Efficacy of anti-TNF alpha in severe and refractory major vessel involvement of Behcet's disease: A multicenter observational study of 18 patients

Publication date: Available online 18 August 2018

Source: Clinical Immunology

Author(s): A.C. Desbois, L. Biard, O. Addimanda, M. Lambert, E. Hachulla, D. Launay, F. Ackerman, L. Pérard, A. Hot, F. Maurier, C. Mausservey, F. Bernard, N. Noel, L. Alric, T. Mirault, F. Cohen, S. Boussouar, M. Resche-Rigon, P. Cacoub, D. Saadoun

Abstract

Objective

To describe the outcome and tolerance in patients treated with anti-TNFα in severe and refractory major vessel disease in Behçet's disease (BD).

Methods

A multicenter study evaluating 18 refractory BD patients with major vessel involvement [pulmonary artery (n = 4), aorta (n = 4) or peripheral artery aneurysm (n = 1) and/or pulmonary artery (n = 7), inferior vena cava (n = 5), or intra-cardiac (n = 3) thrombosis or Budd Chiari Syndrome (n = 2)] treated with anti-TNFα agents.

Results

Vascular remission was achieved in 16 (89%) patients. The 9 months risk of relapse was significantly higher with conventional immunosuppressants used prior anti-TNFα agents as compared to anti-TNFα therapy [OR = 8.7 (1.42–62.6), p = 0.03]. The median daily dose of corticosteroids significantly decreased at 12 months. Side effects included infection (n = 4) and pulmonary edema (n = 1).

Conclusion

TNFα-antagonists are safe and might be associated with a decreased risk of relapse at 9 months compared to conventional immunosuppressants in BD patients with major vessels disease.

https://ift.tt/2wf8skW

Feasibility study of bilateral radical ethmoidectomy in ambulatory surgery

Publication date: Available online 17 August 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): M. Kérimian, P.-L. Bastier, N. Réville, S. Fierens, L. de Gabory

Abstract

Objectives

To assess the feasibility of bilateral radical ethmoidectomy in ambulatory surgery by risk analysis, and to calculate possible medico-economic savings.

Methods

This study was performed retrospectively over a 2-year period and prospectively for 1 year. It included all patients undergoing bilateral ethmoidectomy, associated to sphenoidotomy and/or septoplasty or not, in a university hospital department. Data were collected on demographics, disease etiology, previous surgery, operative details, postoperative course, complications and satisfaction assessed by questionnaire at days 1 and 30. Ambulatory surgery eligibility criteria were applied to this population, and an economic analysis compared savings between inpatient and outpatient management.

Results

Hundred and sixty-five patients were included. Surgical indications comprised nasal polyposis (87%), chronic sinusitis without nasal polyps (6%) or cystic fibrosis (7%). Seventy-five septoplasties were associated (45.5%). Operating time depended on associated septoplasty (P = 0.005), surgeon experience (P < 0.0001) and previous sinus surgery (P = 0.041). Only 37% of the patients wished for same-day discharge; reasons for refusal were home-to-hospital distance and bleeding risk. Considering anesthesia contraindications, immediate complications and operating time, 107 patients were eligible for outpatient treatment, although only 13 patients underwent ambulatory surgery. Medical-economic savings with outpatient management would have been about €20,000 per year.

Conclusions

Bilateral radical ethmoidectomy, associated to septoplasty or not, could be performed on an outpatient basis in more than 60% of cases, without increased risk, and with cost savings of 28.4%.

https://ift.tt/2MWddqK

Mixed Meal and Intravenous L-Arginine Tests Both Stimulate Incretin Release Across Glucose Tolerance in Man: Lack of Correlation with β Cell Function

Metabolic Syndrome and Related Disorders, Ahead of Print.


https://ift.tt/2wcY51n

Auto-obliteration of maxillary sinuses through osteoneogenesis in children with cystic fibrosis: A possible new way to reduce morbidity

Publication date: Available online 18 August 2018

Source: American Journal of Otolaryngology

Author(s): Madison Buras, Alberto Simoncini, Anil Gungor

Abstract

Background

Cystic Fibrosis is an autosomal recessive disorder with a mutation in the cystic fibrosis transmembrane regulator gene, leading to dysregulation of epithelial fluid transport, dehydration of airway surfaces and impaired mucociliary function in the sinuses, lungs, pancreas and other organs. This leads to thickened secretion which blocks the sinus ostia and promotes chronic bacterial overgrowth and destruction of the mucosa. Chronic rhinosinusitis in cystic fibrosis patients leads to a decreased quality of life involving increased hospitalizations, infections, pneumonia, and acute exacerbations, warranting multiple sinus surgeries. This study investigates the effects of a more aggressive surgical approach on reducing the need for repeat surgeries.

Methods

A retrospective review of CT scans of nine cystic fibrosis patients who have had aggressive endoscopic sinus surgery for the treatment of chronic rhinosinusitis (CRS) was performed. The decrease in maxillary sinus volume was measured using pre-operative and post-operative scans.

Results

A significant decrease in maxillary sinus volume was observed in all subjects. Volume reduction occurred through osteoneogenesis, causing auto-obliteration of the sinuses with cancellous bone.

Conclusions

Aggressive endoscopic sinus surgery for maxillary sinuses incites an osteoneogenetic reaction that leads to auto-obliteration of the sinus and reduces sinus-related morbidity in children with cystic fibrosis. Through this osteoneogenesis, the sinus is transformed into a shallow cup that does not retain secretions and is easy to clear. It is our impression that this may lead to reduced morbidity and a decreased need for repeat maxillary sinus surgery.

https://ift.tt/2MVF8ay

Viral Epitope Escape in Acute HIV-1 Infection

Viral Immunology, Ahead of Print.


https://ift.tt/2PhqjAB

Discrepant Clinical Significance of CD28+CD8− and CD4+CD25high Regulatory T Cells During the Progression of Hepatitis B Virus Infection

Viral Immunology, Ahead of Print.


https://ift.tt/2L5AxRv

Sequential bilateral cochlear implant: results in children and adolescents

Publication date: Available online 18 August 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Gabriela Felix Lazarini Almeida, Marcella Ferrari Martins, Lucas Bevilacqua Alves da Costa, Orozimbo Alves da Costa, Ana Claudia Martinho de Carvalho

Abstract

Introduction

The use of the bilateral cochlear implants can promote the symmetrical development of the central auditory pathways, thus benefiting the development of auditory abilities and improving sound localization and the ability of auditory speech perception in situations of competitive noise.

Objective

To evaluate the ability of speech perception in children and adolescents using sequential bilateral cochlear implants, considering the association of these variables: age at surgery, time of device use and interval between surgeries.

Methods

14 individuals were assessed, between 10 and 16 years of age, who demonstrated a surgical indication for the use of sequential bilateral cochlear implants as intervention in the auditory habilitation process. The speech perception ability was assessed through sentence lists constructed in the Portuguese language, presented in two situations: in silence, with fixed intensity of 60 dB SPL, and in competitive noise, with a signal-to-noise ratio of +15 dB. The evaluation was performed under the following conditions: unilateral with the first activated cochlear implant, unilateral with the second activated cochlear implant and bilateral with both devices activated.

Results

The results of the speech perception tests showed better performance in both silence and in noise for the bilateral cochlear implant condition when compared to the 1st cochlear implant and the 2nd cochlear implant alone. A worse result of speech perception was found using the 2nd cochlear implant alone. No statistically significant correlation was found between age at the surgical procedure, interval between surgeries and the time of use of the 2nd cochlear implant, and the auditory speech perception performance for all assessed conditions. The use of a personal sound amplification product prior to the 2nd cochlear implant resulted in benefits for auditory speech perception with the 2nd cochlear implant, both in silence and in noise.

Conclusion

The bilateral cochlear implant provided better speech perception in silence and in noise situations when compared to the unilateral cochlear implant, regardless of the interval between surgeries, age at the surgical procedure and the time of use of the 2nd cochlear implant. Speech perception with the 1st cochlear implant was significantly better than with the 2nd cochlear implant, both in silence and in noise. The use of the personal sound amplification product prior to the 2nd cochlear implant influenced speech perception performance with the 2nd cochlear implant, both in silence and in noise.

Resumo

Introdução

A utilização do implante coclear bilateral pode promover o desenvolvimento das vias auditivas centrais de maneira simétrica, beneficiando, assim, o desenvolvimento das habilidades auditivas e melhorando a localização sonora e a habilidade de percepção auditiva da fala em situações de ruído competitivo.

Objetivo

Avaliar a habilidade de reconhecimento de fala em crianças e adolescentes usuários do implante coclear bilateral sequencial, considerando a relação das variáveis: idade cirúrgica, tempo de uso do dispositivo e intervalo entre as cirurgias.

Método

Foram avaliados 14 indivíduos com idades entre 10 e 16 anos, que receberam indicação cirúrgica para a utilização do implante coclear bilateral sequencial como forma de intervenção no processo de habilitação auditiva. A habilidade de reconhecimento de fala foi avaliada por meio de listas de sentenças construídas na língua portuguesa, apresentadas em duas situações: no silêncio, com intensidade fixa de 60 dB NPS, e no ruído competitivo, com a relação sinal/ruído de + 15 dB. A avaliação foi realizada nas seguintes condições: unilateral com o 1° implante coclear ativado, unilateral com o 2° implante coclear ativado e bilateral com ambos os dispositivos ativados.

Resultado

Os resultados dos testes de reconhecimento de fala demonstraram melhor desempenho tanto no silêncio quanto no ruído para a condição implante coclear bilateral, quando comparado ao 1° implante coclear e 2° implante coclear isoladamente. Um pior resultado de reconhecimento de fala foi encontrado com o uso 2° implante coclear isoladamente. Não foi encontrada correlação estatisticamente significante entre idade cirúrgica, intervalo entre as cirurgias e tempo de uso do 2° implante coclear e o desempenho de percepção auditiva da fala para todas as condições avaliadas. O uso do aparelho de amplificação sonora individual anterior ao 2° implante coclear beneficiou os resultados de percepção auditiva da fala com o 2° implante coclear, tanto no silêncio quanto no ruído.

Conclusão

O implante coclear bilateral proporcionou melhor reconhecimento de fala em situações de silêncio e de ruído, quando comparado com o implante coclear unilateral, independente do intervalo entre as cirurgias, da idade cirúrgica e do tempo de uso do 2° implante coclear. O reconhecimento de fala com o 1° implante coclear foi significativamente melhor do que com o 2° implante coclear, tanto no silêncio quanto no ruído. O uso do aparelho de amplificação sonora individual anterior ao 2° implante coclear influenciou o desempenho de reconhecimento de fala com o 2° implante coclear, tanto no silêncio quanto no ruído.

https://ift.tt/2BmkVJE

Subclinical Hypothyroidism and the Risk of Cardiovascular Disease and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies

Thyroid, Ahead of Print.


https://ift.tt/2BkFExj

Effects of hyperleptinemia in rat saliva composition, histology and ultrastructure of the major salivary glands

Publication date: Available online 17 August 2018

Source: Archives of Oral Biology

Author(s): Elsa Lamy, Sandra Neves, Joana Ferreira, Lénia Rodrigues, Gonçalo da Costa, Carlos Cordeiro, Luísa Fialho, Mónica Lima, Ana Rodrigues Costa, Célia Miguel Antunes, Orlando Lopes, Francisco Amado, Fernando Capela e Silva

Abstract

Objective

To study the effect of the satiety hormone, leptin, in saliva proteome and salivary gland histology and ultrastructure.

Design

Increases in blood leptin levels were induced through mini-pump infusion in male Wistar rats, during a period of 7 days. Saliva was collected before and at the end of the experimental period, for proteomic analysis, and major salivary glands were collected, at the end, for biochemical, histological and ultrastructural analysis.

Results

Immunohistochemistry revealed the presence of leptin receptors in major salivary glands. Salivary amylase levels and enzymatic activity were decreased in saliva, whereas the enzymatic activity of this protein was increased in the cytosol of parotid gland cells. Transmission electron microscopy allowed the observation of high number of electron-dense granules in cytosol of parotid acinar cells.

Conclusions

Increased levels of plasmatic leptin result in changes in saliva composition and salivary glands function. To our knowledge, this is the first study providing evidences for a potential role of leptin in salivary gland secretion and saliva composition. An understanding of how appetite/satiety factors influence saliva composition and how this composition influences food processing in mouth may be relevant in understanding ingestive behaviour.

https://ift.tt/2Mpq2Ot

Bartter syndrome-like phenotype in a patient with diabetes: a case report

Bartter's syndrome is a rare genetic tubulopathy affecting the loop of Henle leading to salt wasting. It is commonly seen in utero or in early neonatal period. Rare cases of acquired Bartter's syndrome are report...

https://ift.tt/2PinEGI

Dedifferentiated parosteal osteosarcoma of the maxilla: a case report and review of the literature

Parosteal osteosarcomas are usually low-grade tumors, however, sometimes they transform to high-grade tumors, which is named dedifferentiation. This phenomenon has been reported in long bones. Recently, we enc...

https://ift.tt/2OK8LvP

Basophil Activation Test Differentiates Between Patients with Alpha-Gal Syndrome and Asymptomatic Alpha-Gal Sensitization

Publication date: Available online 17 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): J. Mehlich, J. Fischer, C. Hilger, K. Swiontek, M. Morisset, F. Codreanu-Morel, M. Schiener, S. Blank, M. Ollert, U. Darsow, T. Biedermann, B. Eberlein

Abstract

Background

The alpha-gal syndrome is characterized by the presence of sIgE antibodies to alpha-gal and delayed type I allergic reaction to the carbohydrate galactose-alpha-1,3-galactose (alpha-gal) after consumption of mammalian (red) meat products and drugs of a mammalian origin. Diagnostics currently rely on patient history, skin tests, determination of sIgE antibodies, oral food or drug challenges.

Objective

Assessing the utility of different basophil parameters (basophil reactivity and sensitivity, the ratio of the percentage of allergen-induced CD63⁺ basophils to percentage of anti-FcεRI antibody-induced CD63⁺ basophils [%CD63⁺/anti-FcεRI], the area under the dose-response curve [AUC]) as biomarkers for the clinical outcome of patients with alpha-gal syndrome compared to individuals with asymptomatic alpha-gal sensitization.

Methods

Besides routine diagnostics, a basophil activation test (Flow CAST^®) with different concentrations of alpha-gal-containing allergens (e.g., commercially available alpha-gal-carrying proteins, pork kidney extracts) was performed in 21 patients with alpha-gal syndrome, 12 alpha-gal sensitized individuals and 18 controls.

Results

Alpha-gal-containing allergens induced strong basophil activation in a dose-dependent manner in patients. Basophil reactivity at distinct allergen concentrations, the ratio %CD63+/anti-FcεRI across most allergen concentrations, the area under the curve (AUC) of dose-response curves and CD-sens with pork kidney extract were significantly higher in patients with alpha-gal syndrome compared to sensitized individuals. All parameters were negative in controls.

Conclusion

The basophil activation test should be considered as an additional diagnostic test before performing time-consuming and potentially risky oral provocation tests. The ratio %CD63⁺/anti-FcεRI for all allergens and AUC for pork kidney were the best parameters for distinguishing patients with alpha-gal syndrome from individuals with asymptomatic alpha-gal sensitization.

Clinical implications

Distinct parameters of the basophil activation test allowed a good differentiation between patients with alpha-gal syndrome and asymptomatic alpha-gal sensitization and should be determined before performing oral provocation tests.

Graphical abstract

https://ift.tt/2MoYNDq

Genetically engineered cell factories produce glycoengineered vaccines that target antigen presenting cells and reduce antigen specific T-cell reactivity

Publication date: Available online 17 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Caroline B.K. Mathiesen, Michael C. Carlsson, Stephanie Brand, Svenning Rune Möller, Manja Idorn, Per T. Straten, Anders E. Pedersen, Sally Dabelsteen, Adnan Halim, Peter Adler Würtzen, Jens Brimnes, Henrik Ipsen, Bent L. Petersen, Hans H. Wandall

https://ift.tt/2Bkg9MB

Prophylactic and therapeutic inhibition of allergic airway inflammation by probiotic E. coli O83

Publication date: Available online 17 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Christian Zwicker, Priya Sarate, Mirjana Drinic, Katharina Ambroz, Elke Korb, Ursula Smole, Cordula Köhler, Mark S. Wilson, Hana Kozakova, Peter Sebo, Miloslav Kverka, Ursula Wiedermann, Irma Schabussova

https://ift.tt/2MndNSs

Morphea with oral mucosa involvement and unilateral nevoid telangiectasia: A case report and review of the literature

Morphea is a localized inflammatory skin disease that presents with sclerosis of the skin and underlying tissues due to excessive collagen deposition. Although the incidence of odontostomatologic abnormalities in patients with linear scleroderma of the face is higher, oral involvement remains quite rare. Unilateral nevoid telangiectasia is a rare vascular dermatosis characterized by unilateral telangiectasia distributed in a dermatomal pattern, especially on the upper trunk and extremities. We describe a case of a 10-year-old girl that presents with morphea on her left chin and upper lip extending to the inner oral mucosa as well as an unilateral nevoid telangiectasia on her left cheek.

https://ift.tt/2L2eZoL

Recurrent systemic follicular lymphoma presenting as facial nodules

Systemic follicular lymphomas (SFL) exhibit heterogeneous clinical presentations and cutaneous involvement is rare with less than 4% of patients developing skin involvement during their disease course. We report a case of recurrent SFL presenting with facial nodules. A 64-year-old man with a history of stage IV SFL had a complete response to bendamustine and rituximab in 2012. Approximately 5 years later, the patient presented with enlarging rubbery, violaceous, nontender nodules on his left submandibular, left zygomatic, and right temple areas that appeared one month before.

https://ift.tt/2vTGYC9

Psoriasis and the risk of foot and ankle tendinopathy or enthesopathy: A population-based study

Objectives: Cross-sectional imaging studies have demonstrated that patients with psoriasis often have asymptomatic bone and tendon changes of the foot and ankle consistent with tendinopathy or enthesopathy. While considered an extra-articular manifestation of psoriatic arthritis, it is unknown if psoriasis patients without psoriatic arthritis have an increased risk of symptomatic foot and ankle tendinopathy or enthesopathy compared with the general population.

https://ift.tt/2KYJ0FW

Real-world apremilast experience in Australia

Introduction: This retrospective analysis undertaken in June 2017 was performed on 80 patients with chronic plaque psoriasis (CPP) who received apremilast in Australia and were enrolled in the Australasian Psoriasis Registry (APR). Apremilast received Therapeutic Goods Administration-approval in Australia in 2015. Other products approved for CPP include biologic agents targeting tumor necrosis factor alpha (TNF-α), interleukin (IL) 12/23 and IL-17, as well as conventional oral systemic therapies methotrexate, acitretin, and cyclosporine.

https://ift.tt/2vUWihS

Pyoderma gangrenosum–like fixed cutaneous sporotrichosis

Introduction: Cutaneous sporotrichosis (CS) is a rare mycotic infection, caused by the Sporothrix schenckii complex. Lesions of CS are polymorphic by nature; however, most patients develop lymphocutaneous-type lesions following fungal inoculation, and only a minority disseminated disease or fixed cutaneous lesions. Fixed CS may display a wide range of clinical morphologies, including ulcerated, crusted, verrucous or psoriasiform plaques, with or without satellite lesions.

https://ift.tt/2L4ZqN0

A novel surgical technique: Crushed septal cartilage graft application in endonasal septoplasty

Nowadays, different septoplasty procedures are applied for therapy of nasal septum deviation. However, various complications of the septoplasty procedures have been described. Several techniques have been developed to decrease the incidence of these complications by surgeons. We aimed to present the effectiveness of the crushed septal cartilage graft, which is a novel septoplasty technique.

https://ift.tt/2OHkwDo

Survival Analysis and Interpretation of Time-to-Event Data: The Tortoise and the Hare

Survival analysis, or more generally, time-to-event analysis, refers to a set of methods for analyzing the length of time until the occurrence of a well-defined end point of interest. A unique feature of survival data is that typically not all patients experience the event (eg, death) by the end of the observation period, so the actual survival times for some patients are unknown. This phenomenon, referred to as censoring, must be accounted for in the analysis to allow for valid inferences. Moreover, survival times are usually skewed, limiting the usefulness of analysis methods that assume a normal data distribution. As part of the ongoing series in Anesthesia & Analgesia, this tutorial reviews statistical methods for the appropriate analysis of time-to-event data, including nonparametric and semiparametric methods—specifically the Kaplan-Meier estimator, log-rank test, and Cox proportional hazards model. These methods are by far the most commonly used techniques for such data in medical literature. Illustrative examples from studies published in Anesthesia & Analgesia demonstrate how these techniques are used in practice. Full parametric models and models to deal with special circumstances, such as recurrent events models, competing risks models, and frailty models, are briefly discussed.

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Critically Ill, Then Chronically Painful: Pain and Interference With Everyday Life

No abstract available

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Informed Consent for Sugammadex and Oral Contraceptives: Through the Looking Glass

No abstract available

https://ift.tt/2MVKv9H

Another Win for Lidocaine, Another Loss for Magnesium?

No abstract available

https://ift.tt/2vSWTkm

Caution When Dosing Anesthetic Medications: Are We Putting Too Much Weight on Patient Weight?

No abstract available

https://ift.tt/2MUHKFE

Dyeing to Find Out How an “AWEsim” Bundle Can Impact Anesthesia Work Environment Contamination

No abstract available

https://ift.tt/2vSWKgO

Readiness for Discharge After Foot and Ankle Surgery Using Peripheral Nerve Blocks: A Randomized Controlled Trial Comparing Spinal and General Anesthesia as Supplements to Nerve Blocks

BACKGROUND: Neuraxial anesthesia is often viewed as superior to general anesthesia but may delay discharge. Comparisons do not typically use multimodal analgesics and nerve blockade. Combining nerve blockade with general anesthesia may reduce pain, opioid consumption, and nausea. We hypothesized that general anesthesia (with nerve blocks) would lead to earlier readiness for discharge, compared to spinal anesthesia (with nerve blocks). METHODS: All patients underwent ambulatory foot and ankle surgery, with a predicted case duration of 1–3 hours. All patients received popliteal and adductor canal nerve blocks using bupivacaine and dexamethasone. No intraoperative opioids were administered. All patients received ondansetron, dexamethasone, ketamine, and ketorolac. Patients, data collectors, and the data analyst were not informed of group assignment. Patients were randomized to spinal or general anesthesia with concealed allocation. Spinal anesthesia was performed with mepivacaine and accompanied with propofol sedation. After general anesthesia was induced with propofol, a laryngeal mask airway was inserted, followed by sevoflurane and propofol. Time until ready for discharge, the primary outcome, was compared between groups after adjusting for age and surgery time using multivariable unconditional quantile regression. Secondary outcomes compared at multiple timepoints were adjusted for multiple comparisons using the Holm–Bonferroni step-down procedure. RESULTS: General anesthesia patients were ready for discharge at a median of 39 minutes earlier (95% confidence interval, 2–75; P = .038) versus spinal anesthesia patients. Patients in both groups met readiness criteria for discharge substantially before actual discharge. Pain scores at rest were higher among general anesthesia patients 1 hour after leaving the operating room (adjusted difference in means, 2.1 [95% confidence interval, 1.0–3.2]; P

https://ift.tt/2MVKa6S

Intraoperative Transfusion Guidelines: Promoting Clinician Adherence in the Operating Room

No abstract available

https://ift.tt/2vSWDSq

Pediatric Intensive Care, 1st ed

No abstract available

https://ift.tt/2MUHJBA

Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers Before Elective Noncardiac Surgery: An Ongoing Dilemma

No abstract available

https://ift.tt/2vSWyy6

Cardiac Arrest in the Operating Room: Resuscitation and Management for the Anesthesiologist Part 1

No abstract available

https://ift.tt/2L1RUSQ

Local Anesthetics as…Cancer Therapy?

No abstract available

https://ift.tt/2PhSmQg

Promoting a Restrictive Intraoperative Transfusion Strategy: The Influence of a Transfusion Guideline and a Novel Software Tool

BACKGROUND: The effect of neither transfusion guidelines nor decision support tools on intraoperative transfusion has been previously evaluated. The University of Michigan introduced a transfusion guideline in 2009, and in 2011, the Department of Anesthesiology developed a transfusion decision support tool. The primary aim of this study was to assess the associations of the transfusion guideline and the optional use of the software transfusion tool with intraoperative behaviors; pretransfusion hematocrit assessment (whether or not a hematocrit was checked before each red cell unit) and restrictive red cell use (withholding transfusion unless the hematocrit was ≤21%). METHODS: This was a before–after retrospective study without a concurrent control group of patients transfused 1–3 units of red cells intraoperatively. Three phases were studied to provide data both before and after the implementation of the transfusion guideline and the intraoperative software tool. Within each phase, trends of checking hematocrits before transfusion and restrictive transfusion were charted against time. F tests were used to measure differences of slopes. The difference between means of each phase was measured using Mann-Whitney U tests. Independent associations were measured using mixed-effects multivariable logistic regression. A secondary outcome analysis was conducted for 30-day mortality, myocardial infarction, renal injury, and their combination. RESULTS: The transfusion guideline was associated with increased pretransfusion hematocrit evaluation (67.4%, standard deviation [SD] 3.9 vs 76.5%, SD 2.7; P

https://ift.tt/2L1ROdW

Fibrinogen Concentrate: Is It Standard Currency or Bitcoin in Bleeding Management?

No abstract available

https://ift.tt/2vOStLa

α-Asarone Alleviated Chronic Constriction Injury–Induced Neuropathic Pain Through Inhibition of Spinal Endoplasmic Reticulum Stress in an Liver X Receptor–Dependent Manner

BACKGROUND: Neuropathic pain is an intractable and complex disease. Recent studies have shown a close relationship between endoplasmic reticulum (ER) stress and neuropathic pain. Here, we investigated the effect of α-asarone, an ER stress inhibitor, on chronic constriction injury (CCI)–induced neuropathic pain. METHODS: Two parts were included in this study. In part 1, rats were assigned to 7 groups: the sham group, the sham + α-asarone 20 mg/kg group, the CCI group, the CCI + vehicle group, the CCI + α-asarone 5 mg/kg group, the CCI + α-asarone 10 mg/kg group, and the CCI + α-asarone 20 mg/kg group. After surgery, the rats were treated with α-asarone or normal saline daily. Pain thresholds were measured, and samples of the L3–6 spinal cord were taken for western blotting and immunofluorescence on day 7. In part 2, rats were intrathecally implanted with PE-10 tubes and divided into 4 groups: the CCI + α-asarone 20 mg/kg group, the CCI + α-asarone 20 mg/kg + vehicle group, the CCI + α-asarone 20 mg/kg + SR9243 group, and the CCI group. Five rats in each group were separated for behavioral tests 1 hour after intrathecal injection. The rest of them were killed for western blotting on day 7. RESULTS: In this study, CCI surgery significantly induced mechanical allodynia and thermal hyperalgesia. CCI surgery significantly induced activation of ER stress (PERK-eIF2α, IRE1α, CHOP, and XBP-1s) in rats. However, treatment with 20 mg/kg of α-asarone significantly alleviated CCI-induced activation of ER stress. Behavioral results showed that daily treatment with 20 mg/kg of α-asarone significantly alleviated CCI-induced nociceptive behaviors, on day 7 (mechanical allodynia, P = .016, 95% confidence interval, 0.645–5.811; thermal hyperalgesia, P = .012, 95% confidence interval, 0.860–6.507). Furthermore, α-asarone induced upregulated expression of liver X receptor β (LXRβ) and downstream proteins in the spinal cord. The LXR antagonist SR9243 completely inhibited the anti-ER stress and antinociceptive effects of α-asarone in rats. CONCLUSIONS: α-Asarone relieved CCI-induced neuropathic pain in an LXR-dependent manner. α-Asarone may be a potential agent for treatment of neuropathic pain.

https://ift.tt/2MZQcDG

Surveying the Literature: Synopsis of Recent Key Publications

No abstract available

https://ift.tt/2Piru2E

Perioperative Care of the Elderly Patient

No abstract available

https://ift.tt/2MT54DK

Description of a Novel Set-up for Functional Echocardiographic Assessment of Left Ventricular Performance During Ex Vivo Heart Perfusion

Ex vivo heart perfusion (EVHP) is a new technology aimed at decreasing cold ischemia time and evaluating cardiac function before transplanting a donor heart. In an experimental EVHP swine model, we tested a 3D-printed custom-made set-up to perform surface echocardiography on an isolated beating heart during left ventricular loading. The views obtained at any time point were equivalent to standard transesophageal and transthoracic views. A decrease in left ventricular function during EVHP was observed in all experiments.

https://ift.tt/2PkvKyX

Observation and Experiment: An Introduction to Causal Inference

No abstract available

https://ift.tt/2L2GSwO

Fibrinogen Concentrate in Cardiovascular Surgery: A Meta-analysis of Randomized Controlled Trials

BACKGROUND: Postoperative bleeding remains a frequent complication after cardiovascular surgery and may contribute to serious morbidity and mortality. Observational studies have suggested a relationship between low endogenous plasma fibrinogen concentration and increased risk of postoperative blood loss in cardiac surgery. Although the transfusion of fibrinogen concentrate has been increasing, potential benefits and risks associated with perioperative fibrinogen supplementation in cardiovascular surgery are not fully understood. METHODS: PubMed, Cochrane Library, Ovid MEDLINE, Embase, Web of Science, and China National Knowledge Infrastructure were searched on January 15, 2017, with automated updates searched until February 15, 2018, to identify all randomized controlled trials (RCTs) of fibrinogen concentrate, whether for prophylaxis or treatment of bleeding, in adults undergoing cardiovascular surgery. All RCTs comparing fibrinogen infusion versus any other comparator (placebo/standard of care or another active comparator) in adult cardiovascular surgery and reporting at least 1 predefined clinical outcome were included. The random-effects model was used to calculate risk ratios and weighted mean differences (95% confidence interval [CI]) for dichotomous and continuous variables, respectively. Subgroup analyses by fibrinogen dose and by baseline risk for bleeding were preplanned. RESULTS: A total of 8 RCTs of fibrinogen concentrate in adults (n = 597) of mixed risk or high risk undergoing cardiovascular surgery were included. Compared to placebo or inactive control, perioperative fibrinogen concentrate did not significantly impact risk of all-cause mortality (risk ratio, 0.41; 95% CI, 0.12–1.38; I2 = 10%; P = .15). Fibrinogen significantly reduced incidence of allogeneic red blood cell transfusion (risk ratio, 0.64; 95% CI, 0.49–0.83; I2 = 0%; P = .001). No significant differences were found for other clinical outcomes. Subgroup analyses were unremarkable when analyzed according to fibrinogen dose, time of infusion initiation, mean cardiopulmonary bypass time, and rotational thromboelastometry/fibrinogen temogram use (all P values for subgroup interaction were nonsignificant). CONCLUSIONS: Current evidence remains insufficient to support or refute routine perioperative administration of fibrinogen concentrate in patients undergoing cardiovascular surgery. Fibrinogen concentrate may reduce the need for additional allogeneic blood product transfusion in cardiovascular surgery patients at high risk or with evidence of bleeding. However, no definitive advantage was found for reduction in risk of mortality or other clinically relevant outcomes. The small number of clinical events within existing randomized trials suggests that further well-designed studies of adequate power and duration to measure all-cause mortality, stroke, myocardial infarction, reoperation, and thromboembolic events should be conducted. Future studies should also address cost-effectiveness relative to standard of care.

https://ift.tt/2vRzEa3

Transplantation of human induced pluripotent stem cell-derived cardiomyocytes is superior to somatic stem cell therapy for restoring cardiac function and oxygen consumption in a porcine model of myocardial infarction

Background Somatic stem cell (SC) therapy can improve cardiac performance following ischemic injury. In this study, we investigated whether induced pluripotent SC-derived cardiomyocytes (iPS-CMs) are more effective than somatic SCs, such as skeletal myoblasts (SM) and mesenchymal (M)SCs, in promoting functional recovery upon transplantation in a porcine model of myocardial infarction (MI). Methods Myocardial injury was induced by ameroid ring placement in immunosuppressed female mini-pigs; after 1 month, epicardial cell transplantation was performed with iPS-CMs (n = 7), SMs (n = 7), and MSCs (n = 7). Control pigs underwent sham operation (n = 8). Results Cell therapy improved functional recovery 2 months after MI, as evidenced by increased ejection fraction (iPS-CM, +7.3% ± 2.2% and SM, +5.8% ± 5.4% vs. Control: -4.4% ± 3.8%; P

https://ift.tt/2PiJqdG

Clinical efficacy of anti-IL-5 monoclonal antibody mepolizumab in the treatment of eosinophilic otitis media

Publication date: Available online 16 August 2018

Source: Auris Nasus Larynx

Author(s): Yukiko Iino, Eri Takahashi, Saeko Ida, Saori Kikuchi

Abstract

Objective

Eosinophilic otitis media (EOM) is an intractable otitis media characterized by a highly viscous effusion containing eosinophils, and it is mostly associated with bronchial asthma. Recently, anti-IL-5 therapy using mepolizumab has been reported to be effective for patients with severe and refractory eosinophilic bronchial asthma. EOM shows accumulation of eiosinophils in the middle ear effusion and most EOM patients have high numbers of peripheral blood eosinophils. Therefore, we carried out a retrospective study to determine whether anti-IL-5 therapy is also effective in the treatment of EOM.

Patients and methods

Nine patients with EOM associated with bronchial asthma received the anti-IL-5 agent mepoliumab as an add-on therapy for at least 6 months (mepolizumab group). They were evaluated by EOM severity scores, symptom scores, bone conduction hearing levels, and surrogate markers before and after receiving the anti-IL-5 therapy. Thirteen EOM patients associated with bronchial asthma who did not receive the anti-IL-5 therapy were also included as controls (control group).

Results

The severity scores of most patients in the mepolizumab group were dramatically reduced at 3 months after the initiation of this therapy and, as therapy continued, they further decreased to levels significantly lower than the baseline. However, two patients with a granulation type of EOM showed minimal improvement from the therapy. The severity scores of control patients showed no significant changes during the study period. Significant deterioration of the bone conduction hearing levels was not observed in either group. The number of peripheral blood eosinophils was significantly reduced, and eosinophils were scarcely observed in the middle ear effusion and middle ear mucosa after the mepolizumab therapy.

Conclusions

Anti-IL-5 therapy using mepolizumab was effective at inhibiting eosinophilic recruitment to the middle ear in patients with EOM. However, this therapy showed minimal effect on patients with the granulation type of EOM. Therefore, this therapy may be a viable treatment option for refractory EOM without severe mucosal change.

https://ift.tt/2nIoaBo

Sinonasal pleomorphic adenoma: A single institution case series combined with a comprehensive review of literatures

Publication date: Available online 16 August 2018

Source: Auris Nasus Larynx

Author(s): Min-Seok Rha, Sewon Jeong, Hyung-Ju Cho, Joo-Heon Yoon, Chang-Hoon Kim

Abstract

Objective

This study aimed to reveal diagnosis, management, and treatment outcome characteristics of sinonasal pleomorphic adenoma and to identify predictors for disease recurrence.

Methods

This study comprised a retrospective review of data from seven patients with sinonasal pleomorphic adenoma who were treated by the authors at a tertiary medical center between January 2005 and May 2017. In addition, the MEDLINE database was searched for literature published in English. A systematic review of the published articles was performed.

Results

A total of 42 articles were eligible for review. Data from the seven treated patients and 101 patients described in the literature were included in the analysis. An endoscopic approach was employed in all cases treated at our institution, and recurrence was found in one patient with a large, 5.5-cm tumor. In reviewing prior publications, the mean age at surgery was 45.4 years, and the primary sign at diagnosis was nasal obstruction. The most common primary tumor site was the nasal septum (57.4%), and the mean tumor size was 3.6 cm (range, 0.5–10 cm) in 76 cases for which detailed information was available. Endoscopic endonasal resection achieved successful oncologic control in applied cases (25/25, 100%). Recurrence was found in eight of 101 patients. Multivariate analysis identified tumor origin of the paranasal sinus (adjusted OR 31.000, p = 0.016) as being significantly associated with a high prevalence of recurrence.

Conclusion

Pleomorphic adenoma is a rare benign tumor of the sinonasal tract. Surgery that achieves clear margins is the treatment of choice. The tumor may be accessible via an endoscopic endonasal approach in most cases, although incomplete resection of the tumor stem may allow for tumor recurrence. In addition, our findings suggest that a tumor originating from the paranasal sinus is significantly associated with a high prevalence of recurrence.

https://ift.tt/2OO6U9B

Finding the Right Pediatrician for Your Family

Finding the right pediatrician for your growing family is a big step and can lead to many questions. What should you look for in a pediatrician? Where should you go for recommendations? Dr. Kristen Bruno provides her advice to help guide you in making this important decision.

The post Finding the Right Pediatrician for Your Family appeared first on ChildrensMD.

https://ift.tt/2OFHiLR

Radiologic predictors of immune checkpoint inhibitor response in advanced head and neck squamous cell carcinoma

Publication date: October 2018

Source: Oral Oncology, Volume 85

Author(s): Vishwajith Sridharan, Rifaquat M. Rahman, Raymond Y. Huang, Nicole G. Chau, Jochen H. Lorch, Ravindra Uppaluri, Robert I. Haddad, Glenn J. Hanna, Jonathan D. Schoenfeld

Abstract

Radiologic predictors of response to immune checkpoint blockade (ICPi) in advanced head and neck squamous cell carcinoma (HNSCC) patients could help guide patient selection and management. We analyzed a large institutional cohort of 100 consecutive HNSCC patients treated with ICPi to investigate associations between molecular and radiologic phenotype and assess radiologic predictors of response and survival. Of particular interest was the impact of increased total tumor burden (TB), calculated as the sum of the largest diameter of all measurable lesions according to RECIST 1.1, and early radiologic indicators of response versus progression.

Within our cohort, 42% of patients had HPV+ associated disease, 64% had persistent/recurrent head and neck lesions, and 77% had distant metastases. Median TB was 5.4 cm. HPV+ disease and increased total mutational burden were associated with distant disease in the absence of locoregional disease (p < 0.01 and p = 0.03, respectively).

Forty patients (40%) demonstrated clinical benefit to ICPi, and the median overall survival (OS) on PD-1 therapy was 4.5 months. A lower tumor burden at baseline was associated with clinical benefit (p = 0.03) and improved OS (p < 0.01, HR 2.33). There was only one instance of pseudoprogression; indeed any increase in TB on first interval scan was associated with poor OS (p = 0.02, HR 2.39). These data suggest that HNSCC patients who benefit from ICPi are more likely to have lower tumor burden at the onset of treatment and minimal increase in tumor burden while on treatment.

https://ift.tt/2ONYIpR

The Spider Limb Positioner in subscapular system free flaps

Publication date: October 2018

Source: Oral Oncology, Volume 85

Author(s): Jayne R. Stevens, Andrew J. Rosko, Emily Marchiano, Cate Haring, Steven B. Chinn, Kelly M. Malloy, Mark E. Prince, Keith Casper, Jeffrey Moyer, Douglas Chepeha, Chaz L. Stucken, Matthew E. Spector

Abstract

Background

The subscapular system is a versatile vascular network that can provide multiple flaps for reconstruction of the head and neck. A significant drawback of using the subscapular system is that patient positioning can preclude the use of simultaneous two-team ablative and reconstructive surgery. Herein, we describe a novel use of an upper extremity limb positioner (Spider Limb Positioner) used primarily in orthopedic surgery to facilitate concurrent two-team technique in head and neck surgery.

Methods

Using a bean bag and the Spider Limb Positioner for the upper extremity, a semidecubitus position was used for subscapular donor site dissection. Ablative and reconstructive teams worked concurrently in all cases.

Results

This technique was utilized 78 times on 73 patients, with chimeric flaps used in 38% of cases. The average operative time was 466 min. Only one patient required repositioning intraoperatively due to a change in the subscapular donor site side. There were no nerve compression injuries or positioning related complications.

Conclusion

Scapular and parascapular free flaps are useful tools for reconstruction of the head and neck. In a two-team approach, the use of a semidecubitus position in conjunction with the Spider Limb Positioner facilitates exposure for the reconstructive team without compromising access for the ablative team.

https://ift.tt/2nL0b4v

Can healthy diet intercept progression of oral potentially malignant disorders?

Publication date: Available online 17 August 2018

Source: Oral Oncology

Author(s): Prashanth Panta, Sachin C. Sarode, Gargi S. Sarode, Shankargouda Patil

https://ift.tt/2OFEgar

Regulatory mechanisms of PD-L1 expression in cancer cells

Abstract

Immunotherapy targeting the PD-L1/PD-1 pathway using antibodies is effective in the clinical treatment of a multitude of cancers. This makes research of the regulatory mechanisms of PD-1 expression in cancer cells intriguing. PD-L1 expression can be categorized into inducible expression, attributed to extrinsic factors in the microenvironment, and constitutive expression, attributed to intrinsic cancer-driving gene alteration. The mechanisms of PD-L1 expression in cancer cells operate at multiple levels, including gene amplification, chromatin modification, transcription, posttranscription, translation and posttranslation. Moreover, some open questions in this field that need to be answered in future research are proposed. Studies of regulatory mechanisms of PD-L1 expression pave the way for the application of more effective approaches in the future of cancer immunotherapy.

https://ift.tt/2MW9h9N

Human Vestibulo-Ocular Reflex Adaptation: Consolidation Time Between Repeated Training Blocks Improves Retention

Abstract

We sought to determine if separating vestibulo-ocular reflex (VOR) adaptation training into training blocks with a consolidation (rest) period in between repetitions would result in improved VOR adaptation and retention. Consolidation of motor learning refers to the brain benefitting from a rest period after prior exposure to motor training. The role of consolidation on VOR adaptation is unknown, though clinicians often recommend rest periods as a part of vestibular rehabilitation. The VOR is the main gaze stabilising system during rapid head movements. The VOR is highly plastic and its gain (eye/head velocity) can be increased via training that induces an incrementally increasing retinal image slip error signal to drive VOR adaptation. The unilateral incremental adaptation technique typically consists of one 15-min training block leading to an increase in VOR gain of ~ 10 % towards the training side. We tested nine normal subjects, each over six separate sessions/days. Three training protocols/sessions were 5 min each (1 × 5-min training) and three training protocols/sessions were 55 min each. Each 55-min protocol comprised 5-min training, 20-min rest, 5-min training, 20-min rest, 5-min training (3 × 5-min training). Active and passive VOR gains were measured before and after training. For training with consolidation breaks, VOR gain retention was measured over 1 h. The VOR gain increase after 1 × 5-min training was 3.1 ± 2.1 % (P < 0.01). One might expect that repeating this training three times would result in × 3 total increase of 9.3 %; however, the gain increase after 3 × 5-min training was only 7.1 ± 2.8 % (P < 0.001), suggesting that consolidation did not improve VOR adaptation for our protocols. However, retention was improved by the addition of consolidation breaks, i.e. gains did not decrease over 1 h (P = 0.43). These data suggest that for optimal retention VOR adaptation exercises should be performed over shorter repeated blocks.

https://ift.tt/2BhHajZ

Baseline IL22 expression in atopic dermatitis patients stratifies tissue responses to fezakinumab

Publication date: Available online 17 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Patrick M. Brunner, Ana B. Pavel, Saakshi Khattri, Alexandra Leonard, Kunal Malik, Sharon Rose, Shelbi Jim On, Anjali S. Vekaria, Claudia Traidl-Hoffmann, Giselle K. Singer, Danielle Baum, Patricia Gilleaudeau, Mary Sullivan-Whalen, Judilyn Fuentes-Duculan, Xuan Li, Xiuzhong Zheng, Yeriel Estrada, Sandra Garcet, Huei-Chi Wen, Juana Gonzalez

Abstract

Background

IL-22 is potentially a pathogenic cytokine in AD, but molecular effects of IL-22 antagonism have not been defined in humans.

Objective

We sought to evaluate cellular and molecular effects of IL-22 blockade in tissues from moderate-to-severe AD patients.

Methods

We assessed lesional and non-lesional skin from 59 moderate-to-severe AD patients treated with anti-IL-22 (fezakinumab) vs. placebo (2:1), using transcriptomic and immunohistochemistry analyses.

Results

Greater reversal of the AD genomic profile was seen with fezakinumab vs. placebo, namely 25.3% vs. 10.9% at 4wks (p=1.7*10^-5) and 65.5% vs. 13.9% at 12wks (p=9.5*10^-19), respectively. Since IL-22 blockade showed clinical efficacy only in severe AD, we used baseline median IL22 expression to stratify for high (n=30) and low (n=29) IL22-expression groups. Much stronger mean transcriptomic improvements were seen with fezakinumab in the IL22-high drug group (82.8% and 139.4% at 4 and 12wks, respectively), than in the respective IL22-high placebo (39.6% and 53.6% at 4 and 12wks) or the IL22-low groups. Significant downregulations of multiple immune pathways, including Th1/CXCL9, Th2/CCL18/CCL22, Th17/CCL20/DEFB4A, and Th22/IL22/S100As, were restricted to the IL22-high drug-group (p<0.05). Consistently, tissue predictors of clinical response were mostly genes involved in T-cell and dendritic cell activation and differentiation.

Conclusions

This is the first report showing a profound effect of IL-22 blockade on multiple inflammatory pathways in AD. These data, supported by the robust effects in patients with high IL22 baseline expression, suggest a central role for IL-22 in AD, indicating the need for a precision medicine approach for improving therapeutic outcomes in AD.

Clinical Implications

Stratification of cytokine expression at baseline might help future precision medicine approaches to effectively treat atopic dermatitis patient subsets that might benefit from IL-22 antagonism or other specific blockers.

https://ift.tt/2weXETY

Human Vestibulo-Ocular Reflex Adaptation: Consolidation Time Between Repeated Training Blocks Improves Retention

Abstract

We sought to determine if separating vestibulo-ocular reflex (VOR) adaptation training into training blocks with a consolidation (rest) period in between repetitions would result in improved VOR adaptation and retention. Consolidation of motor learning refers to the brain benefitting from a rest period after prior exposure to motor training. The role of consolidation on VOR adaptation is unknown, though clinicians often recommend rest periods as a part of vestibular rehabilitation. The VOR is the main gaze stabilising system during rapid head movements. The VOR is highly plastic and its gain (eye/head velocity) can be increased via training that induces an incrementally increasing retinal image slip error signal to drive VOR adaptation. The unilateral incremental adaptation technique typically consists of one 15-min training block leading to an increase in VOR gain of ~ 10 % towards the training side. We tested nine normal subjects, each over six separate sessions/days. Three training protocols/sessions were 5 min each (1 × 5-min training) and three training protocols/sessions were 55 min each. Each 55-min protocol comprised 5-min training, 20-min rest, 5-min training, 20-min rest, 5-min training (3 × 5-min training). Active and passive VOR gains were measured before and after training. For training with consolidation breaks, VOR gain retention was measured over 1 h. The VOR gain increase after 1 × 5-min training was 3.1 ± 2.1 % (P < 0.01). One might expect that repeating this training three times would result in × 3 total increase of 9.3 %; however, the gain increase after 3 × 5-min training was only 7.1 ± 2.8 % (P < 0.001), suggesting that consolidation did not improve VOR adaptation for our protocols. However, retention was improved by the addition of consolidation breaks, i.e. gains did not decrease over 1 h (P = 0.43). These data suggest that for optimal retention VOR adaptation exercises should be performed over shorter repeated blocks.

https://ift.tt/2BhHajZ

Identifying Candidate Biomarkers for Pleomorphic Adenoma: A Case–Control Study

Abstract

Pleomorphic adenoma (PA) is the most common benign salivary gland tumor. Kallikrein-related peptidases have been identified as biomarkers in many human tumors and may influence tumor behavior. We investigated KLK1−15 messenger ribonucleic acid and proteins in PA specimens to determine a KLK expression profile for this tumor. Fresh frozen PA tissue specimens (n = 26) and matched controls were subjected to quantitative real-time reverse transcription polymerase chain reaction to detect KLK1−15 mRNA. Expression of KLK1, KLK12, KLK13, and KLK8 proteins were then evaluated via immunostaining techniques. Statistical analyses were performed with the level of significance set at P < .05. We observed downregulation of KLK1, KLK12, and KLK13 mRNA expression, and immunostaining studies revealed downregulation of the corresponding proteins. Histologic evidence of capsular perforation was associated with increased KLK1 protein expression. Tumor size was not associated with capsular invasion and/or perforation. This study is the first to detail a KLK expression profile for PA at both the transcriptional level and the protein level. Future work is required to develop clinical applications of these findings.

https://ift.tt/2L3f5fF

Laryngeal Epstein–Barr Virus-Associated Smooth Muscle Tumor in an Undernourished Child

Abstract

Smooth muscle tumors associated with Epstein–Barr virus infections (EBV–SMT) of laryngeal origin are exceedingly rare and have been reported in few adult patients, but not in children. This reported case describes a lesion found in the larynx of an 8-year-old Guatemalan undernourished girl. Microscopically, the lesion showed a highly cellular mesenchymal spindle cell tumor, containing frequent lymphocytes. The immunohistochemical analysis revealed positivity for α-smooth muscle actin and h-caldesmon. In addition, most of the tumor cells were positive for EBV by in situ hybridization. To the best of the author's knowledge, this is the first literature-reported case of laryngeal EBV–SMT occurring in an undernourished child.

https://ift.tt/2Bvpcuv

Identifying Candidate Biomarkers for Pleomorphic Adenoma: A Case–Control Study

Abstract

Pleomorphic adenoma (PA) is the most common benign salivary gland tumor. Kallikrein-related peptidases have been identified as biomarkers in many human tumors and may influence tumor behavior. We investigated KLK1−15 messenger ribonucleic acid and proteins in PA specimens to determine a KLK expression profile for this tumor. Fresh frozen PA tissue specimens (n = 26) and matched controls were subjected to quantitative real-time reverse transcription polymerase chain reaction to detect KLK1−15 mRNA. Expression of KLK1, KLK12, KLK13, and KLK8 proteins were then evaluated via immunostaining techniques. Statistical analyses were performed with the level of significance set at P < .05. We observed downregulation of KLK1, KLK12, and KLK13 mRNA expression, and immunostaining studies revealed downregulation of the corresponding proteins. Histologic evidence of capsular perforation was associated with increased KLK1 protein expression. Tumor size was not associated with capsular invasion and/or perforation. This study is the first to detail a KLK expression profile for PA at both the transcriptional level and the protein level. Future work is required to develop clinical applications of these findings.

https://ift.tt/2L3f5fF

Emergence of mature cortical activity in wakefulness and sleep in healthy preterm and full-term infants

Whitehead, K; Laudiano-Dray, P; Meek, J; Fabrizi, L; (2018) Emergence of mature cortical activity in wakefulness and sleep in healthy preterm and full-term infants. Sleep , 41 (8) , Article zsy096. 10.1093/sleep/zsy096 . Green open access

https://ift.tt/2PiVXxI

c-Maf controls immune responses by regulating disease-specific gene networks and repressing IL-2 in CD4+ T cells

Gabryšová, L; Alvarez-Martinez, M; Luisier, R; Cox, LS; Sodenkamp, J; Hosking, C; Pérez-Mazliah, D; ... O'Garra, A; + view all Gabryšová, L; Alvarez-Martinez, M; Luisier, R; Cox, LS; Sodenkamp, J; Hosking, C; Pérez-Mazliah, D; Whicher, C; Kannan, Y; Potempa, K; Wu, X; Bhaw, L; Wende, H; Sieweke, MH; Elgar, G; Wilson, M; Briscoe, J; Metzis, V; Langhorne, J; Luscombe, NM; O'Garra, A; - view fewer (2018) c-Maf controls immune responses by regulating disease-specific gene networks and repressing IL-2 in CD4+ T cells. Nature Immunology , 19 pp. 497-507. 10.1038/s41590-018-0083-5 .

https://ift.tt/2OKgqdK

Former Carers' Views on Assisted Dying in Dementia

Tomlinson, EJ; (2013) Former Carers' Views on Assisted Dying in Dementia. Doctoral thesis (D.Clin.Psy), UCL (University College London).

https://ift.tt/2Pj1F2r

Exploring computerised cognitive training as a therapeutic intervention for people with Huntington’s disease (CogTrainHD): protocol for a randomised feasibility study

Yhnell, E; Furby, H; Breen, RS; Brookes-Howell, LC; Drew, CJG; Playle, R; Watson, G; ... Busse, ME; + view all Yhnell, E; Furby, H; Breen, RS; Brookes-Howell, LC; Drew, CJG; Playle, R; Watson, G; Metzler-Baddeley, C; Rosser, AE; Busse, ME; - view fewer (2018) Exploring computerised cognitive training as a therapeutic intervention for people with Huntington's disease (CogTrainHD): protocol for a randomised feasibility study. Pilot and Feasibility Studies , 4 , Article 45. 10.1186/s40814-018-0237-0 . Green open access

https://ift.tt/2OIF3HG

Gas Phase Electrochemical Analysis of Amino Acids and their Fragments

Caruana, DJ; Calleja, M; Elahi, A; (2018) Gas Phase Electrochemical Analysis of Amino Acids and their Fragments. Communications Chemistry 10.1038/s42004-018-0046-7 . (In press).

https://ift.tt/2PiIxBW

Does Short-Term Starvation have an Effect on Socio-Emotional Functioning in Healthy Volunteers?

Thompson, SD; (2013) Does Short-Term Starvation have an Effect on Socio-Emotional Functioning in Healthy Volunteers? Doctoral thesis (D.Clin.Psy), UCL (University College London).

https://ift.tt/2OIETQA

Piloting the Effect of a Film-Based Intervention on Attitudes and Stigma towards People with Intellectual Disabilities in the South Asian Community

Seewooruttun, L; (2013) Piloting the Effect of a Film-Based Intervention on Attitudes and Stigma towards People with Intellectual Disabilities in the South Asian Community. Doctoral thesis (D.Clin.Psy), UCL. Green open access

https://ift.tt/2Miui1U

Validation of the Persistence, Perseveration and Perfectionism Questionnaire

Russouw, L; (2013) Validation of the Persistence, Perseveration and Perfectionism Questionnaire. Doctoral thesis (D.Clin.Psy), UCL.

https://ift.tt/2BklROD

Laryngeal Epstein–Barr Virus-Associated Smooth Muscle Tumor in an Undernourished Child

Abstract

Smooth muscle tumors associated with Epstein–Barr virus infections (EBV–SMT) of laryngeal origin are exceedingly rare and have been reported in few adult patients, but not in children. This reported case describes a lesion found in the larynx of an 8-year-old Guatemalan undernourished girl. Microscopically, the lesion showed a highly cellular mesenchymal spindle cell tumor, containing frequent lymphocytes. The immunohistochemical analysis revealed positivity for α-smooth muscle actin and h-caldesmon. In addition, most of the tumor cells were positive for EBV by in situ hybridization. To the best of the author's knowledge, this is the first literature-reported case of laryngeal EBV–SMT occurring in an undernourished child.

https://ift.tt/2Bvpcuv

Identifying Candidate Biomarkers for Pleomorphic Adenoma: A Case–Control Study

Abstract

Pleomorphic adenoma (PA) is the most common benign salivary gland tumor. Kallikrein-related peptidases have been identified as biomarkers in many human tumors and may influence tumor behavior. We investigated KLK1−15 messenger ribonucleic acid and proteins in PA specimens to determine a KLK expression profile for this tumor. Fresh frozen PA tissue specimens (n = 26) and matched controls were subjected to quantitative real-time reverse transcription polymerase chain reaction to detect KLK1−15 mRNA. Expression of KLK1, KLK12, KLK13, and KLK8 proteins were then evaluated via immunostaining techniques. Statistical analyses were performed with the level of significance set at P < .05. We observed downregulation of KLK1, KLK12, and KLK13 mRNA expression, and immunostaining studies revealed downregulation of the corresponding proteins. Histologic evidence of capsular perforation was associated with increased KLK1 protein expression. Tumor size was not associated with capsular invasion and/or perforation. This study is the first to detail a KLK expression profile for PA at both the transcriptional level and the protein level. Future work is required to develop clinical applications of these findings.

https://ift.tt/2L3f5fF

Dose Escalation of RMC-4630 Monotherapy in Relapsed/Refractory Solid Tumors

Condition:   Solid Tumors
Intervention:   Drug: RMC-4630
Sponsors:   Revolution Medicines, Inc.;   Sanofi
Not yet recruiting

https://ift.tt/2MCFeXO

Evaluation of 18F-FDOPA PET-CT in the Preoperative Initial Assessment of Medullary Thyroid Carcinoma

Condition:   Medullary Thyroid Carcinoma
Intervention:   Other: PET at 18F-FDOPA
Sponsor:   Assistance Publique Hopitaux De Marseille
Not yet recruiting

https://ift.tt/2L3fcYD

Effect of IONM on Efficacy and Safety Using Sugammadex in Thyroid Surgery

Conditions:   Vocal Cord Paralysis;   Recurrent Laryngeal Nerve
Intervention:   Drug: Group B. Sugammadex sodium-IONM
Sponsor:   Lütfiye Nuri Burat Government Hospital
Recruiting

https://ift.tt/2MswBPr

Radiotherapy With Durvalumab Prior to Surgical Resection for HPV Negative Squamous Cell Carcinoma

Condition:   Squamous Cell Carcinoma of the Head and Neck
Interventions:   Drug: Durvalumab;   Radiation: Stereotactic Body Radiation Therapy (SBRT);   Procedure: Standard of Care Therapy
Sponsors:   University of Colorado, Denver;   AstraZeneca
Not yet recruiting

https://ift.tt/2BloCiO

The Application of 3T MRI in Esophageal Cancer

Conditions:   Esophageal Cancer TNM Staging;   Magnetic Resonance Imaging;   Prognosis
Intervention:   Other: No intervention
Sponsor:   Henan Cancer Hospital
Not yet recruiting

https://ift.tt/2vTHKz2

Association of HER2 gene amplification and tumor progression in early gastric cancer

Abstract

Overexpression of human epidermal growth factor receptor 2 (HER2) protein in association with HER2 gene amplification is found in 7–34% of gastric cancers. In breast cancer, HER2 overexpression is a prognostic factor in advanced cases and is associated with tumor progression in ductal carcinoma in situ. However, the biological and clinical significance of HER2 status in early gastric cancer is unknown. Here, we aimed to examine the correlation between HER2 gene amplification and tumor progression in early gastric cancer. The HER2 status was evaluated in 149 lesions from 141 consecutive patients with early gastric cancer who underwent endoscopic resection by immunohistochemistry and dual color in situ hybridization. HER2 gene amplification was detected in 35 (23.5%) of 149 lesions, and of those, 26 cases (74.3%) showed intratumoral heterogeneity. HER2 gene amplification was found in noninvasive carcinoma, and there was a significant correlation between HER2 status and T factor (P = 0.0290). Our study demonstrated that HER2 gene amplification occurred during the early stages of gastric cancer and showed heterogeneity in several cases. HER2 gene amplification may be involved in tumor progression in early gastric cancer.

https://ift.tt/2nMnJ9i

Laryngeal Epstein–Barr Virus-Associated Smooth Muscle Tumor in an Undernourished Child

Abstract

Smooth muscle tumors associated with Epstein–Barr virus infections (EBV–SMT) of laryngeal origin are exceedingly rare and have been reported in few adult patients, but not in children. This reported case describes a lesion found in the larynx of an 8-year-old Guatemalan undernourished girl. Microscopically, the lesion showed a highly cellular mesenchymal spindle cell tumor, containing frequent lymphocytes. The immunohistochemical analysis revealed positivity for α-smooth muscle actin and h-caldesmon. In addition, most of the tumor cells were positive for EBV by in situ hybridization. To the best of the author's knowledge, this is the first literature-reported case of laryngeal EBV–SMT occurring in an undernourished child.

https://ift.tt/2Bvpcuv

Comparable Electrode Impedance and Speech Perception at 12 Months after Cochlear Implantation Using Round Window versus Cochleostomy: An Analysis of 40 Patients

Objective: The objective of this study was to examine whether cochlear implantation using the round window (RW) route versus cochleostomy achieves comparable electrode impedance and hearing results. Methods: This retrospective analysis included 40 patients receiving a cochlear implant (REZ-1): 20 using the RW approach and the remaining 20 using cochleostomy. Electrode impedance and tone, vowel, consonant, disyllable and sentence perception were measured during and after the implantation. Results: Electrode impedance did not differ significantly between the 2 groups at any time points [F(1, 38) = 1.84; p = 0.184]: 1.87, 5.16, 6.47 and 6.70 kΩ in the RW group versus 2.86, 5.33, 6.92 and 8.16 kΩ in the cochleostomy group at 0, 1, 3 and 12 months, respectively. There was no significant difference between the RW and cochleostomy groups for tone (77.50 vs. 80.50%; p = 0.472), vowel (77.70 vs. 78.65%; p = 0.760), consonant (75.50 vs. 78.25%; p = 0.443), disyllable (78.60 vs. 81.50%; p = 0.317) and sentence (50.90 vs. 52.50%; p = 0.684) perception at 12 months. Conclusion: The RW approach is comparable to cochleostomy in electrode placement as reflected by impedance and function as reflected by tone, vowel, consonant, disyllable and sentence perception.
ORL

https://ift.tt/2nHpaWq

Morphological Evaluation of Thyroid Cartilage Invasion in Early Glottic Tumors Involving the Anterior Commissure

Introduction: The anterior commissure is an area of glottic cancer infiltration, even in early stages. Objective: To evaluate the invasion by tumors into the anterior commissure cartilage in surgical specimens of frontolateral laryngectomy. Methods: Forty-eight patients who had undergone frontolateral laryngectomy for T1b/T2 squamous cell carcinoma were included. Epidemiological and clinical aspects as well as morphological histopathological analysis were evaluated. Results: Of the 48 patients, 42 (87.5%) had T1b lesions and 6 (12.5%) had T2. Thirty-four cases (70.8%) showed healthy tissue between the tumor and the thyroid cartilage, 10 cases (20.8%) had a tumor in close proximity to the cartilage, and in 4 cases (8.3%) there was cartilage invasion. There was no major risk of adverse outcome in the groups with infiltration or tumor adjacent to the cartilage. Level of differentiation, mitotic index, nuclear irregularity, and the presence of nucleolus and tumor necrosis were not related to cartilage invasion. Conclusion: The infiltration of thyroid cartilage occurred in 8.3% of tumors and did not change the outcome in patients submitted to frontolateral laryngectomy. The morphological characteristics did not present any statistical significance.
ORL

https://ift.tt/2MTQ8VE

The Old and the New: An Enhanced Vision for JNA

No abstract available

https://ift.tt/2MWvHaW

Epithelial-myoepithelial carcinoma: a population-based survival analysis

Epithelial-myoepithelial carcinoma is an uncommon malignant neoplasm seen most frequently in the salivary glands, representing approximately 1 to 2% of salivary gland tumors. Less than 600 cases have been repo...

https://ift.tt/2Bs1yiu

Trichophyton mentagrophytes – vom Schneeleoparden zum Menschen

Zusammenfassung

Infektionsquelle für Trichophyton (T.) mentagrophytes, einen zoophilen Dermatophyten, sind als Haustiere gehaltene Nagetiere (Meerschweinchen, Mäuse, Kaninchen), manchmal auch Katzen. Infektionen des Menschen durch Dermatophyten nach Kontakt zu Zootieren sind dagegen extrem selten. Vier Tierpfleger des Zoologischen Gartens Basel erkrankten an einer Tinea manus und Tinea corporis durch T. mentagrophytes. Die 22 Jahre alte Tochter eines der Tierpfleger litt ebenfalls an einer Tinea corporis. Die Identifizierung des Isolates vom Indexpatienten wurde mittels direkter Uniplex-PCR(Polymerasekettenreaktion)-EIA (Enzyme-Immoassay) und Sequenzierungsanalyse der ITS(„internal transcribed spacer")-Region der ribosomalen DNA (18S rRNA, ITS1, 5.8S rRNA, ITS2, 28S rRNA) als T. mentagrophytes bestätigt. Infektionsquelle für die Dermatomykosen waren 3 junge Schneeleoparden im Zoo Basel. Die Übertragung erfolgte durch direkten Kontakt der Tierpfleger zu den Leoparden, denen Igelzecken (Ixodes hexagonus) per Hand aus dem Fell entfernt worden waren. Zwei adulte Schneeleoparden zeigten eine fokale Alopezie der Schnauzen- und Nasenregion, die von den Zootierärzten als Dermatomykose durch T. mentagrophytes diagnostiziert wurde. Die DNA-Sequenzierung zweier tierischer Dermatophytenisolate und eines einzelnen Stammes vom Indexpatienten erbrachte eine 100 %ige Übereinstimmung, was für die Übertragung von T. mentagrophytes von den Tieren auf die Tierpfleger spricht. Die molekularbiologische Identifizierung zeigte zudem eine sehr enge Verwandtschaft der Dermatophytenstämme mit einem vom europäischen Nerz (Mustela lutreola) in Finnland isolierten T. mentagrophytes. Die Patienten wurden mit topischen Azolen und oraler Gabe von 250 mg Terbinafin 1‑mal täglich für 4 Wochen behandelt. Sowohl die adulten Schneeleoparden als auch die asymptomatischen Jungtiere erhielten orales Itraconazol.

https://ift.tt/2nHLcse

Protocells realize their potential

Powner, MW; Islam, S; (2018) Protocells realize their potential. [Editorial comment]. Nature Catalysis , 1 pp. 569-570. 10.1038/s41929-018-0131-4 .

https://ift.tt/2vT8DmG

From Ark to Bank: Extinction, proxies and biocapital in ex-situ biodiversity conservation practices

Breithoff, E; Harrison, R; (2018) From Ark to Bank: Extinction, proxies and biocapital in ex-situ biodiversity conservation practices. International Journal of Heritage Studies (In press).

https://ift.tt/2L0gQug

Cover Image

Head &Neck, Volume 40, Issue 8, Page C1-C1, August 2018.


https://ift.tt/2OIlZZZ

Issue Information

Head &Neck, Volume 40, Issue 8, Page 1611-1613, August 2018.


https://ift.tt/2PiZOuP

Exploring Ideas about Isotopic Variation in Breastfeeding and Weaning within and between Populations: Case Studies from the American Midcontinent

International Journal of Osteoarchaeology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2nMIIJc

Issue Information

Dermatologic Therapy, Volume 31, Issue 4, July/August 2018.


https://ift.tt/2OEpGQz

Between inflammation and melanoma: The 4th ADF Round Table

Experimental Dermatology, EarlyView.


https://ift.tt/2KZRrAU

SLIT with house dust mite tablets in children – the evidence based journey of AIT proceeds

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


https://ift.tt/2PgUoQU

Abstracts OAS

Allergy, Volume 73, Issue S105, Page 3-115, August 2018.


https://ift.tt/2OFuOE8

Abstracts LB PDS

Allergy, Volume 73, Issue S105, Page 336-369, August 2018.


https://ift.tt/2PetKIi

Abstracts PDS

Allergy, Volume 73, Issue S105, Page 134-335, August 2018.


https://ift.tt/2MW5h9g

Abstracts LB OAS

Allergy, Volume 73, Issue S105, Page 116-133, August 2018.


https://ift.tt/2PettVM

Issue Information

Allergy, Volume 73, Issue S105, Page 1-2, August 2018.


https://ift.tt/2OEmN2b

Abstracts LB TPS

Allergy, Volume 73, Issue S105, Page 797-859, August 2018.


https://ift.tt/2Pc1Ix0

Abstracts TPS

Allergy, Volume 73, Issue S105, Page 370-796, August 2018.


https://ift.tt/2MW5gCe

Author index

Allergy, Volume 73, Issue S105, Page 860-903, August 2018.


https://ift.tt/2PetJUK

Intralobar pulmonary sequestration associated with Bochdalek hernia: first reported case in an adult male and literature review

Abstract

Pulmonary sequestrations (PS) are rare congenital malformations that can be difficult to diagnose. PS have no connection with the bronchial tree and are vascularized through an aberrant artery mostly arising from descending thoracic or abdominal aorta. The standard diagnostic method is the computed tomography angiography and delayed diagnosis can lead to recurrent pneumonia and hemoptysis. Herein, we have a case of a patient with an intralobar sequestration associated with a Bochdalek hernia. The diagnosis was delayed in this case as with many other similar case reports because details of the patient's history were overlooked.

https://ift.tt/2PdWHE6

Ruptured pseudoaneurysm of an unnamed vessel as complication of chronic pancreatitis

Abstract

Pseudoaneurysms in the celiac territory are mostly managed conservatively. Endovascular thromboembolisation with or without stenting is currently the standard treatment with good outcome. We present a case of a patient with chronic pancreatitis who initially underwent endovascular treatment for presumed splenic artery pseudoaneurysm and subsequently required surgical intervention for complicated unnamed artery pseudoaneurysm. Radiological diagnosis was instrumental in guiding the ensuing surgical procedure and the patient made a good postoperative recovery.

https://ift.tt/2OElj87

Bifid omental band: an unusual cause of small bowel obstruction

Abstract

Small bowel obstruction (SBO) in adults is most commonly caused by postoperative adhesions, hernias or neoplasms. Here, we report a unique case of SBO caused by a bifid omental band in a 65-year-old female who presented with abdominal pain, nausea and vomiting. Abdominal and pelvic computed tomography showed dilation of mid-small bowel suggestive of partial SBO. An abdominal x-ray and small bowel series confirmed a high grade SBO. When initial conservative treatment failed, exploratory laparoscopy was performed and it was discovered that the patient had a bifid omental band encircling the small bowel, resulting in obstruction. Following resection of the band, she had an uneventful post-surgical recovery.

https://ift.tt/2PfXHri

The Extent of PXE Skin Changes is Related to Cardiovascular Complications and Visual Loss: a Cross‐sectional Study

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2w5uEhm

Recurrent fungal infections in a Chinese patient with CARD9 deficiency and a review of 48 cases

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2PicfXE

Associations between maternal socioeconomic position and psoriasis: A cohort study among the offspring of the Danish National Birth Cohort

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2wbX2P5

Hormonal, Stem Cell and Notch Signaling as Possible Mechanisms of Disease in Hidradenitis Suppurativa: a Systems‐Level Transcriptomic Analysis

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2nL24OT

Locally advanced skin cancers of the frail and elderly – consider adaptive split course radiotherapy (ASCRT)

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2OJtW1j

Atrophic scar formation in patients with acne involves long‐acting immune responses with plasma cells and alteration of sebaceous glands

British Journal of Dermatology, EarlyView.


https://ift.tt/2PfW0tW

Sensitive skin can be small fiber neuropathy: Results from a case‐control quantitative sensory testing study

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2wbBXEB

Somatic GNAQ mutation in different structures of port‐wine macrocheilia

British Journal of Dermatology, EarlyView.


https://ift.tt/2Pen2lv

Cardiomyopathy in patients with epidermolysis bullosa simplex with mutations in KLHL24

British Journal of Dermatology, EarlyView.


https://ift.tt/2OFtr8m

Secukinumab shows high efficacy irrespective of HLA‐Cw6 status in patients with moderate‐to‐severe plaque‐type psoriasis: SUPREME study

British Journal of Dermatology, EarlyView.


https://ift.tt/2PemTyt

Photosensitizing antihypertensive drug use and risk of cutaneous squamous cell carcinoma

British Journal of Dermatology, EarlyView.


https://ift.tt/2OHz0Tw

Monocytes are involved in the balance between regulatory T cells and Th17 cells in severe drug eruptions

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


https://ift.tt/2Phorrr

Mixed‐methods content and sentiment analysis of adolescents’ voice‐diaries describing daily experiences with asthma and self‐management decision‐making

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


https://ift.tt/2BdKXyF

Endotypes of Severe Allergic Asthma Patients Who Clinically Benefit from Anti‐IgE Therapy

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


https://ift.tt/2MtwzXu

NOx in exhaled breath condensate is related to allergic sensitization in young and middle‐aged adults

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


https://ift.tt/2BhxvcZ

Novel eosinophilic gene expression networks associated with IgE in two distinct asthma populations

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


https://ift.tt/2MsUk1M

Idiopathic histiocytoid Sweet syndrome: a case report with clinical and histopathological considerations

International Journal of Dermatology, EarlyView.


https://ift.tt/2KVhNE5

Chromoblastomycosis: clinical experience and review of literature

International Journal of Dermatology, EarlyView.


https://ift.tt/2vRWpe1

The role of interleukins in vitiligo: a systematic review

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2OIPlaN

Truths and myths in sunscreen labeling

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2OHTWtH

Organ preservation vs primary surgery in the management of T3 laryngeal and hypopharyngeal cancers

Abstract

Objective

The main objective is to compare the oncologic outcomes of patients with T3 laryngeal cancers who underwent total laryngectomy or organ preservation protocol (OPP) as the initial plan of management.

Materials and methods

This is a retrospective study on 120 patients treated for T3 laryngeal and hypopharyngeal cancers. Patients with functional larynx underwent OPP and dysfunctional larynx underwent upfront laryngectomy. Median follow-up of the patients was 4.6 years.

Results

There was a significant difference in 3 year disease-free survival (DFS) between upfront laryngectomy and OPP (73.2 vs. 55.7%; P = 0.028) group but not in 3 year overall survival (73.2 vs. 68.7%, P = 0.8). The rate laryngeal preservation was 65% in CCRT and 44% in only radiotherapy group. At 3 years, the laryngectomy-free survival was 57.2% and the laryngo-esophageal dysfunction-free survival (LEDS) was 53.0%.

Conclusion

T3 laryngeal cancers treated with upfront laryngectomy have an improved DFS when compared to those treated with non-surgical modalities. Primary surgery should be offered as an option for selected patients especially when CCRT is not feasible.

https://ift.tt/2vRfwoO

Predictable prosthesis length on a high-resolution CT scan before a stapedotomy

Abstract

Objective

(1) To assess the correlation between preoperative high-resolution CT (HRCT) imaging measurement from the long process of the incus to the footplate and the length of intraoperative selected prosthesis. (2) To determine if HRCT has a predictive value of prolapsed facial nerve during stapedotomy.

Materials and methods

We evaluated in our tertiary care center, in a retrospective case series, 94 patients undergoing primary stapedotomy. Preoperative temporal bone HRCT scans were reformatted in the plane of the stapes to measure on the same section the distance between the long process of the incus and the footplate. Measurement was performed by otolaryngology resident and neurotologist. We analyze the interobserver correlation and the mean length measured on the HRCT to the selected prosthesis size intraoperatively.

Results

Mean HRCT measurement of the incus long process/footplate distance assessed by the otolaryngology resident and neurotologist was 4.34 and 4.38 mm, respectively. Interobserver correlation was statistically significant [intraclass correlation coefficient (ICC) of 0.679 (p < 0.001)]. Mean selected prosthesis length intraoperatively was 4.36 mm. Correlation between the mean selected length prosthesis and the mean HRCT measurement was also statistically significant [ICC of 0.791 (p < 0.001)]. Postoperatively, a statistical improvement was shown in air conduction (p < 0.001), bone conduction (p < 0.001) and air–bone gap reduction (p < 0.001). 2 cases of facial nerve covering one-half of the oval window were identified by HRCT and confirmed intraoperatively.

Conclusion

HRCT is a valuable tool to predict preoperatively the length of the stapedotomy prosthesis. Moreover, it might be helpful to identify a potential prolapsed facial nerve, to confirm the diagnosis of otosclerosis and to rule out other abnormalities. Ultimately, it may optimize the stapedotomy procedure planning.

https://ift.tt/2BdCVG1

Comparison of unidirectional and circumferential manometric measures within the pharyngoesophageal segment: an exploratory study

Abstract

Background

Notable differences have been identified between low-resolution manometry (LRM) and high-resolution manometry (HRM) in normative data.

Objective

This study aimed to investigate within-subject differences between unidirectional LRM and circumferential HRM solid-state measurement sensors in the pharyngoesophageal segment during swallowing.

Methods

Ten healthy subjects (mean 26.9 years) were evaluated with both a 2.10 mm unidirectional catheter and a 2.75 mm circumferential catheter, with randomized order of catheter placement. Unidirectional measurements were made in four directions (posterior, anterior, right-lateral, left-lateral). Pressures and durations were analyzed to compare (1) posterior to anterior and lateral recordings and (2) posterior and average-LRM measures (C-LRM) to HRM measures at same anatomical location.

Results

No significant differences were found in any of the measures across the four radial directions. A lower amplitude was measured in C-LRM compared to HRM for pharyngeal sensors (LRM Sensor 1: − 39.7 mmHg; Sensor 2: − 61.4 mmHg). Compared with posterior-LRM, HRM recorded higher UES pressures (− 12.8 mmHg) and longer UES relaxation durations (− 0.31 s).

Conclusion

This exploratory study is the first to compare within-subject pressures between unidirectional LRM and circumferential HRM. Substantial differences in pharyngeal manometric measures were found, particularly with regard to UES function. This is clinically important as manometry is uniquely able to evaluate UES function and clarify differential diagnoses in patients with dysphagia.

https://ift.tt/2MhdqJ3

Laryngopharyngeal reflux is a potential cause of nasal congestion and obstructive sleep apnea syndrome

https://ift.tt/2KZUlFu

In reference to ‘Therapeutic efficacy of azithromycin and acetylcysteine in chronic otitis media with effusion’

https://ift.tt/2vPwK5X

Perhaps consider transmeatal approach for microscopic myringoplasty

https://ift.tt/2BhrrRI

Epithelial hyperplasia is responsible for the compensatory enlargement of remaining thyroid lobe after thyroidectomy

https://ift.tt/2vRftJE

Rapid growth of scalp melanoma in a pediatric patient

The Journal of Dermatology, EarlyView.


https://ift.tt/2MhcrZn

Heat Loss Is Impaired in Older Men on the Day after Prolonged Work in the Heat

Purpose Prolonged work in the heat may exacerbate the rise in core temperature on the next work day, especially in older workers who display impairments in whole-body heat loss that increase body heat storage and core temperature relative to young adults during heat stress. We therefore evaluated whether whole-body heat loss in older adults was impaired on the day after prolonged work in the heat. Methods Whole-body heat exchange and heat storage were assessed in nine older (53–64 yr) men during three 30-min bouts of semirecumbent cycling at fixed rates of metabolic heat production (150 [Ex1], 200 [Ex2], 250 W·m−2 [Ex3]), each separated by 15-min recovery, in hot-dry conditions (40°C, 20% relative humidity), immediately before (day 1), and on the day after (day 2) a prolonged, work simulation (~7.5 h) involving moderate-intensity intermittent exercise in hot-dry conditions (38°C, 34% relative humidity). Total heat loss (evaporative ± dry heat exchange) and metabolic heat production were measured using direct and indirect calorimetry, respectively. Body heat storage was quantified as the temporal summation of heat production and loss. Results Total heat loss (mean ± SD) during Ex1 did not differ between days 1 and 2 (151 ± 15 and 147 ± 14 W·m−2, respectively; P = 0.27), but was attenuated on day 2 during Ex2 (181 ± 15 W·m−2) and Ex3 (218 ± 16 W·m−2) relative to day 1 (192 ± 14 and 230 ± 19 W·m−2, respectively; both P

https://ift.tt/2BkAWzO

The Associations between Adiposity, Cognitive Function, and Achievement in Children

Although obesity has been related to measures of academic achievement and cognition in children, the influence of fat distribution, specifically visceral adiposity, on select aspects of achievement and cognitive function remains poorly characterized among preadolescent children. Purpose The aim of this study was to evaluate the relation of adiposity, particularly visceral adipose tissue (VAT), on achievement and cognitive function among children. Methods Children with obesity (ages 8–9 yr old, N = 55, 35 females) completed cognitive and academic tests. Normal weight children (N = 55, 35 females) were matched to this group on demographic characteristics and aerobic fitness. Covariate analyses included age, Brief Intellectual Ability, socioeconomic status, and fat-free V˙O2 (V˙O2 peak adjusted for lean mass; mL·kg lean−1·min−1). Adiposity (i.e., whole body percent fat, subcutaneous abdominal adipose tissue, and VAT) was assessed using dual-energy x-ray absorptiometry. Results The results of this study revealed that, relative to their normal weight counterparts, children with obesity had significantly lower performance on tests of reading and math. Analyses revealed that among children with obesity, %Fat and subcutaneous abdominal adipose tissue were not related to cognitive abilities. However, higher VAT was associated with poorer intellectual abilities (Ps ≤ 0.04) and cognitive performance (i.e., thinking ability and cognitive efficiency, Ps ≤ 0.04). However, among normal weight children, VAT was positively associated with intellectual abilities and cognitive efficiency. Conclusion In conclusion, the results suggest that VAT was selectively and negatively related with cognition among children with obesity. Along with the dangerous metabolic nature of VAT, its detrimental relationship with obese children's intellectual and cognitive functioning is concerning.

https://ift.tt/2MisExf

Effects of Exercise on ASC Methylation and IL-1 Cytokines in Heart Failure

Introduction/Purpose Inflammation contributes to heart failure (HF) progression and the interleukin (IL)-1 cytokine IL-1β is implicated in this process. The adaptor protein apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) is necessary for inflammasome activation of IL-1β. Lower ASC methylation is associated with worse outcomes in HF. The purpose of this study was to examine the effects of exercise on changes in ASC methylation and activation of the IL-1 family cytokine IL-1β in persons with HF. Methods Participants (N = 54) were randomized to receive exercise intervention (n = 38) or attention control (n = 16) for 3 months. Percent methylation of the ASC gene, plasma IL-1β, and ASC mRNA and were obtained at baseline, 3 months, and 6 months. Results ASC methylation was higher in the exercise group as compared to control at 3 months (6.10% ± 0.5% vs 5.80% ± 0.4%; P = 0.04) and 6 months (6.07 ± 0.4 vs 5.82 ± 0.4; P = 0.04). Plasma IL-1β was lower in the exercise group at 3 months (1.43 ± 0.5 pg·mL−1 vs 2.09 ± 1.3 pg·mL−1; P = 0.02) and 6 months (1.49 ± 0.5 pg·mL−1 vs 2.13 ± 1.4 pg·mL−1; P = 0.004). ASC mRNA expression was negatively associated with ASC methylation at baseline (r = −0.97, P = 0.001), 3 months (r = −0.90, P = 0.001), and 6 months (r = −0.81, P = 0.001). ASC mRNA was lower than baseline at 3 months (P = 0.004) and 6 months (P = 0.002) among those in the exercise group. ASC methylation was positively associated with 6-min walk test at baseline (r = 0.517, P

https://ift.tt/2OIsRGJ

Equivalent-Source Acoustic Holography for Projecting Measured Ultrasound Fields through Complex Media.

Treeby, B; Lucka, F; Martin, E; Cox, BT; (2018) Equivalent-Source Acoustic Holography for Projecting Measured Ultrasound Fields through Complex Media. IEEE Trans Ultrason Ferroelectr Freq Control 10.1109/TUFFC.2018.2861895 . (In press). Green open access

https://ift.tt/2OIHGcu

On Hypothesis Testing for Comparing Image Quality Assessment Metrics

Zhu, R; Zhou, F; Yang, W; Xue, J-H; (2018) On Hypothesis Testing for Comparing Image Quality Assessment Metrics. IEEE Signal Processing Magazine , 35 (4) pp. 133-136. 10.1109/MSP.2018.2829209 . Green open access

https://ift.tt/2MvGADj

Magnetic resonance imaging as a prognostic disability marker in clinically isolated syndrome: A systematic review.

Rahn, AC; Köpke, S; Stellmann, J-P; Schiffmann, I; Lukas, C; Chard, D; Heesen, C; (2018) Magnetic resonance imaging as a prognostic disability marker in clinically isolated syndrome: A systematic review. [Review]. Acta Neurol Scand 10.1111/ane.13010 . (In press).

https://ift.tt/2MTgO90

No-reference image quality assessment for photographic images based on robust statistics

Zeng, Z; Yang, W; Sun, W; Xue, JH; Liao, Q; (2018) No-reference image quality assessment for photographic images based on robust statistics. Neurocomputing 10.1016/j.neucom.2018.06.042 . (In press).

https://ift.tt/2MrKai5

Robust adaptive terminal sliding mode control for dynamic positioning of a semi-submersible offshore platform

Zhao, D; Liang, H; Spurgeon, SK; (2018) Robust adaptive terminal sliding mode control for dynamic positioning of a semi-submersible offshore platform. Transactions of the Institute of Measurement and Control 10.1177/0142331218778108 . (In press). Green open access

https://ift.tt/2MRr81f

Sensing interpersonal synchrony between actors and autistic children in theatre using wrist-worn accelerometers

Ward, JA; Richardson, D; Orgs, G; Hunter, K; Hamilton, A; (2018) Sensing interpersonal synchrony between actors and autistic children in theatre using wrist-worn accelerometers. In: (Proceedings) ISWC 2018, International Symposium on Wearable Computers, 8-12 October 2018, Singapore. ACM (In press).

https://ift.tt/2nKUYdd

TGFβ signaling directs serrated adenomas to the mesenchymal colorectal cancer subtype.

Fessler, E; Drost, J; van Hooff, SR; Linnekamp, JF; Wang, X; Jansen, M; De Sousa E Melo, F; ... Medema, JP; + view all Fessler, E; Drost, J; van Hooff, SR; Linnekamp, JF; Wang, X; Jansen, M; De Sousa E Melo, F; Prasetyanti, PR; IJspeert, JE; Franitza, M; Nürnberg, P; van Noesel, CJ; Dekker, E; Vermeulen, L; Clevers, H; Medema, JP; - view fewer (2016) TGFβ signaling directs serrated adenomas to the mesenchymal colorectal cancer subtype. EMBO Molecular Medicine , 8 (7) pp. 745-760. 10.15252/emmm.201606184 . Green open access

https://ift.tt/2MTWep7

Vangl2, a planar cell polarity molecule, is implicated in irreversible and reversible kidney glomerular injury

Papakrivopoulou, E; Vasilopoulou, E; Lindenmeyer, MT; Pacheco, S; Brzóska, HL; Price, KL; Kolatsi-Joannou, M; ... Long, DA; + view all Papakrivopoulou, E; Vasilopoulou, E; Lindenmeyer, MT; Pacheco, S; Brzóska, HL; Price, KL; Kolatsi-Joannou, M; White, KE; Henderson, DJ; Dean, CH; Cohen, CD; Salama, AD; Woolf, AS; Long, DA; - view fewer (2018) Vangl2, a planar cell polarity molecule, is implicated in irreversible and reversible kidney glomerular injury. Journal of Pathology (In press).

https://ift.tt/2MCEeD3

R-matrix study of electron impact excitation and dissociation of CH+ ions

Chakrabarti, K; Dora, A; Ghosh, R; Choudhury, BS; Tennyson, J; (2017) R-matrix study of electron impact excitation and dissociation of CH+ ions. Journal of Physics B: Atomic, Molecular and Optical Physics , 50 (17) , Article 175202. 10.1088/1361-6455/aa8377 .

https://ift.tt/2nIXFMb

A parallel algorithm for Hamiltonian matrix construction in electron-molecule collision calculations: MPI-SCATCI

Al-Refaie, AF; Tennyson, J; (2017) A parallel algorithm for Hamiltonian matrix construction in electron-molecule collision calculations: MPI-SCATCI. Computer Physics Communications , 221 pp. 53-62. 10.1016/j.cpc.2017.07.023 .

https://ift.tt/2OFj5Fw

Binding Truths: Atypical anti-GBM disease mediated by IgA anti-GBM antibodies targeting the α1 chain of type IV collagen

Antonelou, M; Henderson, SR; Bhangal, G; Oliveira, B; Hamour, S; HARBER, M; Salama, AD; (2018) Binding Truths: Atypical anti-GBM disease mediated by IgA anti-GBM antibodies targeting the α1 chain of type IV collagen. Kidney International Reports (In press).

https://ift.tt/2nKUUdt

Interaction of molecular nitrogen with free-electron-laser radiation

Banks, HIB; Little, DA; Tennyson, J; Emmanouilidou, A; (2017) Interaction of molecular nitrogen with free-electron-laser radiation. Physical Chemistry Chemical Physics , 19 (30) pp. 19794-19806. 10.1039/c7cp02345f . Green open access

https://ift.tt/2MUMU4v

The Origins of Stonehenge: On the Track of the bluestones

Parker Pearson, M; Pollard, J; Richards, C; Welham, K; (2017) The Origins of Stonehenge: On the Track of the bluestones. Archaeology International , 20 pp. 52-57. 10.5334/ai.353 . Green open access

https://ift.tt/2MVT5p0