after the entry point, the pressure drop in the CNPAS airway occurs more posteriorly. The total nasal resistance was approximately eight-fold greater in the CNPAS airway than the normal.ConclusionsCFD analysis can be performed on airways of neonates with nasal obstruction, such as in CNPAS. A CFD model may help characterize severity of airway obstruction as it can predict the three-dimensional pattern of airflow. Determining the role of CFD in clinical management of CNPAS requires further investigation.



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Influence of age and gender on reference values for common pediatric sleep questionnaires: Results from a community-based study

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Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Pablo E. Brockmann, Tobias Peters, Christian F. Poets, Barbara Wilhelm, Veronika Weyer-Elberich, Michael S. Urschitz
ObjectivesSleep problems are often assessed using questionnaires, but it is unclear whether the responses given are influenced by age and gender. We addressed this question in several widely used pediatric sleep questionnaires and provide age-dependent percentile curves.MethodsData of a community-based study in schoolchildren were reanalyzed (N = 163, 50% males, age 6–17 years). Children and their parents completed the Sleep-Related Breathing Disorder Scale (SRBDS) of the Pediatric Sleep Questionnaire, the Sleep Disturbance Scale for Children (SDSC), the Sleep Self Report (SSR) of the Children's Sleep Habits Questionnaire in a long and short version, the Epworth Sleepiness Scale in a parent- (ESSp) and self-report version for children (ESSc), and the Pediatric Daytime Sleepiness Scale (PDSS). Linear and quantile regression analysis was used to i) assess the influence of age and gender on scores of questionnaire scales/subscales, ii) to calculate age- and gender-appropriate reference values and iii) to provide age-depending percentile curves.ResultsOnly the PDSS showed relevant gender differences (β [95th confidence interval] = 0.155 [0.000; 0.270], p-value = 0.04, reference category: male), while the following subscales were all age dependent: SRBDS-somnolence and behavioral subscales, SDSC-somnolence subscale, SSR-long and short version; ESSp and ESSc, as well as the PDSS.ConclusionsAge and gender should be taken into account for research purposes and individual patient assessments regarding sleep problems. Preliminary age- and gender-appropriate reference values and percentile curves are now available and may be used by researchers and clinicians.



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Familial lower lip facial paralysis with asymmetric smile: Selective neurectomy of the cervical branch

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Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Tristan Klosterman, Sedat Ulkatan, Thomas Romo, O. Teresa




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Pediatric lateral neck infections – Computed tomography vs ultrasound on initial evaluation

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Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Nicholas A. Quinn, Jared A. Olson, Jeremy D. Meier, Hank Baskin, Jeff E. Schunk, Emily A. Thorell, Laura N. Hodo
ObjectiveReview the evaluation of children with a deep lateral neck infection and define the impact of initial imaging modality on outcomes and costs.MethodCase series, pediatric patients <18 years of age admitted to a tertiary care hospital with lateral neck infection between 01/01/14-05/31/16 as identified by ICD-9 and ICD-10 codes: 289.3 (lymphadenitis, unspecified), 682.1 (cellulitis and abscess of neck), 683 (acute lymphadenitis), I88.9 (nonspecific lymphadenitis, unspecified), L02.11 (cutaneous abscess of neck), L03.221 (cellulitis of neck), and L03.222 (acute lymphangitis of neck). Patients were divided into two groups based on initial imaging modality: primary ultrasound or primary computed tomography. Differences in length of stay, type and total number of imaging studies obtained, number of procedures, hospital readmission, and hospital cost were compared between cohorts.ResultsThere were 40 (31%) primary ultrasound and 88 (69%) primary computed tomography patients (128 total). Median length of stay was 46 (IQR: 25,90) hours (1.9 days) for primary ultrasound and 63 (IQR: 39,88) hours (2.6 days) for primary computed tomography patients (p = 0.33). Drainage was performed in 48% of both groups. Additional imaging occurred in 17 (43%) primary ultrasound and 18 (20%) primary computed tomography patients (p = 0.02). Readmission occurred in 8 patients (6.3%). Retropharyngeal infection was encountered in 13 patients (10%); this was only discovered in patients who had a computed tomography performed. Median cost per primary ultrasound patients was $5363 (IQR: 3011, 7920) and $5992 (IQR: 3450, 8060) for primary computed tomography patients.ConclusionsThe primary imaging modality (ultrasound or computed tomography) used to work-up children with a lateral neck infection did not impact length of stay or hospital cost. However, a significant subset had a coexisting retropharyngeal infection that was only identified on computed tomography. Future studies are needed to identify appropriate criteria for imaging in the work-up of lateral neck infections.



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External auditory canal: Inferior, posterior-inferior, and anterior canal wall overhangs

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Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Kavita Dedhia, Robert F. Yellon, Barton F. Branstetter, Mark Best
ObjectivesTo characterize anatomic variants of the external ear canal (EAC), specifically canal wall overhangs. EAC overhangs are problematic since they obstruct the view of the tympanic membrane (TM) and middle ear, possibly creating diagnostic and surgical difficulties.MethodsWe reviewed pre-operative temporal bone CTs from children with cholesteatoma, and no history of EAC erosion or surgery. We measured the anterior canal wall overhang (ACOH), inferior (ICOH), and posterior-inferior (PICOH). A smaller angle means more EAC overhang. Angles >180° counted as 180° since they are non-obstructing. Analysis was performed between angular measurements and clinical and demographic data.Results86 patients (88 ears total) were studied. Mean age was 8.3 years. Only obstructing angles were analyzed statistically (<180°). The ICOH was most severe and occurred in 72/88 (81.8%) ears with a mean of 145.9 ± 12.8SD° (range 102–171°). ACOH occurred in 60/88 (68.2%) ears with a mean of 148.3 ± 10.9SD° (range 120–169°). PICOH occurred in 59/88 (67%) ears with a mean of 150.4 ± 9.2SD° (range 124–169°). Overall, ICOH was significantly more severe than PICOH (P = 0.026). ICOH had more Severe (142-102°) overhangs (27/88, 30.7%) than ACOH (17/88, 19.3%) or PICOH (11/88, 12.5%), but these were not significantly different. Analysis of clinical data showed that as the ICOH overhang became more severe, there was a history of significantly more (p = 0.039, r = −0.209) tympanostomy tubes placed.ConclusionsThe greatest prevalence and severity of EAC overhang was the ICOH with a mean angle of 145.9°, compared with 148.3° and 150.4° for the ACOH and PICOH, respectively. This anatomic study demonstrates that ICOH and PICOH are prevalent anatomic variants and may possibly cause similar difficulties in otoscopic diagnosis and surgical TM and middle ear exposure as the well-known ACOH.



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The linguistic aspects of the speech of Jordanian children who stutter

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Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Mazin Alqhazo, Sawsan Al-Dennawi
BackgroundThe influence of linguistic variables on moments of stuttering has been a popular area of research for several years. The purpose of this study is to assess the linguistic factors of the speech of children who stutter.MethodsForty-one children who stutter (31 males, 10 females) were selected from 14 schools with age range of 6–13 years. Phonological and morphological variables were measured using spontaneous speech task, whereas syntactic variables were measured using sentence completion task.ResultsResults indicated significantly that (a) inflected words (M = 50, SD = 30) are more likely to be stuttered than non-inflected words (M = 32, SD = 18) [P = 0.000], (b) stuttering occurs more on initial position of the word than medial or final position [P = 0.000], (c) higher rate of stuttering is associated with increasing length of the word [P = 0.000], (d) long sentences are more likely to be stuttered than short sentences [P = 0.000], (e) the loci of stuttering is higher in stressed syllables (M = 34, SD = 30) than unstressed syllables (M = 24, SD = 20) [p = 0.002], (f) the occurrence of stuttering is more on consonant sounds (M = 36, SD = 18) than vowel sounds (M = 25, SD = 28) [P = 0.009].ConclusionsThese results support the relationship between the linguistic factors and the frequency of stuttering which could be taken into consideration in the development of treatment protocols for children who stutter.



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Laryngeal cleft type IV: One pathology, two different presentations

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Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Gabriel Hernández, Francis D. Beauchamp-Pérez, Carlos González-Aquino
Laryngotracheoesophageal cleft is a rare congenital malformation where a communication exists between the aero-digestive tracts that is associated with high morbidity and mortality. In this case series, we describe our experience with two neonates evaluated in our institution with two diverse initial presentations and symptomatology of type IV laryngotracheoesophageal clefts. One patient presented with acute distress and respiratory failure due to bowel contents obstructing the trachea and the other presented with mild subcostal retractions and inspiratory stridor without overt respiratory failure. Most importantly, not every patient with type IV laryngotracheoesophageal clefts will present with fulminant respiratory difficulty. This prompted a literature review.



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Novel endoscopic suturing technique to mitigate risk of graft extrusion in endoscopic posterior cricoid split and costal cartilage grafting: A case report

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Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Janki Shah, Peter Ciolek, Brandon Hopkins




https://ift.tt/2HMGW6s

Sialoblastoma in chin and management of treatment

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Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Qian Wang, Sainan Ma, Huanhuan Chen, Mingli Yang, Weisong Cai
ObjectiveSialoblastoma is a rare salivary gland tumor mainly located in parotid. In this article, we aimed to review the clinical manifestations and treatments of sialoblastoma, especially to provide effective chemotherapy regimens to instruct internal medicine therapy for unresectable or recurrent tumors.MethodWe reported a 1-year old girl who presented a left-sided firm facial mass and subsequently diagnosed as sialoblastoma. Afterwards, we reviewed and analyzed relevant literatures.ResultsSixty-four cases of pediatric sialoblastoma were reviewed. Of them, surgical excision was the basic treatment, 17 cases received chemotherapy, and 15 cases got good response. Lung metastasis was reported in six patients, all of whom had good response to chemotherapy.ConclusionChemotherapy may play an important role in residual, extensive, metastatic and relapsed cases. In addition, lung metastasis was unlikely to exert a significant effect on prognosis.



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Recurrence of a totally occluded aneurysm after treatment with a pipeline embolization device

Treatment with a pipeline embolization device (PED) is widely accepted as an excellent option for patients harboring giant, wide neck, saccular intracranial aneurysms. It has been shown to be safe and very effective. We describe a previously unreported case of a large middle cerebral artery aneurysm, related to the carotid tip, that was treated with a PED and coils. The 6 month follow-up angiogram demonstrated complete occlusion of the aneurysm. However, the 9 month angiogram revealed recurrent filling of the aneurysm sac. To our knowledge, this is the first report to describe recanalization of an aneurysm totally occluded on the control angiography after treatment with a PED. Unanswered questions include the mechanism of recanalization and the need for additional control angiograms and MRI following a previous examination revealing total aneurysm occlusion.



https://ift.tt/2r0a5QW

Previously misdiagnosed linear IgA dermatosis resolved with dapsone

This is the case of a 25-year-old African American woman with a 3-week history of itching with burning, blistering lesions on her torso and extremities. Medical history was unremarkable. Medical treatments included three visits to urgent care, where she was treated with antivirals, oral and topical steroids, antibiotics and antifungals unsuccessfully. We performed a skin biopsy, and immunoflorescent studies revealed a linear deposition of IgA antigen at the basement membrane. The clinical diagnosis of linear IgA dermatosis (LAD) was established, with no eliciting cause, other than potential occupational exposure to Chlamydophila psittaci via her employment in a pet store. This is the first case to our knowledge to report such an association. However, confirmation of the exposure would only establish correlation, not causality. Resolution of symptoms and blisters was achieved with dapsone treatment. Accordingly, we highlight the crucial importance of reviewing exposures, along with the potential aetiology of LAD.



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Not quite Potts puffy tumour

Pott's puffy tumour (PPT) is characterised by a subperiosteal abscess associated with osteomyelitis of the frontal bone—a rare complication of frontal sinusitis, more common in the paediatric population. We describe a case mimicking PPT, where abscess extension was facilitated by previous surgery. Usually patients with PPT would be systemically unwell, but our patient, a 63-year-old Caucasian man, was systemically well with a large swelling of his forehead. A CT was performed to evaluate possible intracranial and intracerebral complications such as epidural, subdural and brain abscesses. Emergent surgical drainage was performed with prolonged administration of antibiotic therapy. 12 weeks later, he had recollection in the frontal sinus requiring incision and drainage. 6 weeks afterwards, he underwent planned Lothrop procedure and endoscopic sinus surgery. Although clinically the patient presented with overwhelming features of PPT, we emphasise that PPT involves osteomyelitis of frontal bone, which is absent in our case.



https://ift.tt/2qXQVve

Epilepsy under my skin?

A 44-year-old male patient was admitted to the hospital for observation after an unwitnessed syncope. Physical examination revealed skin purpura and bilateral tongue haematoma. Laboratory studies were unremarkable. Radiological imaging showed no abnormalities of the vasculature, signs of thrombosis or brain anomalies. Biopsy of a purpuric lesion revealed extravasation of erythrocytes. After excluding several causes of both syncope and purpura, the typical location of these thoracocervicofacial purpura, the tongue haematoma and an elevated prolactin level (which came back later) led to the diagnosis of an epileptic seizure. The patient was referred to the neurology department for follow-up. Within 3 weeks, the purpura were completely resolved, and the patient remained free of seizures during follow-up. In case of an unwitnessed syncope, an epileptic seizure should be carefully considered and thoracocervicofacial purpura can be the pivotal manifestation leading to this diagnosis.



https://ift.tt/2Hqtju3

Unusual case of simple urinary bladder melanosis with complete resolution

A 66-year-old man presented with a long history of recurrent attacks of urinary retention and lower urinary tract symptoms. Flexible cystoscopy showed a urethral stricture. Follow-up cystoscopy 7 years later for recurrent symptoms demonstrated unusual extensive mucosal brown to black pigmentation, which proved histopathologically to be a simple bladder melanosis. Follow-up demonstrated complete resolution over a period of 1 year with no specific treatment. In this report, we highlighted a rare bladder abnormality with uncertain natural history.



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Unique case of non-neutropaenic typhlitis in an immunosuppressed liver transplant patient

Description 

Typhlitis (also known as typhlenteritis or neutropaenic enterocolitis) is a recognised complication of immunosuppression following solid organ transplantation with tacrolimus increasingly thought to be a significant risk factor.1 It is characterised by transmural inflammation of the caecum and terminal ileum and is classically described as a triad of abdominal pain, fever and neutropaenia.2 The causative organism is often a Gram-positive enterococcus3 and typically affects immunosuppressed patients such as those undergoing neoplastic chemotherapy for haematological malignancies, postorgan transplantation or in patients with acute leukaemia or AIDS.

We describe the case of a 63-year-old woman presenting to the emergency department following two episodes of collapse, peritonitis, septic shock with acute renal failure and an elevated lactate of 10. Examination revealed generalised abdominal tenderness with peritonism. Her complete blood count was as follows: White blood count (WBC) 27.1, Red cell count 3.79, Haemoglobin 113, Haematocrit 0.345,...



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Burkholderia cepacia: a rare cause of bacterial keratitis

We describe the first clinical case of Burkholderia cepacia keratitis registered in Southeast Asia. A man in his mid-70s with underlying poorly controlled diabetes mellitus came with complaints of painful red left eye for 4 days. This was accompanied with photophobia and blurring of vision after being injured by a wooden particle while cutting grass. Slit-lamp examination showed a paracentral anterior corneal stromal infiltrates with overlying epithelial defect. Culture of the corneal smear isolated B. cepacia that was sensitive to ceftazidime, meropenem and bactrim (trimethorprim and sulfomethoxazole). Topical ceftazidime was given intensively to the patient and the infection resolved after 6 weeks of treatment.



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Aspiration of a small bowel video capsule: a rare complication

Description 

Video capsule endoscopy (VCE) is a non-invasive tool for the direct visualisation of the small bowel mucosa with a reported complication rate of 1%–3%.1 2 Capsule retention is the most common complication, accounting for 1.5%–2%.1

We present the case of a 72-year-old man with a medical history of inflammatory bowel disease, previous small bowel perforation and ileostomy, undergoing investigation for a high output stoma. Comorbidities included type 2 diabetes.

He had no history of dysphagia and reported no swallowing problems.

The patient underwent VCE after passing a patency capsule of identical dimensions, which exited the stoma 13 hours after ingestion. Following ingestion of the capsule (PillCam SB2, Given Imaging, Yokneam, Israel), the images received on the real-time viewer suggested initial location of the capsule in the oropharynx (see figure 1). Reinspection after 30 min suggested persistent pharyngeal retention. The capsule was located...



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Management of complete tracheal rings in a neonate with tetralogy of Fallot

Description 

A 3-day-old full-term female infant was postnatally diagnosed with tetralogy of Fallot with severe subpulmonary and pulmonary valve obstruction, ventricular septal defect with right to left shunt and patent ductus arteriosus (PDA). She was stable on room air with an intravenous prostaglandin infusion while awaiting surgical repair. On day 3 of life, she was found unresponsive with significant desaturation to 30%. Following successful bag-mask ventilation and recovery of her saturation, multiple attempts to intubate the patient yielded a grade I view (figure 1). However, 3.0, 2.5 or 2.0 endotracheal tubes were unable to be passed due to an obstruction immediately distal to the vocal cords (figure 2). Mask ventilation was maintained without difficulty between each attempt. Transthoracic echocardiogram was performed at bedside in order to confirm adequate pulmonary blood flow through the PDA. The patient was transported to the operating room with mask ventilation...



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Hypomorphic citrullinaemia due to mutated ASS1 with episodic ataxia

Children with citrullinaemia commonly present in the neonatal period with life-threatening hyperammonaemia and progressive encephalopathy. Less often, 'hypomorphic' or mild late-onset childhood or adult-onset forms may be seen with intermittent neurological symptoms or acute crisis in pregnancy. We describe an 11-year-old boy with late-onset citrullinaemia manifesting as brief episodes of ataxia triggered by minor febrile illnesses, significant citrullinaemia, mild hyperammonaemia, normal neurological examination and mild cerebellar atrophy. Targeted gene sequencing showed a homozygous, missense mutation c.815G>A (p.R272H) in exon 12 of ASS1 gene resulting in the amino acid substitution of histidine for arginine at codon 272. Our case highlights the importance of recognising urea cycle defects as a cause of intermittent neurological symptoms such as ataxia. Type-1 citrullinaemia may remain hypomorphic and needs a high index of suspicion.



https://ift.tt/2HooKjT

Méningiomes et acétate de cyprotérone : mise au point

Publication date: Available online 25 April 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-L. Schmutz




https://ift.tt/2HY0jHa

Hydratation cutanée et produits hydratants

Publication date: Available online 25 April 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): H. Duplan, T. Nocera
Une des fonctions majeures de la peau est de fournir à l'organisme une protection vis-à-vis de son environnement en maintenant une barrière épidermique efficace, non seulement vis-à-vis de l'extérieur, mais aussi vis-à-vis de la perte en eau corporelle. En effet, l'homéostasie hydrique est une condition requise pour un fonctionnement physiologique normal de la peau. Le taux d'hydratation influence non seulement les paramètres macroscopiques apparents, tels que souplesse et douceur cutanée, mais aussi des paramètres moléculaires, les activités enzymatiques et la signalisation cellulaire au sein de l'épiderme. Une part de l'eau corporelle est continuellement perdue, mais ce phénomène ainsi que le maintien d'un gradient hydrique optimal dans la peau est garanti par un ensemble de régulations fines, s'appuyant sur les propriétés fonctionnelles et dynamiques de la couche la plus superficielle de la peau constituée par le stratum corneum. Cet article rassemble les données récemment acquises dans le domaine de l'hydratation cutanée et de la caractérisation de la peau déshydratée ou sèche, que ce soit dans la compréhension des phénomènes de régulation mis en jeu ou dans l'évolution des principales techniques de mesure in situ, et par conséquent dans l'optimisation de la prise en charge.One of the skin's principal functions is to protect the body against its environment by maintaining an effective epidermal barrier, not only against external factors, but also to prevent water loss from the body. Indeed, water homeostasis is vital for the normal physiological functioning of skin. Hydration levels affect not only visible microscopic parameters such as the suppleness and softness of skin, but also molecular parameters, enzyme activities and cellular signalling within the epidermis. The body is continually losing some of its water, but this phenomenon is limited and the optimal hydration gradient in skin is ensured via a set of sophisticated regulatory processes that rely on the functional and dynamic properties of the uppermost level of the skin consisting of the stratum corneum. The present article brings together data recently acquired in the fields of skin hydration and the characterisation of dehydrated or dry skin, whether through study of the regulatory processes involved or as a result of changes in the techniques used for in situ measurement, and thus in optimisation of management.



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Angiosarcomes cutanés de la tête et du cou inopérables traités par bevacizumab et paclitaxel

Publication date: Available online 24 April 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): O. Becquart, C. Girard, C. Lesage, B. Guillot




https://ift.tt/2HXsqq1

Traitements des patients atteints de mélanome de stade III inopérable ou de stade IV. Société française de dermatologie

Publication date: Available online 25 April 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): B. Guillot, J. Charles, G. Jeudy, D. Cupissol, A. Dupuy, C. Dutriaux, D. Gangloff, N. Magne, X. Mirabel, A. M'Sadek, M. Pracht, C. Sichel, G. Do Outeiro




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Incidence and Risk Factors for Intraoperative Seizures During Elective Craniotomy

Background: Perioperative seizures may affect 1% to 50% of patients undergoing craniotomy and adversely impact outcomes. However, data on intraoperative seizures are limited. This retrospective case-control study investigated the incidence and risk factors for intraoperative seizures during elective supratentorial craniotomy involving evoked potential monitoring. Materials and Methods: Patients aged 18 years or above undergoing elective supratentorial craniotomy with evoked potential monitoring who experienced intraoperative seizures at our institution between December 2008 and March 2014 were compared with a control group generated using a random number generator. Six controls were used for each case from among the patients who underwent elective supratentorial craniotomy during the same calendar year. Multivariate analysis was conducted using logistic regression to identify the risk factors for intraoperative seizures. Results: Among the 1916 patients who met the inclusion criteria, 45 (2.3%) had intraoperative seizures. The majority of seizures occurred during burr-hole placement or craniotomy, before lesion manipulation. Timing of seizures relative to motor evoked potential runs and stimulus intensity was variable. Significant risk factors for intraoperative seizures were seizure history (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.07-4.46; P=0.03), diagnosis of brain tumor (OR, 2.41; 95% CI, 1.16-4.19; P=0.02), and temporal craniotomy (OR, 5.18; 95% CI, 2.03-13.25; P=0.001). Intraoperative prophylactic use of phenytoin/fosphenytoin and levetiracetam was protective against seizure (phenytoin/fosphenytoin: OR, 0.12; 95% CI, 0.04-0.35; P

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The Gender of Debt and Space: notes from Ramallah-Al Bireh, Palestine

Harker, CG; Shebeitah, R; Sayyad, D; (2018) The Gender of Debt and Space: notes from Ramallah-Al Bireh, Palestine. Geoforum (In press).

https://ift.tt/2HoYDJO

Phase 1 clinical study of an embryonic stem cell-derived retinal pigment epithelium patch in age-related macular degeneration

da Cruz, L; Fynes, K; Georgiadis, O; Kerby, J; Luo, YH; Ahmado, A; Vernon, A; ... Coffey, PJ; + view all da Cruz, L; Fynes, K; Georgiadis, O; Kerby, J; Luo, YH; Ahmado, A; Vernon, A; Daniels, JT; Nommiste, B; Hasan, SM; Gooljar, SB; Carr, A-JF; Vugler, A; Ramsden, CM; Bictash, M; Fenster, M; Steer, J; Harbinson, T; Wilbrey, A; Tufail, A; Feng, G; Whitlock, M; Robson, AG; Holder, GE; Sagoo, MS; Loudon, PT; Whiting, P; Coffey, PJ; - view fewer (2018) Phase 1 clinical study of an embryonic stem cell-derived retinal pigment epithelium patch in age-related macular degeneration. Nature Biotechnology volume , 36 (4) pp. 328-337. 10.1038/nbt.4114 .

https://ift.tt/2r2aanw

The Impact of Complex Family Structure on Child Well‐being: Evidence From Siblings

Tarek, Mostafa; Ludovica, Gambaro; Heather, Joshi; (2018) The Impact of Complex Family Structure on Child Well‐being: Evidence From Siblings. Journal of Marriage and Family 10.1111/jomf.12456 . (In press). Green open access

https://ift.tt/2HtheEv

Local Real-Space View of the Achiral 1T-TiSe2 2 x 2 x 2 Charge Density Wave

Hildebrand, B; Jaouen, T; Mottas, M-L; Monney, G; Barreteau, C; Giannini, E; Bowler, DR; Hildebrand, B; Jaouen, T; Mottas, M-L; Monney, G; Barreteau, C; Giannini, E; Bowler, DR; Aebi, P; - view fewer (2018) Local Real-Space View of the Achiral 1T-TiSe2 2 x 2 x 2 Charge Density Wave. Physical Review Letters , 120 (13) 10.1103/PhysRevLett.120.136404 . Green open access

https://ift.tt/2qYqsNT

Patient and strain characteristics associated with Clostridium difficile transmission and adverse outcomes

Martin, JSH; Eyre, DW; Fawley, WN; Griffiths, D; Davies, K; Mawer, DPC; Peto, TEA; ... Wilcox, MH; + view all Martin, JSH; Eyre, DW; Fawley, WN; Griffiths, D; Davies, K; Mawer, DPC; Peto, TEA; Crook, DW; Walker, AS; Wilcox, MH; - view fewer (2018) Patient and strain characteristics associated with Clostridium difficile transmission and adverse outcomes. Clinical Infectious Diseases (In press).

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Interviewer-driven Variability in Social Network Reporting: Results from Health and Aging in Africa: a Longitudinal Study of an INDEPTH community (HAALSI) in South Africa

Harling, GD; Perkins, JM; Xavier Gómez-Olivé, F; Morris, K; Wagner, RG; Montana, L; Kabudula, CW; ... Berkman, L; + view all Harling, GD; Perkins, JM; Xavier Gómez-Olivé, F; Morris, K; Wagner, RG; Montana, L; Kabudula, CW; Bärnighausen, T; Kahn, K; Berkman, L; - view fewer (2018) Interviewer-driven Variability in Social Network Reporting: Results from Health and Aging in Africa: a Longitudinal Study of an INDEPTH community (HAALSI) in South Africa. Field Methods , 30 (2) pp. 140-154. 10.1177/1525822X18769498 . Green open access

https://ift.tt/2HqoAJ7

The Effect of Tissue Preparation and Donor Age on Striatal Graft Morphology in the Mouse

Harrison, DJ; Roberton, VH; Vinh, N-N; Brooks, SP; Dunnett, SB; Rosser, AE; (2018) The Effect of Tissue Preparation and Donor Age on Striatal Graft Morphology in the Mouse. Cell Transplantation , 27 (2) pp. 230-244. 10.1177/0963689717744788 . Green open access

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