Purpose of review Anaphylaxis is an acute medical emergency characterized by sudden presentation of life-threatening respiratory and cardiovascular symptoms. Rapid diagnosis of anaphylaxis is crucial to implement an appropriate treatment and management plan. However, mistakes in the diagnosis of anaphylaxis may occur because of the limited time during which the diagnosis must be made, the stressful environment of the emergency room, the often aspecific or incomplete clinical features of early anaphylaxis and the lack of useful laboratory markers. Recent findings Several disorders may mimick anaphylaxis and cause wrong or delayed diagnosis increasing chances of fatal outcomes. In addition, certain clinical situations, like general anesthesia, may complicate detection of early signs of anaphylaxis. Drugs like beta-blockers, angiotensin converting enzyme-inhibitors, antihistamines or steroids may hide or blunt initial clinical manifestations of anaphylaxis. Summary A careful evaluation of clinical signs in all organs is mandatory to quickly establish and confirm a diagnosis of anaphylaxis. Alternative diagnosis should be considered, particularly in the case of unresponsive patients. Avoiding pitfalls in anaphylaxis diagnosis will help to establish rapidly effective treatments and would further reduce the rate of fatal events. Correspondence to Massimo Triggiani, MD, PhD, Division of Allergy and Clinical Immunology University of Salerno, Via S. Allende Baronissi, Fisciano, Salerno, Italy. Tel: +39 089 965056; fax: +39 089 965056; e-mail: mtriggiani@unisa.it Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2uR91ko
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Σάββατο 21 Ιουλίου 2018
Perinatal maternal negative life events as risk factors of atopic dermatitis in female offspring
Prenatal maternal stress has been suggested as a factor that promotes the development of allergic diseases in the offspring.1 Maternal stress includes recognition of stressors (perceived stress) such as anxiety and depression and environmental stressors such as negative life events (NLEs): bereavement, loss of her or husband's job, separation, or divorce.1 Recently, we reported that prenatal maternal stress influenced the development of atopic dermatitis (AD) in offspring from two independent birth cohort study.
https://ift.tt/2uVhp2r
Thoracic Superior Duct Cyst: An Incidental Finding
Publication date: July–August 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4
Author(s): Regina María Sánchez Jiménez, Francisca Velázquez Marín
https://ift.tt/2La4Db8
Carotid Canal Bone Erosion. Gradenigo's Syndrome
Publication date: July–August 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4
Author(s): Aina Brunet-Garcia, M. Virginia Barrios-Crispi, Marta Faubel-Serra
https://ift.tt/2LGGZ2s
Primary tuberculosis of the nasal septum: The non-ulcerated form presenting as septal thickening
Publication date: July–August 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4
Author(s): Neeraj Aggarwal, Mainak Dutta, Ramanuj Sinha
https://ift.tt/2LbIkSy
Recommendations on the Use of Neuromonitoring in Thyroid and Parathyroid Surgery
Publication date: July–August 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4
Author(s): José Luis Pardal-Refoyo, Pablo Parente-Arias, Marta María Arroyo-Domingo, Juan Manuel Maza-Solano, José Granell-Navarro, Jesús María Martínez-Salazar, Ramón Moreno-Luna, Elvylins Vargas-Yglesias
Abstract
Introduction
Thyroid and parathyroid surgery (TPTS) is associated with risk of injury to the recurrent laryngeal nerve, superior laryngeal nerve and voice changes. Intraoperative neuromonitoring (IONM), intermittent or continuous, evaluates the functional state of the laryngeal nerves and is being increasingly used. This means that points of consensus on the most controversial aspects are necessary.
Objective
To develop a support document for guidance on the use of IONM in TPTS.
Method
Work group consensus through systematic review and the Delphi method.
Results
Seven sections were identified on which points of consensus were identified: indications, equipment, technique (programming and registration parameters), behaviour on loss of signal, laryngoscopy, voice and legal implications.
Conclusions
IONM helps in the location and identification of the recurrent laryngeal nerve, helps during its dissection, reports on its functional status at the end of surgery and enables decision-making in the event of loss of signal in the first operated side in a scheduled bilateral thyroidectomy or previous contralateral paralysis. The accuracy of IONM depends on variables such as accomplished technique, technology and training in the correct execution of the technique and interpretation of the signal. This document is a starting point for future agreements on TPTS in each of the sections of consensus.
Resumen
Introducción
La cirugía de tiroides y paratiroides (CTPT) se asocia a riesgo de lesión del nervio laríngeo recurrente, nervio laríngeo superior y cambios en la voz. La neuromonitorización intraoperatoria (NMIO), intermitente o continua, en CTPT evalúa el estado funcional de los nervios laríngeos y se utiliza progresivamente con más frecuencia. Esto obliga a adoptar puntos de acuerdo en los aspectos más controvertidos.
Objetivo
Elaborar un documento de ayuda para orientar en la utilización de la NMIO en CTPT.
Método
Consenso en grupo de trabajo mediante revisión sistemática y método Delphi.
Resultados
Se identificaron 7 secciones sobre las que se establecieron puntos de acuerdo: indicaciones, equipo, técnica (parámetros de programación y registro), conducta en pérdida de señal, laringoscopia, voz e implicaciones legales.
Conclusiones
La NMIO ayuda en la localización e identificación del nervio laríngeo recurrente, ayuda durante su disección, informa sobre su estado funcional al finalizar la cirugía y permite tomar decisiones en caso de pérdida de señal en el primer lado operado en una tiroidectomía bilateral programada o si había parálisis contralateral previa. La precisión de la NMIO depende de variables como la técnica realizada, la tecnología utilizada y la formación para la correcta ejecución de la técnica e interpretación de la señal. El documento presentado es un punto de inicio para futuros acuerdos en CTPT en cada una de las secciones de consenso.
https://ift.tt/2JJkqrV
Predictors of locoregional recurrence in early stage buccal cancer with pathologically clear surgical margins and negative neck
Publication date: July–August 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4
Author(s): Shakeel Uz Zaman, Shakil Aqil, Mohammad Ahsan Sulaiman
Abstract
Objective
To identify the significant predictors of locoregional recurrence in early stage squamous cell carcinoma (SCC) of buccal mucosa with pathologically clear surgical margins and negative neck.
Method
Seventy-three patients who underwent per oral wide excision and supraomohyoid neck dissection for early stage buccal SCC with clear surgical margins (>5 mm margins each) and negative neck (N0) were included. None of the patients received postoperative radiotherapy or chemotherapy. Univariate and multivariate analyses were used to identify independent predictors of locoregional recurrence.
Results
Recurrence was observed in 22 of 73 (30%) cases. Twelve had local, seven had regional and three developed locoregional recurrences. Both univariate and multivariate analyses demonstrated that lymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) were independent predictors affecting locoregional control.
Conclusion
Lymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) significantly increased the locoregional recurrence rate in early stage buccal SCC with clear surgical margins and negative nodal status. Adjuvant treatment with either radiation or chemoradiation should be considered when one or both of these factors present.
Resumen
Objetivo
Identificar los predictores significativos de recidiva locorregional en el carcinoma de células escamosas (CCS) en estadios iniciales de la mucosa buccal, con los márgenes quirúrgicos patológico libres y el cuello negativo.
Método
Se incluyeron en el estudio 73 pacientes sometidos a extirpación tumoral y disección supraomoioidea de cuello con cáncer bucal en estadios iniciales con márgenes quirúrgicos libres (margen de 5 mm cada uno) y cuello negativo (N0). Ninguno de los pacientes recibió radioterapia postoperatoria o quimioterapia. Se utilizaron análisis univariantes y multivariantes para identificar los factores predictivos independientes de recidiva locorregional.
Resultados
La recidiva se observó en 22 de 73 casos (30%). Doce tenían recidivas locales, 7 regionales y 3 desarrollaron recidivas locorregionales. Tanto los análisis univariantes como multivariantes demostraron que la invasión linfovascular (LVI) y la invasión muscular no T4 (non-T4MI) fueron predictores independientes que afectaron al control locorregional.
Conclusión
La LVI y la non-T4MI aumentaron significativamente la tasa de recurrencia locorregional en el CCS bucal precoz con márgenes quirúrgicos libres y estado nodal negativo. El tratamiento adyuvante con radiación o quimiorradiación debe considerarse cuando se presentan uno o ambos de estos factores.
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Vertigo and Dizziness in Hospital: Attendance, Flow and Characteristics of Patients
Publication date: July–August 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4
Author(s): Carmen Bécares Martínez, Marta M. Arroyo Domingo, Aurora López Llames, Jaime Marco Algarra, María M. Morales Suárez-Varela
Abstract
Introduction and objectives
Vertigo and dizziness as symptoms are frequent in the population. They are present in a wide range of pathologies and it is usually difficult to make an accurate diagnosis. The general objective of this study is to obtain the information to evaluate vertigo and dizziness in the hospital setting. The specific objectives are: to estimate the burden of these symptoms at the hospital; to study patients' conditions and to detail the flow of these patients inside the hospital.
Methods
Observational descriptive study. We made a search of the referral proposals made in 2011 and 2012 to the hospital because of vertigo symptoms. The patients' demographic and clinical characteristics, and the administrative details of the referrals were analysed.
Results
A total of 558 proposals were analysed corresponding to 494 patients. Vertigo accounted for 0.5% of all referrals made from Primary Care to the hospital. Sixty-three percent of the sample were women; the average age was 58 years. Eighty-eight percent of the patients were evaluated by Otorhinolaryngology, 24% by Neurology. Thirty point eight percent consulted on 3 or more occasions for the symptom. Sixteen percent were assessed for psychiatric conditions in the hospital.
Conclusions
Vertigo as a symptom is a significant burden in the hospital setting. The patients who suffer it consult on several occasions and are assessed by different specialties. This implies in some cases an excessive and ineffective flow of patients. In our setting, otorhinolaryngology is the main department to treat vertigo and dizziness patients.
Resumen
Introducción y objetivos
Los síntomas de vértigo y mareo son frecuentes en la población, se presentan como manifestación de un amplio abanico de enfermedades y habitualmente es difícil realizar un diagnóstico de certeza. El objetivo general de este estudio es obtener la información para evaluar estos síntomas en el entorno hospitalario. Los objetivos específicos son: estimar el peso global que representan estos síntomas en las derivaciones al hospital; conocer las características de los pacientes derivados y detallar el flujo de las consultas.
Métodos
Estudio descriptivo observacional. Se buscaron las propuestas de consulta realizadas en 2011 y 2012 al hospital por el síntoma de vértigo. Se analizaron características demográficas y clínicas de los pacientes, y administrativas de las derivaciones.
Resultados
Se analizaron un total de 558 propuestas correspondientes a 494 pacientes. El vértigo supuso el 0,5% del total de las derivaciones realizadas desde Atención Primaria al hospital. El 63% de la muestra han sido mujeres, con una edad media de 58 años. El 88% de los pacientes fue valorado por Otorrinolaringología y el 24% por Neurología. Un 30,8% consultó en 3 o más ocasiones por el síntoma. El 16% fue valorado por enfermedad psiquiátrica en el hospital.
Conclusiones
El vértigo como síntoma supone una carga significativa en el ámbito hospitalario. Los pacientes que lo presentan consultan en múltiples ocasiones y son valorados en distintas especialidades. En ciertos casos, el flujo de pacientes puede resultar excesivamente dinámico e ineficaz. En nuestro entorno, Otorrinolaringología es el principal receptor de pacientes con síntomas de vértigo y mareo.
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Analysis of Audiometric Relapse-Free Survival in Patients With Immune-Mediated Hearing Loss Exclusively Treated With Corticosteroids
Publication date: July–August 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4
Author(s): Nieves Mata-Castro, Raimon García-Chilleron, Javier Gavilanes-Plasencia, Rafael Ramírez-Camacho, Alfredo García-Fernández, José Ramón García-Berrocal
Abstract
Objective
To describe the results in terms of audiometric relapse-free survival and relapse rate in immunomediated hearing loss patients treated exclusively with corticosteroids.
Method
Retrospective study of patients with audiometric relapses, monitored from 1995 to 2014, in two centres of the Community of Madrid.
Results
We evaluated 31 patients with a mean age of 48.52 years (14.67 SD), of which 61.3% were women. Most hearing loss was fluctuating (48.4%). Only 16.1% of patients had systemic autoimmune disease. There is a moderate positive correlation between the sex variable and the systemic involvement variable (Spearman's correlation coefficient = 0.356): specifically, between being female and systemic disease. The relative incidence rate of relapse in the first year was 2.01 relapses/year with a 95% CI (1.32–2.92). The mean survival time of the event (audiometric relapse) was 5.25 months (SD 0.756). With multivariate analysis, the only variable that achieved statistical significance was age, with a hazard ratio of 1.032 (95% CI; 1.001–1.063, P = .043).
Conclusions
Immune-mediated disease of the inner ear is a chronic disease with relapses. Half of the patients with immunomediated hearing loss treated exclusively with corticosteroids relapse before 6 months of follow-up. In addition, if a patient has not relapsed, they are more likely to relapse as each year passes. Analysis of the audiometric relapse-free survival will enable the effect of future treatments to be compared and their capacity to reduce the rhythm of relapses.
Resumen
Objetivo
Describir los resultados en términos de supervivencia libre de recaída audiométrica y el ritmo de recaída en pacientes con hipoacusia inmunomediada tratados exclusivamente con corticoides.
Método
Estudio retrospectivo de pacientes, con recaídas audiométricas, en seguimiento desde 1995 hasta 2014, en 2 centros de la Comunidad de Madrid.
Resultados
Se evaluaron 31 pacientes con una media de edad de 48,52 años (14,67 DE) de los cuales el 61,3% fueron mujeres. La mayoría de las hipoacusias fueron fluctuantes (48,4%). Solo el 16,1% de los pacientes presentaban enfermedad autoinmune sistémica. Existe una correlación positiva moderada entre ser mujer y presentar afectación sistémica (coeficiente de correlación de Spearman = 0,356). La tasa relativa de incidencia de recaída en el primer año en nuestra serie fue de 2,01 recaídas/año con un IC95% (1,32-2,92). El tiempo de supervivencia medio del evento (recaída audiométrica) fue de 5,25 meses (DE 0,756). Con el análisis multivariante, la única variable que consiguió significación estadística fue la edad, con una hazard ratio de 1,032 (IC95%; 1,001-1,063, p = 0,043)
Conclusiones
La enfermedad inmunomediada del oído interno es una enfermedad crónica con recaídas. La mitad de los pacientes tratados exclusivamente con corticoides recaen antes de los 6 meses de seguimiento. Además, si un paciente no ha presentado recaída, tiene más riesgo de recaer cada año que pasa. El análisis de la supervivencia libre de recaída audiométrica permitirá comparar el efecto de tratamientos futuros y su capacidad para reducir el ritmo de recaídas.
https://ift.tt/2La5cSi
Importance of neoadjuvant chemotherapy in olfactory neuroblastoma treatment: Series report and literature review
Publication date: July–August 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4
Author(s): Ricardo Bartel, Xavier Gonzalez-Compta, Enric Cisa, Francesc Cruellas, Alberto Torres, Aleix Rovira, Manel Manos
Abstract
Introduction and objectives
Olfactory neuroblastoma (ONB) is a rare entity that constitutes less than 5% of nasosinusal malignancies. Mainstream treatment consists in surgical resection +/− adjuvant radiotherapy. By exposing results observed with apparition of new therapeutic options as neoadjuvant chemotherapy, the objective is to evaluate a series and a review of the current literature.
Methods
A retrospective review was conducted including patients diagnosed and followed-up for ONB from 2008 to 2015 in our institution.
Results
9 patients were included. Mean follow-up of 52.5 months (range 10–107). Kadish stage: A, 1 patient (11.1%) treated with endoscopic surgery; B, 2 patients (22.2%) treated with endoscopic surgery (one of them received adjuvant radiotherapy); C, 6 patients (66.7%), 4 patients presented intracranial extension and were treated with neoadjuvant chemotherapy followed by surgery and radiotherapy. The other 2 patients presented isolated orbital extension, treated with radical surgery (endoscopic or craniofacial resection) plus radiotherapy. The 5-year disease free and overall survival observed was 88.9%.
Conclusion
Neoadjuvant chemotherapy could be an effective treatment for tumor reduction, improving surgical resection and reducing its complications.
Resumen
Introducción y objetivos
Elneuroblastoma olfatorio es una entidad rara que se corresponde con menos del 5% de las neoplasias nasosinusales. El tratamiento principal consiste en la resección quirúrgica ± radioterapia adyuvante. El objetivo es evaluar la sobrevida en una serie de casos y la literatura actual, mostrando resultados observados con la aparición de nuevas opciones terapéuticas como la quimioterapia neoadyuvante.
Métodos
Se realizó un estudio retrospectivo incluyendo pacientes tratados y seguidos en nuestro centro desde 2008 a 2015.
Resultados
Dentro del estudio fueron incluidos 9 pacientes. El seguimiento medio fue de 52,5 meses (rango 10-107). Estadio Kadish: A) un paciente (11,1%) fue tratado con resección endoscópica; B) 2 pacientes (22,2%) tratados con resección endoscópica (uno de ellos recibió radioterapia adyuvante); C) 6 pacientes (66,7%), de los cuales 4 presentaron extensión intracraneal y fueron tratados con quimioterapia neoadyuvante, cirugía y radioterapia adyuvante. Los otros 2 pacientes presentaron invasión intraorbitaria aislada, tratados con cirugía radical y radioterapia adyuvante. La sobrevida y periodo libre de enfermedad a 5 años fue del 88,9%.
Conclusión
La quimioterapia neoadyuvante puede ser un tratamiento efectivo para la reducción del tamaño tumoral, mejorando la resección quirúrgica y reduciendo sus complicaciones.
https://ift.tt/2LGGGEQ
Efficacy of Particle Repositioning Manoeuvres in Benign Positional Paroxysmal Vertigo: A Revision of 176 Cases Treated in a Tertiary Care Centre
Publication date: July–August 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4
Author(s): Claudio Carnevale, Diego J. Arancibia-Tagle, Elena Rizzo-Riera, Guillermo Til-Perez, Pedro L. Sarría-Echegaray, Julio J. Rama-Lopez, Santiago Quer-Canut, German Fermin-Gamero, Manuel D. Tomas-Barberan
Abstract
Introduction and objectives
Benign paroxysmal positional vertigo is the most common peripheral vertigo disease. The aim of this paper is to review the results obtained with the different specific particle repositioning manoeuvres, evaluating the possible risk factors linked to a poorer prognosis.
Methods
One hundred and seventy-six patients with a diagnosis of benign paroxysmal positional vertigo were reviewed retrospectively, of whom 150 had vertigo of the posterior canal, 20 had vertigo of the horizontal canal, 3 had vertigo of the superior canal, and 3 had a double vertigo. The Epley manoeuvre was used to treat the posterior and superior canals, and Lempert manoeuvre was used to treat the horizontal canal. An imaging study by nuclear magnetic resonance with gadolin was always used in refractory cases.
Results
The Epley manoeuvre showed an efficacy of 74.6 and 100% at first attempt for posterior and superior canals respectively. The efficacy of the Lempert manoeuvre for the horizontal canal was 72.72% in the patients with canalolithiasis, and 58.33% in the patients with cupulolithiasis. The treatment of patients with more than one affected canal and a history of surgery in the previous month was more difficult.
Conclusions
Particle repositioning manoeuvres show a very high success rate, allowing better results in the treatment of the posterior canal. We need more studies to confirm the suspicion that surgery may be a factor of poorer prognosis.
Resumen
Introducción y objetivos
El vértigo posicional paroxístico benigno es la entidad más frecuente dentro de los vértigos de origen periférico. El objetivo del siguiente trabajo es revisar los resultados obtenidos con las diferentes maniobras de reposicionamiento canalicular específicas para cada tipo de canal semicircular afectado, evaluando posibles factores de riesgo relacionados con un peor pronóstico.
Métodos
Se han revisado retrospectivamente 176 pacientes diagnosticados de vértigo posicional paroxístico benigno en nuestro centro, de los cuales 150 tenían vértigo del canal semicircular posterior, 20 del horizontal, 3 del superior y 3 multicanal. Se ha usado la maniobra de Epley para el tratamiento del canal posterior y del superior y la maniobra de Lempert para el tratamiento del horizontal. En los casos refractarios se ha realizado siempre un estudio de imagen cerebral con resonancia.
Resultados
La maniobra de Epley ha mostrado una eficacia al primer intento del 74,6% para el canal posterior y del 100% para el superior. La eficacia de la maniobra de Lempert para el canal horizontal ha sido del 72,72% en los casos de canalolitiasis y del 58,33% en los de cupulolitiasis. Más complicado ha sido el tratamiento de los pacientes con más de un canal afectado y con antecedente quirúrgico en el mes previo.
Conclusiones
Las maniobras de reposicionamiento canalicular permiten alcanzar una tasa de éxito muy alta, obteniendo mejores resultados en el tratamiento del canal posterior. Hacen falta más estudios para confirmar la sospecha de que la cirugía previa pueda ser un factor de peor pronóstico.
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Evaluation of the Training Capacity of the Spanish Resident Book of Otolaryngology (FORMIR) as an Electronic Portfolio
Publication date: July–August 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4
Author(s): Juan Manuel Maza Solano, Gustavo Benavente Bermudo, Francisco José Estrada Molina, Jesús Ambrosiani Fernández, Serafín Sánchez Gómez
Abstract
Background
and objectives We have evaluated the training capacity of the Spanish resident training book as an electronic portfolio to achieve the learning objectives of otorhinolaryngology (ENT) residents.
Methods
A multi-method qualitative investigation with transversal characteristics, temporal and retrospective guidance was performed on Spanish ENT residents using a structured questionnaire, a semi-structured interview, and a computer application on the FORMIR website.
Results
A 56.5% of ENT-residents specialising in one of the 63 accredited Spanish hospitals between 2009 and 2012 participated in the study. The results obtained show that the ENT residents who used the e-portfolio were better able to implement self-guided study, were more aware of their learning objectives, fulfilled the training programme more efficiently, identified the causes of learning gaps more clearly, and considered FORMIR in e-portfolio format to be an ideal training tool to replace the resident training book in paper format.
Conclusions
The ENT residents greatly appreciated the training benefits of FORMIR as an e-portfolio, especially its simple and intuitive interface, the ease and comfort with which they could record their activities, the automatic and numeric feedback on the acquisition of their competencies (which facilitates self-guided learning), its storage capacity for evidence, and its ability to be used as UEMS logbook as well as a standard curriculum vitae. All these features make FORMIR a training and evaluation tool that outperforms similar instruments available to ENT residents. They do not hesitate to identify it as the ideal resident training book for facilitating their specialised training.
Resumen
Introducción y objetivos
Evaluar la capacidad formativa del libro del residente español como portafolio electrónico para alcanzar los objetivos de aprendizaje de los MIR de Otorrinolaringología (ORL).
Métodos
Se realizó una investigación cualitativa multimétodo de características tranversal, temporal y de orientación retrospectiva sobre los MIR de ORL mediante un cuestionario estructurado y una entrevista semiestructurada, sobre la aplicación informática web FORMIR.
Resultados
Participaron el 56,5% de los MIR de ORL de alguno de los 63 hospitales españoles acreditados para impartir formación en ORL entre 2009 y 2012. Los resultados obtenidos demostraron que los MIR de ORL que utilizaban el portafolio electrónico eran capaces de autoguiar mejor su aprendizaje, conocían mejor sus objetivos de aprendizaje, cumplían más eficientemente el programa de formación, identificaban más claramente las causas de sus carencias en el aprendizaje y consideraban que FORMIR como portafolio electrónico constituía una herramienta formativa idónea para sustituir al libro del residente en formato papel.
Conclusiones
Los MIR de ORL apreciaban de forma muy relevante las prestaciones formativas de FORMIR como portafolio electrónico, especialmente su interfaz, el feedback numérico y automático sobre la adquisición de competencias, su capacidad de almacenamiento de evidencias y su capacidad de visualizarse como logbook de la Unión Europea de Médicos Especialistas o como un curriculum vitae estándar. Este feedback automático facilita el aprendizaje autoguiado. Todo esto hace de FORMIR una herramienta formativa y evaluativa que supera las prestaciones y aceptación de instrumentos similares puestos a disposición de los residentes, que no dudan en proponerlo como el libro del residente más idóneo para facilitar su formación especializada.
https://ift.tt/2LBQ5gM
Angiokératome circonscrit naeviforme
Publication date: Available online 21 July 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): H. Kasssem Youssef, E. Backobi, C. Michel
https://ift.tt/2zZA2bh
Primary immunodeficiency disorder caused by phosphoinositide 3-kinase delta (PI3Kδ) deficiency
Publication date: Available online 21 July 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Georgios Sogkas, Mykola Fedchenko, Akshay Dhingra, Alexandra Jablonka, Reinhold E. Schmidt, Faranaz Atschekzei
Short summary
First publication on human PI3Kδ deficiency. Two patients carrying novel homozygous loss-of-function mutation in PIK3CD, resulting in PI3Kδ deficiency, developed a primary immunodeficiency disorder characterized by hypogammaglobulinemia and inflammatory bowel disease.
https://ift.tt/2uSTHUy
Trans- and inter-generational epigenetic inheritance in allergic diseases
Publication date: Available online 21 July 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Toril Mørkve Knudsen, Faisal I. Rezwan, Yu Jiang, Wilfried Karmaus, Cecilie Svanes, John W. Holloway
ABSTRACT
It has become clear that early life (including in utero exposures), is a key window of vulnerability where environmental exposures can alter developmental trajectories and initiate allergic disease development. However, recent evidence suggests that there may be additional windows of vulnerability to environmental exposures in the parental generation before conception, or even in previous generations. There is evidence suggesting that information of prior exposures can be transferred across generations, and experimental animal models suggest that such transmission may be conveyed through epigenetic mechanisms. While the molecular mechanisms of inter- and trans-generation epigenetic transmission have yet to be determined, the realisation that environment before conception may alter risks of allergic diseases, has profound implications for the development of public health interventions to prevent disease. Future research in both experimental models and in multigenerational human cohorts is needed to better understand the role of inter- and trans-generational effects in asthma and allergic disease. This will provide the knowledge basis for a new approach to efficient intervention strategies aimed at reducing the major public health challenge of these conditions.
https://ift.tt/2mzStKc
Socioeconomics of Atopic Dermatitis-Can We Afford New Treatments?
Publication date: Available online 21 July 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Michael S. Blaiss
https://ift.tt/2O5jphj
Perinatal maternal negative life events as risk factors of atopic dermatitis in female offspring
Publication date: Available online 21 July 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Jisun Yoon, Eun Mi Kim, Mi Young Lee, Sungsu Jung, Hyun-Ju Cho, Yeongho Kim, Yean Jung Choi, Eun Lee, Song-I Yang, So-Yeon Lee, Jeong Rim Lee, Yejin Yi, Soo-Jong Hong
https://ift.tt/2NyRa9s
Differences in egg and milk food challenge outcomes based on tolerance to the baked form
Publication date: Available online 21 July 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Peter Capucilli, Antonella Cianferoni, Joel Fiedler, Laura Gober, Nicholas Pawlowski, Gita Ram, Rushani Saltzman, Jonathan M. Spergel, Jennifer Heimall
Abstract
Background
Previous studies suggest inclusion of baked egg and milk in the diet of egg or cow's milk (CM) allergic children may positively impact native tolerance. Differences in native food reactivity based on historical baked tolerance, however, is not fully understood. Objective: To assess differences in native egg and CM oral food challenge (OFC) outcomes based on presenting history of tolerance and exposure to these foods in the baked form.
Methods
Retrospective review of all egg and CM OFCs at The Children's Hospital of Philadelphia, Philadelphia, PA, over 4 years (n=580). History of baked ingestion was compared to OFC pass rate, eliciting dose, epinephrine use, reaction classification and recent skin test or specific IgE level.
Results
There were 115 egg and 70 CM positive challenges with most eliciting anaphylaxis. Children tolerating baked egg passed OFC more frequently (75%), compared to children who avoided baked egg (58%) (P=0.01) or never ingested egg (45%) (P<0.0001). For positive reactions, baked egg tolerant children reacted at higher eliciting doses of native egg (Median 3.0g, Range 0.125-15.75g) compared to those avoiding baked egg (Median 0.69g, Range 0.13-10.0g) (P=0.03) and those with no egg exposure (Median 0.88g, Range 0.13-13.88g) (P=0.01). Further, epinephrine use was lower in children tolerating baked egg (10%) compared to children avoiding baked egg (22%) (P=0.02) and compared to subjects who never ingested egg (32%) (P=0.0001). These differences were not observed for CM challenges.
Conclusion
Children who historically tolerated baked egg were less sensitive to native egg during OFC compared to children whose baked reactivity was largely unknown.
https://ift.tt/2O84cfh
Activity and clinical relevance of autotaxin and lysophosphatidic acid pathways in high-grade serous carcinoma
Abstract
The aim of this study was to analyze the expression, biological role and clinical relevance of autotaxin (ATX), the enzyme synthetizing lysophosphatidic acid (LPA), and LPA receptors (LPAR) in high-grade serous carcinoma (HGSC). mRNA expression by qRT-PCR of LPAR1-6 was analyzed in 155 HGSC specimens (88 effusions, 67 solid lesions). ATX mRNA expression was analyzed in 97 specimens. ATX, ERK, and AKT protein expression was studied by Western blotting. LPAR2 mRNA was overexpressed in HGSC cells in effusions compared to solid lesions, with opposite findings for LPAR3 and LPAR6 mRNA and ATX protein. Higher LPAR1 levels were significantly related to longer overall survival (OS) in pre-chemotherapy effusions (p = 0.027). Conversely, higher expression of LPAR1, LPAR2, and LPAR5 in post-chemotherapy effusions was significantly associated with shorter OS (p = 0.037, p = 0.025 and p = 0.021, respectively) and progression-free survival (PFS) (p < 0.001, p = 0.007 and p < 0.001, respectively) in univariate survival analysis. LPAR1 mRNA expression was an independent prognosticator of OS in patients with pre-chemotherapy effusions and PFS in patients with post-chemotherapy effusions (p = 0.013 both). In conclusion, LPAR mRNA and ATX protein levels are anatomic site-dependent in HGSC and the former are informative of disease outcome.
https://ift.tt/2uPbkVb
Immunoglobulin genes in Primates
Publication date: September 2018
Source: Molecular Immunology, Volume 101
Author(s): David N. Olivieri, Francisco Gambón Deza
Abstract
Five classes of immunoglobulins are known to exist in mammals. The number of isotypes of classes G, E and A varies among species for unknown reasons. Here, a study of the presence of immunoglobulin genes in Primates was carried out from the genomes and transcriptomes deposited in the NCBI repository. For this, a machine learning application based upon neural networks was implemented that scans the genomes and identifies the exon sequences that encode the immunoglobulin CH domains. From these exons, the immunoglobulins that each species possess can be inferred. Also, the presence of sequences outside the IGHC locus was found which were produced by retrotranscription of RNA that are probably not viable. From this study, the distribution of immunoglobulin genes across primate orders is described in detail. In Prosimians, IgD genes are not found; in Platyrrhines, a gene is identified for each of the immunoglobulin classes but the IgD gene does not have the CH2 exon; in the Cercopithecidae family, a gene is detected for each class in the Colobinae family, while in Cercopithecidae the genes for IgG have been duplicated several times. In hominids, a greater number of duplications that include the genes that code for IgA and IgE are observed. These results indicate that from the appearance of the Cercopithecidae, there is an evolutionary instability in the Ig locus.
https://ift.tt/2zYo6Xa
Anti-polysaccharide and anti-diphtheria protective antibodies after 13-valent pneumococcal conjugate vaccination in rheumatoid arthritis patients under immunosuppressive therapy
Publication date: Available online 21 July 2018
Source: Clinical Immunology
Author(s): Sara Caporuscio, Roberto Ieraci, Guido Valesini, Raffaela Teloni, Sabrina Mariotti, Francesca Romana Spinelli, Claudia Ferlito, Simonetta Salemi, Andrea Picchianti Diamanti, Giorgia Meneguzzi, Milica Markovic, Mayla Sgrulletti, Christina von Hunolstein, Luisa Ralli, Antonietta Pinto, Gerardo Salerno, Marco Canzoni, Maria Laura Sorgi, Bruno Laganà, Roberta Di Rosa
Abstract
Immunogenicity of 13-valent pneumococcal polysaccharide (PnPS) conjugate vaccine (PCV13) was evaluated in 38 rheumatoid arthritis patients under immunosuppressive treatment and 20 healthy controls (HC). Antibodies to all PnPS and diphtheria-toxin analogue conjugate protein were measured pre- (T0), 1 (T1), 6 (T2), 12 (T3) months post-immunization. Patients and HC had similar response to individual PnPS. Mean antibody levels to all PnPS but one doubled at T1 compared with T0, with T3 persistence for only 8-7/13 PnPS. Baseline antibody levels was inversely associated with the rate of responders at T1 (T1/T0≥2) to 11/13 PnPS. Few subjects reached protective IgG levels against some serotypes frequently isolated in Italian patients with invasive pneumococcal disease. Antibody response was not influenced by therapy, except the one to PS7F, which was reduced by tumor necrosis factor-α-inhibitors. Vaccination increased also anti-diphtheria IgG. Despite this study substantially confirmed the PCV13 immunogenicity in immunocompromised patients, it also revealed some limitations.
https://ift.tt/2JIxCgK
Assessment of vestibular function in elderly patients
Purpose of review Individuals over the age of 60 are at an increased risk of falls, even if they do not have an isolated dysfunction of the vestibular system. The aim of this article is to review the various vestibular testing currently available and its usefulness in determining the presence of vestibular dysfunction in the elderly population. The primary vestibular tests to be reviewed include: balance function testing, vestibular evoked myogenic potentials (VEMPs), and video head impulse testing (vHIT). Recent findings Balance function testing is important as it evaluates the integration of vestibular information along with sensory and visual information, which may also be impaired. VEMP testing provides a small diagnostic yield as most elderly patients have absent or reduced responses. vHIT gain is reduced in this population, but will still be within the normal range for individuals with normal balance function. Summary The combination of various vestibular tests provides complimentary information instead of redundant information on the patient's balance function. Each test evaluates various aspects of the vestibular system which are all needed to determine stable balance in the elderly population. Correspondence to Rachael Krager, Audiologist, UC Davis Medical Center, 2521 Stockton Blvd., 6th Floor, Sacramento, CA 95817, USA. E-mail: rkrager@ucdavis.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2LofCgu
https://ift.tt/2LofCgu
Advances in computer-aided design for bony free-flap reconstruction
Purpose of review The current article reviews the most recent publications of computer-assisted reconstruction using bony free flaps, emphasizing on comparative reports using these novel techniques. Recent findings Computer-aided reconstruction has shown some benefits in comparison with traditional techniques and some of the perceived limitations are currently being addressed in the latest reports. Still, there is a lack of appropriate comparative studies and unblinded measurements to establish solid conclusions. Summary Despite the application of new technologies showed encouraging results, it is premature to state that the traditional technique should be replaced by the modern approaches. Correspondence to Kevin Fung, MD, FRCS(C), FACS, Professor, Chair/Chief, Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, LHSC – Victoria Hospital, Room B3-427, 800 Commissioners Rd E, London, ON, Canada N6A 4G5. Tel: +1 519 685 8599; fax: +1 519 685 8567; e-mail: kevin.fung@lhsc.on.ca Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2uTjoUG
https://ift.tt/2uTjoUG
Endogenous Bradykinin and BK1-5 during ACE Inhibitor-Associated Angioedema
Publication date: Available online 21 July 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Scott Hubers, Kevin Kohm, Shouzuo Wei, Chang Yu, Hui Nian, Ryan Grabert, Daniel J. Sexton, Nancy J. Brown
Capsule Summary
Bradykinin concentrations and the ratio of bradykinin to its stable metabolite BK1-5 (RPPGF) were significantly increased in patients presenting with angiotensin-converting enzyme (ACE) inhibitor-associated angioedema compared to ACE inhibitor-treated controls. Cleavage of high molecular weight kininogen was not increased in patients with ACE inhibitor-associated angioedema, indicating that increased bradykinin concentrations result from decreased degradation.
https://ift.tt/2LDanqi
Clinical and genetic differences between pustular psoriasis subtypes
Publication date: Available online 21 July 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Sophie Twelves, Alshimaa Mostafa, Nick Dand, Elias Burri, Katalin Farkas, Rosemary Wilson, Hywel L. Cooper, Alan D. Irvine, Hazel H. Oon, Külli Kingo, Sulev Köks, Ulrich Mrowietz, Luis Puig, Nick Reynolds, Eugene Sern-Ting Tan, Adrian Tanew, Kaspar Torz, Hannes Trattner, Mark Valentine, Shyamal Wahie
Abstract
Background
The term pustular psoriasis indicates a group of severe skin disorders characterised by eruptions of neutrophil-filled pustules. The disease, which often manifests with concurrent psoriasis vulgaris (PV), can have an acute systemic (generalised pustular psoriasis, GPP) or chronic localised presentation (palmoplantar pustulosis, PPP; acrodermatitis continua of Hallopeau, ACH). While mutations have been uncovered in IL36RN and AP1S3, the rarity of the disease has hindered the study of genotype-phenotype correlations.
Objective
We sought to characterise clinical and genetic features of pustular psoriasis through the analysis of an extended patient cohort.
Methods
We ascertained a dataset of unprecedented size, including 863 unrelated patients (251 GPP, 560 PPP, 28 ACH, 24 multiple diagnoses). We undertook mutation screening in 473 cases.
Results
PV concurrence was lowest in PPP (15.8% vs. 54.4% in GPP and 46.2% in ACH, P<0.0005 for both), whereas mean age of onset was earliest in GPP (31.0 years vs. 43.7 in PPP and 51.8 in ACH, P<0.0001 for both). The percentage of females was higher in PPP (77.0%) than GPP (62.5%) (P=5.8x10-5). The same applied to the prevalence of smokers (79.8% vs 28.3%, P<10-15). While AP1S3 alleles had similar frequency (0.03-0.05) across disease subtypes, IL36RN mutations were less common in PPP (0.03) than GPP (0.19) and ACH (0.16) (P=1.9x10-14 and 0.002, respectively). Importantly, IL36RN disease alleles had a dose-dependent effect on age of onset, in all forms of pustular psoriasis (P=0.003).
Conclusions
The analysis of an unparalleled patient resource revealed key clinical and genetic differences between PPP and GPP.
Graphical abstract
https://ift.tt/2Ldk1DT
Basophil levels in PBMC population during childhood acute wheeze/asthma are associated with future exacerbations
Publication date: Available online 21 July 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Jonatan Leffler, Anya C. Jones, Elysia M. Hollams, Franciska Prastanti, Peter N. Le Souëf, Patrick G. Holt, Anthony Bosco, Ingrid A. Laing, Deborah H. Strickland
Encapsulating summary
Our data suggest that a basophil level above 0.18% of the PBMC population during an acute respiratory exacerbation is associated with an increased risk for future exacerbations in children with asthma and/or wheeze.
https://ift.tt/2LAP4FP
Generating evidence to inform an update of asthma clinical practice guidelines: Perspectives from the National Heart, Lung, and Blood Institute
Publication date: Available online 21 July 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): George A. Mensah, James P. Kiley, Gary H. Gibbons
Asthma is the most prevalent chronic respiratory disease worldwide. Its increasing prevalence and evidence of suboptimal control require renewed efforts in the development and widespread implementation of clinical practice guidelines for prevention, treatment, and control. Given the rapidly changing landscape and evolving best practices for guideline development, the National Heart, Lung, and Blood Institute made a commitment to support rigorous systematic evidence reviews that frontline health care providers and stakeholders could use to create new or update existing guidelines. This article describes the protocols, key questions, methodology, and analytic framework to support the update of the 2007 National Asthma Education and Prevention Program Expert Panel Report 3 (EPR-3) on the diagnosis and management of asthma in adults and children. It also describes the expert panel's practical experience in managing asthmatic patients across the age and severity spectrum. The article explains the process for ensuring that the expert panel's deliberations are conducted in accordance with the Institute of Medicine's standards and recommendations for guideline development. The outcome of this ambitious effort will be an update of the EPR-3 asthma guidelines and publication of the key recommendation in the Journal of Allergy and Clinical Immunology. Importantly, several novel approaches will be explored and incorporated as appropriate to accelerate adoption and sustained implementation of the guidelines.
https://ift.tt/2Ld09Av
Thirty-Day Acute Health Care Resource Utilization Following Outpatient Anterior Cruciate Ligament Surgery
Background and Objectives The need for hospital-based acute care following outpatient surgical procedures is expensive and measured as marker for quality. However, little information is available about events leading to emergency department visit or inpatient admission after ambulatory anterior cruciate ligament (ACL) surgery. Methods We studied adult patients who underwent outpatient ACL surgery in New York State between 2009 and 2013 using the Healthcare Cost and Utilization Project database. Emergency department visits and inpatient admissions within 30 days of surgery were identified by cross-matching 2 additional independent Healthcare Cost and Utilization Project databases. Results The final cohort included 26,873 subjects. We identified 1208 (3.90%; 95% confidence interval [CI], 3.6%–4.1%) secondary health care encounters of interest. The majority of these encounters were emergency department visits (951). The most common reasons were musculoskeletal pain (349 [28.9%]), any infection (122 [10.1%]), drug abuse (98 [8.1%]), wound infection (87 [7.2%]), deep venous thrombosis (77 [6.4%]), and psychotic events (54 [4.5%]). Patients operated on in high-volume surgical centers were less likely to require acute care (odds ratio, 0.47; P
https://ift.tt/2JGjEMq
https://ift.tt/2JGjEMq
Bubble Trouble: Venous Air Embolism in Endoscopic Retrograde Cholangiopancreatography
No abstract availablehttps://ift.tt/2JH58Us
The Stress Hormone Cortisol Enhances Interferon-υ–Mediated Proinflammatory Responses of Human Immune Cells
BACKGROUND: Cortisol is a prototypical human stress hormone essential for life, yet the precise role of cortisol in the human stress response to injury or infection is still uncertain. Glucocorticoids (GCs) such as cortisol are widely understood to suppress inflammation and immunity. However, recent research shows that GCs also induce delayed immune effects manifesting as immune stimulation. In this study, we show that cortisol enhances the immune-stimulating effects of a prototypical proinflammatory cytokine, interferon-υ (IFN-υ). We tested the hypothesis that cortisol enhances IFN-υ–mediated proinflammatory responses of human mononuclear phagocytes (monocyte/macrophages [MOs]) stimulated by bacterial endotoxin (lipopolysaccharide [LPS]). METHODS: Human MOs were cultured for 18 hours with or without IFN-υ and/or cortisol before LPS stimulation. MO differentiation factors granulocyte-macrophage colony stimulating factor (GM-CSF) or M-CSF were added to separate cultures. We also compared the inflammatory response with an acute, 4-hour MO incubation with IFN-υ plus cortisol and LPS to a delayed 18-hour incubation with cortisol before LPS exposure. MO activation was assessed by interleukin-6 (IL-6) release and by multiplex analysis of pro- and anti-inflammatory soluble mediators. RESULTS: After the 18-hour incubation, we observed that cortisol significantly increased LPS-stimulated IL-6 release from IFN-υ–treated undifferentiated MOs. In GM-CSF–pretreated MOs, cortisol increased IFN-υ–mediated IL-6 release by >4-fold and release of the immune stimulant IFN-α2 (IFN-α2) by >3-fold, while suppressing release of the anti-inflammatory mediator, IL-1 receptor antagonist to 15% of control. These results were reversed by either the GC receptor antagonist RU486 or by an IFN-υ receptor type 1 antibody antagonist. Cortisol alone increased expression of the IFN-υ receptor type 1 on undifferentiated and GM-CSF–treated MOs. In contrast, an acute 4-hour incubation of MOs with IFN-υ and cortisol showed classic suppression of the IL-6 response to LPS. CONCLUSIONS: These results reveal a surprisingly robust proinflammatory interaction between the human stress response hormone cortisol and the immune activating cytokine IFN-υ. The results support an emerging physiological model with an adaptive role for cortisol, wherein acute release of cortisol suppresses early proinflammatory responses but also primes immune cells for an augmented response to a subsequent immune challenge. These findings have broad clinical implications and provide an experimental framework to examine individual differences, mechanisms, and translational implications of cortisol-enhanced immune responses in humans.https://ift.tt/2LnuHz3
Rashomon Effect and the Contradiction of Data, Practice, and Regulations
No abstract availablehttps://ift.tt/2JH50UY
Adding to Our Competitive Advantage: Making the Case for Teaching Communication and Professionalism
No abstract availablehttps://ift.tt/2LnuETT
Vascular Air Embolism and Endoscopy: Every Bubble Matters
No abstract availablehttps://ift.tt/2uNNHMw
Beyond Emergence: Understanding postoperative Cognitive Dysfunction (POCD)
No abstract availablehttps://ift.tt/2LqJk4w
Repeated Measures Designs and Analysis of Longitudinal Data: If at First You Do Not Succeed—Try, Try Again
Anesthesia, critical care, perioperative, and pain research often involves study designs in which the same outcome variable is repeatedly measured or observed over time on the same patients. Such repeatedly measured data are referred to as longitudinal data, and longitudinal study designs are commonly used to investigate changes in an outcome over time and to compare these changes among treatment groups. From a statistical perspective, longitudinal studies usually increase the precision of estimated treatment effects, thus increasing the power to detect such effects. Commonly used statistical techniques mostly assume independence of the observations or measurements. However, values repeatedly measured in the same individual will usually be more similar to each other than values of different individuals and ignoring the correlation between repeated measurements may lead to biased estimates as well as invalid P values and confidence intervals. Therefore, appropriate analysis of repeated-measures data requires specific statistical techniques. This tutorial reviews 3 classes of commonly used approaches for the analysis of longitudinal data. The first class uses summary statistics to condense the repeatedly measured information to a single number per subject, thus basically eliminating within-subject repeated measurements and allowing for a straightforward comparison of groups using standard statistical hypothesis tests. The second class is historically popular and comprises the repeated-measures analysis of variance type of analyses. However, strong assumptions that are seldom met in practice and low flexibility limit the usefulness of this approach. The third class comprises modern and flexible regression-based techniques that can be generalized to accommodate a wide range of outcome data including continuous, categorical, and count data. Such methods can be further divided into so-called "population-average statistical models" that focus on the specification of the mean response of the outcome estimated by generalized estimating equations, and "subject-specific models" that allow a full specification of the distribution of the outcome by using random effects to capture within-subject correlations. The choice as to which approach to choose partly depends on the aim of the research and the desired interpretation of the estimated effects (population-average versus subject-specific interpretation). This tutorial discusses aspects of the theoretical background for each technique, and with specific examples of studies published in Anesthesia & Analgesia, demonstrates how these techniques are used in practice.https://ift.tt/2LmlYNB
A 2018 Reference Guide to the Banff Classification of Renal Allograft Pathology
The Banff Classification of Allograft Pathology is an international consensus classification for the reporting of biopsies from solid organ transplants. Since its initial conception in 1991 for renal transplants, it has undergone review every 2 years, with attendant updated publications. The rapid expansion of knowledge in the field has led to numerous revisions of the classification. The resultant dispersal of relevant content makes it difficult for novices and experienced pathologists to faithfully apply the classification in routine diagnostic work and in clinical trials. This review shall provide a complete and simple illustrated reference guide of the Banff Classification of Kidney Allograft Pathology based on all publications including the 2017 update. It is intended as a concise desktop reference for pathologists and clinicians, providing definitions, Banff Lesion Scores and Banff Diagnostic Categories. An online website reference guide hosted by the Banff Foundation for Allograft Pathology (www.banfffoundation.org) is being developed, which will be updated with future refinement of the Banff Classification from 2019 onwards. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received 19 February 2018. Revision received 7 May 2018. Accepted 23 May 2018. Corresponding author: Jan U. Becker, MD, Institute of Pathology, University Hospital of Cologne, Kerpener Str. 62, 50937, Germany, Phone: +4922147898803, Fax: +492214786360, E-mail: janbecker@gmx.com Authors' contribution All authors contributed the discussion of the content, the collation of images and illustrations and to writing of the manuscript. Disclosure: The authors declare no conflicts of interest. Funding Dr. Roufosse's and Dr. Simmond's contribution to this research is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Alexandre Loupy is supported by a research grant ATIP AVENIR from the National French Institute of Research. Jan U. Becker is supported by the European Rare Kidney Disease Network (ERKNet); the content of this manuscript is the sole responsibility of the authors. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2mwHEZ9
https://ift.tt/2mwHEZ9
Transplant-free Survival in Chronic Liver Disease Presenting as Acute Liver Failure in Childhood
Background in adults, the absence of a preexisting chronic liver disease (CLD) is required to diagnose acute liver failure (ALF). The paediatric classification does not considered this aspect, thus previous studies pooled together children with ALF and children with unknown CLD presenting with acute hepatic decompensation (ALF-CLD). We aimed to compare prevalence, features and outcome of children with ALF-CLD to those with a proper ALF. Methods Patients admitted between 1996-2017 because of ALF defined by PALF criteria (raised transaminases, INR ≥2.0, no history of liver disease) were classified as ALF-CLD if diagnosed with autoimmune hepatitis (AIH), Wilson disease (WD), Budd-Chiari syndrome, HBV reactivation, inborn errors of metabolism (IEM). The others were classified as ALF. Results 74 children [median age 4 years, 1.0-8.8, M/F =36/38] with ALF were found ; 18 of
https://ift.tt/2uQAjr1
https://ift.tt/2uQAjr1
Assessment of vestibular function in elderly patients
Purpose of review Individuals over the age of 60 are at an increased risk of falls, even if they do not have an isolated dysfunction of the vestibular system. The aim of this article is to review the various vestibular testing currently available and its usefulness in determining the presence of vestibular dysfunction in the elderly population. The primary vestibular tests to be reviewed include: balance function testing, vestibular evoked myogenic potentials (VEMPs), and video head impulse testing (vHIT). Recent findings Balance function testing is important as it evaluates the integration of vestibular information along with sensory and visual information, which may also be impaired. VEMP testing provides a small diagnostic yield as most elderly patients have absent or reduced responses. vHIT gain is reduced in this population, but will still be within the normal range for individuals with normal balance function. Summary The combination of various vestibular tests provides complimentary information instead of redundant information on the patient's balance function. Each test evaluates various aspects of the vestibular system which are all needed to determine stable balance in the elderly population. Correspondence to Rachael Krager, Audiologist, UC Davis Medical Center, 2521 Stockton Blvd., 6th Floor, Sacramento, CA 95817, USA. E-mail: rkrager@ucdavis.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2LofCgu
https://ift.tt/2LofCgu
Advances in computer-aided design for bony free-flap reconstruction
Purpose of review The current article reviews the most recent publications of computer-assisted reconstruction using bony free flaps, emphasizing on comparative reports using these novel techniques. Recent findings Computer-aided reconstruction has shown some benefits in comparison with traditional techniques and some of the perceived limitations are currently being addressed in the latest reports. Still, there is a lack of appropriate comparative studies and unblinded measurements to establish solid conclusions. Summary Despite the application of new technologies showed encouraging results, it is premature to state that the traditional technique should be replaced by the modern approaches. Correspondence to Kevin Fung, MD, FRCS(C), FACS, Professor, Chair/Chief, Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, LHSC – Victoria Hospital, Room B3-427, 800 Commissioners Rd E, London, ON, Canada N6A 4G5. Tel: +1 519 685 8599; fax: +1 519 685 8567; e-mail: kevin.fung@lhsc.on.ca Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2uTjoUG
https://ift.tt/2uTjoUG
Assessing the benefits of demand-side flexibility in residential and transport sectors from an integrated energy systems perspective
Li, PH; Pye, S; (2018) Assessing the benefits of demand-side flexibility in residential and transport sectors from an integrated energy systems perspective. Applied Energy , 228 pp. 965-979. 10.1016/j.apenergy.2018.06.153 . Green open access
https://ift.tt/2JGbaVA
Automated recruitment and randomisation for an efficient randomised controlled trial in primary care
Cornelius, VR; McDermott, L; Forster, AS; Ashworth, M; Wright, AJ; Gulliford, MC; (2018) Automated recruitment and randomisation for an efficient randomised controlled trial in primary care. Trials , 19 , Article 341. 10.1186/s13063-018-2723-3 . Green open access
https://ift.tt/2Lu6bvY
Cascaded lattice Boltzmann method for thermal flows on standard lattices
Fei, L; Luo, KH; (2018) Cascaded lattice Boltzmann method for thermal flows on standard lattices. International Journal of Thermal Sciences , 132 pp. 368-377. 10.1016/j.ijthermalsci.2018.06.017 . Green open access
https://ift.tt/2JIbXFs
Characterization techniques for nanoparticles: comparison and complementarity upon studying nanoparticle properties
Mourdikoudis, S; Pallares, RM; Thanh, NTK; (2018) Characterization techniques for nanoparticles: comparison and complementarity upon studying nanoparticle properties. Nanoscale , 10 (27) pp. 12871-12934. 10.1039/c8nr02278j . Green open access
https://ift.tt/2Lqfw89
Quantitative analysis of hydroxyapatite-binding plasma proteins in genotyped individuals with late-stage age-related macular degeneration
Arya, S; Emri, E; Synowsky, SA; Shirran, SL; Barzegar-Befroei, N; Peto, T; Botting, CH; ... Stewart, AJ; + view all Arya, S; Emri, E; Synowsky, SA; Shirran, SL; Barzegar-Befroei, N; Peto, T; Botting, CH; Lengyel, I; Stewart, AJ; - view fewer (2018) Quantitative analysis of hydroxyapatite-binding plasma proteins in genotyped individuals with late-stage age-related macular degeneration. Experimental Eye Research , 172 pp. 21-29. 10.1016/j.exer.2018.03.023 .
https://ift.tt/2JIbLWK
Towards the cold atom analog false vacuum
Braden, J; Johnson, MC; Peiris, HV; Weinfurtner, S; (2018) Towards the cold atom analog false vacuum. Journal of High Energy Physics (JHEP) , 07 , Article 014. (In press).
https://ift.tt/2Lu4Cyi
Rapid and efficient genetic engineering of both wild type and axenic strains of Dictyostelium discoideum
Paschke, P; Knecht, DA; Silale, A; Traynor, D; Williams, TD; Thomason, PA; Insall, RH; ... Veltman, DM; + view all Paschke, P; Knecht, DA; Silale, A; Traynor, D; Williams, TD; Thomason, PA; Insall, RH; Chubb, JR; Kay, RR; Veltman, DM; - view fewer (2018) Rapid and efficient genetic engineering of both wild type and axenic strains of Dictyostelium discoideum. PLoS ONE , 13 (5) , Article e0196809.. 10.1371/journal.pone.0196809 . Green open access
https://ift.tt/2JFQKvX
Beta-blocker propranolol modulates decision urgency during sequential information gathering
Hauser, TU; Moutoussis, M; Purg, N; Dayan, P; Dolan, RJ; (2018) Beta-blocker propranolol modulates decision urgency during sequential information gathering. Journal of Neuroscience 10.1523/JNEUROSCI.0192-18.2018 . Green open access
https://ift.tt/2LqfvkB
Investigation of Three-Dimensional Microstructure of Tricalcium Silicate (C₃S) by Electron Microscopy
Yang, F; Liu, X; Zhao, Y; Zhang, Y; Wang, P; Robinson, I; Chen, B; (2018) Investigation of Three-Dimensional Microstructure of Tricalcium Silicate (C₃S) by Electron Microscopy. Materials , 11 (7) , Article 1110. 10.3390/ma11071110 . Green open access
https://ift.tt/2uTfYRQ
A hierarchical Bayesian perspective on majorization-minimization for non-convex sparse regression: application to M/EEG source imaging
Bekhti, Y; Lucka, F; Salmon, J; Gramfort, A; (2018) A hierarchical Bayesian perspective on majorization-minimization for non-convex sparse regression: application to M/EEG source imaging. Inverse Problems , 34 (8) , Article 085010. 10.1088/1361-6420/aac9b3 . Green open access
https://ift.tt/2LnoJ17
Nonmonotonic recruitment of ventromedial prefrontal cortex during remote memory recall
Barry, DN; Chadwick, MJ; Maguire, EA; (2018) Nonmonotonic recruitment of ventromedial prefrontal cortex during remote memory recall. PLoS Biology , 16 (7) , Article e2005479. 10.1371/journal.pbio.2005479 . Green open access
https://ift.tt/2uTfOKe
Disorder-Specific and Shared Brain Abnormalities During Vigilance in Autism and Obsessive-Compulsive Disorder
Carlisi, CO; Norman, L; Murphy, CM; Christakou, A; Chantiluke, K; Giampietro, V; Simmons, A; ... Rubia, K; + view all Carlisi, CO; Norman, L; Murphy, CM; Christakou, A; Chantiluke, K; Giampietro, V; Simmons, A; Brammer, M; Murphy, DG; Mataix-Cols, D; Rubia, K; - view fewer (2017) Disorder-Specific and Shared Brain Abnormalities During Vigilance in Autism and Obsessive-Compulsive Disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging , 2 (8) pp. 644-654. 10.1016/j.bpsc.2016.12.005 . Green open access
https://ift.tt/2LscMqH
The role of prefrontal–subcortical circuitry in negative bias in anxiety: Translational, developmental and treatment perspectives
Carlisi, CO; Robinson, OJ; (2018) The role of prefrontal–subcortical circuitry in negative bias in anxiety: Translational, developmental and treatment perspectives. Brain and Neuroscience Advances , 2 10.1177/2398212818774223 . (In press). Green open access
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High Viral Diversity and Mixed Infections in Cerebral Spinal Fluid From Cases of Varicella Zoster Virus Encephalitis
Depledge, DP; Cudini, J; Kundu, S; Atkinson, C; Brown, JR; Haque, T; Houldcroft, CJ; ... Breuer, J; + view all Depledge, DP; Cudini, J; Kundu, S; Atkinson, C; Brown, JR; Haque, T; Houldcroft, CJ; Koay, ES; McGill, F; Milne, R; Whitfield, T; Tang, JW; Underhill, G; Bergstrom, T; Norberg, P; Goldstein, R; Solomon, T; Breuer, J; - view fewer (2018) High Viral Diversity and Mixed Infections in Cerebral Spinal Fluid From Cases of Varicella Zoster Virus Encephalitis. The Journal of Infectious Diseases 10.1093/infdis/jiy358 . Green open access
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The duration of hypothermia affects short-term neuroprotection in a mouse model of neonatal hypoxic ischaemic injury
Rocha-Ferreira, E; Vincent, A; Bright, S; Peebles, DM; Hristova, M; (2018) The duration of hypothermia affects short-term neuroprotection in a mouse model of neonatal hypoxic ischaemic injury. PLoS One , 13 (7) , Article e0199890. 10.1371/journal.pone.0199890 . Green open access
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Mechanisms of acute and chronic pain after surgery: update from findings in experimental animal models
Purpose of review Management of postoperative pain is still a major issue and relevant mechanisms need to be investigated. In preclinical research, substantial progress has been made, for example, by establishing specific rodent models of postoperative pain. By reviewing most recent preclinical studies in animals related to postoperative, incisional pain, we outline the currently available surgical-related pain models, discuss assessment methods for pain-relevant behavior and their shortcomings to reflect the clinical situation, delineate some novel clinical-relevant mechanisms for postoperative pain, and point toward future needs. Recent findings Since the development of the first rodent model of postoperative, incisional pain almost 20 years ago, numerous variations and some procedure-specific models have been emerged including some conceivably relevant for investigating prolonged, chronic pain after surgery. Many mechanisms have been investigated by using these models; most recent studies focussed on endogenous descending inhibition and opioid-induced hyperalgesia. However, surgical models beyond the classical incision model have so far been used only in exceptional cases, and clinical relevant behavioral pain assays are still rarely utilized. Summary Pathophysiological mechanisms of pain after surgery are increasingly discovered, but utilization of pain behavior assays are only sparsely able to reflect clinical-relevant aspects of acute and chronic postoperative pain in patients. Correspondence to Esther Pogatzki-Zahn, Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany. Tel: +49 251 8347261; fax: +49 251 88704; e-mail: pogatzki@anit.uni-muenster.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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