Education in neuroanesthesia and neurocritical care: trends, challenges and advancements

Purpose of review We summarize the latest evidence in neuroanesthesia and neurocritical care (NCC) training. In addition, we describe the newer advancements that clinical educators face in these subspecialties. Lastly, we highlight educational approaches that may lead to an enhanced learning experience and development of necessary skills for neurosciences trainees. Recent findings Current neuroanesthesia and NCC training requires acquisition of specific skills for increasing complex surgical cases, specialized neurosurgical practice and new perioperative technologies. Furthermore, there is increasing international interest for standardization and accreditation of neuroanesthesia fellowship programs. Recent evidence has demonstrated that well structured training using high-fidelity simulation improves cognitive and technical skills in acute neurological crises. Summary High-fidelity simulation in perioperative care of neurosurgical patients can be part of formal neuroanesthesia and NCC curricula, and potentially impact trainees' proficiency. A research agenda is needed to validate the assessment of most effective educational interventions in neurosciences trainees with diverse medical backgrounds. Creative combinations of cost-effective interventions including traditional teaching, specific technical skills workshops, low and high-fidelity simulation deserve to be assessed in future studies. Correspondence to Angela Builes-Aguilar, MD, MSc, MsEpi, Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, Western University, 275 Regent Street, London, ON, Canada N6A2H3. Tel: +1 519 671 0313; e-mail: Angelitabuiles@gmail.com Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Anesthesia for awake craniotomy

Purpose of review The current review reports on current trends in the anesthetic management of awake craniotomy, including preoperative preparation, sedation schemes, pain management, and prevention of intraoperative complications. Recent findings Both approaches for anesthesia for awake craniotomy, asleep–awake–asleep and monitored anesthesia care (MAC), have shown equal efficacy for performing intraoperative brain mapping. Choice of the appropriate scheme is currently based mainly on the preferences of the particular anesthesiologist. Dexmedetomidine has demonstrated high efficacy and safety in MAC for awake craniotomy and has become a rational alternative to propofol. Despite the high efficacy of scalp block and opioids, pain remains a common compliant in awake craniotomy. Appropriate surgical tactics can reduce pain and even prevent postoperative neurological complications. Although the efficacy of prophylaxis of intraoperative seizures with anticonvulsants remains doubtful, levetiracetam can be superior to other drugs for this purpose. Summary Following a great deal of progress in anesthetic management, awake craniotomy, which had been a relatively rare approach, is now a commonly performed procedure for neurosurgical intervention. Modern anesthesia techniques can provide for successful brain mapping in almost any patient. Management of awake craniotomy in high-risk patients is a central task for future research. Correspondence to Alexander Kulikov, MD, PhD, Department of Anesthesiology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia. Tel: +7 903 963 73 64; e-mail: akulikov@nsi.ru Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Opioid-free anesthesia: a different regard to anesthesia practice

Purpose of review In the past two decades, opioids have been prescribed increasingly for the treatment of various chronic pain conditions and during the perioperative period. Perioperative opioid administration is associated with well known adverse effects and recently to long-term use and poor surgical outcomes. In this context, the anesthesiologists have to face their responsibilities. The review discusses the neurophysiological basis of opioid-free anesthesia (OFA), the rational supporting its use in perioperative medicine as well as barriers and future challenges in the field. Recent findings OFA has gained in popularity as a way to enhance early recovery and to spare opioids for the postoperative period. Whether it is possible to deliver safe and stable anesthesia without intraoperative opioids to many patients undergoing various surgical procedures, OFA still raises questions. Accurate monitoring to measure intraoperative nociception and guide the use of adjuvants are not available. There is a need for the development of procedure-specific strategies as well as indications and contraindications to the technique. Finally, objective assessment of OFA use on patient outcomes should be recorded in large multicenter studies. Summary OFA stands as a new paradigm, which questions anesthesiology practice and might help to rationalize perioperative opioids use. Correspondence to Patricia Lavand'homme, MD, PhD, Department of Anesthesiology, Cliniques Universitaires St Luc - University Catholic of Louvain, Av Hippocrate 10, B-1200 Brussels, Belgium. Tel: +32 2 764 18 21; fax: +32 2 764 36 99; e-mail: patricia.lavandhomme@uclouvain.be Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Genetics and genomics in postoperative pain and analgesia

Purpose of review The review describes recent advances in genetics and genomics of postoperative pain, the association between genetic variants and the efficacy of analgesics, and the role of pharmacogenomics in the selection of appropriate analgesic treatments for postoperative pain. Recent findings Recent genetic studies have reported associations of genetic variants in catechol-O-methyltransferase (COMT), brain-derived neurotrophic factor (BDNF), voltage-gated channel alpha subunit 11 (SCN11A) and μ-opioid receptor (OPRM1) genes with postoperative pain. The recent pharmacogenetics studies revealed an association of the organic cation transporter 1 (OCT1) and ATP-binding cassette C3 (ABCC3) polymorphisms with morphine-related adverse effects, an effect of polymorphisms in cytochrome P450 gene CYP2D6 on the analgesic efficacy of tramadol and no effect of CYP2C8 and CYP2C9 variants on efficacy of piroxicam. Summary Genetic variants associate with inter-individual variability in drug responses and they can affect pain sensitivity and intensity of postoperative pain. Despite the recent progress in genetics and genomics of postoperative pain, it is still not possible to precisely predict the patients who are genetically predisposed to have severe postoperative pain or who develop chronic postoperative pain. Correspondence to Eija Kalso, MD, PhD, Pain Clinic, PB 140, 00029 HUS, Finland. Tel: +358 9 47175885; e-mail: eija.kalso@helsinki.fi Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Is epidural analgesia still a viable option for enhanced recovery after abdominal surgery

Purpose of review Although thoracic epidural analgesia (TEA) is considered often as gold standard in multimodal analgesia with regard to major abdominal surgery, there is an ongoing debate if it is still a viable option for enhanced recovery because of its potential severe complications. Recent findings In addition to the unsurpassed analgesic quality, a TEA offers several advantages. Studies have shown that a TEA does have a positive effect on perioperative morbidity and mortality, bowel function, the occurrence of ileus and patient mobility. Furthermore, TEA can reduce opioid-induced side effects, cardiac arrhythmias and pneumonia. When it is embedded into a multimodal fast-track program, it also shortens intensive care and hospital stay. Summary TEA provides superior pain control with a handful of important advantages if used sensibly and with caution. Because of associated risks for severe neurological complications, clear contraindications should be ruled out. Special attention needs be paid to potential hypotension in the setting of epidural analgesia. If these key points are considered, a TEA still represents a viable option for enhanced recovery after major abdominal surgery. Correspondence to Raphael Weiss, MD, University Hospital Münster, Departement of Anesthesiology and Intensive Care Medicine, Albert-Schweitzer-Campus 1, 48149 Münster, NRW, Germany. Tel: +49 251 83 47266; fax: +49 251 83 47257; e-mail: r_weiss@anit.uni-muenster.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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The road to accreditation for fellowship training in regional anesthesiology and acute pain medicine

Purpose of review The purpose of this review is to provide the background and rationale for pursuing accreditation of regional anesthesiology and acute pain medicine (RAAPM) fellowships, explain specific steps and challenges in the process, and forecast the future of fellowship training. Recent findings In 2016, the first fellowship program in RAAPM was able to apply for accreditation from the Accreditation Council for Graduate Medical Education (ACGME). The establishment of this newly accredited subspecialty fellowship and the announcement of the first accredited programs represented a tremendous achievement in anesthesiology training and medical education in general and was the culmination of nearly 4 years of dedicated effort. Summary Programs with initial ACGME accreditation are on a 2-year term and will be reviewed to evaluate adherence to the program requirements and the quality of fellowship training. Deficiencies identified will need to be resolved or face loss of accreditation. However, a program's maintenance of accreditation represents a commitment to its fellows to provide a training experience that can be held as a benchmark for all programs. Correspondence to Edward R. Mariano, MD, MAS, Anesthesiology and Perioperative Care Service; VA Palo Alto Health care System; 3801 Miranda Avenue (112A), Palo Alto, CA 94304, USA. Tel: +650 849 0254; fax: +650 852 3423; e-mail: emariano@stanford.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Anesthesia for electroconvulsive therapy

Purpose of review Electroconvulsive therapy (ECT) is a well established and effective therapy in treatment-resistant depression. It is performed under general anesthesia, but no consensus exists regarding the optimal anesthetic drugs. A growing interest in optimizing adjunctive medication regimes in ECT anesthesia has emerged in recent years. Moreover different methods of seizure induction have been evaluated. Recent findings Pretreatment with dexmedetomidine eased the propofol injection pain and reduced the hyperdynamic response to ECT, but prolonged recovery. Remifentanil exhibited no proconvulsive effect and had no effect on seizure quality. Ketamine showed an antidepressive effect but was associated with cardiovascular side effects and an increased recovery time. A bispectral index-guided anesthesia or a time delay between anesthesia and seizure induction resulted in a better seizure quality presumably by avoiding high concentrations of (anticonvulsive) hypnotics. Seizure induction by magnetism seems to be an alternative to ECT, as the former is associated with less cognitive side effects but comparable antidepressive efficacy. Summary The current practice of anesthesia for ECT should not be modified, as the evidence of studies is either too low or the results are inconsistent. Some approaches are promising but require validation in further studies with a higher number of participants. Correspondence to Prof Dr Martin Soehle, Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany. Tel: +49 228 28714127; e-mail: martin.soehle@ukbonn.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Recent developments in ultrasound imaging for neuraxial blockade

Purpose of review Recent research has shed further light on the place of ultrasound imaging in neuraxial blockade in routine clinical practice, its use in thoracic epidurals, and real-time ultrasound-guided techniques. Recent findings Compared with the conventional technique of surface landmark palpation, preprocedural ultrasound imaging minimizes technical difficulty associated with lumbar neuraxial blockade in patients with poor-quality surface landmarks. Novice practitioners are able to learn to employ the technique effectively. Safety benefits include a reduction in postprocedural back pain associated with fewer needle passes and a lower risk of procedure-associated bleeding. The advantage of ultrasound is minimal however in patients with easily discernible surface landmarks, especially if the practitioner is highly experienced. Recent trials show that preprocedural ultrasound scanning for thoracic epidural insertion reduces needle punctures and increases early analgesic efficacy compared with the palpation technique. Real-time ultrasound-guided techniques, while feasible, remain challenging and may not offer significant benefit over preprocedural imaging in lumbar neuraxial blockade. Their role in thoracic epidural insertion requires further investigation. Summary Ultrasound imaging of the spine is a valuable technique that, while not indicated for routine use, should be part of the skillset of any practitioner that regularly performs lumbar and thoracic neuraxial blockade. Correspondence to Ki Jinn Chin, MBBS, MMed, FRCPC, Department of Anesthesia, Toronto Western Hospital, 399 Bathurst St, McL 2–405, Toronto, Ontario M5T 2S8, Canada. Tel: +1 416 603 5118; fax: +1 416 603 6494; e-mail: gasgenie@gmail.com Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Influence of chronic alcoholism and estrogen deficiency on the immunohistochemical expression of regulatory proteins of the bone resorption process in the periodontium of Wistar rats

Publication date: Available online 10 July 2018

Source: Archives of Oral Biology

Author(s): Adriana Mathias Pereira da Silva Marchini, Gabriela de Fátima Santana-Melo, Miriane Carneiro Machado Salgado, Elis Andrade de Lima Zutin, Leonardo Marchini, Rosilene Fernandes da Rocha, Luana Marotta Reis de Vasconcellos

Abstract

OBJECTIVE

The aim of this study was to investigate possible changes in immunohistochemical expression of proteins regulating the bone resorption process in the periodontium of rats subjected to alcoholism and/or estrogen deficiency. The investigated proteins were receptor activator of nuclear factor-kappa β ligand (RANKL), a protein that stimulates bone resorption, and osteoprotegerin (OPG), a protein that inhibits bone resorption. At the molecular level, decreased OPG expression and/or increased RANKL expression are consistent with a greater predisposition to bone resorption.

DESIGN

Wistar female rats were divided into ovariectomized (ovx) and non-ovariectomized (sham) groups, and subdivided into ad libitum diet (free diet), alcoholic diet (20% solution), and isocaloric diet (diet with a similar amount of calories as compared with groups ingesting an alcoholic diet). The alveolar bone crest and adjacent tissues were evaluated by immunohistochemical analyses for detection of OPG and RANKL.

RESULTS

A significant decrease in OPG expression and a significant increase in RANKL expression were observed in ovariectomized animals which received alcohol as compared with non-ovariectomized animals which received isocaloric diet (experimental control). When estrogen deficiency was evaluated independently of the diet type, a significant decrease in OPG expression and a significant increase in RANKL expression were observed in ovariectomized animals as compared with non-ovariectomized animals.

CONCLUSIONS

Estrogen deficiency associated with alcoholic diet, as well as estrogen deficiency (analyzed independently of diet type), decreased the immunostaining for OPG and increased the immunostaining for RANKL in the periodontium of rats.

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Nature versus nurture in the spectrum of rheumatic diseases: Classification of spondyloarthritis as autoimmune or autoinflammatory

Publication date: Available online 11 July 2018

Source: Autoimmunity Reviews

Author(s): Elena Generali, Tanima Bose, Carlo Selmi, J. Willem Voncken, Jan G.M.C. Damoiseaux

Abstract

Spondyloarthritides (SpA) include inflammatory joint diseases with various clinical phenotypes that may also include the axial skeleton and/or entheses. SpA include psoriatic arthritis, reactive arthritis, enteropathic arthritis and ankylosing spondylitis; the latter is frequently associated with extra-articular manifestations, such as uveitis, psoriasis, and inflammatory bowel disease. SpA are associated with the HLA-B27 allele and recognize T cells as key pathogenetic players. In contrast to other rheumatic diseases, SpA affect women and men equally and are not associated with detectable serum autoantibodies. In addition, but opposite to rheumatoid arthritis, SpA are responsive to treatment regimens including IL-23 or IL-17-targeting biologics, yet are virtually unresponsive to steroid treatment. Based on these differences with prototypical autoimmune diseases, such as rheumatoid arthritis or connective tissue diseases, SpA may be better classified among autoinflammatory diseases, with a predominant innate immunity involvement. This would rank SpA closer to gouty arthritis and periodic fevers in the spectrum of rheumatic diseases, as opposed to autoimmune-predominant diseases. We herein provide available literature on risk factors associated with SpA in support of this hypothesis with a specific focus on genetic and environmental factors.

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Subclinical cardiovascular disease and Systemic Sclerosis: A comparison between risk charts, quantification of coronary calcium and carotid ultrasonography

Publication date: Available online 11 July 2018

Source: Autoimmunity Reviews

Author(s): I. Sanz Pérez, F. Martínez Valle, A. Guillén del Castillo, A. Roque Pérez, H. Cuéllar Calàbria, M.N. Pizzi, A. Fernández Codina, E. Callejas Moragas, O. Orozco Gálvez, V. Fonollosa Pla, C.P. Simeón Aznar

Abstract

Background and objectives

Recently published population-based cohort studies have shown a high prevalence of cardiovascular disease in Systemic Sclerosis (SSc) patients. The aim of this study is to compare three different methods to measure cardiovascular risk in patients with scleroderma.

Methods

Forty-three SSc patients were included. A prospective study was performed for evaluation of cardiovascular risk and subclinical atheromatosis using 3 non-invasive methods: cardiovascular risk tables, carotid Doppler ultrasonography and quantification of coronary calcium by computerized tomography (CT).

Results

The cardiovascular risk charts for the Spanish population did not identify patients at high cardiovascular risk. Framingham-REGICOR identified 13 intermediate-risk patients. Twenty-two patients (51.2%) had plaques on carotid ultrasonography. We performed a ROC curve to identify the best cutoff point for the quantification of coronary artery calcium (CACscore), the value of CACscore > 28 AU (Agatston Units) had the highest sensitivity (73%) and specificity (81%) for the diagnosis of subclinical atheromatosis. In the multiple regression study, age and decreased HDL cholesterol levels were identified as independent factors for subclinical atherosclerotic disease. No disease-related factors were associated with increased subclinical arteriosclerosis.

Conclusion

Carotid ultrasound and CACscore are useful for identifying subclinical atheromatosis in patients with SSc and are superior compared to risk charts used for general population. HDL cholesterol and age were independent factors for the presence of subclinical atherosclerotic disease. A carotid ultrasound or CT should be performed for early detection of subclinical atheromatosis if these factors are present.

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Inflammation and dementia: Using rheumatoid arthritis as a model to develop treatments?

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Alice Mason, Clive Holmes, Christopher J. Edwards

Abstract

Dementia is a major international public health problem which looks set to grow as the ageing population increases. Despite large amounts of investment there has been relatively little progress in developing new therapies to combat this. There is a growing body of evidence that both local and systemic inflammation are important in dementia; with cerebral inflammation occurring secondarily to beta-amyloid plaques, raised levels of serum inflammatory molecules and cytokines being present in Alzheimer's disease patients and systemic inflammation being associated with cerebral microvasculature disease in vascular dementia. Observational studies had suggested that non-steroidal anti-inflammatory drugs may reduce the risk of dementia, but subsequent interventional studies have been disappointing. More recently some observational studies have suggested a protective effect from conventional synthetic disease modifying anti-rheumatic drugs (csDMARDS) and tumour necrosis factor inhibiting (TNFi) biological therapies. Treatments for inflammatory rheumatic diseases have previously been repurposed and used successfully in other diseases, such as TNFi for inflammatory bowel disease. There are also studies looking at the use of csDMARDs such as methotrexate to improve outcomes after cardiovascular events. Ongoing interventional trials are currently looking at whether therapies designed to treat inflammatory and autoimmune diseases have the potential to be used to treat dementia.

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Efficacy and patient satisfaction in the use of subcutaneous immunoglobulin immunotherapy for the treatment of auto-immune neuromuscular diseases

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Taylor Pindi Sala, Jean-Charles Crave, Martin Duracinsky, Lepira Bompeka, Abir Tadmouri, Olivier Chassany, Patrick Cherin

Abstract

We reviewed the efficacy of SCIg administration in terms of muscle strength maintenance and patient satisfaction comparing with IVIg in the treatment of auto-immune neuromuscular diseases. A systematic review was conducted, and identified studies from databases (PUBMED, EMBASE, EBSCO, Web of Science and Google Scholar) which were analyzed. The methodological quality of the selected publications was evaluated using the Newcastle-Ottawa Scale. Data were extracted from a total of 11 studies Fixed and random-effect model meta-analyses were performed. For the maintenance of muscle strength, Overall Neuropathy Limitations Scale (ONLS) data from 100 patients diagnosed with multifocal mononeuropathy (MMN) or chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) were pooled together. Switching to subcutaneous immunoglobulin administration led to a significant improvement (fixed effects model, p = 0.002). In data collected using the Medical Research Council Scale for Muscle Strength data from 140 patients with a wider range of disorders, a small but significant improvement in overall strength was observed in the SCIg group (p < 0.0001). In addition, the results of two studies measuring health-related quality of life and patient satisfaction were pooled. Data from 49 patients suffering from MMN, CIDP, and a variety of different myopathies demonstrated a small but significant increase in the mean 36-Item Short Form Survey (SF-36) scores (p < 0.0001). A highly significant difference was revealed when comparing data from 119 patients' responses to the Life Quality Index questionnaire (LQI) assessing patient satisfaction (p < 0.0001). This is the first analysis showing that SCIg is more effective than IVIg in improving Patient Reported Outcomes in auto-immune neuromuscular disease. These results should permit a broad range of patients to self-administer immunoglobulin treatments at home, potentially improving patient acceptability while reducing hospital visits and healthcare costs for the treatment of chronic auto-immune neuropathies.

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Letter to the Editor: Autoimmune pathogenic mechanisms in Huntington's disease

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Antonio Greco, Massimo Ralli, Armando De Virgilio, Maurizio Inghilleri, Massimo Fusconi, Marco de Vincentiis

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Therapy of scleroderma renal crisis: State of the art

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Elisabetta Zanatta, Pamela Polito, Mariangela Favaro, Maddalena Larosa, Piero Marson, Franco Cozzi, Andrea Doria

Abstract

Scleroderma renal crisis (SRC) is an uncommon but still life-threatening manifestation of systemic sclerosis (SSc). The incidence of SRC has decreased in the last few decades, probably due to a widespread use of vasodilators in SSc patients. It is well-recognized that exposure to different drugs can trigger SRC (corticosteroids, cyclosporine) or prevent its occurrence (iloprost, calcium channel blockers). The prognosis of this life-threatening manifestation has not substantially improved since 1980s, when ACE-inhibitors were introduced in its treatment. ACE-inhibitors remain the mainstay in the therapy of SRC due to their efficacy in controlling malignant hypertension; indeed, the prognosis largely depends on the rapid improvement of the ongoing renal ischemia. Calcium-channel blockers and in third line diuretics and alpha-blockers should be used as additional therapy if blood pressure control remains suboptimal despite maximum tolerated doses of ACE-inhibitors. Given the growing evidence on the role of complement activation and endothelin-1 in the pathogenesis of SRC, recent case-series and case reports have suggested the use of C5-inhibitors and endothelin receptor antagonists in the therapy of SRC, mainly in the refractory cases. Plasma-exchange seems to give some benefits in patients with SRC and microangiopathy or intolerant to ACE-inhibitors. Renal transplantation is the last treatment option and its outcome is similar to that reported in other connective tissue disorders, with a 5-year patient survival rate of about 82%. In this review we summarize the current knowledge in the treatment of SRC.

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Drug-induced lupus: Traditional and new concepts

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Augusto Vaglio, Peter C. Grayson, Paride Fenaroli, Davide Gianfreda, Valeria Boccaletti, Gian Marco Ghiggeri, Gabriella Moroni

Abstract

Drug-induced lupus (DIL) includes a spectrum of drug-induced reactions often characterised by a clinical phenotype similar to that of idiopathic systemic lupus eruthematosus (SLE) but usually lacking major SLE complications. Different drugs may be associated with distinct clinical and serological profiles, and early recognition is crucial. Drugs traditionally associated with DIL include procainamide, hydralazine, quinidine and others, but strong associations with newer agents, such as TNF α (TNFα) inhibitors, are increasingly recognised. The pathogenic mechanisms explaining how drugs that have heterogeneous chemical structure and function lead to autoimmunity are only partially understood. However, it is likely that traditional DIL-associated agents can boost innate immune responses, particularly neutrophil responses, with neutrophil extracellular trap (NET) formation and exposure of autoantigens. Research in the field of DIL is evolving and may provide interesting models for the study of autoimmunity.

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Classification of primary antiphospholipid syndrome as systemic lupus erythematosus: Analysis of a cohort of 214 patients

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Romain Paule, Nathalie Morel, Véronique Le Guern, Micaela Fredi, Laetitia Coutte, Meriem Belhocine, Luc Mouthon, Claire le Jeunne, Anthony Chauvin, Jean-Charles Piette, Nathalie Costedoat-Chalumeau

Abstract

Objectives

To assess the limitations of the SLICC (Systemic Lupus International Collaborating Clinics) classification criteria for systemic lupus erythematosus (SLE), in patients with primary antiphospholipid syndrome (PAPS).

Methods

Retrospective study of a cohort of APS patients (Sydney criteria). We successively excluded patients with (1) at least one "SLE-specific" manifestation (biopsy-proven SLE nephropathy, arthritis, cutaneous, or neurologic SLE manifestations, pericarditis, autoimmune haemolytic anaemia, oral and nasal ulcers, non-scarring alopecia, anti-dsDNA, and anti-Sm antibodies), (2) any other autoimmune connective tissue disease, and/or (3) antinuclear antibodies >1/320. Careful file review confirmed PAPS among the remaining patients. We then assessed the number of SLICC criteria each patient met.

Results

Among these 214 APS patients, we excluded 85 with at least one SLE-specific manifestation, 8 with another connective tissue disease, and 21 with antinuclear antibodies >1/320, leaving 100 patients with primary APS. Among them, 28% met at least 4 SLICC classification criteria including one clinical and one immunological criterion (antiphospholipid antibodies, aPL, by definition) and could thus theoretically be classified with SLE. Fourteen had an arterial phenotype (50%), 9 a history of catastrophic APS (32%), and 18 a triple-positive profile for aPL (64%). None had developed SLE during a median follow-up of 12 [6.5–17] years.

Conclusion

Because 28% of our patients with longstanding and strictly defined PAPS could be mistakenly classified as SLE, they were at risk of deleterious therapeutic management. We therefore suggest that any future classification for SLE should specifically require at least one SLE-specific criterion for patients with aPL.

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HLA-G protein expression in colorectal cancer evaluated by immunohistochemistry and western blot analysis: Its expression characteristics remain enigmatic

Publication date: Available online 10 July 2018

Source: Clinical Immunology

Author(s): Marloes Swets, Anne Wouters, Daniëlle Krijgsman, Ronald L.P. van Vlierberghe, Arnoud Boot, Jaap D. van Eendenburg, Tom van Wezel, Hans Gelderblom, Cornelis J.H. van de Velde, Peter J. van den Elsen, Peter J.K. Kuppen

Abstract

HLA-G protein expression could play a role in evasion of tumor immune surveillance. Accumulating evidence demonstrates that HLA-G is expressed in different types of malignancies, including colorectal cancer (CRC). The purpose of the current study was to further unravel whether HLA-G protein expression could play a role in immune evasion of CRC. Therefore, to firmly establish HLA-G protein expression, eight early passage human CRC cell lines and five human rectal cancer tissues were analyzed by western blot analysis. The results obtained by western blot analysis were compared with immunohistochemistry on tumor tissue sections of the same patient. Furthermore, multiple monoclonal antibodies (mAbs), 4H84, MEM-G/1 and 5A6G7, targeting HLA-G were used to unravel staining patterns. We showed that results obtained with immunohistochemistry did not correlate with protein expression detected by western blot analysis, using three different HLA-G targeting mAbs. Furthermore, with respect to the specificity of the mAbs employed, additional immune reactivity was detected using the mAbs MEM-G/1 and 5A6G7 in western blot analysis with K562 control cell lines overexpressing HLA-A2 or HLA-G, all tumor tissues and in two out of eight CRC cell lines. Based on the current study and our previously reported results, we conclude that claiming HLA-G plays a role in immune modulation of CRC seems premature, as results from anti-body based detection of HLA-G protein remain inconclusive. Until the time that detection of HLA-G is sensitive enough to detect all aspects of HLA-G expression in biological samples, rather than transfected cells or long time cultured cell lines, conclusions should be drawn with great care.

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Oral Health Status of Children with Mouth Breathing Due to Adenotonsillar Hypertrophy

Publication date: Available online 11 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Elif Ballikaya, Bahar Guciz Dogan, Ovsen Onay, Meryem Tekcicek

Abstract

Objectives

Mouth breathing is an important health problem, commonly encountered in children. In children, adeno-tonsillar hypertrophy is the main reason causing partial or complete upper airway obstruction and reduction in airflow. This study aimed to determine the oral health status of children aged 3-15 years, with mouth breathing who were due to have surgery for adeno-tonsillar hypertrophy and referred to the Department of Otorhinolaryngology at Children's Hospital of a University in Ankara, Turkey between January-July 2015.

Methods

The approval of the Non-Interventional Clinical Researches Ethics Board of Hacettepe University and written informed consents from the parents were obtained. The parents completed a questionnaire before the surgery. The children were examined using dental mirror and explorer under dental unit lighting. Oral health status was evaluated with DMFT/S, dmft/s, ICDAS II, dental plaque and gingival indices. The chi-square test, Kruskal Wallis and Mann Whitney U tests were used to statistically analyse the results, with statistical significance p<0.05.

Results

Of the 170 children who had adenotonsillar hypertrophy with mouth breathing, 150 the parents agreed to participate the study. 77 of the children (51.3%) were male; the mean age was 5.9±2.6. Mean dmft was 3.8±3.6, dmfs 9.7±1.1, DMFT 0.4±1.0 and DMFS 0.6±1.5 respectively. Among the children, 101 (67.3%) had cavitated dental caries, and according to ICDAS II, none had healthy teeth, 15 (10.0%) had initial, 42 (28.0%) had moderate and 93 (62.0%) had advanced caries. Of the children, 89.3% had gingivitis and the proportion of gingivitis in posterior region was found to be significantly higher than anterior region (p<0,001).

Conclusions

The oral health status of mouth breathing in children with adeno-tonsillar hypertrophy was poor. To reduce the risk of dental caries and periodontal disease among these children, regular dental follow-up and preventive programmes for oral health are needed.

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A novel rat model for assessment of laryngotracheal injury following transoral intubation

Publication date: Available online 10 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jahshan F, Ertracht O, A. Abu-Amar, Ronen O, Srouji S, L. Apel-Sarid, Eisenbach N, Atar S, Sela E, Gruber M

Abstract

Objective

Laryngotracheal damage is a well-described complication of endotracheal intubation and animal models are essential for studying the underlying cellular injury cascade. This novel rat model is based on transoral intubation and aims to simulate the common clinical scenario of tube-related airway damage.

Methods

Prospective randomized control pilot study. 28 male Sprague-Dawley were randomly assigned into three groups: control, 3-h' intubation and 6-h' intubation. The animals were then euthanized and their laryngotracheal complexes sent for histological analysis. Epithelial damage, mucosal thickness and mucosal gland hypertrophy were reviewed.

Results

Total of 13 control animals and 15 intubated animals. 10 intubated animals survived the study protocol. Loss of epithelial surface architecture including damage to the microscopic ciliary mechanism was a common feature amongst all intubated animals. Average mucosal thickness of the larynx (including vocal cords and subglottic area) was 143±88 μm for control rats, 315±101 μm for rats intubated 3 h and 574±174 μm for rats intubated 6 h .This was a statistically significant difference. Average mucosal gland hypertrophy in the laryngeal subsite was 0.41±0.5 in control rats, 1.4±0.5 in rats intubated 3 h and 2.0±0.0 for rats intubated 6 h (statistically significant difference). There was a clear difference between three and 6 h of intubation with poorer mucosal injury parameters for longer intubation.

Conclusions

We describe a novel rat-based animal model for simulating airway mucosal damage following transoral intubation. This animal model is easy to carry out, reproducible and involves containable animal mortality rates.

https://ift.tt/2JgTqQe

Accuracy of Chest X-Ray Measurements of Pediatric Esophageal Coins

Publication date: Available online 10 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Phillip Huyett, Amber Shaffer, Linda Flom, Jeffrey P. Simons, Noel Jabbour

Abstract

Objective

To determine the accuracy of chest x-ray measurements in children using ingested radiopaque foreign bodies of known size.

Methods

A database of foreign body ingestions at a tertiary care children's hospital was queried from 2013-2016 for children who had ingested a US coin, had a pre-operative chest x-ray and documentation of coin type at the time of endoscopic removal. Four blinded research subjects measured the coin diameter on chest x-ray using iSite PACS software and based on the measurement, predicted the coin type. Measurements were compared to the known coin diameters published by the US Mint.

Results

A total of 51 patients with sixteen esophageal quarters (diameter 24.26 mm), fourteen nickels (21.21 mm), fourteen pennies (19.05 mm) and seven dimes (17.91 mm) were included in the study. The four subjects had a mean accuracy of 60.3% (range 49.0%-72.5%) in predicting the correct coin type. Across all raters, there was poor agreement for pennies (kappa=0.161) and dimes (kappa=0.131), fair agreement for nickels (kappa=0.259), good agreement for quarters (kappa=0.687), and fair agreement overall (kappa=0.371). The study measurements overestimated the coin size in 203 of the 204 measurements by a mean of 1.84 mm (range -0.31 to 3.85 mm). The mean size discrepancy was larger (2.40 vs. 1.30 mm, p<0.001) and accuracy of coin type identification was worse (44.6% vs. 74.1%, p=0.001) in children <4 years old.

Conclusions

Measurement of esophageal coins on chest x-ray is relatively inaccurate and overestimates the size in the majority of cases. Clinicians should use caution when performing fine measurements on chest x-rays, especially in children younger than 4 years old.

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Urinary Iodine Concentration and Mortality Among U.S. Adults

Thyroid, Volume 28, Issue 7, Page 913-920, July 2018.


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Correction to: Hypofractionated Radiotherapy Is Superior to Conventional Fractionation in an Orthotopic Model of Anaplastic Thyroid Cancer, by Oweida A, Phan A, Vancourt B, Robin T, Hararah MK, Bhatia S, Milner D, Lennon S, Pike L, Raben D, Haugen B, Pozdeyev N, Schweppe R, and Karam SD. Thyroid 2018;28:739–747. DOI: 10.1089/thy.2017.0706

Thyroid, Volume 28, Issue 7, Page 957-957, July 2018.


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Changing Trend of Thyroglobulin Antibodies in Patients With Differentiated Thyroid Cancer Treated With Total Thyroidectomy Without 131I Ablation

Thyroid, Volume 28, Issue 7, Page 871-879, July 2018.


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Thyroid Hypoplasia in Congenital Hypothyroidism Associated with Thyroid Peroxidase Mutations

Thyroid, Volume 28, Issue 7, Page 941-944, July 2018.


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Comparative Histopathologic Analysis of “Radiogenic” and “Sporadic” Papillary Thyroid Carcinoma: Patients Born Before and After the Chernobyl Accident

Thyroid, Volume 28, Issue 7, Page 880-890, July 2018.


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An InDel in Phospholipase-C-B-1 Is Linked with Euthyroid Multinodular Goiter

Thyroid, Volume 28, Issue 7, Page 891-901, July 2018.


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Future Meetings

Thyroid, Volume 28, Issue 7, Page 955-956, July 2018.


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Low-Activity Radioactive Iodine Therapy for Thyroid Carcinomas Exhibiting Nodal Metastases and Extrathyroidal Extension May Lead to Early Disease Recurrence

Thyroid, Volume 28, Issue 7, Page 902-912, July 2018.


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Gly m 5/Gly m 8 fusion component as a potential novel candidate molecule for diagnosing soybean allergy in Japanese children

Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.


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Association Between Serum CK-18 Levels and the Degree of Liver Damage in Fructose-Induced Metabolic Syndrome

Metabolic Syndrome and Related Disorders, Ahead of Print.


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Contributors

J. REGAN THOMAS, MD

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Copyright

ELSEVIER

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Injection Rhinoplasty Using Filler

Rhinoplasty is a commonly performed cosmetic surgery in Asia. Rhinoplasty using filler is preferred because has fewer side effects and shorter down time. The part of external nose between the skin and bone or cartilages consists of 4 layers. To prevent vascular compromise, the injection should be into deep fatty layer, preventing embolization. Filler is usually injected in the order of radix, rhinion, tip, and the supratip area. To minimize asymmetry, the surgeon should always mark the midline on the nasal bridge and perform the procedure without deviating from it.

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Alar Base Reduction and Alar-Columellar Relationship

Nasal base modification can improve nostril shape and orientation, reduce alar flaring, improve nasal base width, correct nasal hooding, improve symmetry, and create overall facial harmony. For the correction of alar rim deformities, careful examination, consultation, and analysis and consideration of the condition of the skin are essential. Understanding the ala and surrounding tissue, supporting the lower lateral cartilage, and selecting the proper technique produce functionally and aesthetically good results.

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Septal Extension Graft in Asian Rhinoplasty

A septal extension graft (SEG) can control nasal tip projection, shape, and rotation. SEG and dorsal alloplastic implants have predominated in Asian rhinoplasty, leading to iatrogenic complications such as a foreshortened nose and destruction of remaining septum. The lower nasal two-thirds can be enhanced anteriorly and caudally using the septal L-strut extension graft in Asians with relatively small noses. The septal L-strut extension graft is indicated in primary cases in which the bony dorsum is acceptable but the cartilaginous dorsum is relatively hypoplastic, and in secondary cases with an iatrogenic short-nose deformity due to alloplastic implants.

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Rhinoplasty for the Asian Nose

FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA

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Tip Grafting for the Asian Nose

Tip surgery during rhinoplasty is particularly difficult in Asians. Tip grafting is the best approach. Conchal cartilage with perichondrium and costal cartilage are powerful grafting materials. The most important grafting techniques are tip-onlay grafting, shield grafting, and multilayer tip grafting. Tip-onlay grafts are useful for dorsal convexity. Shield grafts require sufficient support to prevent bending. Multilayer tip grafts (usually 2 layers) are versatile. Asians vary in cartilage configuration, skin thickness, and aesthetic desires: tip-grafting strategies must be tailored to meet the aesthetic goals of individuals. Tip-grafting complications (eg, visible graft contour and infection) are not uncommon and should be considered.

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Contents

Yong Ju Jang

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Hump Nose Correction in Asians

Nasal hump surgery is frequently regarded as a reduction surgery in most Western rhinoplasty textbooks and referred to as reduction rhinoplasty. Most Asian hump noses have a small hump frequently associated with a low nasal dorsum and underprojection of the nasal tip. Correcting a hump nose in Asians has distinct differences in concept and technique. A small hump and additional need for augmentation of the dorsum and the tip often minimizes the amount of hump removal or obviates resection itself. Characteristics of the Asian hump nose with emphasis on surgical techniques commonly used to obtain reliable results are presented.

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Hybrid Approach for Asian Rhinoplasty

The hybrid approach delivers unlimited exposure and technical access, enabling all the procedures of the open approach. In addition, the hybrid approach is flexible in its extent of "dissection/ exposure" It can be more of a classic endonasal or limited access approach in some cases or open structural rhinoplasty and reconstruction in others. The benefits of the nonopen approach deserve equal attention among Asian rhinoplasty surgeons and residents-in-training courses. The difference is not merely that it spares an incision, it is an opportunity to fine-tune minor millimeters of changes in every step of rhinoplasty, a real and significant benefit.

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Forthcoming Issues

Current Utilization of Biologicals

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Truly Asian Rhinoplasty

It is a well-recognized fact that there is a distinctive quality to Asian Rhinoplasty when compared with rhinoplasty for patients from other regions. For Asian patients, especially from East and Southeast Asia, the relatively smaller sized noses have made simple augmentation of the nose using alloplastic implant stand in for the term "Rhinoplasty." However, with growing understanding of the diverse anatomical features of Asian noses and an increased sophistication in patients' aesthetic demands, Asian surgeons came to realize that "Asian Rhinoplasty" can be far more complex.

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Clinical Thyroidology®for the Public – Highlighted Article

From Clinical Thyroidology^® for the Public: The aim of this study was to determine whether selenium supplementation given to patients with Graves' disease who were starting treatment with methimazole resulted in improved response or remission rates Read More…

We welcome your feedback and suggestions. Let us know what you want to see in this publication.

Feedback & Suggestions

The post Clinical Thyroidology^®for the Public – Highlighted Article appeared first on American Thyroid Association.

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Einfluss einer strukturierten Nachsorge auf die Therapietreue bei OSAS-Patienten unter CPAP-Therapie

Laryngo-Rhino-Otol
DOI: 10.1055/a-0640-9198

Hintergrund Die Therapie mit CPAP (continuous positive airway pressure therapy) ist die Referenztherapie beim mittel- und hochgradigen obstruktiven Schlafapnoesyndrom (OSAS). Die Therapietreue bei diesem Verfahren ist jedoch nicht zufriedenstellend. Ziel der Untersuchung war die Analyse der Einflussfaktoren auf die Therapietreue sowie die Evaluation, ob eine strukturierte Nachsorge die Therapietreue verbessert. Material und Methoden In dieser Studie wurden alle Patienten (n = 237) mit der Diagnose eines milden bis schweren OSAS und einer neu angepassten CPAP-Therapie im Zeitraum zwischen 2011 und 2013 untersucht. Die Nachsorgetermine fanden alle 1593,7 ± 77,4 CPAP-Betriebsstunden statt. Ergebnisse Unter Therapie nahm der AHI-Wert (Apnoe-Hypopnoe-Index) signifikant ab (5,6 ± 8,5/h; p < 0,001). 79 % erfüllten die Kriterien einer CPAP-Therapietreue (mindestens 4 Betriebsstunden an 7 Tagen pro Woche). Es gab keine signifikanten Einflüsse von demografischen, klinischen oder pharmakologischen Charakteristika der Patienten auf die Therapietreue. Die häufigsten Probleme unter CPAP-Therapie waren Trockenheit der Nasen- und Rachenschleimhäute (43,7 %) und Druckstellen (22,4 %). Die CPAP-Therapietreue korrelierte nicht mit den Werten der Epworth Sleepiness Scale. Die Zufriedenheit mit der Nachsorge korrelierte signifikant mit der Therapietreue (r = 0,185; p = 0,032), während der Therapiedruck keinen signifikanten Einfluss hierauf zeigte (r = −0,072; p = 0,383). Schlussfolgerungen Eine strukturierte, individuell angepasste Nachsorge ist wichtig für die Therapietreue. In Zukunft sollte im Rahmen der Nachsorge neben der Kontrolle des Therapieerfolges mehr Aufmerksamkeit auf Aspekte der Problemlösung, Rückkopplung, Schulung und Motivation gerichtet werden.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Erratum: Economic Analysis of Using Free Fat Graft or Acellular Dermis to Prevent Post-parotidectomy Frey Syndrome

Facial plast Surg
DOI: 10.1055/s-0038-1667294

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

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Regular follow-up visits reduce the risk for asthma exacerbation requiring admission in Korean adults with asthma

Asthma requires regular follow-up visits and sustained medication use. Although several studies have reported the importance of adherence to medication and compliance with the treatment, none to date have repo...

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Does long-term success from endoscopic DCR correlate with early post-operative reduction in tearing?

The purpose of the study was to determine the association between early post-operative improvement in tearing and the long-term success rate of endoscopic dacryocystorhinostomy (eDCR).

https://ift.tt/2NGse0P

Interleukin-18 as a diagnostic marker of adult-onset Still’s disease in older patients: a case report and review of the literature

Adult onset Still's disease is a systemic auto-inflammatory condition of unknown etiology characterized by intermittent spiking high fever, an evanescent salmon-pink or erythematous maculopapular skin rash, ar...

https://ift.tt/2KP8WZi

Remote partner assisted skin self‐examination skills training of melanoma survivors and their partners

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2L7dMNy

Alcohol‐induced respiratory symptoms improve after aspirin desensitization in patients with aspirin‐exacerbated respiratory disease

International Forum of Allergy &Rhinology, EarlyView.


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Reply to Yoshida: Liver cancer stem cells: Identification and lipid metabolic reprogramming [Biological Sciences]

As a molecular basis by which acyclic retinoid (ACR) prevents recurrence of hepatocellular carcinoma (HCC), we identify MYCN+ liver cancer stem cell (CSC)-like cell serves as a biomarker and therapeutic target to be selectively eliminated by ACR (1). In the Letter by Yoshida (2), the author makes two important comments...

https://ift.tt/2un0Hsx

Reply to Huang et al.: Avoiding “one-size-fits-all” approaches to variant discovery [Biological Sciences]

Huang et al. (1) argue that variant calling methods less conservative than GATK's Best Practices workflow (2) increased false-positive variant discovery in our study of wild and cultivated potatoes (3), impacting diversity estimates. We disagree with their conclusion and highlight the rationale for the variant calling methods used in our...

https://ift.tt/2un0GVv

Genome diversity of the potato [Biological Sciences]

In a recent issue of PNAS, Hardigan et al. (1) state that the genetic diversity of the potato is much greater than that of other major crops, based on 68.9 million SNPs identified from the resequencing of 67 accessions of wild and cultivated potatoes. We questioned this conclusion based on...

https://ift.tt/2u6Kpoq

Correction for Edwards et al., Insight from the maximal activation of the signal transduction excitable network in Dictyostelium discoideum [Correction]

CELL BIOLOGY Correction for "Insight from the maximal activation of the signal transduction excitable network in Dictyostelium discoideum," by Marc Edwards, Huaqing Cai, Bedri Abubaker-Sharif, Yu Long, Thomas J. Lampert, and Peter N. Devreotes, which was first published March 30, 2018; 10.1073/pnas.1710480115 (Proc Natl Acad Sci USA 115:E3722–E3730). The authors...

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Correction for Lampert et al., Shear force-based genetic screen reveals negative regulators of cell adhesion and protrusive activity [Correction]

CELL BIOLOGY Correction for "Shear force-based genetic screen reveals negative regulators of cell adhesion and protrusive activity," by Thomas J. Lampert, Nadine Kamprad, Marc Edwards, Jane Borleis, Ayende J. Watson, Marco Tarantola, and Peter N. Devreotes, which was first published August 28, 2017; 10.1073/pnas.1616600114 (Proc Natl Acad Sci USA 114:E7727–E7736)....

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Correction for LeClere et al., Cross-resistance to dicamba, 2,4-D, and fluroxypyr in Kochia scoparia is endowed by a mutation in an AUX/IAA gene [Correction]

AGRICULTURAL SCIENCES Correction for "Cross-resistance to dicamba, 2,4-D, and fluroxypyr in Kochia scoparia is endowed by a mutation in an AUX/IAA gene," by Sherry LeClere, Chenxi Wu, Philip Westra, and R. Douglas Sammons, which was first published March 12, 2018; 10.1073/pnas.1712372115 (Proc Natl Acad Sci USA 115:E2911–E2920). The authors wish...

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Degradation of unmethylated miRNA/miRNA*s by a DEDDy-type 3' to 5' exoribonuclease Atrimmer 2 in Arabidopsis [Plant Biology]

The 3′ end methylation catalyzed by HUA Enhancer 1 (HEN1) is a crucial step of small RNA stabilization in plants, yet how unmethylated small RNAs undergo degradation remains largely unknown. Using a reverse genetic approach, we here show that Atrimmer 2 (ATRM2), a DEDDy-type 3′ to 5′ exoribonuclease, acts in...

https://ift.tt/2u7byqW

Multigenome analysis implicates miniature inverted-repeat transposable elements (MITEs) in metabolic diversification in eudicots [Plant Biology]

Plants produce a plethora of natural products, including many drugs. It has recently emerged that the genes encoding different natural product pathways may be organized as biosynthetic gene clusters in plant genomes, with >30 examples reported so far. Despite superficial similarities with microbes, these clusters have not arisen by horizontal...

https://ift.tt/2zq74AS

Real-time dynamics of mutagenesis reveal the chronology of DNA repair and damage tolerance responses in single cells [Genetics]

Evolutionary processes are driven by diverse molecular mechanisms that act in the creation and prevention of mutations. It remains unclear how these mechanisms are regulated because limitations of existing mutation assays have precluded measuring how mutation rates vary over time in single cells. Toward this goal, I detected nascent DNA...

https://ift.tt/2zrkn4b

Direct cell-cell contact activates SigM to express the ESX-4 secretion system in Mycobacterium smegmatis [Microbiology]

Conjugal cell–cell contact between strains of Mycobacterium smegmatis induces the esxUT transcript, which encodes the putative primary substrates of the ESAT-6 secretion system 4 (ESX-4) secretion system. This recipient response was required for conjugal transfer of chromosomal DNA from the donor strain. Here we show that the extracytoplasmic σ factor,...

https://ift.tt/2uicbxm

Vibrational coherence transfer in the ultrafast intersystem crossing of a diplatinum complex in solution [Chemistry]

We investigate the ultrafast transient absorption response of tetrakis(μ-pyrophosphito)diplatinate(II), [Pt2(μ-P2O5H2)4]4− [hereafter abbreviated Pt(pop)], in acetonitrile upon excitation of its lowest singlet 1A2u state. Compared with previously reported solvents [van der Veen RM, Cannizzo A, van Mourik F, Vlček A, Jr, Chergui M (2011) J Am Chem Soc 133:305–315], a significant...

https://ift.tt/2u9tn98

Disrupting LXR{alpha} phosphorylation promotes FoxM1 expression and modulates atherosclerosis by inducing macrophage proliferation [Medical Sciences]

Macrophages are key immune cells for the initiation and development of atherosclerotic lesions. However, the macrophage regulatory nodes that determine how lesions progress in response to dietary challenges are not fully understood. Liver X receptors (LXRs) are sterol-regulated transcription factors that play a central role in atherosclerosis by integrating cholesterol...

https://ift.tt/2zmVHd0

Kinetically guided radical-based synthesis of C(sp3)-C(sp3) linkages on DNA [Chemistry]

DNA-encoded libraries (DEL)-based discovery platforms have recently been widely adopted in the pharmaceutical industry, mainly due to their powerful diversity and incredible number of molecules. In the two decades since their disclosure, great strides have been made to expand the toolbox of reaction modes that are compatible with the idiosyncratic...

https://ift.tt/2uicus0

Piano training enhances the neural processing of pitch and improves speech perception in Mandarin-speaking children [Neuroscience]

Musical training confers advantages in speech-sound processing, which could play an important role in early childhood education. To understand the mechanisms of this effect, we used event-related potential and behavioral measures in a longitudinal design. Seventy-four Mandarin-speaking children aged 4–5 y old were pseudorandomly assigned to piano training, reading training,...

https://ift.tt/2uic4lq

Gentamicin induces LAMB3 nonsense mutation readthrough and restores functional laminin 332 in junctional epidermolysis bullosa [Genetics]

Herlitz junctional epidermolysis bullosa (H-JEB) is an incurable, devastating, and mostly fatal inherited skin disease for which there is only supportive care. H-JEB is caused by loss-of-function mutations in LAMA3, LAMB3, or LAMC2, leading to complete loss of laminin 332, the major component of anchoring filaments, which mediate epidermal-dermal adherence....

https://ift.tt/2uichFe

Developmental prosopagnosics have widespread selectivity reductions across category-selective visual cortex [Psychological and Cognitive Sciences]

Developmental prosopagnosia (DP) is a neurodevelopmental disorder characterized by severe deficits with facial identity recognition. It is unclear which cortical areas contribute to face processing deficits in DP, and no previous studies have investigated whether other category-selective areas function normally in DP. To address these issues, we scanned 22 DPs...

https://ift.tt/2un0CoJ

Autoantibodies reactive to adrenocorticotropic hormone can alter cortisol secretion in both aggressive and nonaggressive humans [Medical Sciences]

Violent aggression in humans may involve a modified response to stress, but the underlying mechanisms are not well understood. Here we show that naturally present autoantibodies reactive to adrenocorticotropic hormone (ACTH) exhibit distinct epitope-binding profiles to ACTH peptide in subjects with a history of violent aggression compared with controls. Namely,...

https://ift.tt/2zmVFBU

Unusual duplication mutation in a surface loop of human transthyretin leads to an aggressive drug-resistant amyloid disease [Biochemistry]

Transthyretin (TTR) is a globular tetrameric transport protein in plasma. Nearly 140 single amino acid substitutions in TTR cause life-threatening amyloid disease. We report a one-of-a-kind pathological variant featuring a Glu51, Ser52 duplication mutation (Glu51_Ser52dup). The proband, heterozygous for the mutation, exhibited an unusually aggressive amyloidosis that was refractory to...

https://ift.tt/2u58DPN

Infratemporal fossa tumors: When to suspect a malignant tumor? A retrospective cohort study of 62 cases

Publication date: Available online 10 July 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): Q. Lisan, N. Leclerc, R. Kania, J.-P. Guichard, P. Herman, B. Verillaud

Abstract

Objectives

Infratemporal fossa (ITF) tumors are rare and little is known about their general epidemiology, making it sometimes difficult for clinicians, who seldom encounter them, to distinguish between benign and malignant forms on the basis of the initial clinical and radiological work-up alone. The objectives of this retrospective study were: (i) to determine the respective prevalences of the various histologic types of ITF tumor, and (ii) to assess associations between certain clinical and radiological features and malignancy.

Methods

A single-center observational study in a university hospital included all new consecutive cases of ITF tumor treated from January 2000 to December 2016. Histologic type, demographics, clinical presentation and imaging findings were analyzed.

Results

In total, 62 patients were included. 74% of tumors were benign (n = 46) and 26% malignant. Juvenile nasopharyngeal angiofibroma, adenoid cystic carcinoma and schwannoma were the most frequent histologic types, accounting for 47%, 16% and 10% of cases, respectively. The only clinical or imaging signs significantly associated with malignancy were trismus, facial pain, facial hypoesthesia and neural invasion on magnetic resonance imaging (all P-values < 0.05).

Conclusion

This study provides general epidemiological data on ITF tumors, and identified several clinical and radiologic signs to help clinicians suspect malignancy.

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NCI and VA collaborate to boost veterans’ access to cancer clinical trials

NCI and the Department of Veterans Affairs (VA) are launching the NAVIGATE program at 12 VA facilities across the country to make it easier for veterans to participate in NCI-sponsored clinical trials.

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Multisystem amyloidosis as the unifying diagnosis for constipation, collapse and cardiomyopathy

Amyloidosis a rare disorder characterised by the deposition of amyloid protein aggregates in different organ systems throughout the body with resulting functional impairment of affected organs. It can present with localised or multisystemic deposits. Diagnosis is often delayed due to the non-specific nature of the symptoms. We present the case of a 59-year-old man with a 12-month history of non-specific symptoms. Investigations revealed Helicobacter pylori positive gastritis. Blood tests showed only a normocytic anaemia and thrombocytopaenia. CT scan showed proximal sigmoid thickening. Biopsies were unremarkable. Echocardiogram and cardiac MRI scan showed restrictive cardiomyopathy. Congo red staining of gastric biopsies showed amyloid deposition. The patient had elevated serum kappa light chains and a bone marrow biopsy confirmed multiple myeloma and he was subsequently diagnosed with systemic light chain (AL) amyloidosis secondary to this. He was started on chemotherapy and parenteral nutrition; however, he deteriorated rapidly and so was started on palliative treatment and discharged home.

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Bilateral serpentine radio-opaque shadows near the urinary bladder: nothing but calcified vas deferens!

Description

A 77-year-old man presented with voiding lower urinary tract symptoms with history of terminal haematuria. His ultrasonography (USG) was suggestive of a 58 g prostate with thickened urinary bladder walls along with two vesical calculi. A plain X-ray was taken that showed two radio-opaque shadows in the urinary bladder corresponding to vesical calculi reported on the USG. Along with that there were two serpentine radio-opaque shadows on each side of the urinary bladder (figure 1). The primary care physician thought these shadows to be ureteric calculi/calcification and referred the patient to our centre for further workup and management. On carefully reviewing the X-ray we immediately recognised that the serpentine radio-opaque shadows were nothing but bilaterally calcified vas deferens. The shadow on the left also had a characteristic pattern of loop that the vas makes during its course towards the inguinal canal. The patient was non-diabetic and...

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A case of posterior reversible encephalopathy syndrome associated with sepsis

Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterised by parieto-occipital vasogenic oedema seen on MRI. Infection and sepsis has been reported as a possible cause for this disorder.

We present a 19-year-old immunocompetent Caucasian man with known type 1 diabetes mellitus who presented to the emergency department with acute onset of bilateral visual loss, headaches and hypertension; he had been discharged 2 weeks ago for severe diabetic ketoacidosis and Staphylococcus aureus bacteraemia. Initial CT scan of the head was negative, but MRI showed findings suggestive of PRES. He was treated with nicardipine drip for strict blood pressure management and symptoms resolved within 4 days. PRES is a rare disease that has been increasingly reported as MRI becomes more commonplace. Usually associated with immunological disease, pre-eclampsia and cytotoxic therapies but an association with sepsis due to gram-positive bacteria.

https://ift.tt/2ukOzbz

Gluten-free diet: a possible treatment for chronic diarrhoea in common variable immunodeficiency

Gastrointestinal disorders are frequent in common variable immunodeficiency (CVID). Clinical symptoms and histological alterations in CIVD can resemble celiac disease. Usually, patients with chronic diarrhoea associated with CVID do not improve with a gluten-free diet. The authors present a case of a male patient who was diagnosed with CVID at age 33 and had chronic diarrhoea which resolved after initiating a gluten-free diet. Clinical relapse occurred after gluten reintroduction. The main objective of this case report is to alert clinicians to implement a gluten-free diet in patients with CVID with chronic diarrhoea.

https://ift.tt/2u7o3TC

Unusual surgical emergency in a patient of dengue haemorrhagic fever: spontaneous rectus sheath haematoma leading to abdominal compartment syndrome

Abdominal compartment syndrome (ACS) is an uncommon complication of dengue haemorrhagic fever (DHF), described so far only in association with fluid refractory shock and high-volume resuscitation. We describe an unusual case of ACS in a patient of DHF where raised intra-abdominal pressure was due to spontaneous rectus sheath haematoma causing external compression. Early recognition of the haematoma, constant vigilance and timely decision for surgical intervention could salvage the patient with complete recovery of organ function.

https://ift.tt/2zoj5XN

A novel mutation in Wiskott-Aldrich gene manifesting as macrothrombocytopenia and neutropenia

Wiskott-Aldrich syndrome (WAS) is a rare X-linked disorder, described as a clinical triad of microthrombocytopenia, eczema and recurrent infections. Different mutations in WAS gene have been identified, resulting in various phenotypes and a broad range of disease severity, ranging from classic WAS to X-linked thrombocytopenia and X-linked neutropenia. WAS in some cases can be fatal without haematopoietic stem cell transplantation early in life. In this particular case, we present a novel mutation with a unique presentation. An 18-year-old man incidentally found to have macrothrombocytopenia and neutropenia at 16 years of age later found to be hemizygous for c. 869T>C (p.Ile290Thr) mutation in WAS gene. The late presentation, absence of other manifestations of WAS and presence of macrothrombocytopenia, rather than microthrombocytopenia, which is usually a characteristic finding in WAS, misled the initial diagnosis. On review of literature, this mutation has not been reported as causing WAS.

https://ift.tt/2zpBKSO

Rectus sheath haematoma causing ureteric obstruction

Rectus sheath haematoma is an uncommon condition. However, its incidence is increasing, attributed to greater use of anticoagulant therapy. We present the case of an 83-year-old woman on therapeutic enoxaparin for a prior pulmonary embolus who underwent elective right hemicolectomy and developed a rectus sheath haematoma 13 days postoperatively. Her extensive haematoma compressed retroperitoneal structures including the right ureter. She was successfully managed conservatively.

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Giant abdominal metastasis from cardiac liposarcoma

Description 

The patient was a 58-year-old man. His history began 6 years before the admission to our hospital because of a syncopal episode. MRI showed a 2 cm lesion at the confluence of the left pulmonary veins. It was surgically removed and the histopathological diagnosis was of 'pleomorphic liposarcoma'. The postoperative course was regular.

Since the patient lived in a rural area, he was not treated in a high-volume reference centre for sarcoma and follow-up was not managed by a dedicated multidisciplinary team. Three years later, for the onset of an intestinal occlusion, he underwent emergency laparotomy. An ileo-ileal invagination due to a little ileal lesion was treated with a 30 cm intestinal resection. The histopathological response was again of liposarcoma. Chemotherapy was not performed.

One year later, a thoracoabdominal CT scan showed a heart recurrence and an enormous abdominal mass involving many ileal loops with intestinal subocclusion. The patient...

https://ift.tt/2u6feJU

Mixed extragonadal germ cell tumour of the prostate

Extragonadal germ cell tumours (EGGCTs) originated in prostate are extremely rare, with <20 cases described in the literature. We report a case of a patient with a primary prostatic mixed EGGCT. A 47-year-old man presenting severe low urinary tract symptoms and signs of prostatic enlargement, with no malignancy suspicion, underwent transurethral resection of the prostate. The histopathological evaluation suggested the diagnosis of a retroperitoneal sarcoma. The patient underwent neoadjuvant chemotherapy and then was submitted to radical cystoprostatectomy. Histology revealed a mixed EGGCT of the prostate with yolk sac tumour and seminoma components. No testicular abnormalities were identified on the postoperative scrotal ultrasound. The patient went through four cycles of chemotherapy with bleomycin, etoposide and cisplatin. After 12 months of follow-up, the patient is alive and free of recurrence.

https://ift.tt/2u6dEYs

Recurrent minor strokes/TIA with a right to left shunt

A patient came to our institution for evaluation and closure of suspected patent foramen ovale actively manifesting as cerebrovascular accident. Through further studies, we found the presence of a pulmonary arteriovenous fistula, which was subsequently and successfully closed through non-invasive percutaneous selective segmental pulmonary artery embolisation.

https://ift.tt/2zoiJAr

Empirical treatment of tuberculosis: TB or not TB?

Of the 8.6 million new cases of tuberculosis (TB) that occur globally each year, a quarter occur in India. We describe the case of a 38-year-old Indian woman who presented with symptoms of hepatitis after being treated empirically with anti-TB therapy for five months. The patient was suspected to have TB after having recurrent episodes of coughing which would improve briefly before her respiratory symptoms returned, which led to her being treated at various healthcare clinics and hospitals. We highlight the challenges the patient faced due to the lack of centralised medical records which would have prevented unnecessary investigations and treatment.

https://ift.tt/2u6fdFQ

Cold agglutinin-mediated autoimmune haemolytic anaemia associated with diffuse large B cell lymphoma

Cold agglutinin-mediated autoimmune haemolytic anaemia is associated with the development of autoantibodies that can agglutinate red blood cells at cold temperatures. While primary cold agglutinin disease is an idiopathic lymphoproliferative disorder, secondary cold agglutinin syndrome (CAS) complicates other diseases such as infections, autoimmune diseases and cancers, mostly low-grade lymphomas. Early recognition, treatment of CAS and treatment of its associated underlying diseases are crucial to a successful outcome. We report a case of CAS in a setting of diffuse large B cell lymphoma, in which the treatment course was complicated by worsened anaemia due to chemotherapy-induced myelosuppression. We reviewed previously reported cases and discussed diagnosis and treatment strategies, including novel complement inhibitors, as potential future therapy.

https://ift.tt/2zsNyUo

Postoperative diffuse alveolar haemorrhage: insidious negative pressure or sevoflurane induced?

Negative pressure pulmonary oedema is well described in the literature as an uncommon but recognised complication of general anaesthe sia; negative pressure diffuse alveolar haemorrhage is a rarer consequence. We report a case of massive haemoptysis following elective general anaesthesia using a laryngeal mask airway device and sevoflurane anaesthetic maintenance. The patient had no obvious signs of laryngospasm or other cause of upper airway obstruction perioperatively. We explore the possibility that the haemoptysis was caused by clinically unapparent negative pressure generation, but also ask whether the anaesthetic agent should be considered as a culprit.

https://ift.tt/2u8P218

Hybrid Monte Carlo on Hilbert spaces

Beskos, A; Pinski, FJ; Sanz-Serna, JM; Stuart, AM; (2011) Hybrid Monte Carlo on Hilbert spaces. Stochastic Processes and their Applications , 121 (10) pp. 2201-2230. 10.1016/j.spa.2011.06.003 . Green open access

https://ift.tt/2KXvE0G

Atrial fibrillation monitoring to reduce thromboembolic risk: Selecting the patient and the monitoring device

Barra, S; Providência, R; (2017) Atrial fibrillation monitoring to reduce thromboembolic risk: Selecting the patient and the monitoring device. Revista Portuguesa de Cardiologia , 36 (7-8) pp. 547-549. 10.1016/j.repc.2016.12.011 . Green open access

https://ift.tt/2L1EvLz

Using the forward movement of a container ship navigating in the Arctic to air-cool a marine organic Rankine cycle unit

Greig, AR; Suárez de la Fuente, S; Bucknall, R; Pawling, R; Larsen, U; Kerdan, IG; (2018) Using the forward movement of a container ship navigating in the Arctic to air-cool a marine organic Rankine cycle unit. Energy , 159 pp. 1046-1059. 10.1016/j.energy.2018.06.143 .

https://ift.tt/2KXvhDk

The effect of modulating the dystrophic skeletal muscle environment on satellite cell engraftment

Doreste Gonzalez, Bruno; (2018) The effect of modulating the dystrophic skeletal muscle environment on satellite cell engraftment. Doctoral thesis (Ph.D), UCL (University College London).

https://ift.tt/2L6QiZc

Device complications with addition of defibrillation to cardiac resynchronisation therapy for primary prevention

Barra, S; Providência, R; Boveda, S; Duehmke, R; Narayanan, K; Chow, AW; Piot, O; ... Marijon, E; + view all Barra, S; Providência, R; Boveda, S; Duehmke, R; Narayanan, K; Chow, AW; Piot, O; Klug, D; Defaye, P; Gras, D; Deharo, JC; Milliez, P; Da Costa, A; Mondoly, P; Gonzalez-Panizo, J; Leclercq, C; Heck, P; Virdee, M; Sadoul, N; Le Heuzey, JY; Marijon, E; - view fewer (2018) Device complications with addition of defibrillation to cardiac resynchronisation therapy for primary prevention. Heart 10.1136/heartjnl-2017-312546 . (In press). Green open access

https://ift.tt/2KXvbLY

Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate

Barra, S; Boveda, S; Providência, R; Sadoul, N; Duehmke, R; Reitan, C; Borgquist, R; ... French-UK-Sweden CRT Network, .; + view all Barra, S; Boveda, S; Providência, R; Sadoul, N; Duehmke, R; Reitan, C; Borgquist, R; Narayanan, K; Hidden-Lucet, F; Klug, D; Defaye, P; Gras, D; Anselme, F; Leclercq, C; Hermida, J-S; Deharo, J-C; Looi, K-L; Chow, AW; Virdee, M; Fynn, S; Le Heuzey, J-Y; Marijon, E; Agarwal, S; French-UK-Sweden CRT Network, .; - view fewer (2017) Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate. Journal of the American College of Cardiology , 69 (13) pp. 1669-1678. 10.1016/j.jacc.2017.01.042 . Green open access

https://ift.tt/2L5Gy1h

Long non-coding RNA repertoire and targeting by nuclear exosome, cytoplasmic exonuclease and RNAi in fission yeast

Atkinson, S; Marguerat, S; Bitton, D; Bachand, F; Rodriguez-Lopez, M; Rallis, C; Lemay, J-F; ... Bahler, J; + view all Atkinson, S; Marguerat, S; Bitton, D; Bachand, F; Rodriguez-Lopez, M; Rallis, C; Lemay, J-F; Cotobal, C; Malecki, M; Smialowski, P; Mata, J; Korber, P; Bahler, J; - view fewer (2018) Long non-coding RNA repertoire and targeting by nuclear exosome, cytoplasmic exonuclease and RNAi in fission yeast. RNA 10.1261/rna.065524.118 . (In press). Green open access

https://ift.tt/2KXv574

Increased midlife triglycerides predict brain -amyloid and tau pathology 20 years later

Nagga, K; Gustavsson, A-M; Stomrud, E; Lindqvist, D; van Westen, D; Blennow, K; Zetterberg, H; ... Hansson, O; + view all Nagga, K; Gustavsson, A-M; Stomrud, E; Lindqvist, D; van Westen, D; Blennow, K; Zetterberg, H; Melander, O; Hansson, O; - view fewer (2017) Increased midlife triglycerides predict brain -amyloid and tau pathology 20 years later. Neurology , 90 (1) e73-e81. 10.1212/WNL.0000000000004749 . Green open access

https://ift.tt/2Jbh29b

Increased levels of ascorbic acid in the cerebrospinal fluid of cognitively intact elderly patients with major depression: a preliminary study

Hashimoto, K; Ishima, T; Sato, Y; Bruno, D; Nierenberg, J; Marmar, CR; Zetterberg, H; ... Pomara, N; + view all Hashimoto, K; Ishima, T; Sato, Y; Bruno, D; Nierenberg, J; Marmar, CR; Zetterberg, H; Blennow, K; Pomara, N; - view fewer (2017) Increased levels of ascorbic acid in the cerebrospinal fluid of cognitively intact elderly patients with major depression: a preliminary study. Scientific Reports , 7 , Article 3485. 10.1038/s41598-017-03836-0 . Green open access

https://ift.tt/2KXyUJu

Synthesis and Conformational Studies of the Lipid II-Binding Rings of Nisin and Mutacin I

Dickman, Rachael; (2018) Synthesis and Conformational Studies of the Lipid II-Binding Rings of Nisin and Mutacin I. Doctoral thesis (Ph.D), UCL (University College London).

https://ift.tt/2KYpmxO

Rapid hull collapse strength calculations of double hull oil tankers after collisions

Faisal, M; Noh, SH; Kawsar, MRU; Youssef, SAM; Seo, JK; Ha, YC; Paik, JK; (2017) Rapid hull collapse strength calculations of double hull oil tankers after collisions. Ships and Offshore Structures , 12 (5) pp. 624-639. 10.1080/17445302.2016.1192747 . Green open access

https://ift.tt/2Jcu3PB

Ultimate strength of cylindrical shells with cutouts

Lee, SE; Sahin, S; Rigo, P; Park, M; Paik, JK; (2017) Ultimate strength of cylindrical shells with cutouts. Ships and Offshore Structures , 12 (Supp 1) S153-S173. 10.1080/17445302.2016.1271592 . Green open access

https://ift.tt/2KZDkzl

Ultimate limit state-based multi-objective optimum design technology for hull structural scantlings of merchant cargo ships

Kim, DH; Paik, JK; (2017) Ultimate limit state-based multi-objective optimum design technology for hull structural scantlings of merchant cargo ships. Ocean Engineering , 129 pp. 318-334. 10.1016/j.oceaneng.2016.11.033 . Green open access

https://ift.tt/2KZD8QD

Negative Ions in Outer Solar System Plasmas: TItan, Europa & Rhea

Desai, RT; (2018) Negative Ions in Outer Solar System Plasmas: TItan, Europa & Rhea. Doctoral thesis (Ph.D), UCL (University College London). Green open access

https://ift.tt/2L447aI

Growing Scientific Thinking with Fictional Picture Books: Questioning and Imagination in Early Years

Tunnicliffe, SD; Bruguière, C; (2017) Growing Scientific Thinking with Fictional Picture Books: Questioning and Imagination in Early Years. In: Costa, MFPCM and Dorrío, BVJ, (eds.) Hands-on Science: Growing with Science. (pp. pp. 16-19). The Hands-on Science Network (HSCI) Green open access

https://ift.tt/2L48dCK

Research Update: Cellular “Garbage Disposal” Has Another Job

Johns Hopkins researchers have found that the cellular "garbage disposal," known to scientists as proteasomes, may not only be responsible for the removal of cellular waste, but actually work on some of the most important proteins to neuronal development.

https://ift.tt/2ukWKVc

Lineäre, irregulär konfigurierte Pigmentierungen am gesamten Integument

https://ift.tt/2m57GCs

Traumatologie der Orbita

Zusammenfassung

Hintergrund

Bei einem Trauma des Gesichtsschädels ist eine begleitende Fraktur der Orbita wegen der anatomischen Gegebenheiten (Stützpfeilersystem des Mittelgesichts) häufig. Ätiologisch sind die Ursachen nach lokoregionalen Gegebenheiten vielfältig.

Material/Methoden

Es wird ein Überblick über die Traumatologie der Orbita einschließlich des diagnostischen Vorgehens, der Symptome und der Therapie gegeben. Darüber hinaus erfolgte eine prospektive Analyse am eigenen Patientenkollektiv eines Jahres inklusive eines 5‑Jahres-Follow-up.

Ergebnisse

Die möglichen Frakturen des Mittelgesichts mit Beteiligung der Orbita einschließlich ihrer Klassifikationen werden aufgeführt. Auch die entscheidenden klinischen Symptome und das diagnostische Vorgehen werden dargestellt. Im Rahmen des therapeutischen Vorgehens werden neben dem – meist erforderlichen – operativen Therapieansatz auch die konservativen Therapieoptionen und deren Voraussetzung zur konservativen Therapie aufgezeigt. Im eigenen Patientenkollektiv zeigten sich deutliche Unterschiede im Entstehungsmechanismus. Bei Rohheitsdelikten verletzten sich eher männliche, jüngere Patienten, während vermehrt weibliche, ältere Patienten stürzten. In 17 % der Fälle erfolgte eine konservative Therapie, in 83 % eine operative Versorgung.

Schlussfolgerung

Die Traumatologie der Orbita bedarf einer individuellen Therapieentscheidung. Auch ein konservatives Regime kann zu guten Ergebnissen führen. Die Therapie einer Fraktur der Orbita und des Mittelgesichts sollte aufgrund der fachlichen Kompetenz auch in Bezug auf die Nachbarstrukturen in den Händen erfahrener Mittelgesichtschirurgen liegen.

https://ift.tt/2zsjzvO

Compressive Sensing With Side Information: How to Optimally Capture This Extra Information for GMM Signals?

Chen, M; Renna, F; Rodrigues, MRD; (2018) Compressive Sensing With Side Information: How to Optimally Capture This Extra Information for GMM Signals? IEEE Transactions on Signal Processing , 66 (9) pp. 2314-2329. 10.1109/TSP.2018.2807411 . Green open access

https://ift.tt/2u8kjBr

Demand avoidance is not necessarily defiance

O'Nions, E; Happé, F; Viding, E; Gould, J; Noens, I; (2018) Demand avoidance is not necessarily defiance. The Lancet Child & Adolescent Health , 2 (7) e14. 10.1016/S2352-4642(18)30171-8 .

https://ift.tt/2um0jKR

User-Oriented Piezoelectric Force Sensing and Artificial Neural Networks in Interactive Displays

Gao, S; Duan, J; Kitsos, V; Selviah, D; Nathan, A; (2018) User-Oriented Piezoelectric Force Sensing and Artificial Neural Networks in Interactive Displays. IEEE Journal of the Electron Devices Society 10.1109/JEDS.2018.2848917 . (In press). Green open access

https://ift.tt/2u8kNYh

Specific Immunity to Cytomegalovirus in Pediatric Cardiac Transplantation

Jacobsen, MC; Manunta, MDI; Pincott, ES; Fenton, M; Simpson, GL; Klein, NJ; Burch, M; (2018) Specific Immunity to Cytomegalovirus in Pediatric Cardiac Transplantation. Transplantation 10.1097/TP.0000000000002157 . (In press).

https://ift.tt/2zohn8B

Natural history dioramas for teaching biodiversity on an ecosystem level: pre-service biology teacher education programme

Hrast, Š; Trampuž, L; Tome, S; Tunnicliffe, SD; Torkar, G; (2018) Natural history dioramas for teaching biodiversity on an ecosystem level: pre-service biology teacher education programme. Presented at: Twelfth conference of European Researchers in Didactics of Biology - ERIDOB 2018, Zaragoza, Spain. Green open access

https://ift.tt/2u8jSah

The Hidden Image of Mobile Apps: Geographic, Demographic, and Cultural Factors in Mobile Usage

Peltonen, E; Lagerspetz, E; Hamberg, J; Mehrotra, A; Musolesi, M; Nurmi, P; Tarkoma, S; (2018) The Hidden Image of Mobile Apps: Geographic, Demographic, and Cultural Factors in Mobile Usage. In: (Proceedings) 20th International Conference on Human-Computer Interaction with Mobile Devices and Services (MobileHCI'18). Association for Computing Machinery (ACM): New York, USA. (In press).

https://ift.tt/2zohctX

Cochrane corner: PCSK9 monoclonal antibodies for the primary and secondary prevention of cardiovascular disease

Schmidt, AF; Pearce, LS; Wilkins, JT; Casas, JP; Hingorani, AD; (2018) Cochrane corner: PCSK9 monoclonal antibodies for the primary and secondary prevention of cardiovascular disease. [Editorial comment]. Heart , 104 (13) pp. 1053-1055. 10.1136/heartjnl-2017-312858 . Green open access

https://ift.tt/2u8jMiV

Fixed minimum fluid volume for resuscitation: Con

Perner, A; Singer, M; (2017) Fixed minimum fluid volume for resuscitation: Con. Intensive Care Medicine , 43 (11) pp. 1681-1682. 10.1007/s00134-016-4581-3 . Green open access

https://ift.tt/2ul7AdB

Direct inversion from partial-boundary data in electrical impedance tomography

Hauptmann, A; Santacesaria, M; Siltanen, S; (2017) Direct inversion from partial-boundary data in electrical impedance tomography. Inverse Problems , 33 (2) , Article 025009. 10.1088/1361-6420/33/2/025009 . Green open access

https://ift.tt/2u5PWLW

Character Education in Singapore: Bridging Economic Discontinuities, Maintaining Political Continuities

Chee, AL; (2018) Character Education in Singapore: Bridging Economic Discontinuities, Maintaining Political Continuities. Doctoral thesis (Ph.D), UCL (University College London).

https://ift.tt/2ukgxUR

Natural Infection of C-elegans by an Oomycete Reveals a New Pathogen-Specific Immune Response

Osman, GA; Fasseas, MK; Koneru, SL; Essmann, CL; Kyrou, K; Srinivasan, MA; Zhang, G; ... Barkoulas, M; + view all Osman, GA; Fasseas, MK; Koneru, SL; Essmann, CL; Kyrou, K; Srinivasan, MA; Zhang, G; Sarkies, P; Elix, M-AF; Barkoulas, M; - view fewer (2018) Natural Infection of C-elegans by an Oomycete Reveals a New Pathogen-Specific Immune Response. Current Biology , 28 (4) 640-648.e5. 10.1016/j.cub.2018.01.029 .

https://ift.tt/2u8DbQK

Letter to the editor

Neves, JBN; Brogueira Rodrigues, F; Tran, M; (2018) Letter to the editor. Radiology (In press).

https://ift.tt/2ujBUFC

Seeing the first light: a study of the Dark and Dim ages

Chapman, Emma Olivia; (2014) Seeing the first light: a study of the Dark and Dim ages. Doctoral thesis (Ph.D), UCL (University College London). Green open access

https://ift.tt/2u7GFCS

New approaches to volcanic hazard mapping at Campi Flegrei, Southern Italy

Charlton, Danielle; (2018) New approaches to volcanic hazard mapping at Campi Flegrei, Southern Italy. Doctoral thesis (Ph.D), UCL (University College London).

https://ift.tt/2ujBIWU

Pathogenic role of tissue-resident memory T cells in autoimmune diseases

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Haijing Wu, Wei Liao, Qianwen Li, Hai Long, Heng Yin, Ming Zhao, Vera Chan, Chak-Sing Lau, Qianjin Lu

Abstract

The tissue-resident memory T (T_RM) cells constitute a newly identified subset of memory T cells which are non-circulating and they persist for long-term in epithelial barrier tissues, including skin, lung, gastrointestinal tract and reproductive tract, and in non-barrier tissues, including brain, kidney, pancreas and joint. These cells provide rapid on-site immune protection against previous exposed pathogens in peripheral tissues. There cells are transcriptionally, functionally and phenotypically distinguished from circulating effector memory T cells. In addition to their protective functions, increasing evidence reveals that autoreactive and/or aberrantly activated T_RM cells may be involved in the pathogenesis of autoimmune disorders such as psoriasis and, as recently reported, may contribute to vitiligo, autoimmune hepatitis and rheumatoid arthritis. Therefore, this review aims to summarize the current progress in the biology of T_RM cells, such as the newly identified T_RM markers, upstream regulators, and the functions of T_RM cells. We also discuss the contributions of T_RM cells to the development of autoimmunity to broaden our understanding of autoimmune diseases and to provide novel potential therapeutic strategies for these diseases.

https://ift.tt/2KZ6xKL

Type 2/Th2‐driven inflammation impairs olfactory sensory neurogenesis in mouse chronic rhinosinusitis model

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2KLWM3p

Neuromedin‐U directly induces degranulation of skin mast cells, presumably via MRGPRX2

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2N6PfJo

A missense mutation of the plasminogen gene in hereditary angioedema with normal C1 inhibitor in Japan

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2KHY3IG

Dietary assessment and the development of asthma in Korean adolescents and adults

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2N6P8gW

sIgE and sIgG to airborne atopic allergens: coupled rather than inversely‐related responses

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2KLGebF

Health care resource utilization and costs associated with incremental systemic corticosteroid exposure in asthma

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2N5hSXp

Maternal pregestational or gestational diabetes and childhood wheezing: A population‐based cohort study

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2KJZC9h

Epithelial activators of type 2 inflammation; elevation of TSLP, but not IL‐25 or IL‐33, in chronic rhinosinusitis with nasal polyps in Chicago, Illinois

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2N4xc6i

Rhinology Future Debates 2017 by EUFOREA: Novel treatments and surgical solutions in rhinology

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2KLAaAc

Direct comparison of mastoidal and retrosigmoidal placement of a transcutaneous bone conduction device after canal wall down tympanoplasty

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2N4aivV

Is the team leading surgeon criminally liable for his collaborators' errors? Judges confirm responsibility and condemn an otorhinolaryngologist.

Is the team leading surgeon criminally liable for his collaborators' errors? Judges confirm responsibility and condemn an otorhinolaryngologist.

Acta Otorhinolaryngol Ital. 2018 Jun;38(3):273-276

Authors: Montanari Vergallo G, Ralli M, DI Luca A, DI Luca NM

Abstract
SUMMARY: In current healthcare, delivery of medical and surgical treatment takes place in a multidisciplinary manner. This raises the problem of distinguishing the conditions under which the person who has properly carried out his duties, respecting the related leges artis, can be held responsible for damages materially caused by another member of the medical team. Jurisprudence has developed the so-called "principle of trust" for which every member of the team can rely on the fact that other members are acting in compliance with the leges artis of their specialisation. The Supreme Court has limited the application of this principle. The authors examine the jurisprudence on responsibility of the team in otolaryngology and conclude that individual liability should be limited to the specific expertise of the individual specialist.

PMID: 29984805 [PubMed - in process]

https://ift.tt/2Ja7vyN

The short- and long-term adverse effects of FGF-2 on tympanic membrane perforations.

The short- and long-term adverse effects of FGF-2 on tympanic membrane perforations.

Acta Otorhinolaryngol Ital. 2018 Jun;38(3):264-272

Authors: Zheng-Cai L, Zi-Han L

Abstract
SUMMARY: The objective of this study was to investigate the short- and long-term adverse effects of fibroblast growth factor-2 treatment of tympanic membrane perforations. A total of 134 patients with traumatic tympanic membrane perforations were randomly divided into two groups: an observational group and a fibroblast growth factor-2 treatment group. The closure rate, closure time and principal side-effects were compared between the groups at 6 and 12 months. At 6 months, 131 patients were examined to determine healing outcomes and short-term side-effects. The total closure rate differed significantly between the fibroblast growth factor-2 and observational groups (95.5% vs 73.4, p #x003C; 0.01). The fibroblast growth factor-treated group exhibited a significantly shorter closure time than the observational group (11.9±3.1 days vs 52.6 ± 18.1 days, p = 0.00). Three patients with secondary otitis media with effusion, and three with reperforations, were noted in the fibroblast growth factor-2 group. We additionally performed long-term follow-up on 89.1% of the patients in the observational group and 92.5% of the patients in the fibroblast growth factor-2 group; follow-up was performed 16-42 months after perforation closure. Only a small perforation of the pars flaccida developed in the fibroblast growth factor-2 group. No middle ear cholesteatoma was noted in either group. This study suggests that the topical application of fibroblast growth factor-2 to human traumatic tympanic membranes is safe. Otorrhoea was the most common short-term side-effect; other less common side-effects included otitis media with effusion and reperforation. No serious long-term side-effects were found.

PMID: 29984804 [PubMed - in process]

https://ift.tt/2KWXl9U

Bone-anchored hearing implant surgery: our experience with linear incision and punch techniques.

Bone-anchored hearing implant surgery: our experience with linear incision and punch techniques.

Acta Otorhinolaryngol Ital. 2018 Jun;38(3):257-263

Authors: DI Giustino F, Vannucchi P, Pecci R, Mengucci A, Santimone R, Giannoni B

Abstract
SUMMARY: In recent years, bone-anchored hearing implants (BAHIs) have found wider application in the treatment of conductive and mixed hearing loss. Several surgical techniques have been developed to reduce complications, enhance healing and improve audiological and aesthetic results. We report our experience on the use of three BAHI surgery techniques: Group 1, linear incision with thinning of the subcutaneous tissue; Group 2, linear incision without thinning of the subcutaneous tissue; Group 3, punch technique (Minimally Invasive Ponto Surgery, MIPS). We retrospectively analysed patients undergoing BAHI surgery; results were evaluated on the basis of any intra-operative complication, duration of surgery and occurrence of adverse effects at the implantation site over 1 year of follow-up. We collected a total of 30 implantations (12 for Group 1, 8 for Group 2, 10 for Group 3) with an intra-operative complication rate of 25%, 0% and 10%, respectively. The average surgical time was 62.08 minutes, 34.37 minutes and 18.7 minutes respectively. During follow-up, we reported the occurrence of adverse effects in 10.63% of observations in Group 1, 3.12% in Group 2 and 2.5% in Group 3. This study confirms the low rate of intra and postoperative complications during BAHI surgery and documents the simplicity of execution of the novel MIPS technique, with a significant reduction in surgical time compared to the other two techniques, and positive effects in terms of health care costs.

PMID: 29984803 [PubMed - in process]

https://ift.tt/2L4WUqW

Transtympanic Hearing Aid: exploratory study on a new device.

Transtympanic Hearing Aid: exploratory study on a new device.

Acta Otorhinolaryngol Ital. 2018 Jun;38(3):236-241

Authors: Berrettini S, Bruschini L, DE Vito A, Gnocco T, Rosica NC, Pizzoli L, Forli F

Abstract
SUMMARY: In this paper, we present the preliminary results achieved with a transtympanic hearing aid (THA). This is a modified digital, open-fit external hearing aid (HA) designed for acute study only, which allows coupling with a pre-implanted ventilation tube. The THA conveys amplified sound directly onto the round window, bypassing the ossicular chain, in contrast with traditional HAs that convey sound onto the second or third portion of the external auditory canal. The THA has been developed as an alternative to standard HAs and active middle ear implants for patients who are unsatisfied with traditional HA outcomes and want to avoid middle-ear implantation. The results achieved using the THA were compared to those obtained with an equivalent device, the Latitude 8 Moxi 13 (Moxi), uncoupled from the ventilation tube, and placed onto the outer ear. For this purpose, 12 patients with conductive (1/12), sensorineural (3/12), or mixed (8/12) hearing loss from moderate to severe, with a pre-implanted ventilation tube, underwent audiological evaluation with both the THA and the Latitude 8 Moxi 13 (Moxi). Our initial results showed that the THA provided significant improvement in the warble tone results in comparison to the Moxi. Moreover, patients with a PTA between 41 and 90 also achieved better results in terms of speech recognition using the THA in comparison to the Moxi. In conclusion, these outcomes provide the first evidence of the potential benefits of the THA over standard open-fit HAs. Nevertheless, these preliminary outcomes require further confirmation.

PMID: 29984801 [PubMed - in process]

https://ift.tt/2L0WLIi

Bromelain's penetration into the blood and sinonasal mucosa in patients with chronic rhinosinusitis.

Bromelain's penetration into the blood and sinonasal mucosa in patients with chronic rhinosinusitis.

Acta Otorhinolaryngol Ital. 2018 Jun;38(3):225-228

Authors: Passali D, Passali GC, Bellussi LM, Sarafoleanu C, Loglisci M, Manea C, Iosif C, Passali FM

Abstract
SUMMARY: The aim of this research is to investigate penetration of Bromelain into sinonasal mucosa in patients with chronic rhinosinusitis (CRS) versus a control group. Bromelain is derived from pineapple (Ananas comosus) and has various pharmacological effects. 40 patients (20 patients and 20 controls) were enrolled in the study. Bromelain 500 mg tablet twice daily was administered for 30 days. We scored bromelain presence in turbinate and ethmoid mucosas and in the serum of both the groups. Bromelain has an excellent distribution from blood to rhinosinusal mucosa. Its diffusion ability may allow the use of bromelain as an anti-inflammatory agent in paranasal sinus pathologies.

PMID: 29984799 [PubMed - in process]

https://ift.tt/2L1Kl2L

Implementing strategies for data collection in chronic rhinosinusitis.

Implementing strategies for data collection in chronic rhinosinusitis.

Acta Otorhinolaryngol Ital. 2018 Jun;38(3):222-224

Authors: Castelnuovo P, Bandi F, Preti A, Sica E, DE Bernardi F, Gallo S

Abstract
SUMMARY: Chronic rhinosinusitis (CRS) is a debated topic in the international rhinologic literature because of its high prevalence, heterogeneity of clinical manifestations and unpredictability of disease course. Recently, the focus in CRS research has moved to identify biological subtypes that might explain its aetiology and clinical variability. However, these analyses are still expensive and limited to scientific purposes, so that they cannot be used on a large scale in daily practice. For this reason, we wondered if it was possible to define a risk stratification for CRS patients based only on first level investigations. The heterogeneity of the disease has given us a large amount of data compelling to find an additional storage system. Herein, we present the results of our work, the RhinoBank, as we believe that it is an easy-to-use tool for those professionals dealing with CRS and an effective system to exploit in clinical research.

PMID: 29984798 [PubMed - in process]

https://ift.tt/2L7jr6i

Moderate OSAS and turbinate decongestion: surgical efficacy in improving the quality of life and compliance of CPAP using Epworth score and SNOT-20 score.

Moderate OSAS and turbinate decongestion: surgical efficacy in improving the quality of life and compliance of CPAP using Epworth score and SNOT-20 score.

Acta Otorhinolaryngol Ital. 2018 Jun;38(3):214-221

Authors: Fiorita A, Scarano E, Mastrapasqua R, Picciotti PM, Loperfido A, Rizzotto G, Paludetti G

Abstract
SUMMARY: Drug-induced sleep endoscopy (DISE) is an important procedure in diagnostic pathway of patients affected by moderate OSAS. However, the Italian National Health System does not provide any compatible Diagnosis-related-group (DRG) code codification for DISE, which makes it impossible to obtain regional reimbursement. In order to overcome this problem, DISE is usually associated with other codified surgical procedures. The aim of our study is to assess the association of turbinate decongestion (TD) and DISE in order to combine in a single operating session diagnostic and therapeutic procedures. The objective of our work is to assess the role of nasal surgery on symptoms of moderate OSA. Recent studies have confirmed that isolated nasal surgery improves quality of life (QOL), but not the apnoea hypopnoea index (AHI) during polygraph registration. We enrolled 30 patients, aged between 29 and 64 years (mean 50.53 ± 9.20), 26 males and 4 females, with a mean BMI of 26.07 ± 2.81 kg/m2, who were affected by moderate OSAS. All patients underwent otolaryngologycal pre-operative evaluation, home respiratory polygraph and subjective evaluation through Sino-Nasal-Outcome Test (SNOT-20) and Epworth Sleepiness Scale (ESS). During the same surgery session, they underwent DISE and TD. Patients were re-evaluated six months later using the same questionnaires. We observed a significant improvement (p #x003C; 0.05) in both the mean ESS index (6.03 ± 2.75 vs 4.16 ± 4.63) and total SNOT score (22.53 ± 12.16 vs 13.23 ± 10.82). Significant differences (p #x003C; 0.05) were also identified for partial SNOT questions 1-11 (9.1 ± 5.11 vs 6.13 ± 4.12) and 11-20 (13.36 ± 10.20 vs 7.13 ± 9.644). The results of the present study confirm that TD alone can improve sleepiness, QOL and nasal symptoms. Thus, in absence of a National Health System recognition for DISE, the association of this procedure with TD can be useful for diagnostic and therapeutic management of OSAS, improving CPAP compliance and adherence, reducing sleepiness, ameliorating nasal symptoms and therefore QOL.

PMID: 29984797 [PubMed - in process]

https://ift.tt/2L1KiUD

Efficacy of trans-nasal fiberendoscopic injection laryngoplasty with centrifuged autologous fat in the treatment of glottic insufficiency due to unilateral vocal fold paralysis.

Efficacy of trans-nasal fiberendoscopic injection laryngoplasty with centrifuged autologous fat in the treatment of glottic insufficiency due to unilateral vocal fold paralysis.

Acta Otorhinolaryngol Ital. 2018 Jun;38(3):204-213

Authors: Ricci Maccarini A, Stacchini M, Mozzanica F, Schindler A, Basile E, DE Rossi G, Woo P, Remacle M, Magnani M

Abstract
SUMMARY: The objective of this work is to evaluate the safety, feasibility and efficacy of trans-nasal fiberendoscopic injection laryngoplasty (IL) with centrifuged autologous fat, performed under local anaesthesia, in the treatment of glottic insufficiency due to unilateral vocal fold paralysis (UVFP). It is a within-subject study with follow-up 1 week after phonosurgery and after 6 months. A total of 22 patients with chronic dysphonia caused by glottic insufficiency due to UVFP were enrolled. Each patient underwent trans-nasal IL with centrifuged autologous fat through flexible operative endoscope under local anaesthesia and was evaluated before and twice (1 week and 6 months) after phonosurgery, using a multidimensional set of investigations. The assessment protocol included videolaryngostroboscopy, perceptual evaluation of dysphonia, maximum phonation time and patient's self-assessment on voice-related quality of life (QOL) with the Voice Handicap Index-10 and the comparative self-assessment on vocal fatigue and voice quality pre-post treatment. Trans-nasal IL with centrifuged autologous fat was performed in all 22 patients and there were no complications in any case. Significant improvements in videolaryngostroboscopic findings, perceptual evaluation of dysphonia, maximum phonation time and QoL self-assessment were reported after 1 week and were maintained at 6 months. In one patient, the result after 6 months was not satisfactory and this patient then underwent a medialization laryngoplasty (thyroplasty type I) with satisfactory long-term results. In conclusion, trans-nasal fiberendoscopic IL with centrifuged autologous fat seems to be a safe, feasible and efficacious phonosurgical procedure for treatment of glottic insufficiency due to unilateral vocal fold paralysis.

PMID: 29984796 [PubMed - in process]

https://ift.tt/2L8qADi