Inflammatory myofibroblastic tumor of the pleura with adjacent chest wall invasion and metastasis to the kidney: a case report

Inflammatory myofibroblastic tumor is a rare benign neoplasm that frequently involves the lung and abdominopelvic region, and is found mainly in children and young adults. Inflammatory myofibroblastic tumor te...

https://ift.tt/2MbbFbm

Endoscopic laryngo-pharyngeal surgery for elderly patients

Due to the rising number of elderly patients and advances in endoscopic devices, early laryngeal and pharyngeal cancers are increasingly found in elderly patients. In these cases, minimally invasive endoscopic larygo-pharyngeal surgery (ELPS) may be indicated. However, the safety and efficacy of ELPS in elderly populations has not been established. The purpose of this study was to investigate the safety, outcomes and feasibility of ELPS in very elderly patients.

https://ift.tt/2CAJF1k

Endolymphatic hydrops severity in magnetic resonance imaging evidences disparate vestibular test results

It has been suggested that in Ménière's disease (MD) a dissociated result in the caloric test (abnormal result) and video head-impulse test (normal result) probably indicates that hydrops affects the membranous labyrinth in the horizontal semicircular canal (HSC). The hypothesis in this study is that based on endolymphatic hydrops' cochleocentric progression, hydrops should also be more severe in the vestibule of these patients than in those for whom both tests are normal.

https://ift.tt/2CBJ2o8

Recurrent fevers, progressive lipodystrophy and annular plaques in a child

https://ift.tt/2MeVKbY

Response to the Letter to the Editor entitled, “Use of immortal time within survival analysis”: JAAD-D-18-01157

https://ift.tt/2oSIS1Y

Antibiotic exposure is associated with cutaneous adverse events in hairy cell leukemia patients treated with purine analogs

https://ift.tt/2MbyL1u

An autologous protein gel for soft tissue augmentation: in vitro characterization and clinical evaluation

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2CBs0Xe

20th National Voice Campaign

Publication date: Available online 7 September 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Gustavo Polacow Korn, Marcos André de Sarvat

https://ift.tt/2wUbNqW

Salivary Proteome patterns of individuals exposed to High Altitude

Publication date: Available online 7 September 2018

Source: Archives of Oral Biology

Author(s): Shikha Jain, Yasmin Ahmad, Kalpana Bhargava

Abstract

Objective

Identification of molecular signatures having key roles in hypobaric hypoxia by analysing the salivary proteome. Saliva holds a promising future in the search for new clinical biomarkers that are easily accessible, less complex, accurate, and cost effective as well as being non-invasive.

Methodology

We employed qualitative proteomics approach to develop discriminatory biomarker signatures from human saliva exposed to hypobaric hypoxia. Salivary proteins were analyzed and compared between age-matched healthy subjects exposed to high altitude (~13700 ft) for seven days (HAD7) with control subjects at sea level (Normoxia) by using 2-Dimensional gel electrophoresis/Mass Spectrometry approach.

Results

Several proteins with significant differential expression were found. The up-regulated proteins were apoptosis inducing factor-2, cystatin S, cystatin SN and carbonic anhydrase 6. The down regulated proteins were polymeric immunoglobulin receptor, alpha-enolase and prolactin-inducible protein. Further confirmation of the altered proteins such as alpha enolase, carbonic anhydrase 6, prolactin-inducible protein, apoptosis inducing factor 2, cystatin S and cystatin SN was performed using immunoblotting. The expression patterns of the selected proteins observed by immunoblot were in concurrence with 2-Dimesional gel electrophoresis results, therefore affirming the authenticity of the proteomic investigation.

Conclusion

This study provides the proof of concept of salivary biomarkers for the non-invasive detection of hypobaric hypoxia induced effects. It is highly feasible to turn these biomarkers into an applicable clinical test after large scale validation.

https://ift.tt/2wXgPC2

Shared Decision Making for the Allergist

Publication date: Available online 7 September 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Michael S. Blaiss, Gary C. Steven, Bruce Bender, Don A. Bukstein, Eli O. Meltzer, Tonya Winders

https://ift.tt/2QdnUY2

Unnecessary food allergy testing by primary care providers: Ethical implications for the specialist

Publication date: Available online 7 September 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): David E. Tapke, Rebecca Scherzer, Mitchell H. Grayson

https://ift.tt/2M8Gu0d

Intestinal and non-intestinal nasal cavity adenocarcinoma: Impact of wood dust exposure

Publication date: Available online 7 September 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): P. Gallet, D.T. Nguyen, A. Russel, R. Jankowski, C. Vigouroux, C. Rumeau

Abstract

The aim of the present study was to investigate the role of wood dust exposure in intestinal (ITAC) and non-intestinal type (non-ITAC) nasal adenocarcinoma, so as to improve understanding of the oncogenic mechanisms in the light of the recent literature and of evo-devo concepts.

Materials and methods

All consecutive patients operated in our institution for nasal adenocarcinoma diagnosed on anatomopathology between May 2004 and February 2014 were included. Surgical specimens were examined twice by independent pathologists, blind to wood dust exposure status. Clinical and demographic data, including wood dust exposure, were collected for the two groups (ITAC and non-IATC).

Results

90 patients (84 ITAC, 6 non-ITAC) were included. No non-ITAC patients had history of wood dust exposure, versus 83/84 cases (99%) in ITAC (mean exposure duration: 30 ± 16 years; range 2–65 years). Only 12 ITAC patients (18%) were still exposed at diagnosis. ITAC may develop long after the end of wood dust exposure (up to 60 years). Eight patients (12%) had exposure durations of less than 5 years. Latency between onset of exposure and onset of disease did not decrease with exposure duration.

Conclusion

Exposure to wood dust, even for short periods of time, incurs a risk of developing ITAC, usually after a long latency period. Any exposure requires lifetime follow-up, to ensure prompt treatment. Factors leading to the development of nasal ITAC and non-ITAC are probably different. The analogy with Barret's esophagus and esophageal adenocarcinoma may shed light on the oncogenesis of nasal ITAC.

https://ift.tt/2wTZNF2

Panniculite lipoatrophiante idiopathique de l’adulte traitée par hydroxychloroquine et autogreffe de cellules graisseuses

Publication date: Available online 7 September 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): H. Cornille, L. Adelmand, R. Garmi, F. Comoz, L. Verneuil

Résumé

Introduction

La panniculite lipoatrophiante idiopathique est une pathologie rare. Plusieurs dénominations sont utilisées dans la littérature pour décrire des entités similaires : lipoatrophie annulaire des chevilles, panniculite lipophagique ou panniculite lipoatrophiante. Dans tous les cas, il s'agit d'un processus inflammatoire évoluant vers une atrophie du tissu graisseux.

Cas clinique Une femme de 37 ans avait des lésions hypodermiques annulaires, inflammatoires et douloureuses, symétriquement disposées sur les membres inférieurs, qui évoluaient vers des plages atrophiques avec un pourtour induré inflammatoire. La biopsie montrait une panniculite de type lobulaire avec un infiltrat inflammatoire à prédominance de lymphocytes et de macrophages. Le bilan étiologique permettait d'éliminer toutes les autres causes de panniculite lobulaire. La patiente était traitée efficacement par hydroxychloroquine 400 mg/j pendant 1 an, puis bénéficiait d'une autogreffe graisseuse sur les lésions atrophiques séquellaires.

Discussion

Une revue de la littérature depuis 2006 a trouvé 23 cas de panniculite lipoatrophiante idiopathique, dont 10 cas de lipoatrophie annulaire des chevilles. Les principaux traitements essayés étaient les corticoïdes, l'hydroxychloroquine et le méthotrexate, avec une bonne efficacité sur la phase inflammatoire.

Conclusion

La panniculite lipoatrophiante, pathologie rare, entraîne des séquelles atrophiques importantes. Un traitement précoce permet une limitation des séquelles ; la balance bénéfice-risque de l'hydroxychloroquine semble favorable à son utilisation en première intention. Notre cas souligne aussi l'intérêt du comblement de l'atrophie séquellaire par autogreffe de tissu graisseux à distance de la période inflammatoire.

Summary

Background

Idiopathic lipoatrophic panniculitis is a rare disease. Various terms are used in the literature to describe similar entities: annular lipoatrophy of the ankles, lipophagic panniculitis and lipoatrophic panniculitis. In any event, it consists of an inflammatory process progressing to necrosis of the fatty tissue.

Patients and methods

Herein we report the case of a 37-year-old woman presenting characteristic signs: erythematous, annular, symmetrical, painful, inflammatory lesions of the lower extremities, progressing to areas of atrophy with an indurated inflammatory periphery. Histopathology showed lobular panniculitis composed primarily of lymphocytes and macrophages. The etiological investigations ruled out all other causes of lobular panniculitis. The patient was successfully treated with hydroxychloroquine 400 mg/day for 1 year and she subsequently underwent fat grafting on the secondary lesions.

Discussion

Our literature review identified 23 reported cases of idiopathic lipoatrophic panniculitis since 2006, including 10 cases of annular ankle lipoatrophy. The most commonly used treatments are corticosteroids, hydroxychloroquine and methotrexate, with good efficacy being seen on the inflammatory phase. This disease seems a good indication for fat grafting to limit aesthetic sequelae.

Conclusion

Lipoatrophic panniculitis, a rare disease, results in significant aesthetic sequelae which may be limited by early treatment initiation. The benefit-risk ratio of hydroxychloroquine suggests its value as first-line therapy in this pathology. Our case also demonstrates the value of filling of the secondary atrophy by fat grafting after the inflammatory period has ended.

https://ift.tt/2wVlsh7

The impact of the number of harvested central lymph nodes on the lymph node ratio

Publication date: Available online 7 September 2018

Source: Auris Nasus Larynx

Author(s): Eun-Jae Chung, Sung-Jin Cho, Min-Woo Park, Young-Soo Rho

Abstract

Objective

The purpose of this study was to analyze the impact of lymph node harvest on the lymph node ratio (LNR).

Methods

We retrospectively reviewed 106 patients diagnosed preoperatively with PTMC (papillary thyroid microcarcinoma), no evidence of central or lateral neck nodal metastasis, and who underwent a total thyroidectomy and bilateral central lymph node neck dissection (CND).

Results

The median number of retrieved lymph nodes in the central compartments was 7 ± 6.59 (range: 1–42). The mean number of metastatic lymph nodes in the central compartments on pathology was 1.1 ± 1.79 (range: 0–7). The high node volume group (>7) had a significantly higher rate of central lymph node (CLN) metastasis than the low node volume group (≤7) in the final pathologic report (p < 0.001). With the linear regression method, the number of CLN metastasis increased as the number of retrieved lymph nodes increased (correlation coefficient = 0.286, p = 0.003). The multivariate analysis confirmed the number of retrieved lymph nodes in the central compartments was a risk factor for high LNR (p = 0.008, odds ratio 3.737). The rates of vocal fold palsy and hypoparathyroidism did not differ according to the number of retrieved lymph nodes.

Conclusion

The lymph node ratio in the final pathologic report is larger when a greater number of lymph nodes are retrieved during the central compartment neck dissection.

https://ift.tt/2Mbait3

Vibrant Soundbridge implantation via a retrofacial approach in a patient with congenital aural atresia

Publication date: Available online 7 September 2018

Source: Auris Nasus Larynx

Author(s): Ryoukichi Ikeda, Hiroshi Hidaka, Takaki Murata, Hiromitsu Miyazaki, Yukio Katori, Toshimitsu Kobayashi

Abstract

Objective

A method of Vibrant Soundbridge (VSB) placement to the round window (RW) via the retrofacial approach with preoperative evaluation of the relationship between the facial nerve (FN) and RW by 3D-CT reconstruction was proposed for the treatment of congenital aural atresia (CAA) patient.

Methods

A fenestration to the mesotympanum was made mastoid portion of the FN. During the approach, part of the stapedial muscle was encountered and removed. The RW niche was identified, and the floating mass transducer was placed from an inferior approach into the RW niche.

Results

There were no intra-operative or post-operative surgical complications.

Conclusion

The VSB placement to the RW via the retrofacial approach with partial removal of the stapedial muscle can be feasible alternative in CAA cases associated with an anteriorly and laterally positioned aberrant FN. Preoperative assessment using 3D CT may facilitate in assessing the feasibility of the approach and implantation of VSB.

https://ift.tt/2oPJyVN

Association of Cognition and Age-Related Hearing Impairment in the English Longitudinal Study of Ageing.

Related Articles

Association of Cognition and Age-Related Hearing Impairment in the English Longitudinal Study of Ageing.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 06;:

Authors: Ray J, Popli G, Fell G

Abstract
Importance: Evidence has linked age-related hearing impairment (ARHI) with cognitive decline; however, very few studies (none in the United Kingdom) explore this link in large well-characterized groups of community-dwelling individuals.
Objective: To investigate the link between ARHI and cognitive decline using a cohort of elderly individuals from the United Kingdom and explore untreated hearing loss and social isolation as potential explanations for the observed link.
Design, Setting, and Participants: This cross-sectional analysis of wave 7 (June 2014 through May 2015) of the English Longitudinal Study of Ageing (ELSA) sampled men and women 50 years or older and living in the United Kingdom in a community setting. Those with a diagnosis of dementia, Alzheimer disease, or Parkinson disease or with ear infections and cochlear implants were excluded. Data were analyzed from August 1, 2017, through May 25, 2018.
Main Outcomes and Measures: Memory and executive function as measures of cognitive function and hearing acuity derived from the HearCheck screener device (Siemens).
Results: Of a cohort of 9666 members in wave 7 of ELSA, 7385 were eligible for analysis after applying exclusion criteria (55.1% women; mean [SD] age, 67.4 [9.4] years). Of these, 3056 (41.4%) had mild hearing loss and 755 (10.2%) had severe hearing loss; 834 (11.3%) used a hearing aid; and 7155 (96.9%) were white. Hearing loss had a negative association with cognition; for those with moderate to severe loss, the score on memory assessment was a full 1 point less (-1.00; 95% CI, -1.24 to -0.76), ceteris paribus, relative to those with no hearing loss. However, this association was seen only in the individuals with untreated hearing loss (ie, those who did not use hearing aids) (-1.16; 95% CI, -1.45 to -0.87). Evidence suggests that social isolation acts as a mediating factor.
Conclusions and Relevance: Although hearing loss and cognition are linked, untreated hearing loss drives the association. Social isolation is a mediating factor in the link for those who have untreated hearing loss. Cognitive decline associated with ARHI is probably preventable by early rehabilitation and increased opportunistic screening for the elderly.

PMID: 30193368 [PubMed - as supplied by publisher]

https://ift.tt/2N0wOKu

Validation of Haptic Properties of Materials for Endoscopic Sinus and Skull Base Surgery Simulation.

Related Articles

Validation of Haptic Properties of Materials for Endoscopic Sinus and Skull Base Surgery Simulation.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 06;:

Authors: Favier V, Najaf Y, Captier G

PMID: 30193338 [PubMed - as supplied by publisher]

https://ift.tt/2wThFjh

Symptom Burden Associated With Late Lower Cranial Neuropathy in Long-term Oropharyngeal Cancer Survivors.

Related Articles

Symptom Burden Associated With Late Lower Cranial Neuropathy in Long-term Oropharyngeal Cancer Survivors.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 06;:

Authors: Aggarwal P, Zaveri JS, Goepfert RP, Shi Q, Du XL, Swartz M, Gunn GB, Lai SY, Fuller CD, Hanna EY, Rosenthal DI, Lewin JS, Piller LB, Hutcheson KA

Abstract
Importance: Lower cranial neuropathy (LCNP) is a rare but potentially disabling result of radiotherapy and other head and neck cancer therapies. Survivors who develop late LCNP may experience profound functional impairment, with deficits in swallowing, speech, and voice.
Objective: To investigate the association of late LCNP with severity of cancer treatment-related symptoms and subsequent general functional impairment among oropharyngeal cancer (OPC) survivors.
Design, Setting, and Participants: This cross-sectional survey study analyzed 889 OPC survivors nested within a retrospective cohort of OPC survivors treated at MD Anderson Cancer Center from January 1, 2000, to December 31, 2013. Eligible survey participants were disease free and completed OPC treatment 1 year or more before the survey. Data analysis was performed from October 10, 2017, to March 15, 2018.
Exposures: Late LCNP defined by onset 3 months or more after cancer therapy.
Main Outcomes and Measures: The primary outcome variable was the mean of the top 5 most severely scored symptoms of all 22 core and head and neck cancer-specific symptoms from the MD Anderson Symptom Inventory Head and Neck Cancer Module (MDASI-HN). Secondary outcomes included mean MDASI-HN interference scores and single-item scores of the most severe symptoms. Multivariate models regressed MDASI-HN scores on late LCNP status, adjusting for clinical covariates.
Results: Overall, 36 of 889 OPC survivors (4.0%) (753 [84.7%] male; 821 [92.4%] white; median [range] age, 56 [32-84] years; median [range] survival time, 7 [1-16] years) developed late LCNP. Late LCNP was significantly associated with worse mean top 5 MDASI-HN symptom scores (coefficient, 1.54; 95% CI, 0.82-2.26), adjusting for age, survival time, sex, therapeutic modality, T stage, subsite, type of radiotherapy, smoking, and normal diet before treatment. Late LCNP was also significantly associated with single-item scores for difficulty swallowing or chewing (coefficient, 2.25; 95% CI, 1.33-3.18), mucus (coefficient, 1.97; 95% CI, 1.03-2.91), fatigue (coefficient, 1.35; 95% CI, 0.40-2.21), choking (coefficient, 1.53; 95% CI, 0.65-2.41), and voice or speech symptoms (coefficient, 2.30; 95% CI, 1.60-3.03) in multivariable models. Late LCNP was not significantly associated with mean interference scores after correction for multiple comparisons (mean interference coefficient, 0.72; 95% CI, 0.09-1.35).
Conclusions and Relevance: In this large survey study, OPC survivors with late LCNP reported worse cancer treatment-related symptoms, a finding suggesting an association between late LCNP and symptom burden. This research may inform the development and implementation of strategies for LCNP surveillance and management.

PMID: 30193299 [PubMed - as supplied by publisher]

https://ift.tt/2Mdjs8u

Preoperative Imaging Techniques in Primary Hyperparathyroidism: A Review.

Related Articles

Preoperative Imaging Techniques in Primary Hyperparathyroidism: A Review.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 06;:

Authors: Bunch PM, Kelly HR

Abstract
Importance: Successful minimally invasive parathyroidectomy requires confident and accurate preoperative localization. Several noninvasive imaging techniques are well established for preoperative localization, and others are emerging.
Observations: Ultrasonography and sestamibi imaging are established preoperative localization techniques with good sensitivity and positive predictive value. Multiphase 4-dimensional computed tomography is a newer technique with arguably superior performance, particularly in the setting of negative or discordant ultrasonography and sestamibi imaging, residual or recurrent primary hyperparathyroidism following a previous surgical operation, and multiglandular disease. Emerging techniques that may further facilitate confident and accurate preoperative localization include ultrasonography, elastography, positron emission tomography, and 4-D magnetic resonance imaging.
Conclusions and Relevance: The optimal imaging localization algorithm for hyperparathyroidism remains undetermined, but a combination of techniques tailored to the specific scenario will likely yield the best outcomes. An algorithm is proposed that considers test performance, surgeon confidence, patient-specific factors, cost, local radiologic expertise, and patient radiation exposure.

PMID: 30193297 [PubMed - as supplied by publisher]

https://ift.tt/2oQHsVX

Comparison of Opioid Utilization Patterns After Major Head and Neck Procedures Between Hong Kong and the United States.

Related Articles

Comparison of Opioid Utilization Patterns After Major Head and Neck Procedures Between Hong Kong and the United States.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 06;:

Authors: Li RJ, Loyo Li M, Leon E, Ng CWK, Shindo M, Manzione K, Andersen P, Clayburgh D, Wax M, Chan JYK

Abstract
Importance: The current opioid abuse epidemic in the United States requires evaluation of prescribing practices within all medical specialties. This examination includes a review of postoperative pain management for patients undergoing major head and neck procedures.
Objective: To report differences in postoperative pain regimens between an international and domestic head and neck surgical program.
Design, Setting, and Participants: Pain management patterns after head and neck surgery in the programs at Chinese University of Hong Kong (CUHK) and Oregon Health and Science University (OHSU) were compared with a focus on opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen or paracetamol, and anxiolytics. Cases from July 1, 2013, through August 31, 2017, were reviewed. Standing medication orders the day before surgery (PRE1), postoperative day 6 (POD6), and postoperative day 14 (POD14) were compared between institutions.
Exposures: Head and neck surgery.
Results: A total of 253 cases from CUHK and 567 cases from OHSU were analyzed (mean [SD] age, 59.4 [14.3] and 60.1 [16.4] years, respectively). Patients from OHSU had a significantly higher frequency of opioid orders on PRE1 (15.3% vs 1.6%; odds ratio [OR], 11.3; 95% CI, 4.09-31.10), POD6 (86.8% vs 0.4%; OR, 1653.12; 95% CI, 228.51-11 959.01), and POD14 (71.4% vs 0.8%; OR, 313.75; 95% CI, 77.12-1276.52). There were no significant differences in acetaminophen or paracetamol, NSAID, or anxiolytic orders between institutions. Institution was the most significant indicator for the presence of opioid orders on POD6 (OR, 4271.10; 95% CI, 380.04-47 999.70) and POD14 (OR, 330.35; 95% CI, 79.67-1369.82). In addition to treating institution, multivariate analysis showed that PRE1 opioid orders indicated a significant increase in likelihood of opioid orders on POD6 (OR, 4.77; 95% CI, 1.23-18.57) but not POD14. POD6 anxiolytic orders remained a significant indicator of opioid orders for POD6 (95% CI, 1.49-113.10) and POD14 (95% CI, 1.17-5.03), respectively.
Conclusions and Relevance: A significantly lower frequency of postoperative opioid orders was observed from CUHK compared with OHSU across similar major head and neck procedures. This contrast encourages a careful examination of (1) cultural and patient expectations of pain control, (2) the metrics by which control is assessed, (3) industry and economic drivers of opioid use, and (4) alternatives to opioid pain regimens. A thoughtful shift in postoperative pain protocols that deemphasizes opioid use may be an opportunity to counter the epidemic of opioid abuse in the United States.

PMID: 30193293 [PubMed - as supplied by publisher]

https://ift.tt/2NWj9Rf

Validation of Haptic Properties of Materials for Endoscopic Sinus and Skull Base Surgery Simulation-Reply.

Related Articles

Validation of Haptic Properties of Materials for Endoscopic Sinus and Skull Base Surgery Simulation-Reply.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 06;:

Authors: Hsieh TY, Cervenka B, Steele TO

PMID: 30193287 [PubMed - as supplied by publisher]

https://ift.tt/2MVzEAs

Post-operative radiation effects on lymphopenia, neutrophil to lymphocyte ratio, and clinical outcomes in palatine tonsil cancers

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Alexander J. Lin, Yuan James Rao, Re-I Chin, Jian Campian, Daniel Mullen, Dinesh Thotala, Mackenzie Daly, Hiram Gay, Peter Oppelt, Dennis Hallahan, Douglas Adkins, Wade Thorstad

Abstract

Objective

To evaluate radiation-induced lymphopenia associated with unilateral vs. bilateral neck radiation and to test post-treatment neutrophil to lymphocyte ratio (NLR) as a prognostic clinical biomarker.

Methods

This was a single academic center retrospective review of palatine tonsil squamous cell cancer patients treated with post-operative intensity modulated radiation therapy (IMRT) from 1997 to 2013. Absolute lymphocyte count (ALC) and NLR were evaluated during and after radiation for up to a year. Correlations of lab values with loco-regional control (LRC), freedom from distant metastases (FFDM), and overall survival (OS) were assessed.

Results

Ninety-nine patients with median follow up 5.8 years had ALC recorded at least at baseline and within one year of starting RT. Acute grade 3–4 lymphopenia (<10 weeks from RT start) occurred in 79% of bilateral neck RT patients (n = 70) and 58% of unilateral neck RT patients (n = 29), p = 0.03. There was no significant difference in late grade 3–4 (p = 0.12) lymphopenia. In a multivariable Cox regression model, acute NLR > 11.875 correlated with worse OS (HR = 4.4, 95% CI 1.2–16). Late NLR > 6.875 independently correlated with significantly worse FFDM (HR = 16, 95% CI 1.9–137) and OS (HR = 12, 95% CI 3.0–48).

Conclusions

Unilateral neck radiation may prevent acute iatrogenic immunosuppression. In exploratory analyses, elevated post-treatment NLR was associated with risk for distant metastases and death.

https://ift.tt/2wV9Ri5

The efficacy of induction chemotherapy in the treatment of stage II nasopharyngeal carcinoma in intensity modulated radiotherapy era

Publication date: October 2018

Source: Oral Oncology, Volume 85

Author(s): Pei-Jing Li, Hao-Yuan Mo, Dong-Hua Luo, Wei-Han Hu, Ting Jin

Abstract

Purpose

To evaluate the efficacy of induction chemotherapy in the treatment of stage II nasopharyngeal carcinoma (NPC) in era of intensity modulated radiotherapy (IMRT).

Methods and materials

A total of 173 patients with American Joint Committee on Cancer (AJCC) 7th stage II NPC from two institutions were included. All patients were divided into two groups: induction chemotherapy + concurrent chemoradiotherapy group (ICRT) group and concurrent chemoradiotherapy group (CCRT). Induction chemotherapy was consisted of one to three cycles of cisplatin plus fluorouracil (PF) or paclitaxel plus cisplatin (TP). Concurrent chemotherapy included one to three cycles of cisplatin. We retrospectively assessed overall survival (OS), progression-free survival (PFS), locoregional failure free survival (LRFFS) and distant metastasis free survival (DMFS) in patients of both groups. T-test, Chi-square test, Kaplan–Meier methodology and Cox proportional hazards model were used to analyze.

Results

With a median follow up of 64.7 months, no significant difference was found in grade 3–4 hematologic toxicity, liver dysfunction and renal impairment between ICRT and CCRT group. Univariable analyses shown adding induction chemotherapy to CCRT significantly decreased 5-year OS (87.9% vs 95.5%, P = 0.033), 5-year PFS (74.0% vs 86.1%, P = 0.035), 5-year LRFFS (80.0% vs 91.2%, P = 0.016), but there was no statistically significant difference in 5-year DMFS (87.1% vs 94.7%, P = 0.095). In multivariable analyses, we found the consistent results that induction chemotherapy was a negative factor associated with OS (HR of death = 3.768, 95% CI = 1.117–12.709; P = 0.032), PFS (HR of progression = 2.156, 95% CI = 1.060–4.386; P = 0.034), LRFFS (HR of locoregional relapse = 2.435, 95% CI = 1.009–5.874; P = 0.048) and also DMFS (HR of metastasis = 2.873, 95% CI = 1.005–8.211; P = 0.049), in stage II NPC patients.

Conclusion

In present study, we found that induction chemotherapy caused deleterious effect on stage II NPC patients. However, this is a retrospective study and the adverse effects of induction chemotherapy has not been previously reported. It warrants further investigation.

https://ift.tt/2Cz6v9x

The IgE Memory Reservoir in Food Allergy

Publication date: Available online 7 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Rodrigo Jiménez-Saiz, Kelly Bruton, Joshua FE. Koenig, Susan Waserman, Manel Jordana

https://ift.tt/2QfiMCJ

An admixture mapping meta-analysis implicates genetic variation at 18q21 with asthma susceptibility in Latinos

Publication date: Available online 7 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Chris R. Gignoux, Dara G. Torgerson, Maria Pino-Yanes, Lawrence H. Uricchio, Joshua Galanter, Lindsey A. Roth, Celeste Eng, Donglei Hu, Elizabeth A. Nguyen, Scott Huntsman, Rasika A. Mathias, Rajesh Kumar, Jose Rodriguez-Santana, Neeta Thakur, Sam S. Oh, Meghan McGarry, Andres Moreno-Estrada, Karla Sandoval, Cheryl A. Winkler, Max A. Seibold

Abstract

Background

Asthma is a common but complex disease with racial/ethnic differences in prevalence, morbidity, and response to therapies.

Objective

Perform an analysis of genetic ancestry to identify new loci that contribute to asthma susceptibility.

Methods

We leveraged the mixed ancestry of 3,902 Latinos and performed an admixture mapping meta-analysis for asthma susceptibility. We replicated associations in an independent study of 3,774 Latinos, performed targeted sequencing for fine mapping, and tested for disease correlations with gene expression in the whole blood of >500 individuals from 3 racial/ethnic groups.

Results

We identified a genome-wide significant admixture mapping peak at 18q21 in Latinos (p=6.8x10^-6), where Native American ancestry was associated with increased risk of asthma (OR=1.20, 95% CI=1.07-1.34, p=0.002) and European ancestry with protection (OR=0.86, 95% CI=0.77-0.96, p=0.008). Our findings replicated in an independent childhood asthma study in Latinos (p=5.3x10^-3, combined p=2.6x10^-7). Fine mapping of 18q21 in 1,978 Latinos identified a significant association with multiple variants 5' of SMAD2 in Mexicans, whereas a single rare variant in the same window was the top association in Puerto Ricans. Low versus high SMAD2 blood expression was correlated with case status (13.4% lower expression, OR=3.93, 95% CI 2.12-7.28,p<0.001). In addition, lower expression of SMAD2 was associated with more frequent exacerbations among Puerto Ricans with asthma.

Conclusion

Ancestry at 18q21 was significantly associated with asthma in Latinos, and implicated multiple ancestry-informative non-coding variants upstream of SMAD2 with asthma susceptibility. Furthermore, decreased SMAD2 expression in blood was strongly associated with increased asthma risk and increased exacerbations.

https://ift.tt/2O3jqC8

Long-term survival in a patient with pulmonary spindle cell carcinoma treated with traditional Chinese medicine

Spindle cell carcinoma (SCC) is a rare pulmonary malignancy, accounting for only 0.2%–0.3% of all lung cancers. Therefore, the prognosis and treatment of pulmonary SCC is unclear. There are only 13 reported cases in literature, only three of which had a survival of more than 11 months. Here we reported a long-term survival of a patient with pulmonary SCC who underwent treatment with traditional Chinese medicine. At the most recent follow-up in July 2018, her survival after diagnosis is 48 months and she continues to do well. To our knowledge, this is the longest survival of late stage SCC with the largest tumour burden.

https://ift.tt/2M9gSR4

Recurrent giant cell tumour of the maxillary sinus and pterygoid process treated with denosumab

We report the case of a 74-year-old man with a giant cell tumour (GCT) of the right maxilla and pterygoid process. The patient presented to the maxillofacial and head and neck surgery clinic with an ulcerated lesion of the hard palate. Initial workup with CT revealed a mass within the right maxillary sinus and pterygoid process with associated bone expansion and erosion. Biopsy showed a GCT with mucosal ulceration. Two years after surgical resection, a follow-up CT revealed tumour recurrence involving the right pterygoid process and lateral pterygoid muscle. The patient was then proposed for therapy with denosumab. Under denosumab treatment, the lesion maintained stable dimensions and became sclerotic and heavily ossified.

https://ift.tt/2MXpQ9e

Septicaemia in an adolescent presenting with potentially fatal CA MRSA osteomyelitis

Description 

A 14-year-old boy, with no prior medical history, presented with tenderness on the right knee after minor trauma while playing football the previous day. On physical examination, there were minor inflammatory signs, with no penetrating wound and he was sent home.

Two days later, due to worsening symptoms, MRI of the lower limb was performed and revealed multiple tibial lytic lesions, intraosseous abscesses and diffuse soft tissue oedema (figure 1).

Figure 1

Lower limb MRI imaging revealed multiple serpiginous lytic lesions in the proximal tibial metaphyseal region suggesting intraosseous abscesses.

Surgical debridement was performed and flucloxacillin and amikacin were initiated. The following day, his clinical status deteriorated with septic shock and respiratory failure. He was admitted in the paediatric intensive care unit.

Preoperatory blood cultures identified a methicillin-resistant Staphylococcus aureus (MRSA) Panton-Valentine leucocidin (PVL) positive and antimicrobial therapy was...

https://ift.tt/2NZ7Ibz

Venous thromboembolism leading to diagnosis of de novo malignancy in an organ transplant recipient

We report the case of a patient with remote orthotopic liver transplant who was ultimately diagnosed with Merkel cell carcinoma following admission for initial venous thromboembolism. Additionally, we review pertinent literature related to the risk of skin cancer in solid organ transplant recipients and discuss the importance of yearly skin exams in this patient population.

https://ift.tt/2oRxEeg

Goitre, lymphoma and the doughnut sign

Description 

A 65-year-old woman, with a known case of Hashimoto's thyroiditis on eltroxin for 15 years, presented with progressive diffuse swelling neck for 2 months. She also gave a history of difficulty in swallowing and breathing for 1 week. On examination, she had respiratory distress, low oxygen saturation (85% on pulse oximeter) and cyanosed tongue. Systemic examination was unremarkable except for goitre (grade 2) and stridor. As the saturation was not improving with supplemental oxygen, she underwent an emergency tracheostomy. Subsequently, a contrast-enhanced CT scan of the neck showed large lobulated heterogeneously enhancing lesion in the region of thyroid gland encasing all major structure of neck including trachea (figure 1). Core biopsy and immunohistochemistry (CD45, CD20, CD10 and BCL6 positive) confirmed the diagnosis as diffuse large B cell lymphoma (DLBCL). The patient received R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone). After 1 month, she was asymptomatic with >50% decreased swelling,...

https://ift.tt/2Mc1Tpr

Recurrent gallstone ileus in a patient with ileostomy successfully treated by removal of impacted gallstone via the stoma

A 75-year-old man with a permanent ileostomy presented with recurrent gallstone ileus that was treated successfully with removal of the stones via the stoma.

https://ift.tt/2oPtAuP

Neuromyelitis optica spectrum disorder presenting in an octogenarian

This case describes an 81-year-old woman with a history of Sjögren's syndrome presenting with recurrent falls and poor balance. She subsequently developed new and rapidly evolving neurology including hyperaesthesia, spastic paraplegia and sphincteric dysfunction. Following serial clinical reviews and detailed investigations, MRI (brainstem and cervicothoracic spine) and a seropositive result for aquaporin 4 IgG, a diagnosis of neuromyelitis optica spectrum disorder (NMOSD) was made. This case describes the clinical course of this index patient with an unusual late age of onset. The report also includes a discussion on NMOSD. We review aspects of terminology, brief epidemiology, pathogenesis, notable autoimmune associations, variance in clinical presentation and current diagnostic criteria. We also review the importance of distinguishing NMOSD from multiple sclerosis in view of the significant implications for treatment and prognosis.

https://ift.tt/2NZ7eSN

Effect of halo-type frontal cockpit protection on overtaking

In 2018, the Fédération Internationale de l'Automobile introduced the halo frontal cockpit protection system into Formula 1. While extensive testing was conducted to confirm that the halo protects the driver from contact, the halo's effect on the driver during overtaking was not tested prior to its introduction. Here, we describe the effect of a halo-type structure on the neck muscle activity of one of the authors, a national-level amateur racing driver, during on-track simulations designed to practise overtaking. We found that the halo-type structure caused an increase in the rates of fatigue and workloads of sternocleidomastoid and cervical erector spinae. The results suggest that the driver adopted a forward and right laterally flexed head position, presumably to clear the central pillar from his visible field. This has the potential to increase compressive loading of the cervical spine and affect the ability to use visual cues during steering manoeuvres.

https://ift.tt/2N0Tnir

Adjuvant conundrum in central mucoepidermoid carcinoma of the mandible: case presentation and literature review

The cornerstone modality of treatment of central mucoepidermoid carcinoma (CMEC) of the mandible is surgery, optimally, an en bloc resection with/without segmental or hemimandibulectomy. Notwithstanding the documentation of a survival benefit in few case reports with the addition of postoperative radiotherapy in carefully selected high-risk patients, there does not exist a clearly defined consensus regarding the role of adjuvant radiotherapy. We report the case of a 49-year-old man who presented with right lower jaw swelling which on imaging was found to be a multiloculated lesion causing bony expansion and cortical destruction of the mandible and was diagnosed with CMEC after radiological and histopathological criteria were met. He underwent right hemimandibulectomy and histopathology showed squamous and mucinous cells with positive mucicarmine staining and characteristic immunohistochemistry markers confirming the diagnosis of CMEC. He subsequently underwent adjuvant radiotherapy and is disease free 5 years since treatment completion.

https://ift.tt/2O08aGC

Neuroblastoma with flat genomic profile: a question of representativity?

Neuroblastoma is one of the most common paediatric malignancies. Detection of somatic genetic alterations in this tumour is instrumental for its risk stratification and treatment. On the other hand, an absence of detected chromosomal imbalances in neuroblastoma biopsies is difficult to interpret because it is unclear whether this situation truly reflects the tumour genome or if it is due to suboptimal sampling. We here present a neuroblastoma in the left adrenal of a newborn. The tumour was subjected to single-nucleotide polymorphism array analysis of five tumour regions with >80% tumour cells in histological mirror sections. This revealed no aberrations compared with a normal reference sample from the patient. Whole exome sequencing identified two single-nucleotide variants present in most tumour regions, corroborating that the tumour resulted from monoclonal expansion. Our data provide proof-of-principle that rare cases of neuroblastoma can have a normal whole genome copy number and allelic profile.

https://ift.tt/2oPfBoY

Unusual cause for small bowel obstruction

Description 

Foreign body ingestion is a common occurrence. Although over 80% of ingestions resolve spontaneously, approximately 1% of cases will require open surgical intervention. We present a rare case of foreign body ingestion in an 18-year-old man causing distal mechanical small bowel obstruction, requiring exploratory laparotomy and enterotomy.

An 18-year-old man with no significant medical history and no previous abdominal operations presented to a regional hospital with a 5-day history of persistent nausea, vomiting, absolute constipation and generalised abdominal pain. On clinical examination, he was tachycardic (116 beats/min) with a low-grade temperature (37.8°C), and had abdominal distension with central abdominal guarding. Plain films showed dilated loops of small bowel, consistent with small bowel obstruction. White cell count was 7.5x10⁹/L and C reactive protein was 74 mg/L.

Subsequent evaluation with a CT scan demonstrated appearance of small bowel obstruction with at least one transition point in the left lower abdomen, with...

https://ift.tt/2Ma0YFW

Association Between Age and Patient‐Reported Changes in Voice and Swallowing After Thyroidectomy

The Laryngoscope, EarlyView.


https://ift.tt/2wTm1He

The Effect of Sedating Agents on Drug‐Induced Sleep Endoscopy Findings

The Laryngoscope, EarlyView.


https://ift.tt/2Qc0sKS

Clinical and Economic Impact of Time From Admission for CSF Rhinorrhea to Surgical Repair

The Laryngoscope, EarlyView.


https://ift.tt/2wX2BBc

Changing prognosis of oral cancer: An analysis of survival and treatment between 1973 and 2014

The Laryngoscope, EarlyView.


https://ift.tt/2Qc0p1E

Extended high‐frequency hearing loss following the first episode of otitis media

The Laryngoscope, EarlyView.


https://ift.tt/2wSqERT

Positive surgical margins in parotid malignancies: Institutional variation and survival association

The Laryngoscope, EarlyView.


https://ift.tt/2Qc0kLo

Enhanced interdisciplinary communication: development of an interactive thyroid nodule/cancer disease map

The Laryngoscope, EarlyView.


https://ift.tt/2wUuvhv

Significant orbital and intracranial complications from balloon sinus dilation as a stand‐alone and powered dissector‐assisted procedure

The Laryngoscope, EarlyView.


https://ift.tt/2Qf5Cpt

Gallic acid attenuates allergic airway inflammation via suppressed interleukin‐33 and group 2 innate lymphoid cells in ovalbumin‐induced asthma in mice

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2Mbpy9s

Minocycline decreases Th2 chemokines from M2 macrophages: possible mechanisms for the suppression of bullous pemphigoid by traditional bullous disease drugs

Experimental Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2NWeXkA

The association between ST18 gene polymorphism and severe Pemphigus disease among Iranian population

Experimental Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2wWqD00

Cross‐ European validation of the ItchyQoL in pruritic dermatoses

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2wSZ6wo

Aggressive primary cutaneous CD30+ lymphoproliferative disorder in an organ transplant recipient in sustained complete remission with brentuximab vedotin

International Journal of Dermatology, EarlyView.


https://ift.tt/2Cz4jyS

Pyoderma gangrenosum triggered by switching from adalimumab to secukinumab

The Journal of Dermatology, EarlyView.


https://ift.tt/2O4O0eg

BIOARCHAEOLOGY OF SOCIAL TRANSITION: A DIACHRONIC STUDY OF PATHOLOGICAL CONDITIONS AT TUMILACA LA CHIMBA, PERU

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


https://ift.tt/2QemFYH

Precolonial/early colonial human burials from the site of White Marl, Jamaica. New findings from recent rescue excavations

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


https://ift.tt/2CFsZ8K

Stable isotope analysis of human bone hydroxyapatite and collagen for the reconstruction of dietary patterns of hunter‐gatherers from Jomon populations

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


https://ift.tt/2Qf6jyV

Bioarchaeological perspectives to diachronic life quality and mobility in ancient Boeotia, central Greece: Preliminary insights from Akraiphia

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


https://ift.tt/2CuP1uQ

Acral pseudolymphomatous angiokeratoma of children (APACHE): Dermoscopic features and successful treatment with CO2 laser

Dermatologic Therapy, EarlyView.


https://ift.tt/2MajiyH

A high-throughput fluorescence polarization assay for discovering inhibitors targeting the DNA-binding domain of signal transducer and activator of transcription 3 (STAT3)

Shih, PC; Yang, Y; Parkinson, GN; Wilderspin, A; Wells, G; (2018) A high-throughput fluorescence polarization assay for discovering inhibitors targeting the DNA-binding domain of signal transducer and activator of transcription 3 (STAT3). Oncotarget , 9 (66) pp. 32690-32701. 10.18632/oncotarget.26013 . Green open access

https://ift.tt/2NXNUFw

The development of perceptual averaging: Efficiency metrics in children and adults using a multiple-observation sound-localization task

Jones, PR; (2018) The development of perceptual averaging: Efficiency metrics in children and adults using a multiple-observation sound-localization task. The Journal of the Acoustical Society of America , 144 (1) pp. 228-241. 10.1121/1.5043394 .

https://ift.tt/2wVBtTY

Detecting statistical outliers in psychophysical data

Jones, Pete R.; (2016) Detecting statistical outliers in psychophysical data. (BioRxiv ). Cold Spring Harbor Laboratory Green open access

https://ift.tt/2M6wtRm

Does glaucoma alter eye movements when viewing images of natural scenes? A between-eye study

Asfaw, DS; Jones, PR; Mönter, VM; Smith, ND; Crabb, DP; (2018) Does glaucoma alter eye movements when viewing images of natural scenes? A between-eye study. Investigative Ophthalmology and Visual Science , 59 (8) pp. 3189-3198. 10.1167/iovs.18-23779 . Green open access

https://ift.tt/2wUrpuC

Data on eye movements in people with glaucoma and peers with normal vision

Asfaw, DS; Jones, PR; Smith, ND; Crabb, DP; (2018) Data on eye movements in people with glaucoma and peers with normal vision. Data in Brief , 19 pp. 1266-1273. 10.1016/j.dib.2018.05.076 . Green open access

https://ift.tt/2NVXkBj

Evidence for alterations in fixational eye movements in glaucoma

Montesano, G; Crabb, DP; Jones, PR; Fogagnolo, P; Digiuni, M; Rossetti, LM; (2018) Evidence for alterations in fixational eye movements in glaucoma. BMC Ophthalmology , 18 , Article 191. 10.1186/s12886-018-0870-7 . Green open access

https://ift.tt/2wSR9Y7

'History taught in the pageant way': Education and Historical Performance in Twentieth-Century Britain

Bartie, A; Fleming, L; Freeman, M; Hulme, T; Hutton, A; Readman, P; (2019) 'History taught in the pageant way': Education and Historical Performance in Twentieth-Century Britain. History of Education (In press).

https://ift.tt/2Mafrlp

Pain and delirium in people with dementia in the acute general hospital setting

Feast, AR; White, N; Lord, K; Kupeli, N; Vickerstaff, V; Sampson, E; (2018) Pain and delirium in people with dementia in the acute general hospital setting. Age and Ageing 10.1093/ageing/afy112 . (In press).

https://ift.tt/2x18WwD

Patriarchal pronatalism: Islam, secularism and the conjugal confines of Turkey's IVF boom

Gürtin, ZB; (2016) Patriarchal pronatalism: Islam, secularism and the conjugal confines of Turkey's IVF boom. Reproductive Biomedicine and Society Online , 2 pp. 39-46. 10.1016/j.rbms.2016.04.005 . Green open access

https://ift.tt/2NYiiQ9

Physical activity, sedentary time, and cardiovascular disease biomarkers at age 60 to 64 years

Elhakeem, A; Cooper, R; Whincup, P; Brage, S; Kuh, D; Hardy, R; (2018) Physical activity, sedentary time, and cardiovascular disease biomarkers at age 60 to 64 years. Journal of the American Heart Association , 7 (16) , Article e007459. 10.1161/JAHA.117.007459 . Green open access

https://ift.tt/2wUJjxr

Predicting treatment response in depression: the role of anterior cingulate cortex

Godlewska, BR; Browning, M; Norbury, R; Igoumenou, A; Cowen, PJ; Harmer, CJ; (2018) Predicting treatment response in depression: the role of anterior cingulate cortex. International Journal of Neuropsychopharmacology 10.1093/ijnp/pyy069 . (In press). Green open access

https://ift.tt/2MbFU1T

Social systems: Mentalizing beyond the microcosm of the individual and family

Asen, E; Campbell, C; Fonagy, P; (2019) Social systems: Mentalizing beyond the microcosm of the individual and family. In: Bateman, A and Fonagy, P, (eds.) Handbook of mentalizing in mental health practice. American Psychiatric Publishing: Washington DC, USA. (In press).

https://ift.tt/2x18UF1

Mentalizing and substance use disorder

Arefjord, N; Morken, K; Lossius, K; (2019) Mentalizing and substance use disorder. In: Bateman, A and Fonagy, P, (eds.) Handbook of mentalizing in mental health practice. American Psychiatric Publishing: Washington DC, USA. (In press).

https://ift.tt/2NYii2B

Chapter 14 - Numerical Methods for SSI Analysis of Offshore Wind Turbine Foundations

Lopez-Querol, MS; Cui, L; Bhattacharya, S; (2017) Chapter 14 - Numerical Methods for SSI Analysis of Offshore Wind Turbine Foundations. In: Letcher, T M, (ed.) Wind Energy Engineering: A Handbook for Onshore and Offshore Wind Turbines. (pp. 275-297). Academic Press: London, UK.

https://ift.tt/2wWX5PX

Intraoperative Mortality in Malawi

BACKGROUND: Surgical care is essential to improving population health, but metrics to monitor and evaluate the continuum of surgical care delivery have rarely been applied in low-resource settings, and improved efforts at benchmarking progress are needed. The objective of this study was to measure the intraoperative mortality at a Central Referral Hospital in Malawi, evaluate whether there have been changes in intraoperative mortality between 2 time periods, and assess factors associated with intraoperative mortality. METHODS: This was a retrospective cohort study of patients undergoing surgery at Kamuzu Central Hospital in Lilongwe, Malawi. Data describing daily consecutive operative cases were collected prospectively during 2 time periods: 2004–2006 (early cohort) and 2015–2016 (late cohort). The primary outcome was intraoperative mortality. Inverse probability of treatment weighting was used to analyze the association of intraoperative mortality with time using logistic regression models. Multivariable logistic models were performed to evaluate factors associated with intraoperative mortality. RESULTS: There were 21,090 surgeries performed during the 2 time periods, with 15,846 (75%) and 5244 (25%) completed from 2004 to 2006 and 2015 to 2016, respectively. Intraoperative mortality in the early cohort was 57 deaths per 100,000 surgeries (95% confidence interval [CI], 26–108) and in the late cohort was 133 per 100,000 surgeries (95% CI, 56–286), with 76 per 100,000 surgeries (95% CI, 44–124) overall. After applying inverse probability of treatment weighting, there was no evidence of an association between time periods and intraoperative mortality (odds ratio [OR], 1.6; 95% CI, 0.9–2.8; P = .08). Factors associated with intraoperative mortality, adjusting for demographics, included American Society of Anesthesiology physical status III or IV versus I or II (OR, 4.4; 95% CI, 1.5–12.5; P = .006) and emergency versus elective surgery (OR, 7.7; 95% CI, 2.5–23.6; P

https://ift.tt/2wTocuy

Radiation Safety Perceptions and Practices Among Pediatric Anesthesiologists: A Survey of the Physician Membership of the Society for Pediatric Anesthesia

BACKGROUND: Pediatric anesthesiologists are exposed to ionizing radiation from x-rays on an almost daily basis. Our goal was to determine the culture of safety in which they work and how they adhere to preventative strategies that minimize exposure risk in their daily practice. METHODS: After Institutional Review Board waiver and approval of the Society for Pediatric Anesthesia's research and quality and safety committees, an electronic e-mail questionnaire was sent to the Society's physician, nontrainee members and consisted of questions specific to provider use of protective lead shielding, the routine use of dosimeters, and demographic information. Univariate analyses were performed using the Wilcoxon rank sum test for ordinal variables, the Fisher exact test for categorical variables, and the Spearman test to analyze correlation between 2 ordinal variables, while a proportional odds logistic regression was used for a multivariable ordinal outcome analysis. P values of <.05 were considered statistically significant. results: twenty-one percent of the surveyed anesthesiologists completed online questionnaire. radiation exposure is ubiquitous and regardless sex most respondents either concerned or very about however women significantly more than men odds ratio confidence interval p=".002)." despite this independent level concern was not associated with use a dosimeter .85 lead glasses thyroid shield .12 dosimeters rarely never used mandated in only institutions. virtually none had ever taken safety course received personal dose report notification their knew how many millirem safe. half female while pregnant tried to avoid by requesting be assigned cases requiring x-rays. these requests honored time. discussion: universal ionizing from x-rays pediatric do routinely adhere strategies designed limit intensity work institutions which culture exists. our study highlights need improve education change within operating rooms imaging suites fully investigate utility shielding eye measures anesthesia practice. accepted for publication july funding: none. authors declare no conflicts interest. supplemental digital content available article. direct url citations appear printed text are provided html pdf versions article on journal website g. m. whitney j. thomas contributed equally share first authorship. brief summary statement: routine safety. reprints will authors. address correspondence james md children hospital colorado e ave b090 aurora co e-mail james.j.thomas international research society>

https://ift.tt/2NtSbmW

Obstructive Sleep Apnea and Risk of Postcardiac Surgery Atrial Fibrillation

No abstract available

https://ift.tt/2wUmclK

In Response

No abstract available

https://ift.tt/2NtS5f4

Perioperative Considerations for Evolving Artificial Pancreas Devices

Type 1 diabetes mellitus is a lifelong condition. It requires intensive patient involvement including frequent glucose measurements and subcutaneous insulin dosing to provide optimal glycemic control to decrease short- and long-term complications of diabetes mellitus without causing hypoglycemia. Variations in insulin pharmacokinetics and responsiveness over time in addition to illness, stress, and a myriad of other factors make ideal glucose control a challenge. Control-to-range and control-to-target artificial pancreas devices (closed-loop artificial pancreas devices [C-APDs]) consist of a continuous glucose monitor, response algorithm, and insulin delivery device that work together to automate much of the glycemic management for an individual while continually adjusting insulin dosing toward a glycemic target. In this way, a C-APD can improve glycemic control and decrease the rate of hypoglycemia. The MiniMed 670G (Medtronic, Fridley, MN) system is currently the only Food and Drug Administration–cleared C-APD in the United States. In this system, insulin delivery is continually adjusted to a glucose concentration, and the patient inputs meal-time information to modify insulin delivery as needed. Data thus far suggest improved glycemic control and decreased hypoglycemic events using the system, with decreased need for patient self-management. Thus, the anticipated use of these devices is likely to increase dramatically over time. There are limited case reports of safe intraoperative use of C-APDs, but the Food and Drug Administration has not cleared any device for such use. Nonetheless, C-APDs may offer an opportunity to improve patient safety and outcomes through enhanced intraoperative glycemic control. Anesthesiologists should become familiar with C-APD technology to help develop safe and effective protocols for their intraoperative use. We provide an overview of C-APDs and propose an introductory strategy for intraoperative study of these devices. Accepted for publication August 8, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Micah T. Long, MD, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, B6/319 UW CSC, 600 Highland Ave, Madison, WI 53792. Address e-mail to mtlong@wisc.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2wT6Ttq

Evaluation of the Determinants of Satisfaction With Postoperative Pain Control After Thoracoscopic Surgery: A Single-Center, Survey-Based Study

BACKGROUND: The need to measure, compare, and improve the quality of pain management is important to patients, payers, and health care providers. Pain after thoracic surgery can be severe, and thoracoscopic approaches have not had the favorable impact on pain as anticipated. The aim of this study was to evaluate the determinants of patient satisfaction with acute pain management and the effectiveness of pain control after video-assisted thoracoscopic surgery using a modified version of the Revised American Pain Society Patient Outcome Questionnaire. METHODS: We performed a single-center, prospective, survey-based study of 300 patients who had undergone elective video-assisted thoracoscopic surgery. Patients were enrolled and completed the survey on postoperative day 1 or 2. The primary outcome variable was patient-reported satisfaction with acute postoperative pain treatment measured on a 1–4 scale. The relationship between the items on the survey and patient satisfaction was analyzed to determine the factors significantly associated with satisfaction. RESULTS: Fifty-one percent of the patients had the highest satisfaction level with pain treatment, and 4% of the patients had the lowest satisfaction level. The mean reported acceptable pain level was 3.8 ± 1.9 (numeric rating scale [NRS], 0–10). The average pain intensity score at the time of the survey was 2.8 ± 2.1 (NRS, 0–10). The median for the most pain in the prior 24 hours was 7 (NRS, 0–10; interquartile range, 5–9). Five items from the survey were significantly associated with the satisfaction level. The predictor with the highest associated odds ratio (OR) with satisfaction was the ability to participate in pain management decisions (OR, 1.45; P

https://ift.tt/2NtPcLl

Elevated Presepsin Is Associated With Perioperative Major Adverse Cardiovascular and Cerebrovascular Complications in Elevated-Risk Patients Undergoing Noncardiac Surgery: The Leukocytes and Cardiovascular Perioperative Events Study

BACKGROUND: Perioperative major adverse cardiovascular and cerebrovascular events (MACCEs) are incompletely understood, and risk prediction is imprecise. Atherogenic leukocytes are crucial in cardiovascular events. However, it is unclear if surgical interventions affect leukocyte counts or activation status. Therefore, we investigated whether noncardiac surgery in patients with elevated cardiovascular risk is associated with changes in atherogenic leukocyte subsets and if these changes are related to perioperative MACCEs. METHODS: We enrolled 40 patients in this single-center prospective observational cohort study. Total leukocytes and subpopulations, including classical, intermediate, and nonclassical monocytes and natural killer and regulatory T cells, were quantified before surgery, at 2 and 6 hours after skin incision, and at postoperative days 1 and 2 (POD1+2). The monocyte activation marker presepsin (sCD14-ST) was measured post hoc to determine differentiation of classical to nonclassical monocytes. We evaluated presepsin for prediction of the composite primary end point MACCE (cardiovascular death, myocardial infarction, myocardial ischemia, and stroke) at 30 days. Its additive value to risk assessment based on high-sensitive cardiac troponin T and N-terminal probrain natriuretic peptide (NT-proBNP) was analyzed. RESULTS: We evaluated 38 patients, of whom 5 (13%) reached MACCE. In the entire cohort, classical monocytes continuously increased and peaked at POD1 (0.35 [0.23–0.43] cells per nanoliter blood [nL−1] vs 0.45 [0.31–0.66] cells·nL−1, preoperative [pre-OP] vs POD1, P = .002). Intermediate monocytes doubled by POD1 (0.017 [0.013–0.021] vs 0.036 [0.022–0.043] cells·nL−1, pre-OP versus POD1, P = .0003). Nonclassical monocytes decreased (0.022 [0.012–0.032] vs 0.012 [0.005–0.023] cells·nL−1, pre-OP vs 6 hours, P = .003). In our patient population, we did not detect changes in any of the other predefined leukocyte subsets investigated. In patients experiencing a MACCE, classical monocyte expansion was reduced (0.081 [−0.16 to 0.081] cells·nL−1 vs 0.179 [0.081 to 0.292] cells·nL−1, MACCE versus non-MACCE, P = .016). Patients in the event group presented with elevated pre-OP presepsin (1528 [406–1897] pg·mL−1 vs 123 [82.2–174] pg·mL−1, MACCE versus non-MACCE, P = .0001). Presepsin was associated with MACCE (area under the curve = 0.964, [0.846–0.998], P = .001). Presepsin above the calculated threshold >184 pg·mL−1 was superior to high-sensitive cardiac troponin T for improvement of NT-proBNP-based risk prediction (28 [74%] vs 22 [58%] correctly classified patients, P = .014). CONCLUSIONS: Noncardiac surgery was associated with an increase in atherogenic leukocyte subsets. In a post hoc analysis, elevated pre-OP presepsin was associated with MACCE and improved NT-proBNP-based risk assessment. After validation in an independent data set, a presepsin cutoff of 184 pg·mL−1 might qualify to complement NT-proBNP-based risk prediction, thereby increasing the proportion of correctly identified high-risk patients. Accepted for publication July 10, 2018. Funding: Internal. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Jan Larmann, MD, PhD, Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. Address e-mail to Jan.Larmann@med.uni-heidelberg.de. © 2018 International Anesthesia Research Society

https://ift.tt/2wOyIUD

Advanced Procedures for Pain Management: A Step-by-Step Atlas

No abstract available

https://ift.tt/2O0ZP5d

National Trends and Factors Associated With Inpatient Mortality in Adult Patients With Opioid Overdose

BACKGROUND: The prevalence of opioid misuse and opioid-related mortality has increased dramatically over the past decade. There is limited evidence on factors associated with mortality from opioid overdose in the inpatient setting. The primary objective was to report national trends in opioid overdose and mortality. The secondary objectives were to explore factors associated with inpatient mortality and report differences in prescription opioid overdose (POD) versus illicit opioid overdose (IOD) cohorts. METHODS: Using the 2010–2014 Nationwide Inpatient Sample, we performed a cross-sectional analysis and identified a weighted estimate of 570,987 adult patients with an International Classification of Disease, Ninth Revision, or External Cause of Injury code of POD or IOD. We performed multivariable logistic regression to identify predictors of inpatient mortality. The odds ratio (OR) and their associated 95% confidence interval (CI) are reported. RESULTS: Of the 570,987 patients with opioid overdose, 13.8% had an admissions diagnosis of IOD, and the remaining had POD. Among all opioid overdose admissions, the adjusted odds of IOD admissions increased by 31% per year (OR, 1.31; 95% CI, 1.29–1.31; P

https://ift.tt/2wSQ4j1

Nighttime Extubation Does Not Increase Risk of Reintubation, Length of Stay, or Mortality: Experience of a Large, Urban, Teaching Hospital

BACKGROUND: In the intensive care unit (ICU), extubation failure has been associated with greater resource utilization and worsened clinical outcomes. Most recently, nighttime extubation (NTE) has been reported as a risk factor for increased ICU and hospital mortality. We hypothesized that, in a large, urban, university-affiliated hospital with multidisciplinary assessment for extubation, rigorously protocolized extubation algorithms, and expert airway managers available at all times of day for assessment of high-risk extubations, NTE would not confer additional risk of adverse clinical outcomes. METHODS: This was a retrospective cohort study of mechanically ventilated adults at a single university-affiliated hospital. NTE was defined as occurring between 7:00 PM and 6:59 AM the following day. All data were extracted from the institution's electronic medical record. Multi­vari­able regression analyses were used to assess associations between NTE and reintubation, ICU and hospital length of stay (LOS), and mortality with adjustments for demographic and clinical covariates defined a priori. Palliative, unplanned, and routine postoperative extubations were excluded in sensitivity analyses. RESULTS: Of 2241 patients, 204 of 2241 (9.1%) underwent NTE. The rates of reintubation (NTE 6.9% versus daytime extubation [DTE] 12.4%; adjusted odds ratio [95% confidence interval {CI}], 0.78 [0.43–1.41]; P = .41) and in-hospital mortality (NTE 3.4% versus DTE 5.9%; adjusted odds ratio [95% CI], 0.72 [0.28–1.84]; P = .49) were not found to differ. NTE, compared to DTE, was associated with shorter duration of mechanical ventilation (median [interquartile range], 1 [0–1] days vs 2 [1–4] days; adjusted ratio of geometric means [RGMs] [95% CI], 0.64 [0.54–0.70]; P

https://ift.tt/2MaIDsy

A Study of Practice Behavior for Endotracheal Intubation Site for Children With Congenital Heart Disease Undergoing Surgery: Impact of Endotracheal Intubation Site on Perioperative Outcomes—An Analysis of the Society of Thoracic Surgeons Congenital Cardiac Anesthesia Society Database

BACKGROUND: In adults undergoing cardiopulmonary bypass surgery, oral intubation is typically preferred over nasal intubation due to reduced risk of sinusitis and infection. In children, nasal intubation is more common and sometimes preferred due to perceived benefits of less postoperative sedation and a lower risk for accidental extubation. This study sought to describe the practice of nasal intubation in the pediatric population undergoing cardiopulmonary bypass surgery and assess the risks/benefits of a nasal route against an oral one. METHODS: Patients 100 cases/y) examining how infection risk may change with age at the time of surgery. RESULTS: Nasal intubation was used in 41% of operations in neonates, 38% in infants, 15% in school-aged children, and 2% in adolescents. Nasal intubation appeared protective for accidental extubation only in neonates (P = .02). Multivariable analysis in infants and neonates showed that the nasal route of intubation was not associated with the infection composite (relative risk [RR], 0.84; 95% CI, 0.59–1.18) or a shorter length of stay (RR, 0.992; 95% CI, 0.947–1.039), but was associated with a shorter intubation length (RR, 0.929; 95% CI, 0.869–0.992). Restricting to high-volume centers showed a significant interaction between age and intubation route with a risk change for infection occurring between approximately 6–12 months of age (P = .003). CONCLUSIONS: While older children undergoing nasal intubation trend similar to the adult population with an increased risk of infection, nasal intubation in neonates and infants does not appear to carry a similar risk. Nasal intubation in neonates and infants may also be associated with a shorter intubation length but not a shorter length of stay. Prospective studies are required to better understand these complex associations. Accepted for publication May 21, 2018. Funding: This study was funded jointly by the Society of Thoracic Surgeons and the Congenital Cardiac Anesthesia Society. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Nathaniel H. Greene, MD, MHS, Department of Anesthesiology, Duke ­University Medical Center, Box 3094, Durham, NC 27710. Address e-mail to Nathaniel.Greene@duke.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2wTcu3M

Pharmacokinetics of Dexmedetomidine in Infants and Children After Orthotopic Liver Transplantation

BACKGROUND: Dexmedetomidine (DEX) is a sedative and analgesic medication that is frequently used postoperatively in children after liver transplantation. Hepatic dysfunction, including alterations in drug clearance, is common immediately after liver transplantation. However, the pharmacokinetics (PK) of DEX in this population is unknown. The objective of this study was to determine the PK profile of DEX in children after liver transplantation. METHODS: This was a single-center, open-label PK study of DEX administered as an intravenous loading dose of 0.5 μg/kg followed by a continuous infusion of 0.5 μg/kg/h. Twenty subjects, 1 month to 18 years of age, who were admitted to the pediatric intensive care unit after liver transplantation were enrolled. Whole blood was collected and analyzed for DEX concentration using a dried blood spot method. Nonlinear mixed-effects modeling was used to characterize the population PK of DEX. RESULTS: DEX PK was best described by a 2-compartment model with first-order elimination. A typical child after liver transplantation with an international normalized ratio (INR) of 1.8 was found to have a whole blood DEX clearance of 52 L/h (95% confidence interval [CI], 31–73 L/h). In addition, intercompartmental clearance was 246 L/h (95% CI, 139–391 L/h), central volume of distribution was 186 L/70 kg (95% CI, 140–301 L/70 kg), and peripheral volume of distribution was 203 L (95% CI, 123–338 L). Interindividual variability ranged from 11% to 111% for all parameters. Clearance was not found to be associated with weight but was found to be inversely proportional to INR. An increase in INR to 3.2 resulted in a 50% decrease in DEX clearance. Weight was linearly correlated with central volume of distribution. All other covariates, including age, ischemic time, total bilirubin, and alanine aminotransferase, were not found to be significant predictors of DEX disposition. CONCLUSIONS: Children who received DEX after liver transplantation have large variability in clearance, which was not found to be associated with weight but is influenced by underlying liver function, as reflected by INR. In this population, titration of DEX dosing to clinical effect may be important because weight-based dosing is poorly associated with blood concentrations. More attention to quality of DEX sedation may be warranted when INR values are changing. Accepted for publication July 26, 2018. Funding: Supported by Child Health Research Institute, Ernest and Amelia Gallo Endowed Postdoctoral Fellow, National Institutes of Health, Clinical and Transitional Science Award (NIH CTSA) UL1 RR025744. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Mihaela A. Damian, MD, MPH, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, 770 Welch Rd, Suite 435, Palo Alto, CA 94304. Address e-mail to mdamian@stanford.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2M9Y5F9

An In Vitro Model for Identifying Cardiac Side Effects of Anesthetics

The understanding of anesthetic side effects on the heart has been hindered by the lack of sophisticated clinical models. Using micropatterned human-induced pluripotent stem cell–derived cardiomyocytes, we obtained cardiac muscle depressant profiles for propofol, etomidate, and our newly identified anesthetic compound KSEB01-S2. Propofol was the strongest depressant among the 3 compounds tested, exhibiting the largest decrease in contraction velocity, depression rate, and beating frequency. Interestingly, KSEB01-S2 behaved similarly to etomidate, suggesting a better cardiac safety profile. Our results provide a proof-of-concept for using human-induced pluripotent stem cell–derived cardiomyocytes as an in vitro platform for future drug design. Accepted for publication July 26, 2018. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Funding: This research was supported by the Canadian Institutes of Health Research Fellowship (201411MFE-338745-169197 to A.C.Y.C.); the Baxter Foundation and National Institutes of Health (AG044815 and AR063963 to H.M.B.); and Stanford University Department of Anesthesia Field of anesthesia Investigator Departmental benefit Leverage for external research dollars (FIDL) Grant, Stanford University SPARK Drug Discovery Program, and Stanford University Children's Health Research Initiative to M.F.D. and E.J.B. Reprints will not be available from the authors. Address correspondence to Alex C. Y. Chang, PhD, Stanford University, 269 Campus Dr, CCSR Building, Room 3200, Stanford, CA 94305-5175. Address e-mail to acychang@stanford.edu; and Edward J. Bertaccini, MD, Department of Anesthesia, 112A Palo Alto Veterans Affairs Health Care System, Palo Alto Division, 3801 Miranda Ave, Palo Alto, CA 94304. Address e-mail to edward.Bertaccini@va.gov. © 2018 International Anesthesia Research Society

https://ift.tt/2wUZPgL

Transversus Abdominal Plane Block in Children: Efficacy and Safety A Randomized Clinical Study and Pharmacokinetic Profile

BACKGROUND: The transversus abdominis plane (TAP) block has become a common regional anesthesia technique for pain management in a wide variety of abdominal procedures. Evidence to support any particular local anesthetic regimen as well as pharmacokinetic and systemic toxicity risks of TAP block remain insufficiently studied in children. The aim of this study was to compare the analgesic effects and investigate pharmacokinetic profile of levobupivacaine after ultrasound-guided TAP block using a low volume/high concentration (LVHC) or a high volume/low concentration (HVLC) solution in children. METHODS: This prospective randomized study included children scheduled for day-case inguinal surgery. Children were randomized to receive TAP block using 0.4 mg·kg−1 levobupivacaine as either HVLC (0.2 mL·kg−1 of 0.2% levobupivacaine) or LVHC (0.1 mL·kg−1 of 0.4% levobupivacaine). The primary outcome was the number of children who required opioid rescue analgesia postoperatively. Pharmacokinetic profile study of levobupivacaine was also performed. RESULTS: Seventy patients were equally randomized, and 65 were included in the final analysis. Seventy-one percent of patients did not require any postoperative opioid analgesia. The number of patients who received rescue analgesia was 12 (35%) in the LVHC group and 7 (23%) in the HVLC group (relative risk, 0.64; 95% confidence interval [CI], 0.29–1.42; P = .26). Mean pain scores (FLACC [faces, legs, activity, cry, and consolability]) at postanesthesia care unit discharge did not differ between LVHC and HVLC groups, respectively, 0.39 ± 0.86 and 1 ± 1.71 with mean group difference −0.60 (95% CI, −1.27 to 0.06; P = .08). The pharmacokinetic profile of levobupivacaine was comparable in the 2 groups: the mean total and free levobupivacaine peak concentrations were 379 ± 248 and 3.95 ± 3.16 ng·mL−1, respectively, occurring 22.5 ± 11 minutes after injection. The highest total and free levobupivacaine concentrations collected, respectively, 1360 and 15.1 ng·mL−1, remained far below theoretical toxic thresholds. CONCLUSIONS: In children, quality of postoperative pain control provided by TAP block using levobupivacaine 0.4 mg·kg−1 administered as either HVLC or LVHC did not differ and was associated with a very low risk of local anesthetic systemic toxicity. Accepted for publication July 16, 2018. Funding: Support was provided solely from institutional and departmental sources of Lapeyronie University Hospital, Montpellier, France. The authors declare no conflicts of interest. Clinical registration: Clinical-Trials.gov (NCT02064088), Principal Investigator Chrystelle Sola, Registration Date February 4, 2014. Reprints will not be available from the authors. Address correspondence to Chrystelle Sola, MD, MSc, Pediatric Anesthesia Unit, Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France. Address e-mail to c-sola@chu-montpellier.fr. © 2018 International Anesthesia Research Society

https://ift.tt/2MbCP1P

Perioperative Two-Dimensional Transesophageal Echocardiography: A Practical Handbook, 2nd ed

No abstract available

https://ift.tt/2wUIip7

The Resuscitation Crisis Manual: For the Briefcase, the Breakroom, and Beyond, 1st ed

No abstract available

https://ift.tt/2M8Qnep

Role of Endocannabinoid System in the Peripheral Antinociceptive Action of Aripiprazole

BACKGROUND: Recently, we demonstrated that the antipsychotic dopaminergic and serotoninergic agonist aripiprazole induced peripheral antinociception. However, the mechanism underlying this effect has not been fully established. Here, our aim was to identify possible relationships between this action of aripiprazole and the endocannabinoid system. METHODS: All drugs were given locally into the right hind paw of male Swiss mice weighing 30–35 g in a volume of 20 µL. The hyperalgesia was induced by intraplantar injection of prostaglandin E2 (2 μg). Aripiprazole was injected 10 minutes before the measurement, and an irreversible inhibitor of anandamide hydrolase (MAFP), an inhibitor for monoacylglycerol lipase (JZL184), and an anandamide reuptake inhibitor (VDM11) were given 10 minutes before the aripiprazole. Nociceptive thresholds were measured using an algesimetric apparatus in the third hour after prostaglandin E2 injection. Data were analyzed by ANOVA and Bonferroni tests. RESULTS: The antinociceptive effect induced by aripiprazole (100 μg) was blocked by cannabinoid 1 or 2 receptor antagonists AM251 (40 μg [P

https://ift.tt/2wSPJNh

What Is New in Obstetric Anesthesia: The 2017 Gerard W. Ostheimer Lecture

The Gerard W. Ostheimer lecture is given each year at the Society for Obstetric Anesthesia and Perinatology annual meeting and is intended to summarize important new scientific literature relevant to practicing obstetric anesthesiologists. This review highlights some of the most consequential papers covered in this lecture. It discusses landmark clinical trials that are likely to change the practice of obstetrics and obstetric anesthesia. It summarizes several articles that focus on how to optimize the provision of neuraxial anesthesia and postoperative pain control. Finally, it reviews studies aimed at identifying systems-based interventions that can improve obstetrical outcomes. A proposed "to-do" list focused on quality improvement initiatives that can be implemented on labor and delivery units is provided. Accepted for publication July 26, 2018. Funding: None. The author declares no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Brian T. Bateman, MD, MSc, Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02120. Address e-mail to bbateman@bwh.harvard.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2M6uRqM

Critical Care Sedation

No abstract available

https://ift.tt/2NTzBSe

Pupillary Pain Index Changes After a Standardized Bolus of Alfentanil Under Sevoflurane Anesthesia: First Evaluation of a New Pupillometric Index to Assess the Level of Analgesia During General Anesthesia

BACKGROUND: The pupillary pain index (PPI) is a novel pupillometric index, designed to assess intraoperative analgesia. It is based on the evaluation of the pupillary response to electrical stimuli of increasing intensity. It ranges from 1 (low level of pupillary reactivity, high level of analgesia) to 10 (high level of pupillary reactivity, low level of analgesia). In this first evaluation of the PPI, our objective was to investigate the PPI changes after a bolus of 10 µg·kg−1 of alfentanil in children under sevoflurane general anesthesia. METHODS: After ethics committee approval and informed consent, 20 healthy children (9 ± 5 years) undergoing elective surgery under general anesthesia were included in this prospective, open, registered pilot study (NCT02646592). Anesthetic induction was standardized with sevoflurane 6% and propofol 1 mg·kg−1. After tracheal intubation, sevoflurane concentration was maintained at 2% for 10 minutes. A first PPI measurement was performed (PPI-1), and a bolus of 10 µg·kg−1 was administered. Two minutes after this bolus, a second PPI measurement was performed (PPI-2). Heart rate, blood pressure, and bispectral index were recorded before and after each PPI measurement. Resting pupillary diameter was recorded before each PPI measurement. PPI scores before and after the bolus of alfentanil were compared using a Wilcoxon signed rank test. RESULTS: PPI scores decreased after administration of a bolus of alfentanil (median difference: −3 [95% confidence interval, −4 to −2]). The median (quartiles) of PPI-1 (baseline, before alfentanil) was 6 (4, 7), and the median (quartiles) of PPI-2 (after alfentanil) was 2 (2, 3) (P

https://ift.tt/2wScNMa

Cost‐savings of adalimumab in hidradenitis suppurativa: A retrospective analysis of a real‐world cohort

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


https://ift.tt/2QeUNnq

Photodynamic inactivation of bacteria to decolonize Methicillin resistant Staphylococcus aureus (MRSA) from human skin

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


https://ift.tt/2NYNUoJ