Predicting laryngeal exposure in microlaryngoscopy: External validation of the laryngoscore

Objectives

Optimal laryngeal exposure during transoral laryngeal surgery is fundamental. We aimed to evaluate the reliability of a recently proposed score (Laryngoscore) in predicting difficult laryngeal exposure (DLE) in an independent cohort of patients undergoing elective microlaryngoscopy. We also verified the relation between DLE, surgeon's expertise, and difficult intubation, and investigated possible areas for score improvement.

Study Design

Prospective validation study.

Methods

A total of 136 patients were preoperatively evaluated using the Laryngoscore. Patients were divided into three classes according to patient position, type of laryngoscope, and need for external counterpressure to expose the anterior commissure. Based on their mean scores, two groups were identified: good laryngeal exposure (GLE) and DLE. A receiver operating characteristic curve with the Youden index was used to calculate the optimal cutoff value. The χ² and Fisher exact test were used to correlate GLE and DLE to the surgeon's expertise and difficult intubation. The intraoperative anatomical parameters underlying DLE were also recorded.

Results

The optimal cutoff value for differentiating GLE and DLE was 4, which identified 80.6% of DLE cases. No statistically significant difference in GLE and DLE distribution was found between surgeons (P = 0.43). The correlation between difficult intubation and DLE was statistically significant (P = 0.03). The intraoperative parameters determining DLE were epiglottis characteristics (floppy, tight, or short), bulky abdomen and chest, bulky tongue base, mobile teeth, and a narrow laryngeal aditus.

Conclusion

The Laryngoscore is reliable for detecting DLE preoperatively. The inclusion of additional parameters may allow a more complete assessment and maximize its diagnostic accuracy.

Level of Evidence

2b. Laryngoscope, 2018

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Response to Editorial

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Does metformin usage improve survival in head and neck squamous cell carcinoma? A population-based study

Abstract

Background

We sought to expand upon preliminary data suggesting that metformin confers a survival benefit to patients with head and neck squamous cell carcinoma (HNSCC).

Methods

A large-scale retrospective cohort study of all patients in Ontario diagnosed with squamous cancer of the larynx, hypopharynx, and nasopharynx between Dec 1st 2007 to Dec 1st 2012 was undertaken. The Institute for Clinical and Evaluative Sciences was accessed to obtain patient demographic, treatment and outcome information. We included patients on metformin at the time of diagnosis. Kaplan Meier methods and Cox Regression models were used.

Results

Patients taking metformin at the time of diagnosis had a higher comorbid status but were otherwise similar to patients without metformin usage. Using multivariate analysis, neither overall survival nor disease specific survival was improved in patients on metformin (OS: HR 1.123, p = .338; DSS: HR 1.048, p = .792).

Conclusions

No survival advantage was observed in patients with HNSCC taking metformin at the time of diagnosis.

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Mycotic Aneurysm of the Extracranial Internal Carotid Artery Following Otitis Media

Abstract

Mycotic aneurysm of the internal carotid artery following otomastoiditis can manifest as a nasopharyngeal mass. This is a very rarely described condition. The case of a patient diagnosed with a retropharyngeal mycotic aneurysm of the left internal carotid artery following otitis media, treated with exclusion of the mycotic aneurysm from the circulation and transnasal drainage. Infection of the mastoid can spread to the parapharyngeal space of the nasopharynx and damage the carotid artery wall, resulting in an infected aneurysm. There are no guidelines on how to surgically approach those aneurysms. An endoscopic transnasal approach can be beneficial.

https://ift.tt/2Qa90pe

Mycotic Aneurysm of the Extracranial Internal Carotid Artery Following Otitis Media

Abstract

Mycotic aneurysm of the internal carotid artery following otomastoiditis can manifest as a nasopharyngeal mass. This is a very rarely described condition. The case of a patient diagnosed with a retropharyngeal mycotic aneurysm of the left internal carotid artery following otitis media, treated with exclusion of the mycotic aneurysm from the circulation and transnasal drainage. Infection of the mastoid can spread to the parapharyngeal space of the nasopharynx and damage the carotid artery wall, resulting in an infected aneurysm. There are no guidelines on how to surgically approach those aneurysms. An endoscopic transnasal approach can be beneficial.

https://ift.tt/2Qa90pe

Combination of aspirin plus macrolides in patients with severe community-acquired pneumonia: a hypothesis-generating study [Clinical Therapeutics]

Objectives. While the inflammatory response to severe pneumonia is paramount in reining in and resolving the infection, the excessive inflammation can lead to deleterious effects. We theorized that patients with severe community-acquired pneumonia (CAP), treated with macrolides and aspirin, would receive benefit beyond conventional antibiotic therapy.

Methods. An observational study was conducted on patients with severe CAP. All patients were admitted to 5 teaching hospitals (in Italy, USA, Japan, and China), and data were gathered from their electronic medical records. Severe pneumonia was defined according to ATS/IDSA criteria. Patients were divided in 4 groups: 1) Aspirin only (ASG), 2) Macrolides only (MG), 3) combination Aspirin + Macrolides (ASMG), or 4) neither (NASMG). Survival among the 4 groups was evaluated after adjustment for confounders, and after weighting by propensity score.

Results. A total of 1295 patients were included in the analysis. There were 237 (18.3%) patients in the ASG, 294 (22.7%) in the MG, 148 (11.4%) in the ASMG, and 616 (47.6%) in the NASMG. Mortality at 30 days was 15.5% in the ASMG, compared to 28.2% of the NASMG, 23.8% of the MG, and 21.1% of the ASG. After propensity score analysis, receipt of aspirin plus macrolide (Hazard Ratio 0.71, 95% Confidence Interval 0.58-0.88, p=0.002) was associated with higher 30-day survival.

Conclusions. This is a hypothesis generating a study in which data suggest that combination of aspirin plus a macrolide improves 30-day survival of patients with severe CAP. Further randomized studies will need to be undertaken to confirm this phenomenon.

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Real-Time PCR for the Evaluation of Treatment Response in Clinical Trials of Adult Chronic Chagas Disease: Usefulness of Serial Blood Sampling and qPCR Replicates. [Analytical Procedures]

This work evaluated a serial blood sampling procedure to enhance the sensitivity of duplex real-time PCR (qPCR) for baseline detection and quantification of parasitic loads and post-treatment identification of failure in the context of clinical trials for treatment of chronic Chagas disease, namely DNDi-CH-E1224-001 (NCT01489228) and MSF-DNDi PCR sampling optimization study (NCT01678599). Patients from Cochabamba (N= 294), Tarija (N= 257), and Aiquile (N= 220) were enrolled. Three serial blood samples were collected at each time-point and qPCR triplicates were tested per sample. The first two samples were collected during the same day and the third one seven days later.

A patient was considered PCR positive if at least one qPCR replicate was detectable. Cumulative results of multiple samples and qPCR replicates enhanced the proportion of pre-treatment sample positivity from 54.8 to 76.2%, 59.5 to 77.8%, and 73.5 to 90.2% in Cochabamba, Tarija, and Aiquile cohorts, respectively. This strategy increased the detection of treatment failure from 72.9 to 91.7%, 77.8 to 88.9%, and 42.9 to 69.1% for E1224 low, short, and high dosage regimens, respectively; and from 4.6 to 15.9% and 9.5 to 32.1% for the benznidazole arm in the DNDi-CH-E1224-001 and MSF-DNDi studies, respectively. The addition of the third blood sample and third qPCR replicate in patients with non-detectable PCR results in the first two samples, gave a small, non-statistically significant improvement in qPCR positivity. No change in clinical sensitivity was seen with a blood volume increase from 5 to 10 ml. The monitoring of patients treated with placebo in the DNDi-CH-E1224-001 trial revealed fluctuations in parasitic loads and occasional non-detectable results. In conclusion, serial sampling strategy enhanced PCR sensitivity to detecting treatment failure during follow-up and has the potential for improving recruitment capacity in Chagas disease trials, which require an initial positive qPCR result for patient admission.

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Carbapenem versus Cefepime or Piperacillin-Tazobactam for the Empiric Treatment of Extended Spectrum {beta}-lactamase Producing Escherichia coli Bacteremia in Patients with Hematologic Malignancy [Clinical Therapeutics]

Infections with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli are common in patients with hematologic malignancy. The utility of cefepime and piperacillin-tazobactam as empiric therapy for ESBL E. coli bacteremia in patients with hematologic malignancy is largely unknown. We conducted a single center, retrospective cohort review of 103 adult inpatients with leukemia and/or hematopoietic stem cell transplant (HCT) recipients with monomicrobial ESBL E. coli bacteremia. No association between increased fourteen-day mortality and empiric treatment with cefepime (8%) or piperacillin-tazobactam (0%) relative to carbapenems (19%) was observed (p = 0.19 and p = 0.04, respectively). This observation was consistent in multivariate Cox proportional hazards models adjusted for confounding and an inverse probability of treatment weighted (IPTW) Cox proportional hazards model. Fever and persistent bacteremia were both more common in patients treated empirically with cefepime or piperacillin-tazobactam. Empiric treatment with cefepime or piperacillin-tazobactam does not result in increased mortality relative to treatment with carbapenems in patients with hematologic malignancy and ESBL E. coli bacteremia, although most patients were changed to carbapenems early in treatment. However, due to prolonged fever and persistent bacteremia, their role may be limited in this patient population.

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Comparative activity of ceftriaxone, ciprofloxacin and gentamicin as a function of bacterial growth rate probed by Escherichia coli chromosome replication in the mouse peritonitis model [Clinical Therapeutics]

Commonly used antibiotics exert their effect predominantly on rapidly growing bacterial cells, yet growth dynamics taking place during infection in a complex host environment remain largely unknown. Hence, means to measure in situ bacterial growth rate is essential to predict the outcome of antibacterial treatment. We have recently validated chromosome replication as readout for in situ bacterial growth rate during Escherichia coli infection in the mouse peritonitis model. By the use of two complementary methods (qPCR and fluorescence microscopy) for differential genome origin and terminus copy number quantification, we demonstrated the ability to track bacterial growth rate, both on a population average and on a single-cell level; from one single biological specimen. Here, we asked whether the in situ growth rate could predict antibiotic treatment effect during infection in the same model. Parallel in vitro growth experiments were conducted as proof-of-concept. Our data demonstrate that the activity of commonly used antibiotics ceftriaxone and gentamicin correlated with pre-treatment bacterial growth rate; both drugs performing better during rapid growth than during slow growth. Conversely, ciprofloxacin was less sensitive to bacterial growth rate, both in a homogenous in vitro bacterial population and in a more heterogeneous in vivo bacterial population. The method serves as a platform to test any antibiotic's dependency upon active in situ bacterial growth. Improved insight into this relationship in vivo could ultimately prove helpful in evaluating future antibacterial strategies.

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Genetic and transcriptomic analyses of ciprofloxacin-tolerant Staphylococcus aureus isolated by the Replica Plating Tolerance Isolation System (REPTIS) [Mechanisms of Resistance]

We developed a simple, efficient, and cost-effective method, named the Replica Plating Tolerance Isolation System (REPTIS), to detect the antibiotic-tolerance potential of a bacterial strain. This method can also be used to quantify the antibiotic-tolerant subpopulation in a susceptible population. Using REPTIS, we isolated ciprofloxacin (CPFX)-tolerant mutants (R2, R3, R5 and R6) carrying a total of 12 mutations in 12 different genes from a methicillin-sensitive Staphylococcus aureus (MSSA) FDA209P strain. Each mutant carried multiple mutations, while few strains shared the same mutation. The R2 strain carried a nonsense mutation in the stress-mediating gene, relA. Additionally, two strains carried the same point mutation in the leuS gene encoding leucyl-tRNA synthetase. Furthermore, RNA-sequencing of R strains showed a common up-regulation of relA. Overall, transcriptome analysis showed down-regulation of genes related to translation; carbohydrate, fat, and energy metabolism; and nucleotide synthesis, and up-regulation of amino acid biosynthesis and transportation genes in R2, R3, and R6, similar to that observed in the FDA209P strain treated with mupirocin (MUP0.03). However, R5 showed a unique transcription pattern that differed from that of MUP0.03. REPTIS is a unique and convenient method for quantifying the level of tolerance of a clinical isolate. Genomic and transcriptomic analyses of R strains demonstrated that CPFX tolerance in these S. aureus mutants occurs via at least two distinct mechanisms, one of which is similar to mupirocin treatment.

https://ift.tt/2Qa7V0E

In vitro activity of Omadacycline against Chlamydia pneumoniae [Susceptibility]

The in vitro activity of omadacycline, azithromycin, doxycycline, moxifloxacin and levofloxacin, was tested against 15 isolates of Chlamydia pneumoniae. The minimum inhibitory concentrations at which 90% of the isolates of C. pneumoniae were inhibited (MIC₉₀) by omadacycline were 0.25 μg/ml (range 0.03-0.5 μg/ml).

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Is One Sample Enough? {beta}-lactam Target Attainment and Penetration into Epithelial Lining Fluid based on Multiple Bronchoalveolar Lavage Sampling Time Points in a Swine Pneumonia Model [Pharmacology]

Describing the disposition of antimicrobials agents at the site of infection is crucial to guide optimal dosing for investigational agents. For antibiotics in development for nosocomial pneumonia, concentrations are frequently determined in the epithelial lining fluid (ELF) of the lung from a bronchoscopy at a single time point. The influence of profiles constructed from a single ELF concentration point for each subject has never been reported. This study compares the pharmacokinetics of two β-lactams, ceftolozane and piperacillin, among different ELF sampling approaches using simulated human regimens in a swine pneumonia model. Plasma and ELF concentration-time profiles were characterized in two-compartment models by robustly sampled ELF concentrations and by random selection of one or two ELF concentrations from each swine. A 5,000 subject Monte Carlo simulation was performed for each model to define the ELF penetration, as described by the ratio area under the concentration curve (AUC) in ELF to free AUC in plasma (AUC_ELF/fAUC_plasma) and probability of target attainment (PTA). Given the intersubject variability of ELF penetrations observed, differences between models developed using robust versus one or two ELFs per swine were minimal for both drugs (maximum dispersion < 20%). Using a threshold exposure of 60% free time above the MIC, ceftolozane and piperacillin regimens achieved PTAs of ≥90% at MICs up to 4 and 1 µg/mL, respectively, among different ELF sampling strategies. These models suggest that ELF models constructed from sparse ELF time points result in similar exposure estimates to robustly sampled ELF profiles.

https://ift.tt/2QeIkE1

Mutagen Synergy: The Antibiotic Trimethoprim Displays Strong Mutagenic Synergy with 2-aminopurine [Mechanisms of Action]

We show that trimethoprim (TMP), an antibiotic in current use, displays a strong synergistic effect on mutagenesis in Escherichia coli when paired with the base analog 2-aminopurine (2AP), resulting in a 35-fold increase in mutation frequencies in the rpoB/Rif^r system. Combination therapies are often employed both as antibiotic treatments and in cancer chemotherapy. However, mutagenic effects of these combinations are rarely examined. An analysis of the mutational spectra of TMP, 2AP, and the combination indicates that together they trigger a response via an alteration in deoxynucleoside triphosphate (dNTP) ratios that neither compound alone can trigger. A similar, although less strong, response is seen with the frameshift mutagen ICR191 and 2AP. These results underscore the need for testing the effects on mutagenesis of combinations of antibiotics and chemotherapeutics.

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In Vitro Susceptibility Testing of Bedaquiline Against Mycobacterium abscessus Complex [Susceptibility]

We performed bedaquiline broth microdilution susceptibility using Clinical and Laboratory Standards Institute (CLSI) guidelines on 104 non-duplicate isolates of Mycobacterium abscessus complex [M. abscessus subsp. abscessus (76), M. abscessus subsp. massiliense (10), M. abscessus subsp. bolletii, (2) and M. abscessus subsp. abscessus/subsp. massiliense hybrid, i.e., M. abscessus subsp. abscessus by rpoB gene and subsp. massiliense by erm(41) gene (16)]. All isolates from patients not known to have been on prior bedaquiline had MIC values ≤0.25 µg/mL. The bedaquiline MIC₅₀ values for 76 isolates of M. abscessus subsp. abscessus and 16 isolates of M. abscessus subsp. abscessus/subsp. massiliense hybrid were 0.06 µg/mL. The MIC₅₀ and MIC₉₀ values for 10 isolates of M. abscessus subsp. massiliense were 0.12 µg/mL. Only two isolates of M. abscessus subsp. bolletii were tested with bedaquiline MICs of 0.06 µg/mL.

Our study suggests that oral bedaquiline may have potential use in treatment of disease caused by the M. abscessus complex. Combination therapy with other agents (imipenem, cefoxitin, amikacin, and/or tigecycline) is recommended.

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Mutations in cdsA and pgsA Correlate With Daptomycin Resistance in S. mitis/oralis [Mechanisms of Resistance]

We investigated the ability of several recent clinical viridans group streptococci (VGS) bloodstream isolates (S. mitis/oralis sub-group) from daptomycin (DAP)-naïve patients to develop DAP resistance in vitro. All strains rapidly developed high-level and stable DAP-resistance. Substitutions in two enzymes involved in the cardiolipin biosynthesis pathway were identified: CdsA (phosphatidate cytidylyltransferase) and/or PgsA (CDP-diacylglycerol-glycerol-3-phosphate-3-phosphatidyltransferase). These mutations were associated with complete disappearance of phosphatidylglycerol and cardiolipin from cell membranes. DAP interactions with the cell membrane differed between isolates with PgsA vs CdsA substitutions.

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Antibiotics stimulate vesicles formation in Staphylococcus aureus in a phage-dependent and independent fashion and via different routes [Clinical Therapeutics]

Bacterial membrane vesicles research has so far mainly focussed on Gram-negative bacteria. Only recently Gram-positive bacteria have been demonstrated to produce and release extracellular membrane vesicles (MVs) that contribute to bacterial virulence. Although treatment of bacteria with antibiotics is a well-established trigger of bacterial MVs formation, the underlying mechanisms are poorly understood. In this study we show that antibiotics can induce MVs through different routes in the important human pathogen Staphylococcus aureus. DNA damaging agents and antibiotics inducing the SOS response triggered vesicle formation in lysogenic strains of S. aureus but not in their phage-devoid counterparts. β-lactam antibiotics flucloxacillin and ceftaroline increased vesicle formation in a prophage-independent manner by weakening the peptidoglycan layer. We present evidence that the amount of DNA associated with MVs formed by phage lysis is higher than that of MVs formed by β-lactam antibiotics-induced blebbing. The purified MVs derived from S. aureus protected the bacteria from challenge with daptomycin, a membrane-targeting antibiotic, both in vitro and ex vivo in whole blood. In addition, the MVs protected S. aureus from killing in whole blood, indicating that antibiotic-induced MVs function as a decoy and thereby contribute to the survival of the bacterium.

https://ift.tt/2Qa7P9i

Population Pharmacokinetics and Dosing Optimization of Amoxicillin in Neonates and Young Infants [Pharmacology]

Backgrounds: Amoxicillin is widely used to treat bacterial infections in neonates. However, considerable inter-center variability in dosage regimens of antibiotic exist in clinical practice. Pharmacokinetics of amoxicillin has been described in only a few preterm neonates. Thus, we aimed to evaluate population pharmacokinetics of amoxicillin through a large samples covered entire age range of neonates and young infants, and establish evidence-based dosage regimens based on developmental pharmacokinetics–pharmacodynamics.

Methods: This is a prospective, multi-center, pharmacokinetic study using an opportunistic sampling design. Amoxicillin plasma concentrations were determined using high performance liquid chromatography. Population pharmacokinetic analysis was performed using NONMEM.

Results: A total of 224 pharmacokinetic samples from 187 newborns (postmenstrual age range: 28.4 – 46.3 weeks) were available for analysis. A 2-compartment model with first-order elimination was used to describe population pharmacokinetics. Covariate analysis showed that current weight, postnatal age and gestational age were significant covariates. The final model was further validated for predictive performance in an independent cohort of patients. Monte Carlo simulation demonstrated that for early-onset sepsis, the currently used dosage regimen (25mg/kg BID) resulted in 99.0% of premature neonates and 87.3% of term neonates achieving the pharmacodynamic target (% time above MIC), using MIC breakpoint of 1 mg/L. For late-onset sepsis, 86.1% of premature neonates treated with 25mg/kg TID and 79.0% of term neonates receiving 25mg/kg QID reached the pharmacodynamic target, using MIC breakpoint of 2 mg/L.

Conclusion: The population pharmacokinetics of amoxicillin was assessed in neonates and young infants. A dosage regimen was established based on developmental pharmacokinetics-pharmacodynamics.

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Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016

Metabolic Syndrome and Related Disorders, Ahead of Print.


https://ift.tt/2FZybGm

Standardized laboratory monitoring with use of isotretinoin in acne

-The optimal timing of laboratory tests for patients on isotretinoin treatment for acne is uncertain.-In this series, although abnormalities in serum lipids in patients receiving isotretinoin were not infrequent, they were mild to moderate, and were generally noted around the second month of treatment.-For healthy patients on isotretinoin, we recommend that a lipid panel and liver function test be performed at baseline and at month 2, when peak dosing is achieved. Further testing should be considered if a significant abnormal value is noted.

https://ift.tt/2Q9YMVH

Pemphigus and hematologic malignancies: A population-based study of 11,859 patients

•Hematologic malignancies have been reported sporadically in patients with pemphigus.•In the current study, significant associations were observed between pemphigus and chronic leukemia, multiple myeloma, and non-Hodgkin lymphoma.•Further research is needed to confirm these findings in other cohorts.

https://ift.tt/2RwbGdn

The incidence of herpes zoster in cutaneous lupus erythematosus (CLE), dermatomyositis (DM), pemphigus vulgaris (PV), and bullous pemphigoid (BP)

The incidence of zoster is increased in many autoimmune diseases. This study found a significantly increased zoster incidence in dermatomyositis and cutaneous lupus erythematosus compared with a control group.Physicians should be aware of this risk and consider administering the vaccine against zoster to these patients if not contraindicated.

https://ift.tt/2QcYHAQ

Trends of skin cancer mortality after transplantation in the United States: 1987 to 2013

- -Organ transplant recipients are at high risk of skin cancer mortality.-This study defines population-based mortality from skin cancer posttransplantation and identifies recipients at increased risk of skin cancer mortality.-These findings can guide dermatologists in adopting skin cancerescreening protocols specific to the identified high- risk categories.

https://ift.tt/2Rx39Hf

Risk of venous thromboembolism in patients with mycosis fungoides and parapsoriasis: A Danish nationwide population-based cohort study

•Active cancers and inflammation increase the risk for venous thromboembolism. It is unknown whether this applies to mycosis fungoides and parapsoriasis.•Patients with mycosis fungoides and parapsoriasis have increased risk for venous thromboembolism.•These findings should increase awareness of comorbidities as part of the disease spectrum in patients with mycosis fungoides and parapsoriasis.

https://ift.tt/2QcHmru

Cognitive and visual diagnostic errors in dermatology

Summary

This review (part 1 of 2) from New York in the USA is concerned with the heuristic techniques ('heuristics') used to make diagnoses. A heuristic approach to problem‐solving is one that relies on a practical method rather than a logical one. Examples include a 'guesstimate', 'unwritten rule', 'gut feeling' or just recognising something. Heuristics often work as shortcuts in the way a diagnosis is made. One way in which doctors make diagnoses is from experience: experienced doctors instantly recognise psoriasis because they have seen lots of it; they don't need to tick off every feature every time. If the diagnosis is not immediately obvious, then they may switch to a more logical approach, such as putting together a set of clinical signs. The first method is simpler and quicker but more prone to errors, especially in the hands of the inexperienced. The inexperienced may, therefore, be obliged to use the second method, sometimes laboriously. Often we use a mixture of the two, but we make mistakes with both: a proportion of the consistent level of incorrect diagnosis in medicine may be due to our own thinking processes. Over forty types of heuristic are listed. If doctors have already reached a diagnosis, for example, they may stop prematurely, ignore more subtle information and fail to consider alternatives (the 'anchoring heuristic'). For dermatologists, heuristics including colour, site, shape and texture are important, but 12 images illustrate how they can be led astray. Humans do better with purely visual information, which seems good news for radiologists and histopathologists.

https://ift.tt/2zFz4OA

Treatment of clinically amyopathic dermatomyositis

Summary

Dermatomyositis is an unusual auto‐immune condition (where the body's immune system doesn't function correctly) where a characteristic rash is associated with muscle inflammation. However, some patients have the skin disease without associated muscle disease, which is called amyopathic dermatomyositis, and there is no set agreement about the best way to treat these patients. The authors, based in Cardiff, Wales, reviewed the literature concerning the treatment of patients with amyopathic dermatomyositis. They identified eighteen case series (information from more than one patient) and 42 case reports (information from just one patient), but no randomised controlled trials, which are the gold‐standard of research. Antimalarials, such as hydroxychloroquine, were most commonly used, but ineffective in 55% of patients. Other drugs included topical and systemic corticosteroids, methotrexate, dapsone, mycophenolate mofetil and topical tacrolimus. Intravenous immunoglobulin led to improvement or even remission in the greatest number of patients with dermatomyositis with or without muscle involvement. The authors emphasise the need for more robust, unbiased studies to assess the efficacy of treatment in this condition.

https://ift.tt/2PfNBWj

Dermatomyositis: a slow path towards targeted therapies or will conventional therapies prevail?

https://ift.tt/2PfNzxF

通过光动力治疗实现人皮肤的 MRSA 非殖民化治疗

Summary

作为医院感染的来源之一, 患者皮肤表面(载体)存在潜在有害细菌, 它们不会产生感染, 但在某些条件下可能传播给其他人。皮肤表面生活的细菌也会导致湿疹恶化。目前去除这些微生物(细菌)皮肤的方法包括给患者使用局部抗生素(皮肤上的)或口服抗生素(口服),但随着时间的推移, 这种策略被认为导致了抗生素耐药性, 这意味着抗生素不再能杀死细菌。本文中描述的是由德国雷根斯堡大学的一个小组进行的研究。他们使用切掉的猪和人体皮肤样本, 在样本中加入耐药细菌,如耐甲氧西林葡萄球菌或 MRSA, 然后用一种化学溶液对皮肤进行处理, 这种化学溶液的作用是增加对光的敏感性。皮肤样本随后暴露在光源下,这一过程被称为光动力激活。他们发现这种技术可以在不损害皮肤细胞的情况下, 大量减少细菌的数量。作者建议,这一过程现在应该作为一种更安全的方法来研究, 以减少表面细菌运输, 而不增加细菌耐药性的风险,也不损害皮肤。

https://ift.tt/2zFUtaB

外阴佩吉特病的相关恶性肿瘤

Summary

外阴佩吉特病(VPD)是一种罕见的皮肤疾病,常见于绝经后的白人女性,它会引起外阴周围的皮肤瘙痒或灼烧。这种疾病有不同的类型,并且在过去,所有类型的 VPD 都与乳腺、肠道和泌尿系统的恶性肿瘤(如癌症)有关。这项来自荷兰的研究着眼于皮肤非侵入性 VPD, 其中在诊断时它只影响皮肤。研究人员想知道,与一般人群(没有 VPD 的人)相比,这种类型的 VPD 是否确实增加了患乳腺癌、肠道或泌尿系统恶性肿瘤的风险,并且评估是否所有 VPD 患者都应该进行常规的恶性肿瘤筛查。从荷兰的全国病理报告档案中获得了 2000 年至 2015 年期间任何类型 VPD 患者的肿瘤学(癌症)历史数据。从荷兰癌症登记处获得了随访数据和来自普通人群的对照组。在 VPD 患者中, 76.9% 诊断为皮肤非侵入性 VPD。研究人员发现,虽然其他类型的 VPD 可能与恶性肿瘤有关,但皮肤非侵入性 VPD 组患乳腺、肠道或泌尿道恶性肿瘤的风险并未增加。这表明,在诊断为皮肤非侵入性 VPD 的患者中,对这些恶性肿瘤的常规筛查可能没有必要。

https://ift.tt/2Pig3XJ

Sleep disturbance in psoriasis

Summary

Psoriasis is a common skin disease that affects 4‐5% of people worldwide. Psoriasis can be recognized by red, scaly areas on the skin, most often on the elbows, knees, scalp, and lower back. Given these physical symptoms, one could suspect that people with psoriasis may have difficulty sleeping. This study from Copenhagen, Denmark aimed to examine sleep disturbance in psoriasis. The study included 179 patients with psoriasis and 105 people without psoriasis, who all completed questionnaires on sleep quality. Twenty‐five per cent of the patients with psoriasis had difficulty sleeping and over half of them could be classified as poor sleepers. These numbers were much higher than what was what found in the people without psoriasis. Also, the authors found out that itchy skin was the main explanation for the reduced sleep quality in patients with psoriasis.

https://ift.tt/2zCVsZ6

Diagnostic heuristics: metacognition and other fixes

Summary

The shortcuts in thinking that humans use to solve problems ('heuristics', covered in an earlier review) are not always perfect, and in medicine this can lead to errors in diagnosis. So, how to recognize what is happening and try to combat it? In this review (part 2 of 2) the authors from the USA suggest ways of getting doctors 'to think about the way they think' (an approach known as metacognition) during the process of diagnosis. A number of strategies are considered: for instance, learning to pay more attention to – and acting more readily on – gut feelings of uncertainty, and being more aware of when to take time out to look at possibly uncertain diagnoses from different angles ('What else could it be?' 'Why does this not fit?' 'Let's discuss it with a colleague.'). Even being more consciously aware of when the work environment is too demanding or distracting (the phone never stops ringing, emails are constantly coming in, fatigue is kicking in, etc.) is an important skill. Reflecting on personal errors in diagnosis is another simple, practical example, as is asking for feedback from patients about what worked and what didn't. High risk professions have used checklists for a long time: does medicine need to catch up? Finally, the authors comment that experience can be a two‐edged sword: although experienced doctors generally use heuristics more effectively in diagnosis than inexperienced ones (see part 1), this can be undermined if they also 'become less likely to seek outside opinions or use reference materials'.

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皮肌炎的发病机制

Summary

皮肌炎是一种不常见的疾病,其特点是肌肉皮疹和炎症,可导致严重的虚弱,有时会造成呼吸和吞咽困难。在这项研究中,来自威尔士加的夫的作者回顾了这种潜在严重疾病的成因。与其他自身免疫性疾病一样,皮肌炎被认为是由遗传和环境因素共同作用的结果。一些基因(如 HLA B 类等位基因)与皮肤肌炎有关,并且特定基因与产生独特抗体密切相关,而这些抗体又与特定类型的疾病有关。一些环境因素触发皮肤肌炎的发展。其中包括紫外线、维生素 D 缺乏、感染和潜在的癌症(尤其是老年人)。药物(尤其是他汀类药物)可以引起肌炎(肌肉炎症),而全身类固醇可引起肌肉无力,但症状通常在减少药物后有所改善。皮肌炎涉及多种免疫因素。肌肉活检显示有炎症,其中有大量被称为淋巴细胞和巨噬细胞的 T 细胞,他们导致组织损伤。此外,一些自体抗体似乎针对肌肉,也会损害肌肉细胞。有增加血液中的一些细胞因子(TNFα 等分子)也会引发炎症。因此,许多不同的遗传因素和环境因素结合在一起可以触发皮肌炎的发展。

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英国儿童移植人群皮肤癌随访研究

Summary

众所周知,接受肝或肾移植的成年人更容易患皮肤癌。这是因为为了防止移植器官的排斥反应而服用的药物还会降低人体对癌症的抵抗力。但我们对于接受过器官移植的儿童(儿科器官移植接受者,POTR)患皮肤癌的风险则知之甚少。在这项研究中,英国伯明翰的研究人员调查了 45 名在儿童时期进行肝脏或肾脏移植后患皮肤癌的患者。10 年前,当没有发现皮肤癌时,同样的患者也接受了检查。他们的平均年龄现在是 24 岁,移植后的时间从 15 年到 26 年不等。在种族上, 34 人是白人, 7 人是有色人种。同样,没有发现皮肤癌或可疑的病变,但 45 人中有 41 人的痣明显多于 10 年前,71% 的痣出现在阳光照射部位,尤其是手臂。其中 11 个人的痣超过 50 个,这个数字过高,表明患黑色素瘤皮肤癌的风险增加。尽管之前曾获得关于防晒的建议,因为有皮肤癌的风险,但 78% 的人经历过晒伤,特别是那些在国外度假的人, 22% 的人承认用过日光浴浴床。那些经常被晒伤的人腿部和背部的痣更多。奇怪的是,那些手臂上有更多痣的人使用了更多的防晒霜,但这些对他们的日光曝晒量来说可能不足的。移植后 15‐26 年,这些 POTR 中没有患皮肤癌,这是令人鼓舞的,并且与其他显示移植后 12‐19 年 POTR 中首次出现癌症的研究相比,这项研究要好得多。然而,我们没有理由自满:这些年轻人仍然处于危险之中,并且显然需要更好的、年龄适宜的防晒教育。

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Editor's Choice

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Technology and the dermatologist: clinical resources at our fingertips

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Photodynamic therapy for basal cell carcinoma

Summary

This is the largest systematic review to‐date which compares the treatment of basal cell carcinoma (BCC) with a treatment called photodynamic therapy (PDT) and alternative treatments. PDT is an established treatment option for low‐risk BCC.  PDT involves putting a cream on the skin and leaving it for 3 hours. Then a red light is shone on it; this often causes pain for a few minutes but few other side effects.  At least two treatment sessions are needed.  In our study we only used evidence from high quality studies (Randomised Control Trials) and only looked at studies which included treatments for low‐risk BCC types (superficial and nodular).  The main medical databases were searched to find all suitable studies. The benefits of treatments were compared, using previously‐agreed criteria. The differences between how often treatments would cure (effectiveness), how the area would look after treatment (cosmetic result), and the side‐effects, including pain, were compared at different times. Imiquimod and fluorouracil creams are applied regularly to the BCC over 4‐6 weeks. The creams cause discomfort which increases with time.  The peak pain from PDT was higher than imiquimod and fluorouracil, although the combined discomfort from imiquimod and PDT appeared similar. Cure rates between fluorouracil and PDT were comparable although rates with imiquimod were higher than PDT applied once. The cosmetic result with both creams was similar to PDT. Cryosurgery (freezing with liquid nitrogen) is a convenient quick treatment.  Cure rates were similar to PDT, although the cosmetic results were poorer. Surgical excision, where the tumour is cut out and the skin stitched, showed the highest cure rates. The cosmetic result after PDT was as good or better than other treatments. Our review showed that PDT is an effective treatment for low‐risk BCC, with excellent cosmetic results and safety.

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Laser treatments in early wound healing to improve scar formation

Summary

For decades, lasers have been used to treat scars on the skin. In recent years, doctors have started using lasers during the actual wound healing process, rather than after the scar has formed, to try to minimise the scar developing. However, there is not yet a set method for exactly how this should best be done. In this study, from Germany and Denmark, 30 patients having skin surgery had half of their wound treated with a type of laser called 1540 nm NAFL, immediately before surgery, at suture removal and six weeks after surgery. The other half of the wound did not get any laser treatment. Three months later the scars were assessed by experts and by the patients and using different scales. NAFL‐treated halves were less red, more pliable and smoother compared to untreated halves. The authors conclude that three NAFL‐treatments provided in early wound healing may improve scar formation, although NAFL‐treated wounds did not heal without any scarring. It may be necessary to leave longer than three months after surgery to properly assess the scar formation and how well the treatment works.

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蕈样肉芽肿/ Se´zary综合症中的感染性事件

Summary

感染是晚期蕈状肉芽肿 (MF) 或 Sezary 综合征 (SS) 患者死亡的主要原因之一。然而,对于哪种类型的感染是最常见的,以及不同的危险因素,最新数据却很少。因此,这项来自法国的研究查看了 71 名 MF 或 SS 患者的记录。在 40 名患者中记录了 80 起感染事件(即患者遭受感染的事件),包括 28 起皮肤和软组织感染和 25 起肺炎。51.8% 的感染病例需要患者住院治疗。记录了 11 例与感染相关的死亡。SS 比 MF 具有更高的感染风险。该研究确认了感染性事件作为 MF 和 SS 患者发病率和死亡率的主要原因的重要性。一种叫做金黄色葡萄球菌的细菌造成了 78% 的细菌感染,并且 22% 的感染对甲氧西林(一种抗生素)有抗药性,这是在开抗生素处方时需要考虑的一个事实。该研究概述了预防感染的可能方法,如特定的疫苗和药物。

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银屑病严重程度的定义

Summary

由于各种原因,衡量患者的银屑病严重程度非常重要。例如,它使医生能够选择正确的治疗水平,然后观察治疗效果如何,它还使研究人员能够对相似患者的不同疗法进行比较。一些被称为全身疗法的治疗方法作用于全身而不仅仅是皮肤,它们只适用于"中度至重度"疾病患者。银屑病严重程度的测量通常基于两种不同的评分系统:银屑病面积和严重指数 (PASI) 和皮肤病生活质量指数 (DLQI)。PASI 用于记录患者银屑病的发红程度、厚度和范围,并用于衡量疗效(PASI 分值降低,即表示症状减轻)。DLQI 包含 10 个问题,涉及皮肤病患者在过去一周内关于生活质量 (QoL) 的各个不同方面(包括症状和感觉、日常活动、休闲、工作或学习、人际关系以及治疗的副作用)受到皮肤病影响的感受。分数越高说明 QoL 受到的损害越大。然而,并不是所有的指南都对如何结合 DLQI 和 PASI 的结果给出了相同的建议;例如,有些指南认为 DLQI 和 PASI 的评分都 >10 表明是中度至重度银屑病,而其他指南则认为 DLQI 或 PASI 的评分 >10 表明是中度至重度银屑病。在这项来自德国的研究中,研究人员同时基于或者分别基于 PASI 和 DLQI 对 3274 名患者的数据进行了分析。PASI 和 DLQI >10的患者比例为 14.0%,但 45.3% 的患者至少达到 PASI 或 DLQI >10。因此,为了更可靠的治疗和保健规划,作者提议了一个国际标准化。

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Documenting and defining psoriasis severity: an ongoing challenge

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Relapse of porphyria cutanea tarda after treatment

Summary

Porphyria cutanea tarda (PCT) is a skin disease causing a rash and sunlight sensitivity. Patients affected by this condition can be treated by removing some of their blood, or with a medication that is also used to prevent and treat malaria (antimalarials). In this study, the authors compared the effectiveness of these quite different treatment approaches. They included data on patients, from previous clinical studies, who were treated for PCT and monitored for at least one year after their symptoms had cleared. They aimed to assess PCT disease recurrence (i.e. the symptoms returning) either by skin rash, sunlight sensitivity or an elevation in a certain blood test. Authors included data on patients from 5 clinical studies in which patients received high dose of antimalarial medication, 5 clinical studies in which patients received low dose antimalarial medication and 3 clinical studies in which patients were treated by removing some of their blood. While one third of the patients treated with either high or low dose antimalarial medication experienced disease recurrence, only one fifth of patients treated by removing blood experienced such disease recurrence. Their study showed that if 100 patients were followed for one year, disease recurrence will happen in 8 patients receiving high dose antimalarials, 17 patients receiving low dose antimalarials, and 5 patients undergoing blood removal. The authors concluded that the recurrence is lowest if the PCT is treated by blood removal. However, larger studies are needed to better define recurrence rate of PCT after treatment with one of the two treatments.

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Infections in mycosis fungoides and Sézary syndrome are a frequent cause of morbidity and contribute to mortality. What can be done?

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Quality of life evaluation in lymphoedema

Summary

The lymphatic system is a network of small vessels draining clear fluid (lymph) from all bodily tissues. Many different disorders, including birth defect, infection and malignancy (cancer), can cause blockage of the system, resulting in chronic swelling, usually affecting arms or legs. This "lymphoedema" causes considerable discomfort and affects many aspects of the patient's life. Health‐related quality of life (QOL) is an important measure in health care, but to date the only QOL measure for patients with lymphoedema has been the Freiburg Life Quality Assessment for lymphoedema (FLQA‐L) ‐ a reliable measure but just too detailed for regular use in clinical practice, having 92 questions. This study from Germany aimed to create a more user‐friendly version. First, they re‐analysed the original FLQA‐L data and identified 33 questions which appeared most informative, covering 5 domains: physical impairments, daily life, social life, mental health and therapy. This shorter version (FLQA‐LS) was then mailed out to 348 lymphoedema patients at 33 clinics; 91% were women and the average age was 57 years. 295 patients completed the questionnaire. The items scoring highest (meaning having the highest impact) were "anxiety about a possible worsening of the disease", "feeling pain in the arm or leg", "joint pain" and "time‐consuming treatments", while impairment of social life showed the lowest values. Statistical analysis of the results showed good correlations with other general health related QOL scores. The FLQA‐LS appears to be a valuable assessment tool for patients with lymphoedema and now needs to be tested in patients over time.

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Screening for associated malignancies in vulval Paget disease clarified

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Optic neuritis as the initial clinical presentation of limbic encephalitis: a case report

Limbic encephalitis is characterized by rapid onset of working memory deficit, mood changes, and often seizures. The condition has a strong paraneoplastic association, but not all cases are invariably due to t...

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Issue Information

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Volume Contents

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Issue Information

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Allergen-specific IgE and IgG4 patterns among patients with different allergic diseases

In addition to allergen-specific IgE (sIgE), allergen-specific IgG4 (sIgG4) antibodies are also involved in the immune response resulting from an allergen exposure. The aim of our study was to analyze sIgE and...

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Omalizumab in the treatment of eosinophilic granulomatosis with polyangiitis (EGPA): single-center experience in 18 cases

Data are limited regarding the effectiveness of omalizumab in patients with eosinophilic granulomatosis with polyangiitis (EGPA). Our aim was to evaluate the clinical and functional effectiveness of omalizumab...

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Impact of a digital health intervention on asthma resource utilization

Digital health interventions have been associated with reduced rescue inhaler use and improved controller medication adherence. This quality improvement project assessed the benefit of these interventions on a...

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Are environmental risk factors for current wheeze in the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three due to reverse causation?

Abstract

Background

Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC) measured the global prevalence of symptoms of asthma in children. We undertook comprehensive analyses addressing risk factors for asthma symptoms in combination, at both the individual and the school level, to explore the potential role of reverse causation due to selective avoidance or confounding by indication.

Objective

To explore the role of reverse causation in risk factors of asthma symptoms.

Methods

We compared two sets of multilevel logistic regression analyses, using (i) individual‐level exposure data and (ii) school‐level average exposure (i.e. prevalence), in two different age groups. In individual‐level analyses, reverse causation is a possible concern if individual‐level exposure statuses were changed as a result of asthma symptoms or diagnosis. School‐level analyses may suffer from ecologic confounding, but reverse causation is less of a concern because individual changes in exposure status as a result of asthma symptoms would only have a small effect on overall school exposure levels.

Results

There were 131,924 children age 6‐7 years (2,428 schools, 25 countries) with complete exposure, outcome and confounder data. The strongest associations in individual‐level analyses (fully‐adjusted) were for current paracetamol use (odds ratio = 2.06; 95% confidence interval 1.97‐2.16), early life antibiotic use (1.65; 1.58‐1.73), and open fire cooking (1.44; 1.26‐1.65). In school‐level analyses these risk factors again showed increased risks.

There were 238,586 adolescents age 13‐14 years (2,072 schools, 42 countries) with complete exposure, outcome and confounder data. The strongest associations in individual‐level analyses (fully‐adjusted) were for current paracetamol use (1.80; 1.75‐1.86), cooking on an open fire (1.32; 1.22‐1.43), and maternal tobacco use (1.23; 1.18‐1.27). In school‐level analyses these risk factors again showed increased risks.

Conclusions & clinical relevance

These analyses strengthen the potentially causal interpretation of previously reported individual‐level findings, by providing evidence against reverse causation.

This article is protected by copyright. All rights reserved.

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Opioid analgesic use and patient‐reported pain outcomes after rhinologic surgery

Background

Opioid‐based analgesics are routinely prescribed after elective rhinologic surgery. Balancing appropriate pain management while avoiding overprescription necessitates an evidence‐based approach.

Methods

Patients undergoing elective rhinologic surgery, including endoscopic sinus surgery (ESS), septoplasty, or ESS with septoplasty, were prospectively enrolled. Patients completed demographic and psychometric questionnaires assessing attitudes toward pain, baseline anxiety, and depression before surgery. Postoperatively, patients documented peak pain levels (0‐100 visual analog scale) and daily prescription and nonprescription medication requirements over a 2‐week period.

Results

Of the 42 patients enrolled, 15 underwent ESS, 14 septoplasty, and 13 ESS with septoplasty. Five patients (11.9%) reported a history of chronic pain before surgery. Patients were given a median of 30 opioid pain pills after surgery: acetaminophen with codeine 325/30 mg (10 patients) or oxycodone with acetaminophen 5/325 mg (32 patients). Patients had a median of 27 pills left over at the end of the study period. Median peak pain levels for all procedures were 22 (range, 0‐94) on day 0, 26.5 (range, 0‐86) on day 1, 8.5 (range, 0‐85) on day 3, and 3 (range, 0‐52) on day 7. Median opioid requirements measured in morphine milligram equivalents (MME) over those same days were 6.0, 4.1, 0, and 0, respectively.

Conclusion

Postoperative pain after elective rhinologic surgery appears to peak over the first 3 days and decreases rapidly afterward. Most patients require a few doses of opioid analgesics. Opioid requirements and pain levels did not vary based on surgeon, type and extent of surgery, and demographic factors. Judicious prescribing of opioid medication after rhinologic surgery represents a practical opportunity for rhinologists and otolaryngologists to reduce opioid overprescription and abuse.

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Salvage laryngectomy and laryngopharyngectomy: A multicenter review of outcomes associated with a reconstructive approach

Abstract

Background

Surgeons have developed various reconstructive techniques to minimize the rate of pharyngocutaneous fistula and optimize functional outcome after salvage laryngectomy or laryngopharyngectomy.

Methods

Multicenter retrospective review at 33 institutions of 486 patients with a history of squamous cell carcinoma (SCC) of the larynx or hypopharynx previously treated with primary chemoradiotherapy (CRT) who required salvage surgery. Outcomes evaluated were overall fistula rate, fistula requiring reoperation, and 12‐month speech and swallowing function.

Results

Primary closure of the hypopharynx was associated with a statistically higher overall fistula rate and fistula requiring reoperation compared to reconstruction with vascularized tissue augmentation. Vascularized tissue augmentation with muscle led to worse 12‐month "understandability of speech" and "nutritional mode" scores compared to vascularized tissue augmentation without muscle.

Conclusion

Vascularized tissue augmentation reduces the overall fistula rate and fistula requiring reoperation but vascularized tissue augmentation with muscle may impair speech and swallowing outcomes.

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Understanding sources of measurement error in the Wi-Fi sensor data in the Smart City

Lugomer, K; Soundararaj, B; Murcio, R; Cheshire, J; Longley, P; (2017) Understanding sources of measurement error in the Wi-Fi sensor data in the Smart City. In: Proceedings for the 25th GIS Research UK (GISRUK) Conference (GISRUK 2017). GIS Research UK (GISRUK) Green open access

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Integrating New Measures of Retail Unit Attractiveness into Spatial Interaction Models

Trasberg, T; Cheshire, JA; Longley, P; (2018) Integrating New Measures of Retail Unit Attractiveness into Spatial Interaction Models. In: Proceedings of the 26th GIScience Research UK Conference, University of Leicester (GISRUK 2018). GIS Research UK (GISRUK) Green open access

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Chromatic Dispersion Compensation With Feed Forward Equalizer and Decision Feedback Equalizer for Manchester Coded Signals

Liu, Z; Li, M; Chan, C-K; (2011) Chromatic Dispersion Compensation With Feed Forward Equalizer and Decision Feedback Equalizer for Manchester Coded Signals. Journal of Lightwave Technology , 29 (18) pp. 2740-2746. 10.1109/JLT.2011.2163385 . Green open access

https://ift.tt/2SlxtVg

Behavioural Analysis of Smart Card Data

Sari Aslam, N; Cheng, T; Cheshire, JA; (2018) Behavioural Analysis of Smart Card Data. In: Proceedings of the 26th GIScience Research UK Conference, University of Leicester (GISRUK 2018). GIS Research UK (GISRUK) Green open access

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Architecture-Dependent Anisotropic Hysteresis in Smooth Muscle Cells

Win, Z; Buksa, JM; Alford, PW; (2018) Architecture-Dependent Anisotropic Hysteresis in Smooth Muscle Cells. Biophysical Journal , 115 (10) pp. 2044-2054. 10.1016/j.bpj.2018.09.027 .

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Reduced Slow-Wave Sleep Is Associated with High Cerebrospinal Fluid A beta 42 Levels in Cognitively Normal Elderly

Varga, AW; Wohlleber, ME; Gimenez, S; Romero, S; Alonso, JF; Ducca, EL; Kam, K; ... Osorio, RS; + view all Varga, AW; Wohlleber, ME; Gimenez, S; Romero, S; Alonso, JF; Ducca, EL; Kam, K; Lewis, C; Tanzi, EB; Tweardy, S; Kishi, A; Parekh, A; Fischer, E; Gumb, T; Alcolea, D; Fortea, J; Lleo, A; Blennow, K; Zetterberg, H; Mosconi, L; Glodzik, L; Pirraglia, E; Burschtin, OE; de Leon, MJ; Rapoport, DM; Lu, S-E; Ayappa, I; Osorio, RS; - view fewer (2016) Reduced Slow-Wave Sleep Is Associated with High Cerebrospinal Fluid A beta 42 Levels in Cognitively Normal Elderly. Sleep , 39 (11) pp. 2041-2048. 10.5665/sleep.6240 . Green open access

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Obstructive Sleep Apnea Severity Affects Amyloid Burden in Cognitively Normal Elderly. A Longitudinal Study

Sharma, RA; Varga, AW; Bubu, OM; Pirraglia, E; Kam, K; Parekh, A; Wohlleber, M; ... Osorio, RS; + view all Sharma, RA; Varga, AW; Bubu, OM; Pirraglia, E; Kam, K; Parekh, A; Wohlleber, M; Miller, MD; Andrade, A; Lewis, C; Tweardy, S; Buj, M; Yau, PL; Sadda, R; Mosconi, L; Li, Y; Butler, T; Glodzik, L; Fieremans, E; Babb, JS; Blennow, K; Zetterberg, H; Lu, SE; Badia, SG; Romero, S; Rosenzweig, I; Gosselin, N; Jean-Louis, G; Rapoport, D; de Leon, MJ; Ayappa, I; Osorio, RS; - view fewer (2018) Obstructive Sleep Apnea Severity Affects Amyloid Burden in Cognitively Normal Elderly. A Longitudinal Study. American Journal of Respiratory and Critical Care Medicine , 197 (7) pp. 933-943. 10.1164/rccm.201704-0704OC . Green open access

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Moving Beyond Promise: A Response to the Choice Theory of Contracts

Saprai, P; (2019) Moving Beyond Promise: A Response to the Choice Theory of Contracts. Jerusalem Review of Legal Studies (In press).

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The Academic Book of the Future: Communities of practice

Rayner, S; (2018) The Academic Book of the Future: Communities of practice. Logos , 29 (2-3) pp. 80-90. 10.1163/18784712-02902009 .

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Edge of Chaos: Towards intelligent architecture through distributed control systems based on Cellular Automata

Glynn, RUAIRI; Abramovic, V; Overvelde, B; (2018) Edge of Chaos: Towards intelligent architecture through distributed control systems based on Cellular Automata. In: Acadia 2018 Recalibration: On Imprecision and Infidelity: Proceedings of the 38th Annual Conference of the Association for Computer Aided Design in Architecture. ACADIA

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Unauthorized Military Interventions for the Public Good: A response to Harold Koh

Trapp, KN; (2017) Unauthorized Military Interventions for the Public Good: A response to Harold Koh. AJIL Unbound , 111 pp. 292-296. 10.1017/aju.2017.74 . Green open access

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New thinking about thinking, part two. Theoretical articles for Alzheimer's & Dementia

Khachaturian, AS; Hayden, KM; Mielke, MM; Tang, Y; Lutz, MW; Gold, M; Kukull, WA; ... Khachaturian, ZS; + view all Khachaturian, AS; Hayden, KM; Mielke, MM; Tang, Y; Lutz, MW; Gold, M; Kukull, WA; Mohs, R; Gauthier, S; Luis Molinuevo, J; Zetterberg, H; Khachaturian, ZS; - view fewer (2018) New thinking about thinking, part two. Theoretical articles for Alzheimer's & Dementia. [Editorial comment]. Alzheimer's and Dementia , 14 (6) pp. 703-706. 10.1016/j.jalz.2018.05.002 .

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Neuroinflammation and Tau Interact with Amyloid in Predicting Sleep Problems in Aging Independently of Atrophy

Fjell, AM; Idland, A-V; Sala-Llonch, R; Watne, LO; Borza, T; Braekhus, A; Lona, T; ... Walhovd, KB; + view all Fjell, AM; Idland, A-V; Sala-Llonch, R; Watne, LO; Borza, T; Braekhus, A; Lona, T; Zetterberg, H; Blennow, K; Wyller, TB; Walhovd, KB; - view fewer (2018) Neuroinflammation and Tau Interact with Amyloid in Predicting Sleep Problems in Aging Independently of Atrophy. Cerebral Cortex , 28 (8) pp. 2775-2785. 10.1093/cercor/bhx157 . Green open access

https://ift.tt/2SoqHOo

Doing It Together Science: D6.6 Innovation Management Plan: "Making citizen science work"

DITOS Consortium, ; (2018) Doing It Together Science: D6.6 Innovation Management Plan: "Making citizen science work". DITOS Consortium: London, UK. Green open access

https://ift.tt/2EbvlfO

S-[F-18] THK-5117-PET and [C-11] PIB-PET Imaging in Idiopathic Normal Pressure Hydrocephalus in Relation to Confirmed Amyloid-beta Plaques and Tau in Brain Biopsies

Leinonen, V; Rauramaa, T; Johansson, J; Bottelbergs, A; Tesseur, I; van der Ark, P; Pemberton, D; ... Rinne, JO; + view all Leinonen, V; Rauramaa, T; Johansson, J; Bottelbergs, A; Tesseur, I; van der Ark, P; Pemberton, D; Koivisto, AM; Jaaskelainen, JE; Hiltunen, M; Herukka, S-K; Blennow, K; Zetterberg, H; Jokinen, P; Rokka, J; Heliu, S; Haaparanta-Solin, M; Solin, O; Okamura, N; Kolb, HC; Rinne, JO; - view fewer (2018) S-[F-18] THK-5117-PET and [C-11] PIB-PET Imaging in Idiopathic Normal Pressure Hydrocephalus in Relation to Confirmed Amyloid-beta Plaques and Tau in Brain Biopsies. Journal of Alzheimer's Disease , 64 (1) pp. 171-179. 10.3233/JAD-180071 . Green open access

https://ift.tt/2Ss11ka

Effects of the Learning Together intervention on bullying and aggression in English secondary schools (INCLUSIVE): a cluster randomised controlled trial

Bonell, C; Allen, E; Warren, E; McGowan, J; Bevilacqua, L; Jamal, F; Legood, R; ... Viner, RM; + view all Bonell, C; Allen, E; Warren, E; McGowan, J; Bevilacqua, L; Jamal, F; Legood, R; Wiggins, M; Opondo, C; Mathiot, A; Sturgess, J; Fletcher, A; Sadique, Z; Elbourne, D; Christie, D; Bond, L; Scott, S; Viner, RM; - view fewer (2018) Effects of the Learning Together intervention on bullying and aggression in English secondary schools (INCLUSIVE): a cluster randomised controlled trial. The Lancet 10.1016/S0140-6736(18)31782-3 . (In press). Green open access

https://ift.tt/2Eb6lVQ

Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries

Loyse, A; Burry, J; Cohn, J; Ford, N; Chiller, T; Ribeiro, I; Koulla-Shiro, S; ... Harrison, TS; + view all Loyse, A; Burry, J; Cohn, J; Ford, N; Chiller, T; Ribeiro, I; Koulla-Shiro, S; Mghamba, J; Ramadhani, A; Nyirenda, R; Aliyu, SH; Wilson, D; Le, T; Oladele, R; Lesikari, S; Muzoora, C; Kalata, N; Temfack, E; Mapoure, Y; Sini, V; Chanda, D; Shimwela, M; Lakhi, S; Ngoma, J; Gondwe-Chunda, L; Perfect, C; Shroufi, A; Andrieux-Meyer, I; Chan, A; Schutz, C; Hosseinipour, M; Van der Horst, C; Klausner, JD; Boulware, DR; Heyderman, R; Lalloo, D; Day, J; Jarvis, JN; Rodrigues, M; Jaffar, S; Denning, D; Migone, C; Doherty, M; Lortholary, O; Dromer, F; Stack, M; Molloy, SF; Bicanic, T; van Oosterhout, J; Mwaba, P; Kanyama, C; Kouanfack, C; Mfinanga, S; Govender, N; Harrison, TS; - view fewer (2018) Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries. Lancet Infectious Diseases 10.1016/S1473-3099(18)30493-6 . (In press).

https://ift.tt/2St0O04

Infratrochlear neuralgia: A prospective series of seven patients treated with infratrochlear nerve blocks

Villar-Quiles, R-N; Garcia-Moreno, H; Mayo, D; Gutierrez-Viedma, A; Ramos, M-I; Casas-Limon, J; Cuadrado, M-L; (2018) Infratrochlear neuralgia: A prospective series of seven patients treated with infratrochlear nerve blocks. Cephalalgia , 38 (3) pp. 585-591. 10.1177/0333102417690493 . Green open access

https://ift.tt/2E7PHq4

Neurofilament light protein levels in cerebrospinal fluid predict long-term disability of Guillain-Barre syndrome: A pilot study

Axelsson, M; Sjogren, M; Andersen, O; Blennow, K; Zetterberg, H; Lycke, J; (2018) Neurofilament light protein levels in cerebrospinal fluid predict long-term disability of Guillain-Barre syndrome: A pilot study. Acta Neurologica Scandinavica , 138 (2) pp. 143-150. 10.1111/ane.12927 .

https://ift.tt/2SurBct

Safety, pharmacodynamics, and potential benefit of omaveloxolone in Friedreich ataxia

Lynch, DR; Farmer, J; Hauser, L; Blair, IA; Wang, QQ; Mesaros, C; Snyder, N; ... Meyer, C; + view all Lynch, DR; Farmer, J; Hauser, L; Blair, IA; Wang, QQ; Mesaros, C; Snyder, N; Boesch, S; Chin, M; Delatycki, MB; Giunti, P; Goldsberry, A; Hoyle, C; McBride, MG; Nachbauer, W; O'Grady, M; Perlman, S; Subramony, SH; Wilmot, GR; Zesiewicz, T; Meyer, C; - view fewer (2018) Safety, pharmacodynamics, and potential benefit of omaveloxolone in Friedreich ataxia. Annals of Clinical and Translational Neurology 10.1002/acn3.660 . Green open access

https://ift.tt/2E9mQSv

Amide proton transfer MRI detects early changes in nasopharyngeal carcinoma: providing a potential imaging marker for treatment response

Abstract

Purpose

To determine if treatment of nasopharyngeal carcinoma (NPC) induces early changes in amide proton transfer-weighted (APTw) magnetic resonance imaging (MRI), and to perform a preliminary evaluation of APTw imaging in response assessment.

Methods

Sixteen patients with NPC planned for treatment with radiotherapy and/or chemotherapy underwent APTw imaging of the primary tumour pre-treatment and 2-week intra-treatment. Difference in pre- and intra-treatment APT mean (APT_mean) was compared using the Wilcoxon signed rank test. Differences in APT_mean and percentage change (%Δ) in APT_mean were compared between responders and non-responders based on the outcome at 6 months, using the Mann–Whitney U test.

Results

APT_mean decreased in 9/16 (56.3%) and increased in 7/16 (43.7%) with no significant difference between the pre- and intra-treatment APT values for the whole group (p > 0.05). NPC showed response in 11/16 (68.8%) and non-response in 5/11 (31.2%). There were significant differences between the %Δ of responders and non-responders for APT_mean (p = 0.01). Responders showed %Δ decrease in APT_mean of − 23.12% while non-responders showed a %Δ increase in APT_mean of + 102.28%.

Conclusion

APT value changes can be detected in early intra-treatment. Intra-treatment %Δ APT_mean shows potential in predicting short-term outcome.

https://ift.tt/2rhJE9W

Surgeons successfully perform full face transplant

With the help of innovative techniques, surgeons at New York University Langone Health have successfully conducted a full face transplant.

https://ift.tt/2zHw8RH

Nail pitting and splinter hemorrhage possibly induced by zolpidem

https://ift.tt/2BNP6Yf

Comparison of 2‐D shear wave elastography with clinical score in localized scleroderma: A new method to increase the diagnostic accuracy

Abstract

There is no established diagnostic criteria or widely accepted severity classification of localized scleroderma (LS) by imaging. Acoustic radiation force impulse (ARFI) technology by normalized mean shear wave velocity (SWV) may be as a probing tool for diagnosing and staging LS accurately and objectively. Fifty‐six patients with LS of inflammatory (n = 21), sclerotic (n = 24) and atrophic (n = 11) stage and 30 healthy controls were evaluated on the basis of pathological results. Dermal thickness, ARFI quality (elastography score) and quantity (mean SWV) were measured by ultrasonography (US), diagnosis and stage performances of LS using the dermal thickness, elastography score and mean SWV compared with modified localized scleroderma skin severity index (mLoSSI) were evaluated. Significant differences in the dermal thickness, elastography score and mean SWV were found between the normal adult and LS patients; for diagnosing LS, the area under the receiver–operator curves (AUROC) of the dermal thickness, elastography score, mean SWV and mLoSSI were 0.93 ± 0.03, 0.95 ± 0.01, 0.93 ± 0.03 and 0.93 ± 0.02, respectively. Compared with the dermal thickness, the elastography score and mLoSSI, the AUROC and the specificities of mean SWV for differentiating sclerotic from inflammatory stage and atrophic from sclerotic LS increased significantly, especially by normalized mean SWV (AUROC, 0.84 ± 0.06 and 0.83 ± 0.07; specificity, 85.71% and 91.67%). As non‐invasive methods, mean SWV and dermal thickness by US may provide reliable information to diagnose and stage LS compared with mLoSSI especially by normalized mean SWV.

https://ift.tt/2KSgZBe

Case of pityriasis rubra pilaris progressed to generalized erythroderma following blockade of interleukin‐17A, but improved after blockade of interleukin‐12/23 p40

Abstract

We report herein a case of a 72‐year‐old man with pityriasis rubra pilaris (PRP) that was refractory to conventional therapies. His skin lesions progressed to generalized erythroderma despite anti‐interleukin (IL)‐17A antibody therapy. Topical corticosteroids, emollients, systemic retinoid, methotrexate, cyclosporin and phototherapy yielded no therapeutic response. However, blockade of IL‐12/23 p40 dramatically improved his cutaneous lesions. Complete remission was achieved 4 weeks after the first injection of ustekinumab and maintained for more than 48 weeks. Our data indicate that IL‐12 was associated with the onset of PRP in this patient, rather than IL‐23. IL‐12 is critical for the differentiation of T‐helper (Th)1 cells. Thus, the Th1 pathway may be associated with the onset of PRP.

https://ift.tt/2BORePw

Improvement of porphyria cutanea tarda following treatment of hepatitis C virus by direct‐acting antivirals: A case report

https://ift.tt/2KOkCsd

Nrf2/ARE pathway inhibits inflammatory infiltration by macrophage in rats with autoimmune myositis

Publication date: January 2019

Source: Molecular Immunology, Volume 105

Author(s): Yutao Liu, Yuan Gao, Jing Yang, Changhe Shi, Yanlin Wang, Yuming Xu

Abstract

Background

Idiopathic inflammatory myopathies (IIM) are a group of autoimmune diseases characterized by muscle disorders. We conducted this study to detect whether NF-E2-related factor 2 (Nrf2) pathway inhibit inflammatory infiltration by macrophage in experimental autoimmune myositis (EAM) rat model.

Methods

CD163 levels were examined by immunohistochemistry (IHC), while serum creatine kinase (CK), reactive oxygen species (ROS), and serum monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) levels were determined by enzyme linked immunosorbnent assay (ELISA), both in IIM patients and EAM rat. We also detected MCP-1, TNF-α, IL-6, and Nrf2 levels by Realtime quantitative PCR (RT-PCR) in patients' muscles, and MCP-1, TNF-α, IL-6, and Nrf2, HO-1, NQO-1 levels by RT-PCR and Western blot in EAM rats' muscles. EAM macrophages were separated, and Nrf2 over-expression macrophages were constructed. ROS level and cell migration were detected by flow cytometer and transwell assay respectively. Then, levels of MCP-1, TNF-α, IL-6, Nrf2, Heme oxygenase-1 (HO-1) and NAD(P)H: quinine oxidoreductase 1 (NQO-1) were detected by RT-PCR and Western blot.

Results

Results showed that EAM rats were histopathologically inflammatory cell infiltration. Levels of CD163, serum CK and ROS, serum/muscle MCP-1, TNF-α and IL-6 increased and muscle Nrf2 level decreased in IIM patients and EAM rats. Cell migration ability and levels of ROS, MCP-1, TNF-α, IL-6, and plasma Nrf2 were down-regulated, and total/nucleus Nrf2, HO-1, NQO-1 were up-regulated notably when Nrf2 over-expressed.

Conclusion

Nrf2 inhibited EAM macrophage infiltration by activating Nrf2/ARE pathway which could induce ROS degradation and inhibit pro-inflammatory factors expression.

https://ift.tt/2BPp1bv

Water‐related dermatoses

Abstract

Water‐related dermatoses are a spectrum of diseases that are associated with water exposure. They result either from the direct influence of water or after injury from water inhabitants. In this review, clinical entities that manifest after water exposure (aquagenic pruritus, aquagenic urticaria, and aquagenic wrinkling of the palms) will be discussed with particular focus on the reported pathogenesis. Aquatic organisms and activities can be linked to cutaneous injuries that require identification and distinct management. Marine and freshwater dermatoses were summarized to provide physicians with easy access to the causative organism, method of injury, and appropriate management.

https://ift.tt/2SrLbpI

Basal cell carcinoma of the vulva: a case report and systematic review of the literature

Abstract

The vulva is an unusual site for basal cell carcinoma (BCC). Vulvar BCC accounts for <1% of all BCCs and <5% of all vulvar malignancies. We report the case of an 83 year‐old woman who presented with a 2‐month history of a tender labial growth, with histopathology confirming nodular BCC. We conducted a systematic literature review of the characteristics of reported cases of vulvar BCCs. A comprehensive systematic review of articles indexed for MEDLINE and Embase yielded 96 reports describing 437 patients with 446 BCCs of the vulva. The mean age at presentation was 70 (range 20–100). Most women had no underlying vulvar disease. Approximately 60% of cases were of the nodular subtype. Treatment approach varied widely with over half of cases treated with wide local or local excision. Mohs micrographic surgery (MMS) for vulvar BCC was first reported in 1988 with seven total MMS cases reported. Twenty‐three cases of recurrence have been reported; 21 of these cases after local excision but none following MMS. Vulvar BCC is a rarely reported cancer that affects older women predominantly. MMS represents a promising treatment for BCC in this anatomic location.

https://ift.tt/2Eesin0

Rethinking the female predominance in hidradenitis suppurativa

https://ift.tt/2Ssq6LL

Use of platelet‐rich plasma to suspend noncultured epidermal cell suspension improves repigmentation after autologous transplantation in stable vitiligo: a double‐blind randomized controlled trial

Abstract

Background

Noncultured epidermal cell suspension (NCES) is an effective surgical modality for stable vitiligo which involves transplantation of the basal layer of epidermal cells onto the dermabraded vitiliginous patch. Platelet‐rich plasma (PRP) has growth factors which may stimulate melanocyte migration and proliferation of keratinocytes and fibroblasts. The objective of this study was to compare the extent of repigmentation achieved by transplantation of NCES suspended in PRP with that of NCES suspended in phosphate buffered saline (PBS).

Methods

Twenty‐one patients of stable vitiligo with at least two lesions of comparable size were included. The two vitiligo patches were randomized to receive NCES suspended in PRP or PBS. Postoperatively after 1 week, patients were given heliotherapy for 15 minutes daily.

Results

At 6 months follow‐up, mean repigmentation by area method in PRP arm was 75.6 ± 30% SD and in non‐PRP arm was 65 ± 34% SD (P = 0.0036). Patient satisfaction by visual analogue scale at 6 months also showed better results in PRP arm (P = 0.001). Assessment by three independent observers showed better repigmentation in PRP side both at 3 and 6 months.

Conclusions

Suspending NCES in PRP can result in significantly greater mean repigmentation and patient satisfaction than suspending in PBS.

https://ift.tt/2E7Aw04

Atypical presentation of necrobiosis lipoidica in a pediatric patient

Abstract

Necrobiosis lipoidica (NL) is a rare chronic granulomatous inflammatory skin disease characterized by brownish‐red papules and yellowish plaques with atrophic centers, which usually affect the legs, bilaterally. The average age of onset is 30‐40 years, and there are very few reported cases of necrobiosis lipoidica in children. A nondiabetic girl aged 14 years presented to our clinic with a history of an asymptomatic, 7 × 5‐cm single red plaque over her back in the interscapular area, which had started 5 years ago. Her laboratory tests were normal. A histopathologic evaluation confirmed the diagnosis of NL, and local treatment with clobetasol propionate twice daily was administrated. The patient will be followed up to monitor plasma glucose levels and evaluation of the lesion. Herein, we report a pediatric patient without diabetes mellitus who had NL in an atypical location and review the literature in view of the clinical features, complications, and treatment regimens for NL in children.

https://ift.tt/2QEayHH

Neonatal skin care: Developments in care to maintain neonatal barrier function and prevention of diaper dermatitis

Abstract

Background

Understanding the importance of the barrier function of the skin of preterm and term neonates is crucial in effective neonatal skin and diaper care. This literature search aimed to review the development of different practices in neonatal care to maintain skin barrier function, in turn preventing diaper dermatitis.

Methods

We performed two quantitative literature searches of English language studies: an initial literature search of studies published in the last 5 years was conducted using Cinahl, Medline, Embase, British Nursing Index, and DelphiS, followed by a second search of publications from 1990 to 2017 using the National Institute of Clinical Excellence Health Databases Advanced Search using key words, synonyms, and Boolean phrasing. Titles and abstracts were reviewed for relevance.

Results

One hundred ten studies were analyzed for the purpose of this review; however, data are of variable quality. Guidance can be drawn from the existing literature relating to best practice options for diaper area cleansing methods, diaper type selection, and use of barrier creams. More research is required into the benefit or otherwise of diaper‐free time.

Conclusions

Super‐absorbent diapers reduce moisture at skin level and reduce diaper dermatitis. Barrier creams carry benefit both in prevention and cure but do not provide a substitute for frequent diaper changes. The literature does not demonstrate superiority of one cleansing method over another, but neither the use of wipes nor water increases diaper dermatitis prevalence. Further studies are required to explore the potential benefit of diaper‐free time, taking due consideration of the practicalities, particularly for vulnerable neonates within the Intensive Care setting.

https://ift.tt/2E23nSX

Neurocognitive function in moderate–severe pediatric atopic dermatitis: A case–control study

Abstract

Background/Objectives

Epidemiological studies have shown an increased prevalence of attention deficit hyperactivity disorder (ADHD) in children with atopic dermatitis (AD), but many of the features of ADHD may occur as a result of the poor sleep and itch distraction associated with AD.

Methods

A case–control study was performed in children aged 6‐17 years with moderate/severe AD compared with age‐/sex‐matched healthy controls. Participants were screened for ADHD using Vanderbilt assessments.

Results

Seventeen patients with AD and 18 controls completed the study. Two children with AD (11.7%) and one control (5.56%) met screening criteria for ADHD via parent‐completed Vanderbilt assessments; AD patients were not significantly more likely to screen positive for ADHD (P = 0.47), or comorbid behavior disorders (P = 0.23). However, AD patients were more likely than controls to exhibit ADHD‐associated behaviors, most significantly inattention.

Conclusions

Our AD cohort did not have a significantly increased prevalence of ADHD. Certain neurocognitive symptoms are increased in children with moderate‐to‐severe AD compared to controls.

https://ift.tt/2QsnvnN

Systemic sclerosis phase III clinical trials: Hope on the horizon?

Aringer, M; Denton, CP; (2018) Systemic sclerosis phase III clinical trials: Hope on the horizon? Journal of Scleroderma and Related Disorders , 3 (3) pp. 193-200. 10.1177/2397198318775353 . Green open access

https://ift.tt/2zF5PLT

Connected cities: Driving digital transformation in complex ecosystems

Duus, R; Cooray, M; Bundgaard, L; (2018) Connected cities: Driving digital transformation in complex ecosystems. The European Business Review

https://ift.tt/2PgCvAp

Failure is Not an Option: Policy Learning for Adaptive Recovery in Space Operations

McGuire, S; Furlong, PM; Heckman, C; Julier, S; Szafir, D; Ahmed, N; (2018) Failure is Not an Option: Policy Learning for Adaptive Recovery in Space Operations. IEEE Robotics and Automation Letters , 3 (3) pp. 1639-1646. 10.1109/LRA.2018.2801468 . Green open access

https://ift.tt/2zF5Jnv

Insights into brain microstructure from in vivo DW-MRS

Palombo, M; Shemesh, N; Ronen, I; Valette, J; (2018) Insights into brain microstructure from in vivo DW-MRS. Neuroimage , 182 pp. 97-116. 10.1016/j.neuroimage.2017.11.028 . Green open access

https://ift.tt/2PgBTe2

Taxation as tyranny: American Progress and the ultraconservative movement

Huntington, J.; (2018) Taxation as tyranny: American Progress and the ultraconservative movement. Radical Americas , 3 (1) pp. 1-23. 10.14324/111.444.ra.2018.v3.1.010 . Green open access

https://ift.tt/2zF5EjH

The Role of Aneuploidy in Cancer Evolution

Sansregret, L; Swanton, C; (2017) The Role of Aneuploidy in Cancer Evolution. Cold Spring Harbor Perspectives in Medicine , 7 (1) , Article a028373. 10.1101/cshperspect.a028373 .

https://ift.tt/2PgCuwl

High-Content Imaging and RNAi Screens for Investigating Kinase Network Plasticity

Stockwell, SR; Mittnacht, S; (2017) High-Content Imaging and RNAi Screens for Investigating Kinase Network Plasticity. Kinase Signaling Networks , 1636 pp. 133-161. 10.1007/978-1-4939-7154-1_10 . Green open access

https://ift.tt/2zDzQvQ

Memorial Traces as Tropes of Postcolonial Hauntings in Robert Lalonde’s Sept Lacs plus au Nord and Nina Bouraoui’s Mes mauvaises pensées

Bolfek-Radovani, J.; (2018) Memorial Traces as Tropes of Postcolonial Hauntings in Robert Lalonde's Sept Lacs plus au Nord and Nina Bouraoui's Mes mauvaises pensées. London Journal of Canadian Studies , 33 (7) pp. 94-110. 10.14324/111.444.ljcs.2018v33.007. . Green open access

https://ift.tt/2PgJzx0

Progress in neurology 2017-2018

Schapira, AHV; (2018) Progress in neurology 2017-2018. [Editorial comment]. European Journal of Neurology , 25 (12) pp. 1389-1397. 10.1111/ene.13846 . (In press).

https://ift.tt/2zEHLZH

The Hauntings of Canada in Michael Crummey’s Sweetland

Polić, V.; (2018) The Hauntings of Canada in Michael Crummey's Sweetland. London Journal of Canadian Studies , 33 (6) pp. 77-93. 10. 14324/111.444.ljcs.2018v33.006. . Green open access

https://ift.tt/2PkM5m0

Clinical challenges and future therapeutic approaches for neuronal ceroid lipofuscinosis

Mole, SE; Anderson, G; Band, HA; Berkovic, SF; Cooper, JD; Kleine Holthaus, S-M; McKay, TR; ... Smith, AJ; + view all Mole, SE; Anderson, G; Band, HA; Berkovic, SF; Cooper, JD; Kleine Holthaus, S-M; McKay, TR; Medina, DL; Rahim, AA; Schulz, A; Smith, AJ; - view fewer (2018) Clinical challenges and future therapeutic approaches for neuronal ceroid lipofuscinosis. [Review]. Lancet Neurology 10.1016/S1474-4422(18)30368-5 . (In press).

https://ift.tt/2zGi5vT

Learning in Physical Science Opportunities at Natural History Dioramas

Tunnicliffe, SD; Gazey, R; Gkouskou, E; (2018) Learning in Physical Science Opportunities at Natural History Dioramas. In: Scheersoi, A and Tunnicliffe, SD, (eds.) Natural History Dioramas – Traditional Exhibits for Current Educational Themes: Science Educational Aspects. (pp. 171-183). Springer: Cham, Switzerland.

https://ift.tt/2PfDbG8

Simulation-Based Evaluation and Optimization of Control Strategies in Buildings

Kontes, GD; Giannakis, GI; Sánchez, V; Agustin-Camacho, P; Romero-Amorrotu, A; Panagiotidou, N; Rovas, D; ... Grün, G; + view all Kontes, GD; Giannakis, GI; Sánchez, V; Agustin-Camacho, P; Romero-Amorrotu, A; Panagiotidou, N; Rovas, D; Steiger, S; Mutschler, C; Grün, G; - view fewer (2018) Simulation-Based Evaluation and Optimization of Control Strategies in Buildings. Energies , 11 (12) , Article 3376. 10.3390/en11123376 . Green open access

https://ift.tt/2zDvtAK

The usability of climate information in sub-national planning in India, Kenya and Uganda: the role of social learning and intermediary organisations

Fisher, S; Dodman, D; Van Epp, M; Garside, B; (2018) The usability of climate information in sub-national planning in India, Kenya and Uganda: the role of social learning and intermediary organisations. Climatic Change , 151 (2) pp. 219-245. 10.1007/s10584-018-2291-2 .

https://ift.tt/2PhiklN

Necrotizing granulomatous inflammation of the glans penis

Christodoulidou, M; Bunker, CB; Trevisan, G; Muneer, A; (2016) Necrotizing granulomatous inflammation of the glans penis. BMJ Case Report , 2016 , Article bcr2016216913. 10.1136/bcr-2016-216913 . Green open access

https://ift.tt/2zBHmHq

Follies subdued: Informational efficiency under adaptive expectations and confirmatory bias

Aldashev, G; Carletti, T; Righi, S; (2011) Follies subdued: Informational efficiency under adaptive expectations and confirmatory bias. Journal of Economic Behavior & Organization , 80 (1) pp. 110-121. 10.1016/j.jebo.2011.03.001 . Green open access

https://ift.tt/2Pgyb3Y

Emerging structures in social networks guided by opinions’ exchanges

Carletti, T; Righi, S; (2011) Emerging structures in social networks guided by opinions' exchanges. Advances in Complex Systems , 14 (1) pp. 13-30. 10.1142/S021952591100286X . Green open access

https://ift.tt/2zBHd6Q

The Words Change Everything: Haunting, Contagion and The Stranger in Tony Burgess’s Pontypool

Deshane, E.; Morton, R.; (2018) The Words Change Everything: Haunting, Contagion and The Stranger in Tony Burgess's Pontypool. London Journal of Canadian Studies , 33 (5) pp. 58-76. 10.14324/111.444.ljcs.2018v33.005 . Green open access

https://ift.tt/2PfDaC4

Through Neural Stimulation to Behavior Manipulation: A Novel Method for Analyzing Dynamical Cognitive Models

Hope, T; Stoianov, I; Zorzi, M; (2010) Through Neural Stimulation to Behavior Manipulation: A Novel Method for Analyzing Dynamical Cognitive Models. Cognitive Science , 34 (3) pp. 406-433. 10.1111/j.1551-6709.2009.01079.x .

https://ift.tt/2zBH3wg

Predicting cryptocurrency price bubbles using social media data and epidemic modelling

Phillips, RC; Gorse, D; (2018) Predicting cryptocurrency price bubbles using social media data and epidemic modelling. In: Proceedings of the 2017 IEEE Symposium Series on Computational Intelligence (SSCI). (pp. pp. 394-400). IEEE: Honolulu, HI, USA. Green open access

https://ift.tt/2PfB19B

The use of subcutaneous immunoglobulins in the treatment of dermatomyositis

https://ift.tt/2ALDhQx

British Association of Dermatologists and British Photodermatology Group guidelines for topical photodynamic therapy 2018

https://ift.tt/2EayzQK

Predictive factors of patients’ general quality of life after nasal septoplasty

Abstract

Purpose

Although septoplasty is considered to be the definitive treatment of septal deviation and is associated with an increase of nasal patency, patients are not always satisfied with the surgical outcome as assessed by its effect on their general Quality of Life (QOL).The aim of this study was to identify the predictive factors that influence the patients' QOL after surgery.

Methods

60 patients with nasal obstruction and septal deviation were enrolled in this prospective study, and they all completed the follow-up survey of 6 postoperative months. Symptom severity (Nasal Obstruction Symptom Evaluation—NOSE, Sino nasal outcome test 22—SNOT-22), sleep quality (Epworth Sleepiness Scale—ESS), olfactory function (Threshold Discrimination Identification—TDI score), voice quality (Nasalance score and Voice Handicap Index—VHI), stress (SQ test) and emotional status (Beck Depression Index—BDI) were evaluated as predictive factors of patients' QOL (Glasgow Benefit Inventory—GBI) postoperatively. We also analyzed age, gender, smoking, socioeconomic status, type of septal deviation and changes of nasal patency (with the use of rhinomanometry, acoustic rhinometry, and peak nasal inspiratory flow).

Results

From all the analyzed parameters, the nasal obstruction symptom severity, the sleep quality, and stress levels were only significantly associated with patients' overall QOL (p < 0.05; univariate analysis). However, on multiple regression, positive changes in NOSE score (OR 15.09, 95% CI 1.47–22.64, p < 0.05) and SQ test (OR 4, 95% CI 1.12–14.3, p < 0.05) were only related with higher likelihood of participants' QOL improvement after surgery.

Conclusions

Thorough preoperative evaluation of the symptom severity and stress levels is critical as these two factors are predictive of patient's satisfaction after septoplasty.

https://ift.tt/2zEQiM5

Osteoporosis increases the risk of benign paroxysmal positional vertigo: a nested case–control study using a national sample cohort

Abstract

Introduction

The previous studies suggested an association between osteoporosis and sudden sensory neural hearing loss (SSNHL). The aim of the present study was to evaluate the association between osteoporosis and benign paroxysmal positional vertigo (BPPV).

Materials and methods

Data from the Korean National Health Insurance Service-National Sample Cohort of participants who were ≥ 50 years old were collected from 2002 to 2013. A total of 13,484 BPPV participants were matched with respect to age group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia to 53,936 controls. In both the BPPV and control groups, the previous histories of osteoporosis were evaluated. Crude (simple) and adjusted odds ratios (ORs) of osteoporosis for BPPV were analyzed using unconditional logistic regression analyses. Subgroup analyses were conducted according to age, sex, and BPPV frequency.

Results

A total of 18.64% (2514/13,464) of the BPPV group and 12.21% (6589/53,936) of the control group had a history of osteoporosis (P < 0.001). The adjusted OR of osteoporosis for BPPV was 1.29 (95% CI = 1.23–1.35, P < 0.001). In the subgroup analysis according to age and sex, the ≥ 70-year-old men did not demonstrate a high adjusted OR of osteoporosis for BPPV. All other age and sex subgroups demonstrated high adjusted ORs of osteoporosis for BPPV.

Conclusions

Osteoporosis increased the risk of BPPV in the population aged ≥ 50 years. The OR of osteoporosis was higher in the frequent BPPV group than in the less frequent BPPV group.

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