Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Πέμπτη 10 Μαΐου 2018
The multidisciplinary tumor board for the management of cutaneous neoplasms: A national survey of academic medical centers
To the Editor: The multidisciplinary tumor board (MTB) is a meeting of various medical specialties to discuss the management of patients with cancer. In lung, esophageal, and head and neck cancers, tumor boards increase adherence to national treatment guidelines, decrease treatment delays, are educational, and instill the importance of multidisciplinary care early in training.1-4 However, little is known about the MTB for cutaneous neoplasms. This study assesses the structure, goals, and participation patterns of the MTB in a nationwide sample of academic dermatology centers.
https://ift.tt/2KV6dKm
Should medical students follow up on skin biopsy results? When education conflicts with patient privacy
With the increased availability of EHR across clinical medicine, medical trainees are increasingly using this technology as a learning tool. Although medical students are standardly given access to patient records to carry out clinical duties, one study found that 96% of students use EHRs to follow-up on outcomes after patients have left the student's direct care.1 Of these students, 93% found the practice to be educationally beneficial.1 However, what implications does this have for a patient's right to privacy, which reflects the ethical principle of respect for patient autonomy? Autonomy represents self-governance or self-rule whereby a person is free from the control or undue influence of others.
https://ift.tt/2ryKpvM
Author index∗∗January, pp. 1-236; February, pp. 237-432 and S1-S24; March, pp. 433-644 and S25-S84; April, pp. 645-838; May, pp. 839-1034; June, pp. 1035-1294.
Abanmi A (see Thiboutot et al). 2018;78:S1-23 (Supplement article)
https://ift.tt/2wA043a
In the blink of an eye
It seems like just the other day that I stood before the AAD Board of Directors to discuss my vision for the Journal of the American Academy of Dermatology (JAAD). That "other day" was actually in July 2007, and the presentation was to support my candidacy for Editor of the Journal. I simply cannot believe how quickly time has passed. As the old saying goes, "Time flies when you're having fun."
https://ift.tt/2rAtIAh
Langerhans cell histiocytosis in children
Langerhans cell histiocytosis (LCH) is an inflammatory neoplasia of myeloid precursor cells driven by mutations in the mitogen-activated protein kinase pathway. When disease involves the skin, LCH most commonly presents as a seborrheic dermatitis or eczematous eruption on the scalp and trunk. Evaluation for involvement of other organ systems is essential, because 9 of 10 patients presenting with cutaneous disease also have multisystem involvement. Clinical manifestations range from isolated disease with spontaneous resolution to life-threatening multisystem disease.
https://ift.tt/2Kb5IKP
Instagram and the dermatologist: An ethical analysis
Instagram, one of the most popular social media platforms, is a mobile media sharing app that allows users to share their content with a large, diverse audience. Among the 1 million advertisers1 on Instagram are business savvy physicians who are engaging with potential patients and customers on this platform. The growing application of Instagram as a tool to connect with an audience and build a personal brand presents unique ethical dilemmas to physician users of this platform. Dr M's moral obligations as a physician may conflict with the perceived need to adapt to the changing landscape of marketing in medicine.
https://ift.tt/2ryRNra
Generalized urticaria caused by ingestion of sweet potato cake
Publication date: Available online 10 May 2018
Source:Allergology International
Author(s): David El-Qutob, Fernando Pineda, Isabela Raducan, Miriam Castillo
https://ift.tt/2jPADkU
Acquisition of tolerance to egg allergy in a child with repeated egg-induced acute pancreatitis
Publication date: Available online 10 May 2018
Source:Allergology International
Author(s): Ken-ichi Nagakura, Noriyuki Yanagida, Sakura Sato, Kiyotake Ogura, Motohiro Ebisawa
https://ift.tt/2jN6DWM
Implication of fraction of exhaled nitric oxide and blood eosinophil count in severe asthma
Publication date: Available online 10 May 2018
Source:Allergology International
Author(s): Tomoyuki Soma, Hidetoshi Iemura, Erika Naito, Sachiko Miyauchi, Yoshitaka Uchida, Kazuyuki Nakagome, Makoto Nagata
BackgroundSevere asthma is a complex disease with heterogeneous features and involves type 2 airway inflammation, including eosinophil accumulation. Surrogate biomarkers, fraction of exhaled nitric oxide (FeNO) and blood eosinophil count (b-EOS), may predict eosinophilic airway inflammation. Here we investigated clinical characteristics of severe asthma phenotype using a combined analysis of FeNO and b-EOS.MethodsThis retrospective study examined clinical data of patients with severe asthma (N = 107; median age, 64 years) treated at Saitama Medical University Hospital from 2009 to 2016. Thresholds of FeNO and b-EOS for sputum eosinophil ratio ≥2% were determined using receiver operating characteristic curve (ROC) analysis. Clinical characteristics were analyzed after classifying patients into four subgroups according to these thresholds.ResultsOf 39 induced sputum samples examined, ROC area under the curve for predicting sputum eosinophilia was 82.0% (p = 0.001) for b-EOS and 77.0% (p = 0.006) for FeNO at optimal cut-off values of ≥300/μL and ≥25 ppb, respectively. The number of sensitized allergens was higher in the high FeNO/low b-EOS and high FeNO/high b-EOS subgroups (p < 0.05). The prevalence of chronic sinusitis was higher in the low FeNO/high b-EOS and high FeNO/high b-EOS subgroups (p = 0.04). The high FeNO/high b-EOS subgroup included the largest proportion (approximately 40%) of patients experiencing frequent severe exacerbations. Both low FeNO/low b-EOS and high FeNO/low b-EOS subgroups showed less severe exacerbations.ConclusionsCombined evaluation of FeNO and b-EOS can identify patients with frequent exacerbations and stratify the appropriate therapy for type 2 inflammation-predominant severe asthma.
https://ift.tt/2IeUQuS
World Thyroid Day Recognized Globally on May 25th
World Thyroid Day Recognized Globally
American Thyroid Association® collaborates with International Thyroid Societies
May 25, 2018
On May 25th the American Thyroid Association® (ATA) (www.thyroid.org), in cooperation with the European Thyroid Association (www.eurothyroid.com), will be making an extraordinary effort to promote its year-round goals —focus attention on that small butterfly-shaped gland at the base of the neck that causes approximately 20 million Americans to experience thyroid disease. In addition to the millions who have some form of thyroid disease, it is estimated that more than 12 percent of the U.S. population will develop a thyroid condition during their lifetime.
The important goal of the ATA® and our sister thyroid organizations is to get the word out about Thyroid! Perhaps the most stunning statistics are that up to 60 percent of those with thyroid disease are unaware of their condition and that women are five to eight times more likely than men to have thyroid problems. Almost everyone knows someone affected by thyroid disease or thyroid cancer and the ATA is proud to promote international awareness on World Thyroid Day so that symptoms, diagnosis, and treatment of conditions are available around the globe. If you or someone you know are experiencing thyroid symptoms, make an appointment to see a thyroid specialist – you can find one in your area (in the US and internationally) by using the ATA Physician Referral Tool and you can read up on the thyroid educational materials in the ATA Thyroid Information Library.
The ATA® is the leading organization devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health. Our mission assures that we communicate the importance of the thyroid gland, which produces hormones that influence every cell, tissue, and organ in the body. Thyroid hormones regulate the body's metabolism—the rate at which the body produces energy from nutrients and oxygen—and affects critical body functions, such as energy level and heart rate. Through its mission, the ATA® supports the clinicians and researchers who are at the frontlines of thyroid treatments and research. We also work with the public, patients, and their families to educate and increase awareness of thyroid diseases.
ATA® member of 30 years, Dr. Gregory Brent – Chair, Department of Medicine from the University of California-Los Angeles says that, "The ATA has been my professional home since my fellowship and it has been a privilege to serve with my many valued colleagues and with such a committed and talented staff. I am most grateful to my mentors, who have encouraged and guided me. The professional and personal growths I have experienced from my involvement with the ATA are immeasurable."
The ATA Patient Thyroid Information library is just a few clicks away on the ATA® website – http://www.thyroid.org/thyroid-information/ and we encourage you to check back regularly for updates and new materials. We are also pleased to offer many of our brochures in Spanish – http://www.thyroid.org/informacion-sobre-la-tiroides/ and provide a translator on the website for most languages. The ATA website provides easy-to-access, patient-friendly information on topics such as:
Hypothyroidism: One of the most common thyroid conditions that occurs when the thyroid gland does not produce enough thyroid hormone. Symptoms include fatigue, depression, forgetfulness, irregular menses and weight gain. Treatment of hypothyroidism is usually with a synthetic form of thyroid hormone called "levothyroxine." Hashimoto's Thyroiditis is an autoimmune disease affecting the thyroid is the most common cause of hypothyroidism in the US, affecting mostly women. Diagnosis is usually confirmed by symptoms suggesting thyroid underactivity, positive anti-thyroid antibodies, and small goiter (thyroid enlargement) on physical examination. Patients with an elevated blood level of TSH and/or goiter are treated with thyroxine (T4).
On the opposite side of the spectrum is Hyperthyroidism and this occurs when the thyroid gland produces too much thyroid hormone. Symptoms include irritability, nervousness, muscle weakness, unexplained weight loss, sleep disturbances, vision problems and eye irritation. One type of hyperthyroidism, Graves' disease, is an autoimmune disorder that is partly genetic.
In addition to these common thyroid conditions, we also know that Thyroid Cancer is the most rapidly increasing form of cancer in the United States. The American Cancer Society estimates 53,990 new cases of thyroid cancer will be diagnosed in 2018 resulting in over 2,000 deaths. When thyroid cancer is identified and treated early, the majority of patients can be completely cured.
Mary Catherine Petermann whose father was diagnosed with Anaplastic Thyroid Cancer in 2006 describes how the ATA impacted her search for help, "The ATA was a valuable resource for our family when my dad was diagnosed with Anaplastic Thyroid Cancer. When you are faced with a detrimental diagnosis where even a few days can make the difference in life or death, understanding your options quickly is critical. The ATA website offers a one-stop shop for patients and caregivers to find specialists, current clinical trials, general thyroid cancer information, and links to other patient support groups and information" Mary Catherine's father was treated by ATA member physicians at Mayo Clinic and has clean scans as of October 2016.
For thyroid cancer, Endocrinologists can sometimes employ minimally invasive procedures to distinguish thyroid cancer from benign thyroid nodules, which are common in the population. The ATA produces management guidelines for thyroid diseases and thyroid cancer, which, are open to the public and can accessed on the ATA website here: https://www.thyroid.org/professionals/ata-professional-guidelines/
We invite and encourage you to take a moment on the 25th of May, World Thyroid Day, to help ATA® continue to serve patients, families, and the physicians to treat them by making a donation on the ATA® World Thyroid Day Donation Page: https://www.crowdrise.com/world-thyroid-day
Your donation will help ATA continue the important work of education, research, and awareness on this most important disease. No donation is too small and if you would like to make a recurring donation throughout the year, please visit this page: https://www.givedirect.org/donate/?cid=723 and select frequency that is good for you.
Your interest and support help make a positive impact on the lives of so many who struggle with thyroid conditions and thyroid cancer every day and we thank you for joining us and helping carry-out the ATA® mission!
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The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis and treatment of thyroid disorders and thyroid cancer. ATA is an international individual membership organization for over 1,700 clinicians and researchers from 43 countries around the world, representing a broad diversity of medical disciplines. It also serves the public, patients and their family through education and awareness efforts
Celebrating its 95th anniversary, ATA delivers its mission through several key endeavors: the publication of highly regarded monthly journals, THYROID, Clinical Thyroidology, VideoEndocrinology and Clinical Thyroidology for the Public; annual scientific meetings; biennial clinical and research symposia; research grant programs for young investigators, support of online professional, public and patient educational programs; and the development of guidelines for clinical management of thyroid disease.
More information about ATA is found at www.thyroid.org.
The post <i>World Thyroid Day </i>Recognized Globally on May 25th appeared first on American Thyroid Association.
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Nemolizumab in moderate-to-severe atopic dermatitis: Randomized, phase II, long-term extension study
Publication date: Available online 10 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Kenji Kabashima, Masutaka Furue, Jon M. Hanifin, Grazyna Pulka, Andreas Wollenberg, Ryszard Galus, Takafumi Etoh, Ryosuke Mihara, Miwa Nakano, Thomas Ruzicka
BackgroundNemolizumab, an anti–interleukin-31 receptor A monoclonal antibody, improved pruritus, dermatitis, and sleep in adults with moderate-to-severe atopic dermatitis inadequately controlled by topical treatments in a phase II, 12-week, randomized, double-blind, placebo-controlled study (Part A) (NCT01986933).ObjectiveTo assess long-term efficacy and safety of nemolizumab injected subcutaneously every 4 weeks (Q4W) or every 8 weeks (Q8W) in a 52-week double-blind extension (Part B).MethodsDuring Part B, patients continued previous nemolizumab dose (0.1, 0.5, or 2.0 mg/kg Q4W or 2.0 mg/kg Q8W). Part B endpoints included percentage improvement from baseline in pruritus visual analogue scale (VAS) and dermatitis scores (including Eczema Area and Severity Index [EASI]).ResultsOverall, 216/264 patients completed Part A and 191 entered Part B; 131 completed Part B. In 153 patients randomized to nemolizumab in Part A, improvement from baseline in pruritus VAS was maintained/increased from Week 12 to 64, with greatest improvement in the 0.5-mg/kg Q4W group (percentage change from baseline at Week 64: −73.0, −89.6, −74.7, and −79.1 in the 0.1-, 0.5-, and 2.0-mg/kg Q4W and 2.0-mg/kg Q8W groups, respectively). Improvement from baseline in dermatitis scores was also maintained/increased to Week 64 (percent change in EASI score: −68.5, −75.8, −78.9, and −69.3 in the 0.1-, 0.5-, and 2.0-mg/kg Q4W and 2.0-mg/kg Q8W groups, respectively). Over 64 weeks, 83–89% had ≥1 adverse event, with no new safety concerns identified.ConclusionNemolizumab for up to 64 weeks was efficacious and, overall, well tolerated in patients with moderate-to-severe atopic dermatitis inadequately controlled by topical therapy.
https://ift.tt/2KSw0Tf
Medical and dietary management of eosinophilic esophagitis
Eosinophilic esophagitis (EoE) is a disease of chronic, allergen-driven, T-helper 2 (Th2) immune-mediated inflammation that progresses to fibrostenosis of the esophagus if left untreated. There are currently no FDA-approved drugs for the treatment of EoE. This review focuses on medical and dietary management of EoE.
https://ift.tt/2I7swib
Minimally-invasive biomarker studies in eosinophilic esophagitis: a systematic review
Eosinophilic esophagitis (EoE) is a chronic, inflammatory disease of the esophagus which currently requires repeated endoscopic biopsies for diagnosis and monitoring as no reliable non-invasive markers have been identified.
https://ift.tt/2rBZ88q
Efficacy of a single dose of omalizumab for the prevention of ethylene oxide intraoperative anaphylaxis
Ethylene oxide (EtO) is a highly reactive gas commonly used to sterilize pharmaceutical and biomedical thermo-sensitive products, such as infusion sets, cannulae, intubation materials, ventriculo-peritoneal shunts, dialysis catheters and stents 1.
https://ift.tt/2I7ssyX
An EAACI task force report: recognising the potential of the primary care physician in the diagnosis and management of drug hypersensitivity
Adverse drug reactions include drug hypersensitivity reactions (DHRs), which can be immunologically mediated (allergy) or non-immunologically mediated. The high number of DHRs that are unconfirmed and often se...
https://ift.tt/2rwUZDU
Septic arthritis of the sternoclavicular joint: A unique late complication after tracheostomy
Septic arthritis of the sternoclavicular joint is a rare infection associated with significant morbidity and mortality. Several risk factors for septic arthritis have been reported in the literature ranging from immunodeficiency to intravenous drug use.
https://ift.tt/2I8EcRO
Total mandibulectomy defect in the setting of chronic bisphosphonate use
Bisphosphonates are among several drugs known in modern medicine to have a potentially deleterious effect on the mandible with chronic use. While purportedly causing a necrotic reaction in the bone, the complete mechanism is not fully elucidated yet as cases are quite rare in the general public. Despite the esoteric nature of this entity, patients suffering from bisphosphonate induced necrosis have a complicated and prolonged course often involving varying degrees of mandibular debridement with severe cases requiring reconstruction.
https://ift.tt/2ryE4Qp
Editorial Board
Source:Autoimmunity Reviews, Volume 17, Issue 6
https://ift.tt/2G572fU
Sinonasal adenoid cystic carcinoma-role of on-site FNAC: a case report
Adenoid cystic carcinoma (ACC), a rare tumor of epithelial cell origin, commonly arises from the major salivary glands. Uncommonly it may be found outside the salivary glands and it's especially rare in the na...
https://ift.tt/2G4Dcbw
Loss of bronchoprotection to Salbutamol during sputum induction with hypertonic saline: implications for asthma therapy
Sputum induction with hypertonic saline in obstructive airway diseases is generally safe. However, saline induces bronchoconstriction in some patients despite pre-medication with Salbutamol. Our objectives wer...
https://ift.tt/2KOzhTI
Tone-Evoked Acoustic Change Complex (ACC) Recorded in a Sedated Animal Model
Abstract
The acoustic change complex (ACC) is a scalp-recorded cortical evoked potential complex generated in response to changes (e.g., frequency, amplitude) in an auditory stimulus. The ACC has been well studied in humans, but to our knowledge, no animal model has been evaluated. In particular, it was not known whether the ACC could be recorded under the conditions of sedation that likely would be necessary for recordings from animals. For that reason, we tested the feasibility of recording ACC from sedated cats in response to changes of frequency and amplitude of pure-tone stimuli. Cats were sedated with ketamine and acepromazine, and subdermal needle electrodes were used to record electroencephalographic (EEG) activity. Tones were presented from a small loudspeaker located near the right ear. Continuous tones alternated at 500-ms intervals between two frequencies or two levels. Neurometric functions were created by recording neural response amplitudes while systematically varying the magnitude of steps in frequency centered in octave frequency around 2, 4, 8, and 16 kHz, all at 75 dB SPL, or in decibel level around 75 dB SPL tested at 4 and 8 kHz. The ACC could be recorded readily under this ketamine/azepromazine sedation. In contrast, ACC could not be recorded reliably under any level of isoflurane anesthesia that was tested. The minimum frequency (expressed as Weber fractions (df/f)) or level steps (expressed in dB) needed to elicit ACC fell in the range of previous thresholds reported in animal psychophysical tests of discrimination. The success in recording ACC in sedated animals suggests that the ACC will be a useful tool for evaluation of other aspects of auditory acuity in normal hearing and, presumably, in electrical cochlear stimulation, especially for novel stimulation modes that are not yet feasible in humans.
https://ift.tt/2G5FNSm
Tone-Evoked Acoustic Change Complex (ACC) Recorded in a Sedated Animal Model
Abstract
The acoustic change complex (ACC) is a scalp-recorded cortical evoked potential complex generated in response to changes (e.g., frequency, amplitude) in an auditory stimulus. The ACC has been well studied in humans, but to our knowledge, no animal model has been evaluated. In particular, it was not known whether the ACC could be recorded under the conditions of sedation that likely would be necessary for recordings from animals. For that reason, we tested the feasibility of recording ACC from sedated cats in response to changes of frequency and amplitude of pure-tone stimuli. Cats were sedated with ketamine and acepromazine, and subdermal needle electrodes were used to record electroencephalographic (EEG) activity. Tones were presented from a small loudspeaker located near the right ear. Continuous tones alternated at 500-ms intervals between two frequencies or two levels. Neurometric functions were created by recording neural response amplitudes while systematically varying the magnitude of steps in frequency centered in octave frequency around 2, 4, 8, and 16 kHz, all at 75 dB SPL, or in decibel level around 75 dB SPL tested at 4 and 8 kHz. The ACC could be recorded readily under this ketamine/azepromazine sedation. In contrast, ACC could not be recorded reliably under any level of isoflurane anesthesia that was tested. The minimum frequency (expressed as Weber fractions (df/f)) or level steps (expressed in dB) needed to elicit ACC fell in the range of previous thresholds reported in animal psychophysical tests of discrimination. The success in recording ACC in sedated animals suggests that the ACC will be a useful tool for evaluation of other aspects of auditory acuity in normal hearing and, presumably, in electrical cochlear stimulation, especially for novel stimulation modes that are not yet feasible in humans.
https://ift.tt/2G5FNSm
Roxithromycin monotherapy inducing a partial response in a patient with myeloma: a case report
Clarithromycin is an efficacious treatment for myeloma in combination with other anti-myeloma therapy but not as monotherapy. To date, all studies have focused on a clarithromycin-specific effect rather than a...
https://ift.tt/2wq61PY
Exploration of Patient Characteristics and Quality of Life in Patients with Lipoedema Using a Survey
Abstract
Introduction
Lipoedema is a chronic disorder in which excessive fat distribution occurs predominantly from the waist down, resulting in a disproportion between the lower extremities and upper torso. Lipoedema is often not recognized, while patients experience pain and easy bruising. As a long-term condition, lipoedema has a massive effect on patients' lives and mental health. The aim of this study is to explore patient characteristics, quality of life, physical complaints and comorbidities in patients with lipoedema.
Methods
A survey was conducted by email amongst lipoedema patients, consisting of informed consent and multiple questionnaires. The questionnaires included general patient characteristics, physical complaints, comorbidities, RAND-36 and EQ-5D-3L. Participants who responded to a message on the Dutch Lipoedema Association website were recruited.
Results
All lipoedema patients experience physical complaints, with pain (88.3 %) and easy bruising (85.9 %) as primary complaints. The diagnosis was mostly made by a dermatologist after visiting a mean of 2.8 doctors. Furthermore, mean time from onset until diagnosis was 18 years. Quality of life (59.3) was significantly lower than the Dutch female average (74.9; p < 0.001). Additionally, patients with comorbidities had significant lower quality of life (RAND 54.7, p < 0.001).
Conclusions
Lipoedema patients often have severe complaints and experience lower quality of life regarding physical, emotional and social functioning. Additionally, comorbidities have a large impact on quality of life.
https://ift.tt/2rwdg4e
A Novel Computer Algorithm for Printing a 3-Dimensional Nasal Prosthetic
This pilot study describes a novel computer algorithm for the creation of a 3-dimensional model of a nose and uses a survey to evaluate the similarity of appearance of the nasal prosthesis with that of the individual's nose.
https://ift.tt/2KStzQU
https://ift.tt/2KStzQU
Human Papillomavirus in the Mouth and Throat
In this issue of JAMA Otolaryngology—Head & Neck Surgery, Li et al shows that human papillomavirus–positive squamous cell carcinoma (SCC) may be associated with improved overall survival not only in the oropharynx but also possibly in the upper aerodigestive tract subsites—oral cavity, larynx, and hypopharynx. This finding is persuasive given the large sample size used, which was obtained from the National Cancer Database (NCDB), and the multivariate analysis performed. Previous studies with smaller sample sizes have similarly suggested the favorable prognostic role of HPV in cancer in nonoropharyngeal head and neck sites, although other studies have refuted this possibility.
https://ift.tt/2rzVHzl
https://ift.tt/2rzVHzl
Association of HPV Status at Head and Neck Carcinoma Subsites With Overall Survival
This cohort study examines the association of human papillomavirus (HPV) in head and neck carcinoma subsites with overall survival in patients with HPV-positive and HPV-negative status.
https://ift.tt/2KOaEGC
https://ift.tt/2KOaEGC
Three-Dimensional Printing of Nasal Prosthetics
Although the technology has existed for decades, craniofacial applications for 3-dimensional (3-D) printing remains in its infancy. Preoperative surgical planning, education, reconstruction, and implantation are among the current topics of investigation into craniofacial applications for 3-D printing. The implications for 3-D printing in soft tissue reconstruction have been thoroughly discussed in the setting of congenital anomalies and ablative or traumatic defects. The execution of this technology in routine reconstructive practice has suffered from technologic naivety as well as the requisite cost, time, and resources.
https://ift.tt/2rul1Xo
https://ift.tt/2rul1Xo
Microvessel density in head and neck squamous cell carcinoma
Abstract
Purpose
Microvessel density (MVD) corresponds to the intensity of neo-angiogenesis. MVD assessments are based on the expression levels of the vascular endothelium markers such as, e.g., CD34 or CD105. The goal of this study was to assess MVD among patients with head and neck squamous cell carcinoma (HNSCC), and to evaluate the predictive value of MVD in head and neck cancers.
Methods
The study included 49 patients treated for HNSCC and 11 patients with dysplasia of the upper respiratory tract epithelium. Control tissues consisted of 12 normal mucous membranes of the throat. Expression levels of MVD markers were assessed by immunohistochemistry (IHC) using tissue microarrays (TMA). Clinicopathological factors and patients' survival over the 5-year follow-up period were analyzed.
Results
The MVD/CD34 values were found to be significantly elevated in the HNSCCs compared to the non-malignant control tissues (p = 0.001) and to dysplastic tissues. (p = 0.02). Significantly higher MVD/CD105 values were also seen in the tumor compared to the control tissues (p = 0.001) or the dysplastic tissues (p = 0.001). Unexpectedly, significantly lower MVD/CD34 values were seen in the tumor tissues of patients with the T3–T4 tumors compared to those with T1–T2 tumors (p = 0.01).
Conclusions
HNSCCs have statistically higher MVD values compared to dysplasia of the upper respiratory tract epithelium. However, the MVD/CD34 values did not correlate with local invasiveness (the T feature) of HNSCCs. This counterintuitive observation suggests that assessments of MVD as performed on TMA by IHC using anti-CD34 or anti-CD105 antibodies considered to be specific for endothelial cell markers might underestimate the extent of the tumor vascularity in HNSCC.
https://ift.tt/2rwJ8oc
Incidence of akathisia after postoperative nausea and vomiting prophylaxis with droperidol and ondansetron in outpatient surgery: A multicentre controlled randomised trial
BACKGROUND Akathisia, a distressing movement disorder induced by butyrophenones, has been described with low doses of droperidol used for postoperative nausea and vomiting (PONV) prophylaxis, but the incidence remains unclear. OBJECTIVES To determine the incidence of akathisia after PONV prophylaxis with two doses of droperidol in comparison with ondansetron, in patients undergoing ambulatory surgery. We hypothesised that the incidence of akathisia is higher with droperidol than that with ondansetron. DESIGN Randomised controlled double blind trial. SETTING Two University Hospital Centres and two private Clinics from January to September 2014. PATIENTS Patients (n=297) undergoing general anaesthesia for ambulatory surgery were randomly allocated to receive PONV prophylaxis with droperidol (0.625 or 1.25 mg) or ondansetron 4 mg; patients of the three groups also received 4 mg of dexamethasone. Exclusion criteria were contraindication to droperidol and ondansetron, use of psychotropic medications or benzodiazepines or history of psychotic illness. INTERVENTIONS Participants received droperidol (0.625 or 1.25 mg) or ondansetron 4 mg during general anaesthesia. After discharge from the postanaesthesia care unit presence and severity of akathisia were assessed using the Barnes Akathisia Rating Scale at 4 h postoperatively. MAIN OUTCOME MEASURES Score of the Global Clinical Assessment of Akathisia of Barnes Akathisia Rating Scale. RESULTS The number of akathisia observed was 1/118 (0.8%) in the ondansetron group, 1/84 (1.2%) in droperidol 0.625 mg group (DRO 0.625), and 3/87 (3.4%) in droperidol 1.25 mg group (DRO 1.25). The akathisia rate difference among the three groups was not significant (P = 0.52). We could not demonstrate significant differences in the incidence of akathisia between the two doses of droperidol. The only case of marked akathisia treated with benzodiazepines was observed after droperidol 1.25 mg. CONCLUSION The use of droperidol or ondansetron for PONV prophylaxis is associated to a low incidence of akathisia (0.8 to 3.4%) after general anaesthesia for ambulatory surgery. TRIAL REGISTRATION Clinicaltrials.gov: NCT01942343. Correspondence to Antoine Charton, Service d'Anesthésie-Réanimation, Hôpital de Hautepierre, 1 Avenue Molière, CP 67000 Strasbourg, France Tel: +33 388127076; fax: +33 388127074; e-mail: Antoine.charton@chru-strasbourg.fr © 2018 European Society of Anaesthesiology
https://ift.tt/2rzk28u
https://ift.tt/2rzk28u
Mobilization of Fluids in the Intensive Treatment of Primary and Secondary Lymphedemas
Background. Lymphedema is a clinical condition resulting from the accumulation of macromolecules in the interstitial space with a consequent buildup of fluids. Aim. The objective of this study was to compare the therapeutic response to treatment that mobilizes fluids between primary and secondary lymphedemas. Method. Thirty-three patients with severe leg lymphedema who underwent intensive treatment for five consecutive days in 2013 and 2014 at the Clínica Godoy were evaluated in a prospective clinical trial. Diagnosis was based on the patient's history and physical examination. Treatment consisted of eight hours/day of Mechanical Lymphatic Therapy using an electromechanical device (RAGodoy®) that performs plantar flexion and extension associated with 15 minutes of Cervical Lymphatic Therapy, a technique developed by Godoy and Godoy that involves stimulation in the cervical region and a grosgrain compression stocking alternated with elastic bandages. The unpaired -test and Fisher's exact test were used for statistical analysis with an alpha error of 5% ( value
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International Travel Vaccines
School is almost out and your family is counting down the days until you leave for vacation. If you're traveling abroad, keep your family healthy by receiving the appropriate international travel vaccines for your destination. Here is our advice on how to have a safe, enjoyable time with your family.
The post International Travel Vaccines appeared first on ChildrensMD.
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Lipomas of the Oral Cavity: Utility of MDM2 and CDK4 in Avoiding Overdiagnosis as Atypical Lipomatous Tumor
Abstract
Traumatized lipomas with degenerative change may demonstrate histopathologic features that mimic atypical lipomatous tumor (ALT). Previously reported series of ALT involving the oral cavity preceded routine use of MDM2 and CDK4 immunohistochemistry. Our aim is to evaluate MDM2 and CDK4 immunohistochemical expression in adipocytic tumors arising in this site, in conjunction with the histiocytic marker PU.1, to determine whether MDM2 and CDK4 impacts classification. 17 cases originally diagnosed as ALT were retrieved and immunohistochemical studies for MDM2, CDK4 and PU.1 were performed. FISH analysis for MDM2 amplification was performed in select cases. For this study group, the male:female ratio was 9:8 and the median age was 62 (range 41–88). All 17 cases presented as well- or predominantly well-circumscribed proliferations of variably sized, mature adipocytes exhibiting uni- or multi-vacuolation with occasional scalloped nuclei and mild nuclear atypia. Variable amounts of fibrous stroma with focal myxoid change and bland spindle cells were identified in 14/17 cases. Lipoblasts or atypical hyperchromatic stromal cells were not identified in any cases. 14 of 17 cases were negative for MDM2 and CDK4 in tumor cells and 11 of these 14 showed weak nuclear positivity for MDM2 in histiocytes. 3 of 17 cases showed weak, multifocal immunohistochemical expression of MDM2 and CDK4. PU.1 highlighted histiocytes in all 17 cases. FISH analysis for MDM2 amplification was negative in all 3 cases with weak MDM2/CDK4 expression. All cases were reclassified as lipoma with degenerative changes. ALT, in all likelihood, is less common than previously thought in this anatomic location and best diagnosed with ancillary studies. MDM2 expression in histiocytes is best interpreted in conjunction with CDK4 immunohistochemistry and confirmatory FISH for MDM2 amplification.
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Gender Equality from a European Perspective: Myth and Reality
Salinas, PC; Bagni, C; (2017) Gender Equality from a European Perspective: Myth and Reality. Neuron , 96 (4) pp. 721-729. 10.1016/j.neuron.2017.10.002 .
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One Step forwards: the availability of Wrotham Park damages for breach of contract
Davies, PS; (2017) One Step forwards: the availability of Wrotham Park damages for breach of contract. Lloyd's Maritime and Commercial Law Quarterly , 2 pp. 201-206.
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Inhibition of arterial medial calcification and bone mineralization by extracellular nucleotides: The same functional effect mediated by different cellular mechanisms
Patel, JJ; Zhu, D; Opdebeeck, B; D'Haese, P; Millan, JL; Bourne, LE; Wheeler-Jones, CPD; ... Orriss, IR; + view all Patel, JJ; Zhu, D; Opdebeeck, B; D'Haese, P; Millan, JL; Bourne, LE; Wheeler-Jones, CPD; Arnett, TR; MacRae, VE; Orriss, IR; - view fewer (2018) Inhibition of arterial medial calcification and bone mineralization by extracellular nucleotides: The same functional effect mediated by different cellular mechanisms. Journal of Cellular Physiology , 233 (4) pp. 3230-3243. 10.1002/jcp.26166 .
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Mineral Pigments in Archaeology: Their Analysis and the Range of Available Materials
Siddall, R; (2018) Mineral Pigments in Archaeology: Their Analysis and the Range of Available Materials. Minerals , 8 (5) , Article 201. 10.3390/min8050201 . Green open access
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Use of a GP-endorsed 12 months' reminder letter to promote uptake of bowel scope screening: Protocol for a randomised controlled trial in a hard-to-reach population
Von Wagner, C; Hirst, MY; Tookey, S; Kerrison, R; Marshall, S; Prentice, A; Vulkan, D; ... Duffy, S; + view all Von Wagner, C; Hirst, MY; Tookey, S; Kerrison, R; Marshall, S; Prentice, A; Vulkan, D; MacLeod, U; Duffy, S; - view fewer (2018) Use of a GP-endorsed 12 months' reminder letter to promote uptake of bowel scope screening: Protocol for a randomised controlled trial in a hard-to-reach population. BMJ Open , 8 (5) , Article e022263. 10.1136/bmjopen-2018-022263 . Green open access
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Model-based design of experiments in the presence of structural model uncertainty: an extended information matrix approach
Quaglio, M; Fraga, E; Galvanin, F; (2018) Model-based design of experiments in the presence of structural model uncertainty: an extended information matrix approach. Chemical Engineering Research and Design 10.1016/j.cherd.2018.04.041 . (In press).
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Filament rigidity and connectivity tune the deformation modes of active biopolymer networks
Stam, S; Freedman, SL; Banerjee, S; Weirich, KL; Dinner, AR; Gardel, ML; (2017) Filament rigidity and connectivity tune the deformation modes of active biopolymer networks. Proceedings of the National Academy of Sciences , 114 (47) E10037-E10045. 10.1073/pnas.1708625114 . Green open access
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A search for resonances decaying into a Higgs boson and a new particle X in the XH → qqbb final state with the ATLAS detector
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Watson, MF; Watts, G; Watts, S; Waugh, BM; Webb, AF; Webb, S; Weber, MS; Weber, SM; Weber, SW; Weber, SA; Webster, JS; Weidberg, AR; Weinert, B; Weingarten, J; Weirich, M; Weiser, C; Wells, PS; Wenaus, T; Wengler, T; Wenig, S; Wermes, N; Werner, MD; Werner, P; Wessels, M; Weston, TD; Whalen, K; Whallon, NL; Wharton, AM; White, AS; White, A; White, MJ; White, R; Whiteson, D; Whitmore, BW; Wickens, FJ; Wiedenmann, W; Wielers, M; Wiglesworth, C; Wiik-Fuchs, LAM; Wildauer, A; Wilk, F; Wilkens, HG; Williams, HH; Williams, S; Willis, C; Willocq, S; Wilson, JA; Wingerter-Seez, I; Winkels, E; Winklmeier, F; Winston, OJ; Winter, BT; Wittgen, M; Wobisch, M; Wolf, A; Wolf, TMH; Wolff, R; Wolter, MW; Wolters, H; Wong, VWS; Woods, NL; Worm, SD; Wosiek, BK; Wotschack, J; Wozniak, KW; Wu, M; Wu, SL; Wu, X; Wu, Y; Wyatt, TR; Wynne, BM; Xella, S; Xi, Z; Xia, L; Xu, D; Xu, L; Xu, T; Xu, W; Yabsley, B; Yacoob, S; Yamaguchi, D; Yamaguchi, Y; Yamamoto, A; Yamamoto, S; Yamanaka, T; Yamane, F; Yamatani, M; Yamazaki, T; Yamazaki, Y; Yan, Z; Yang, H; Yang, H; Yang, Y; Yang, Z; Yao, W-M; Yap, YC; Yasu, Y; Yatsenko, E; Wong, KHY; Ye, J; Ye, S; Yeletskikh, I; Yigitbasi, E; Yildirim, E; Yorita, K; Yoshihara, K; Young, C; Young, CJS; Yu, J; Yu, J; Yuen, SPY; Yusuff, I; Zabinski, B; Zacharis, G; Zaidan, R; Zaitsevak, AM; Zakharchuk, N; Zalieckas, J; Zaman, A; Zambito, S; Zanzi, D; Zeitnitz, C; Zemaityte, G; Zemla, A; Zeng, JC; Zeng, Q; Zenin, O; Zenis, T; Zerwas, D; Zhang, D; Zhang, D; Zhang, F; Zhang, G; Zhang, H; Zhang, J; Zhang, L; Zhang, L; Zhang, M; Zhang, P; Zhang, R; Zhang, R; Zhang, X; Zhang, Y; Zhang, Z; Zhao, X; Zhao, Y; Zhao, Z; Zhemchugov, A; Zhou, B; Zhou, C; Zhou, L; Zhou, M; Zhou, M; Zhou, N; Zhou, Y; Zhu, CG; Zhu, H; Zhu, J; Zhu, Y; Zhuang, X; Zhukov, K; Zibell, A; Zieminska, D; Zimine, NI; Zimmermann, C; Zimmermann, S; Zinonos, Z; Zinser, M; Ziolkowski, M; Zivkovic, L; Zobernig, G; Zoccoli, A; Zou, R; Nedden, MZ; Zwalinski, L; - view fewer (2018) A search for resonances decaying into a Higgs boson and a new particle X in the XH → qqbb final state with the ATLAS detector. Physics Letters B , 779 pp. 24-45. 10.1016/j.physletb.2018.01.042 . Green open access
https://ift.tt/2ItDXjz
Effects of pulse width, waveform and current direction in the cortex: A combined cTMS-EEG study
Casula, EP; Rocchi, L; Hannah, R; Rothwell, JC; (2018) Effects of pulse width, waveform and current direction in the cortex: A combined cTMS-EEG study. Brain Stimulation 10.1016/j.brs.2018.04.015 . (In press).
https://ift.tt/2wya112
Child and parental perspectives on communication and decision-making in pediatric chronic kidney disease: a focus group study
Gutman, T; Hanson, C; Bernays, S; Craig, J; Sinha, A; Dart, A; Eddy, A; ... Tong, A; + view all Gutman, T; Hanson, C; Bernays, S; Craig, J; Sinha, A; Dart, A; Eddy, A; Gipson, DS; Bockenhauer, D; Yap, H-K; Groothoff, J; Zappitelli, M; Webb, NJA; Alexander, S; Goldstein, SL; Further, S; Samuel, S; Blydt-Hansen, T; Dionne, J; Michael, M; Wenderfer, SE; Winkelmayer, W; Currier, H; McTaggart, S; Walker, A; Ralph, AF; Ji, A; James, L; Carter, S; Tong, A; - view fewer (2018) Child and parental perspectives on communication and decision-making in pediatric chronic kidney disease: a focus group study. American Journal of Kidney Diseases (In press).
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Cosmology with 21cm intensity mapping
Carucci, IP; (2018) Cosmology with 21cm intensity mapping. In: Journal of Physics: Conference Series. (pp. 012003). IOP Publishing Ltd Green open access
https://ift.tt/2wsYfox
A Longitudinal Study on the Formation of Chinese Students' Translation Competence: with a particular focus on metacognitive reflection and web searching
Chang, L-Y; (2018) A Longitudinal Study on the Formation of Chinese Students' Translation Competence: with a particular focus on metacognitive reflection and web searching. Doctoral thesis (Ph.D), UCL (University College London). Green open access
https://ift.tt/2IsraOd
Influences on use of hand moisturizers in nurses
Burke, KM; Wright, A; Parsons, V; Madan, I; (2018) Influences on use of hand moisturizers in nurses. Occupational Medicine 10.1093/occmed/kqy068 . (In press).
https://ift.tt/2KaVkTk
Travelling traders’ exchange problem: stochastic modelling framework and two-layer model identification strategy
Huang, C; Cattani, F; Piccione, PM; Galvanin, F; (2018) Travelling traders' exchange problem: stochastic modelling framework and two-layer model identification strategy. Industrial and Engineering Chemistry Research 10.1021/acs.iecr.8b00338 . (In press).
https://ift.tt/2Iyg0YB
On the stochastic modelling of surface reactions through reflected chemical Langevin equations
Pineda, M; Stamatakis, M; (2018) On the stochastic modelling of surface reactions through reflected chemical Langevin equations. Computers and Chemical Engineering (In press).
https://ift.tt/2wuxPmk
Control of mitochondrial superoxide production by reverse electron transport at complex I
Eaton, SJ; Robb, E; Hall, A; Prime, T; Szibor, M; Viscimo, C; James, A; Eaton, SJ; Robb, E; Hall, A; Prime, T; Szibor, M; Viscimo, C; James, A; Murphy, M; - view fewer (2018) Control of mitochondrial superoxide production by reverse electron transport at complex I. Journal of Biological Chemistry (In press).
https://ift.tt/2G2yZoR
Synergistic malaria vaccine combinations identified by systematic antigen screening
Bustamante, LY; Powell, GT; Lin, Y-C; Macklin, MD; Cross, N; Kemp, A; Cawkill, P; ... Rayner, JC; + view all Bustamante, LY; Powell, GT; Lin, Y-C; Macklin, MD; Cross, N; Kemp, A; Cawkill, P; Sanderson, T; Crosnier, C; Muller-Sienerth, N; Doumbo, OK; Traore, B; Crompton, PD; Cicuta, P; Tran, TM; Wright, GJ; Rayner, JC; - view fewer (2017) Synergistic malaria vaccine combinations identified by systematic antigen screening. PNAS - Proceedings of the National Academy of Sciences of the United States of America , 114 (45) pp. 12045-12050. 10.1073/pnas.1702944114 . Green open access
https://ift.tt/2KNONz4
Array imperfection calibration for wireless channel multipath characterisation
Zhou, Juan; (2018) Array imperfection calibration for wireless channel multipath characterisation. Masters thesis (M.Phil), UCL (University College London). Green open access
https://ift.tt/2G5rqNU
Inhibitor-induced HER2-HER3 heterodimerisation promotes proliferation through a novel dimer interface
Claus, J; Patel, G; Autore, F; Colomba, A; Weitsman, G; Soliman, TN; Roberts, S; ... Parker, PJ; + view all Claus, J; Patel, G; Autore, F; Colomba, A; Weitsman, G; Soliman, TN; Roberts, S; Zanetti-Domingues, LC; Hirsch, M; Collu, F; George, R; Ortiz-Zapater, E; Barber, PR; Vojnovic, B; Yarden, Y; Martin-Fernandez, ML; Cameron, A; Fraternali, F; Ng, T; Parker, PJ; - view fewer (2018) Inhibitor-induced HER2-HER3 heterodimerisation promotes proliferation through a novel dimer interface. eLIFE , 7 , Article e32271. 10.7554/eLife.32271 . Green open access
https://ift.tt/2KNOLqW
Putting the United Nations Sustainable Development Goals into practice: A review of implementation, monitoring, and finance
Georgeson, LT; Maslin, M; (2018) Putting the United Nations Sustainable Development Goals into practice: A review of implementation, monitoring, and finance. Geo: Geography and Environment , 5 (1) , Article e00049. 10.1002/geo2.49 . Green open access
https://ift.tt/2G2rNJd
Update on complications in cleft orthognathic surgery
Purpose of review To give an update on recent publications and tendencies concerning complications in cleft orthognathic surgery. Recent findings Cleft-specific changes after orthognathic surgery and their impact on surgical outcomes are discussed. Focus lays on the causes and mechanisms of cleft-related surgical complications and strategies to prevent or minimize these complications. Bimaxillary surgery is seen as a safe procedure for cleft patients. Maxillary distraction, total or segmental, is pointed out as an alternative method to improve outcomes. Different techniques for osteotomies and maxillary mobilization could decrease adverse events. Summary Cleft patients are more susceptible to the occurrence of complications because of peculiar presurgical conditions. Different surgical approaches and techniques are presented to overcome these difficulties, to achieve better results and to increase patient safety. The importance of communication between patient, family and cleft team members is emphasized. Correspondence to Philip Kuo-Ting Chen, Craniofacial Center, Taipei Medical University Hospital, 252 Wu-Xing Street, Xinyi District 110, Taipei City, Taiwan. Tel: +886937062575; e-mail: philip.ktchen@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2jNL0Ws
https://ift.tt/2jNL0Ws
Blepharoptosis repair
Purpose of review To review recent advances on the mechanisms and management of acquired aponeurotic blepharoptosis. Recent findings Recent advances over the past year have focused on refining well known methods of ptosis repair, expanding and modifying techniques to treat difficult and more severe conditions, and uncovering the biomechanical and neurostimulatory mechanisms of ptosis and its repair. Summary Innovations in ptosis repair are discussed in the context of current treatment paradigms. Correspondence to Pete Setabutr, MD, Department of Ophthalmology, 1855 West Taylor Street, Chicago, IL 60612, USA. Tel: +1 312 996 9120; fax: +1 312 413 7895; e-mail: psetabut@uic.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2G2Nzwg
https://ift.tt/2G2Nzwg
Update on complications in cleft orthognathic surgery
Purpose of review To give an update on recent publications and tendencies concerning complications in cleft orthognathic surgery. Recent findings Cleft-specific changes after orthognathic surgery and their impact on surgical outcomes are discussed. Focus lays on the causes and mechanisms of cleft-related surgical complications and strategies to prevent or minimize these complications. Bimaxillary surgery is seen as a safe procedure for cleft patients. Maxillary distraction, total or segmental, is pointed out as an alternative method to improve outcomes. Different techniques for osteotomies and maxillary mobilization could decrease adverse events. Summary Cleft patients are more susceptible to the occurrence of complications because of peculiar presurgical conditions. Different surgical approaches and techniques are presented to overcome these difficulties, to achieve better results and to increase patient safety. The importance of communication between patient, family and cleft team members is emphasized. Correspondence to Philip Kuo-Ting Chen, Craniofacial Center, Taipei Medical University Hospital, 252 Wu-Xing Street, Xinyi District 110, Taipei City, Taiwan. Tel: +886937062575; e-mail: philip.ktchen@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2jNL0Ws
https://ift.tt/2jNL0Ws
Blepharoptosis repair
Purpose of review To review recent advances on the mechanisms and management of acquired aponeurotic blepharoptosis. Recent findings Recent advances over the past year have focused on refining well known methods of ptosis repair, expanding and modifying techniques to treat difficult and more severe conditions, and uncovering the biomechanical and neurostimulatory mechanisms of ptosis and its repair. Summary Innovations in ptosis repair are discussed in the context of current treatment paradigms. Correspondence to Pete Setabutr, MD, Department of Ophthalmology, 1855 West Taylor Street, Chicago, IL 60612, USA. Tel: +1 312 996 9120; fax: +1 312 413 7895; e-mail: psetabut@uic.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2G2Nzwg
https://ift.tt/2G2Nzwg
Lipomas of the Oral Cavity: Utility of MDM2 and CDK4 in Avoiding Overdiagnosis as Atypical Lipomatous Tumor
Abstract
Traumatized lipomas with degenerative change may demonstrate histopathologic features that mimic atypical lipomatous tumor (ALT). Previously reported series of ALT involving the oral cavity preceded routine use of MDM2 and CDK4 immunohistochemistry. Our aim is to evaluate MDM2 and CDK4 immunohistochemical expression in adipocytic tumors arising in this site, in conjunction with the histiocytic marker PU.1, to determine whether MDM2 and CDK4 impacts classification. 17 cases originally diagnosed as ALT were retrieved and immunohistochemical studies for MDM2, CDK4 and PU.1 were performed. FISH analysis for MDM2 amplification was performed in select cases. For this study group, the male:female ratio was 9:8 and the median age was 62 (range 41–88). All 17 cases presented as well- or predominantly well-circumscribed proliferations of variably sized, mature adipocytes exhibiting uni- or multi-vacuolation with occasional scalloped nuclei and mild nuclear atypia. Variable amounts of fibrous stroma with focal myxoid change and bland spindle cells were identified in 14/17 cases. Lipoblasts or atypical hyperchromatic stromal cells were not identified in any cases. 14 of 17 cases were negative for MDM2 and CDK4 in tumor cells and 11 of these 14 showed weak nuclear positivity for MDM2 in histiocytes. 3 of 17 cases showed weak, multifocal immunohistochemical expression of MDM2 and CDK4. PU.1 highlighted histiocytes in all 17 cases. FISH analysis for MDM2 amplification was negative in all 3 cases with weak MDM2/CDK4 expression. All cases were reclassified as lipoma with degenerative changes. ALT, in all likelihood, is less common than previously thought in this anatomic location and best diagnosed with ancillary studies. MDM2 expression in histiocytes is best interpreted in conjunction with CDK4 immunohistochemistry and confirmatory FISH for MDM2 amplification.
https://ift.tt/2I8w67r
Lipomas of the Oral Cavity: Utility of MDM2 and CDK4 in Avoiding Overdiagnosis as Atypical Lipomatous Tumor
Abstract
Traumatized lipomas with degenerative change may demonstrate histopathologic features that mimic atypical lipomatous tumor (ALT). Previously reported series of ALT involving the oral cavity preceded routine use of MDM2 and CDK4 immunohistochemistry. Our aim is to evaluate MDM2 and CDK4 immunohistochemical expression in adipocytic tumors arising in this site, in conjunction with the histiocytic marker PU.1, to determine whether MDM2 and CDK4 impacts classification. 17 cases originally diagnosed as ALT were retrieved and immunohistochemical studies for MDM2, CDK4 and PU.1 were performed. FISH analysis for MDM2 amplification was performed in select cases. For this study group, the male:female ratio was 9:8 and the median age was 62 (range 41–88). All 17 cases presented as well- or predominantly well-circumscribed proliferations of variably sized, mature adipocytes exhibiting uni- or multi-vacuolation with occasional scalloped nuclei and mild nuclear atypia. Variable amounts of fibrous stroma with focal myxoid change and bland spindle cells were identified in 14/17 cases. Lipoblasts or atypical hyperchromatic stromal cells were not identified in any cases. 14 of 17 cases were negative for MDM2 and CDK4 in tumor cells and 11 of these 14 showed weak nuclear positivity for MDM2 in histiocytes. 3 of 17 cases showed weak, multifocal immunohistochemical expression of MDM2 and CDK4. PU.1 highlighted histiocytes in all 17 cases. FISH analysis for MDM2 amplification was negative in all 3 cases with weak MDM2/CDK4 expression. All cases were reclassified as lipoma with degenerative changes. ALT, in all likelihood, is less common than previously thought in this anatomic location and best diagnosed with ancillary studies. MDM2 expression in histiocytes is best interpreted in conjunction with CDK4 immunohistochemistry and confirmatory FISH for MDM2 amplification.
https://ift.tt/2I8w67r
The prevalence and impact of otitis media with effusion in children admitted for adeno-tonsillectomy at Dr George Mukhari Academic Hospital, Pretoria, South Africa
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Timothy Els, Ian Paul Olwoch
IntroductionOtitis media with effusion (OME) is a leading cause of acquired hearing loss in children worldwide. However, previous South African studies have consistently reported the local paediatric OME prevalence to be lower than typically published in international literature. Furthermore, no South African studies have investigated OME in children with adenotonsillar hypertrophy. The objective of this study was to determine the prevalence of OME in children admitted for adeno-tonsillectomy at our institution in Pretoria, South Africa. In addition, the study sought to gauge the impact of OME on quality of life using a validated questionnaire (OM-6).MethodsA cross-sectional, observational study was conducted between July 2015 and May 2016 at the Otorhinolaryngology outpatient department at DGMAH. he study included 109 consecutively sampled children, aged 2–12 years (mean 6.1; 49.7% female). Pneumatic otoscopy and tympanometry were performed on all participants. Adenoid hypertrophy was quantified using he adenoid-nasopharyngeal ratio (ANR) on a lateral post-nasal space radiograph (Fujioka's method). The OM-6 questionnaire was completed for each participant. Pure tone audiometry was performed for participants diagnosed with OME.ResultsThe prevalence of bilateral OME was 11.9%. For unilateral OME, the prevalence was 22.9% and 16.5%, for the left and right ears, respectively (p > 0.05). The mean hearing loss (SD) was 19.8 dB (9.4). Clinically significant adenoid hypertrophy (ANR ≥ 0.71) was present in 43% of participants. There was no statistically significant (p > 0.05) correlation between the presence OME and adenoid hypertrophy. The mean total OM-6 survey score was 1.67 (SD ± 0.59) in children with OME, and 1.31 (SD ± 0.45) without OME, showing no statistically significant difference (p > 0.05). There was a significant (P < 0.05) correlation between OME and the presence of atopy.ConclusionAdeno-tonsillar pathology may play an aetio-pathological role in the development of OME. However, this may be due to the presence of biofilms rather than obstructive adenoid hypertrophy, given the lack of a significant (p > 0.05) correlation between adenoid hypertrophy and OME. Whilst OME was not found to impair quality of life in this population group, the validity of the OM-6 in the South African paediatric population requires further investigation.
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Reduced Hemidiaphragmatic Paresis With a “Corner Pocket” Technique for Supraclavicular Brachial Plexus Block: Single-Center, Observer-Blinded, Randomized Controlled Trial
Background and Objective Hemidiaphragmatic paresis is common after supraclavicular brachial plexus block (SCBPB). In this randomized trial, we compared the incidence of hemidiaphragmatic paresis in patients who had local anesthetic injected primarily in the corner pocket (defined as the intersection of the first rib and subclavian artery) during SCBPB with that of patients who underwent injection primarily inside the neural cluster. Methods Thirty-six patients scheduled for right elbow, forearm, wrist, or hand surgery under SCBPB (using 12.5 mL of 0.75% ropivacaine and 12.5 mL of 2% lidocaine with 1:200,000 epinephrine) were randomly assigned to 1 of 2 groups. In group CP, local anesthetic was injected primarily in the corner pocket (20 mL) and secondarily inside the neural cluster (5 mL). In group NC, local anesthetic was deposited primarily inside the neural cluster (20 mL) and secondarily in the corner pocket (5 mL). The primary outcome was the incidence of hemidiaphragmatic paresis, as measured by M-mode ultrasonography 30 minutes after SCBPB. Results The incidence of hemidiaphragmatic paresis was significantly lower in group CP than in group NC (27.8% vs 66.7%, P = 0.019). The median decreases in forced expiratory volume at 1 second (7.5% [interquartile range, 3.3%–17.1%] vs 24.4% [interquartile range, 10.2%–31.2%]; P = 0.010) and forced vital capacity (6.4% [interquartile range, 3.3%–11.1%] vs 19.3% [interquartile range, 13.7%–33.2%]; P = 0.001) were also lower in group CP than in group NC. Conclusions The incidence of hemidiaphragmatic paresis was effectively reduced when local anesthetic was injected primarily in the corner pocket during right-sided SCBPB. However, the 28% incidence of hemidiaphragmatic paresis associated with the corner pocket technique may still represent a prohibitive risk for patients with preexisting pulmonary compromise. Clinical Trial Registration This study was registered at Clinical Trial Registry of Korea, identifier KCT0001769. Accepted for publication January 15, 2018. Address correspondence to: Duck Hwan Choi, MD, PhD, Department of Anesthesiology and Pain Medicine, Samsung Medical Center, 81 Irwon ro, Gangnam gu, Seoul 06351, Korea (e-mail: duckhwanc@gmail.com). R.A.K. and Y.H.C. contributed equally as first authors. The authors have no sources of funding to declare for this article. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
https://ift.tt/2G3CnPX
https://ift.tt/2G3CnPX
A Cadaveric Study Investigating the Mechanism of Action of Erector Spinae Blockade
Background and Objectives Erector spinae block is an ultrasound-guided interfascial plane block first described in 2016. The objectives of this cadaveric dye injection and dissection study were to simulate an erector spinae block to determine if dye would spread anteriorly to the involve origins of the ventral and dorsal branches of the spinal nerves. Methods In 10 unembalmed human cadavers, 20 mL of 0.25% methylene blue dye was injected bilaterally into the plane between the fifth thoracic transverse process and erector spinae muscle. An in-plane ultrasound-guided technique with the transducer orientated longitudinally was used. During dissection, superficial and deep muscles were identified, and extent of dye spread was documented in cephalocaudal and lateral directions. The ventral and dorsal rami of spinal nerves and dorsal root ganglion at each level were examined to determine if they were stained by dye. Results There was extensive cephalocaudad and lateral spread of dye deep and superficial to the erector spinae muscles. Except for 1 injection (from 20), the ventral rami were not stained by the dye. In only 2 injections did the dye track posteriorly through the costotransverse foramen to the dorsal root ganglion. In all other cases, the dorsal root ganglia were not involved in the dye injection. The dye stained the dorsal rami posterior to the costotransverse foramen. Conclusions There was no spread of dye anteriorly to the paravertebral space to involve origins of the ventral and dorsal branches of the thoracic spinal nerves. Dorsal ramus involvement was posterior to the costotransverse foramen. Accepted for publication January 15, 2018. Address correspondence to: Michael J. Barrington, PhD, MBBS, FANZCA, Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Victoria Parade, PO Box 2900 Fitzroy, Victoria 3065, Australia (e-mail: Michael.Barrington@svha.org.au). Funding was from departmental resources only. Support was provided by the Imaging and Posters Unit at the Department of Anatomy and Neuroscience, University of Melbourne, and Anastasia Arsenoulis from FUJIFILM SonoSite, Inc, which provided an ultrasound machine. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
https://ift.tt/2KRLuXW
https://ift.tt/2KRLuXW
Perceived need of, and interest in, HIV pre-exposure prophylaxis amongst men who have sex with men attending three sexual health clinics in London, UK
Bull, L; Dimitrijevic, P; Beverley, S; Scarborough, A; Mandalia, S; Dosekun, O; Barber, T; ... Rayment, M; + view all Bull, L; Dimitrijevic, P; Beverley, S; Scarborough, A; Mandalia, S; Dosekun, O; Barber, T; Reeves, I; McCormack, S; Rayment, M; - view fewer (2017) Perceived need of, and interest in, HIV pre-exposure prophylaxis amongst men who have sex with men attending three sexual health clinics in London, UK. International Journal of STD and AIDS , 29 (5) pp. 435-442. 10.1177/0956462417730259 . Green open access
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Time-step analysis of the DECC 2050 Calculator pathways
Barton, J; McKenna, E; Thomson, M; (2017) Time-step analysis of the DECC 2050 Calculator pathways. Proceedings of the Institution of Mechanical Engineers, Part A: Journal of Power and Energy , 231 (6) pp. 551-579. 10.1177/0957650917704993 . Green open access
https://ift.tt/2G1kgu8
Multiple core-hole formation by free-electron laser radiation in molecular nitrogen
Banks, HIB; Little, DA; Emmanouilidou, A; (2018) Multiple core-hole formation by free-electron laser radiation in molecular nitrogen. Journal of Physics B: Atomic, Molecular and Optical Physics , 51 (9) , Article 095001. 10.1088/1361-6455/aab40f . (In press). Green open access
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Planning for robust water supply system investments under global change
Huskova, Ivana; (2018) Planning for robust water supply system investments under global change. Doctoral thesis (Eng.D), UCL (University College London).
https://ift.tt/2G4FE1s
3D printing from Microfocus Computed Tomography (micro-CT) in Human Specimens: Education and Future Implications
Shelmerdine, SC; Simcock, IC; Hutchinson, JC; Aughwane, R; Melbourne, A; Nikitichev, DI; Ong, J-L; ... Arthurs, OJ; + view all Shelmerdine, SC; Simcock, IC; Hutchinson, JC; Aughwane, R; Melbourne, A; Nikitichev, DI; Ong, J-L; Borghi, A; Cole, G; Kingham, E; Calder, AD; Capelli, C; Akhtar, A; Cook, AC; Schievano, S; David, A; Ourselin, S; Sebire, NJ; Arthurs, OJ; - view fewer (2018) 3D printing from Microfocus Computed Tomography (micro-CT) in Human Specimens: Education and Future Implications. British Journal of Radiology 10.1259/bjr.20180306 . (In press).
https://ift.tt/2jNuRQQ
Structural and physico-chemical analysis of calcium/strontium substituted, near-invert phosphate based glasses for biomedical applications
Patel, U; Moss, RM; Hossain, KMZ; Kennedy, AR; Barney, ER; Ahmed, I; Hannon, AC; (2017) Structural and physico-chemical analysis of calcium/strontium substituted, near-invert phosphate based glasses for biomedical applications. Acta Biomaterialia , 60 pp. 109-127. 10.1016/j.actbio.2017.07.002 .
https://ift.tt/2G3hpAS
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